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Difficulty: Very hardAssignment, Delegation and Supervision

An RN is distributing clinical tasks for a group of complex clients on a general medical unit. The team matrix consists of the RN, a licensed practical nurse (LPN/VN), and an unlicensed assistive personnel (UAP). To maintain client safety and adhere to the authorized scope of practice, which assignment is most appropriate for the RN to make?

  1. Assigning the LPN/VN to perform sterile tracheostomy care and suctioning for a client with a chronic tracheostomy who is awaiting placement in a skilled nursing facility.Answer
  2. B
    Directing the UAP to assist a client with an acute exacerbation of chronic obstructive pulmonary disease (COPD) with their first meal immediately following the discontinuation of continuous positive airway pressure (CPAP).
  3. C
    Instructing the LPN/VN to formulate the initial nursing care plan and provide discharge teaching for a client who underwent an uncomplicated laparoscopic appendectomy.
  4. D
    Delegating the UAP to obtain orthostatic vital signs on a client admitted one hour ago with dark, tarry stools and a hemoglobin level of 7.1 g/dL.

Answer

The most appropriate delegation is assigning the LPN/VN to perform sterile tracheostomy care and suctioning for the client with a chronic tracheostomy.
The correct assignment is instructing the LPN/VN to perform sterile tracheostomy care for the client awaiting placement. Under standard delegation guidelines, LPN/VNs are authorized to perform sterile procedures, including tracheostomy care and suctioning, provided the client is stable. The keywords 'chronic' and 'awaiting placement' confirm that this client's physiological condition is stable and their response to the procedure is predictable, making this a safe and legally sound delegation.

Step-by-Step Solution

1
Analyze the authorized scope of practice for the LPN/VN and UAP based on National Council of State Boards of Nursing (NCSBN) guidelines.
The RN retains responsibility for all assessments, initial teaching, and clinical judgments (EAT). The LPN/VN can perform sterile procedures on stable clients. The UAP assists with standard activities of daily living for stable clients.
Establishing the baseline regulatory rules for delegation is necessary before evaluating specific clinical scenarios.
2
Evaluate the clinical stability and acuity of the client with a chronic tracheostomy.
The client is highly stable, which is indicated by the chronic nature of the tracheostomy and their status of awaiting long-term care placement.
Client stability and the predictability of their response are primary determinants of whether a nursing task can be safely delegated.
3
Determine if the assigned task falls within the LPN/VN scope of practice for this specific client.
Yes. Because the client is stable with predictable outcomes, the LPN/VN can safely perform the sterile procedure of tracheostomy care and suctioning.
This aligns with the LPN/VN scope of practice for executing established care protocols on non-acute clients.

Key Concept

Delegation, Scope of Practice, and Client Stability
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Topics

Assignment, Delegation and Supervision

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