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Difficulty: HardAssignment, Delegation and Supervision

Following notification of an impending unstable transfer from the intensive care unit, a charge nurse on a neurological step-down unit must rapidly reorganize care assignments. The available staffing mix includes a core neurological registered nurse (RN), a float RN from a general medical-surgical unit, an experienced licensed practical/vocational nurse (LPN/VN), and an unlicensed assistive personnel (UAP). Which delegation or assignment decision is most appropriate?

  1. A
    Assigning the LPN/VN to conduct the comprehensive admission assessment and establish baseline neurological parameters for the incoming transfer from the intensive care unit.
  2. Assigning the medical-surgical float RN to care for a client who is 48 hours post-craniotomy, has a consistent Glasgow Coma Scale score of 15, and requires scheduled intravenous antibiotics.Answer
  3. C
    Instructing the float RN to assume care of a client exhibiting a sudden decrease in level of consciousness and bradycardia, while the core neurological RN completes discharge documentation for another client.
  4. D
    Directing the UAP to assist a client with a newly applied cervical halo vest traction device to sit on the edge of the bed for the first time since application.

Answer

The most appropriate decision is assigning the medical-surgical float RN to care for the stable client who is 48 hours post-craniotomy and requires scheduled intravenous antibiotics.
Assigning the medical-surgical float RN to the stable client who is 48 hours post-craniotomy is the most appropriate decision. According to safe assignment principles, a float nurse should be assigned to clients whose conditions are stable, have predictable outcomes, and require care that aligns with standard nursing competencies. A client with a consistent Glasgow Coma Scale score of 15 (fully alert and oriented) requiring only scheduled intravenous antibiotics fits these criteria perfectly.

Step-by-Step Solution

1
Analyze the acuity and stability of each client presented in the options.
The post-craniotomy client with a GCS of 15 is stable. The client with a sudden decrease in LOC and bradycardia is highly unstable. The incoming ICU transfer is unstable and requires a baseline evaluation. The client with the new halo vest requires assessment during initial mobilization.
Safe assignment and delegation require matching the client's current acuity level with the competency and scope of practice of the healthcare team member.
2
Evaluate the scope of practice and competencies of the available staff members.
The core RN is best equipped for unstable neurological clients. The float RN can safely manage stable clients requiring standard RN care (like IV antibiotics). The LPN/VN cannot perform initial assessments. The UAP cannot perform tasks requiring nursing assessment or clinical judgment.
Adhering to the Five Rights of Delegation ensures legal and safe clinical practice.
3
Determine the most appropriate match between staff and client needs.
Assigning the stable, predictable post-craniotomy client to the medical-surgical float RN is the only safe and appropriate choice among the options.
This assignment aligns the float RN's skills with a client who has predictable outcomes and no specialized acute needs, freeing up the core RN for unstable clients.

Key Concept

Principles of safe delegation and assignment based on client acuity and staff scope of practice
Estimated Time:2m 0s
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Topics

Assignment, Delegation and Supervision

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