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Difficulty: HardAssignment, Delegation and Supervision

While managing a high-acuity medical ward, a registered nurse (RN) is coordinating the care for an older adult client diagnosed with heart failure and an active Clostridioides difficile (C. diff) infection. The client experiences severe fatigue, requires assistance with mobility, and has frequent episodes of liquid diarrhea. The RN is partnering with an experienced unlicensed assistive personnel (UAP) for the shift. Which specific tasks can the RN safely and legally assign to the UAP? Select all that apply.

  1. Assisting the client to pivot from the bed to the bedside commode using a gait belt.Answer
  2. Documenting the volume of the client's liquid stool output in the designated flow sheet.Answer
  3. C
    Evaluating the effectiveness of the client's current skin barrier cream in preventing moisture-associated breakdown.
  4. D
    Explaining the strict rationale for contact precautions to the client's newly arrived family members.
  5. Washing the client's hands specifically with soap and water following each commode use.Answer
  6. F
    Identifying the presence of new perineal skin excoriation during routine hygiene care.

Answer

The tasks that can be safely delegated to the UAP include assisting the client to the commode using a gait belt, documenting stool volume, and washing the client's hands with soap and water.
Unlicensed assistive personnel (UAP) are trained to assist with activities of daily living (ADLs), routine mobility, and the collection of objective, non-invasive data. Assisting a client to a commode using a gait belt is a standard safety procedure within their scope. Documenting the volume of stool is the recording of objective intake and output data. Washing the client's hands with soap and water is a routine hygiene task; while the RN must utilize clinical judgment to know that soap and water is specifically required for C. diff (since spores are not killed by alcohol-based rubs), the UAP can safely execute the physical task of hand washing as directed by the RN.

Step-by-Step Solution

1
Review the scope of practice for unlicensed assistive personnel (UAP) regarding delegation.
UAPs can perform standard, unchanging procedures that do not require clinical judgment, assessment, teaching, or evaluation.
The National Council of State Boards of Nursing (NCSBN) dictates that RNs cannot delegate any part of the nursing process (EAT: Evaluate, Assess, Teach).
2
Analyze the client's specific clinical scenario.
The client has C. diff, requiring strict contact precautions and specific hand hygiene (soap and water). The client also has mobility deficits requiring assistance.
Delegation must consider both the complexity of the task itself and the specific circumstances of the client (Right Circumstance).
3
Evaluate each proposed task against the UAP scope of practice.
Assisting with mobility (using a gait belt), documenting objective data (stool volume), and performing routine hygiene (washing hands) fall within the UAP's scope.
These tasks are repetitive, require minimal problem-solving, and have predictable, low-risk outcomes.
4
Identify tasks that violate delegation principles.
Evaluating barrier cream, explaining precautions to family, and identifying new skin breakdown require independent nursing judgment.
Evaluating outcomes, providing initial education, and conducting clinical assessments are exclusive RN responsibilities.

Key Concept

Delegation to unlicensed assistive personnel requires strict adherence to the Five Rights of Delegation, ensuring the RN retains all tasks involving assessment, clinical judgment, initial teaching, and evaluation (EAT).
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Topics

Assignment, Delegation and Supervision

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