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Difficulty: HardAssignment, Delegation and Supervision

A registered nurse (RN) observes an unlicensed assistive personnel (UAP) independently silencing an alarm on a client's patient-controlled analgesia (PCA) pump. Place the RN's actions in the correct order of priority, from first to last.

  1. 1Instruct the UAP to step away from the PCA pump immediately.
  2. 2Assess the client's respiratory rate, oxygen saturation, and level of sedation.
  3. 3Verify the PCA pump programming and settings against the prescribed orders.
  4. 4Discuss the scope of practice limitation with the UAP in a private setting.
  5. 5Complete a facility incident report documenting the scope of practice violation.

Answer

The correct sequence prioritizes immediate safety intervention, followed by client assessment, equipment verification, staff supervision, and finally administrative reporting.
When managing a scope of practice violation, the RN must follow a strict prioritization framework: halt the unsafe action to prevent harm, assess the client using the nursing process, secure the equipment, provide supervisory education, and complete administrative documentation.

Step-by-Step Solution

1
Instruct the UAP to step away from the PCA pump immediately.
The unsafe action is halted.
Silencing alarms or manipulating a PCA pump is entirely outside a UAP's scope of practice. Stopping the action prevents potential medication errors.
2
Assess the client's respiratory rate, oxygen saturation, and level of sedation.
The client's clinical stability is determined.
According to the nursing process, assessing the client for potential harm (e.g., respiratory depression) is the primary clinical responsibility after a safety breach.
3
Verify the PCA pump programming and settings against the prescribed orders.
The integrity of the medication administration system is confirmed.
The RN must determine why the pump alarmed and ensure that the UAP did not accidentally change the settings while attempting to silence it.
4
Discuss the scope of practice limitation with the UAP in a private setting.
The UAP receives corrective feedback.
The RN exercises their supervisory role by addressing the knowledge deficit immediately after clinical issues are resolved, maintaining confidentiality.
5
Complete a facility incident report documenting the scope of practice violation.
The event is formally documented for institutional review.
Systemic reporting is the final step, occurring only after client safety is secured and immediate staff education has been provided.

Key Concept

Delegation and Supervision: Prioritizing Interventions for Scope of Practice Violations
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Topics

Assignment, Delegation and Supervision

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