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Difficulty: Very hardAssignment, Delegation and Supervision

A nursing care team on an intermediate medical unit consists of a registered nurse (RN), a licensed practical nurse (LPN/VN), and an unlicensed assistive personnel (UAP). The RN is coordinating client care for the shift. Which of the following task assignments represent safe and appropriate delegation? Select all that apply.

  1. A
    Directing the UAP to perform passive range-of-motion exercises on the affected lower extremity of a client with a newly diagnosed deep vein thrombosis.
  2. B
    Assigning the LPN/VN to titrate a continuous intravenous heparin infusion based on the client's most recent activated partial thromboplastin time (aPTT) results.
  3. Instructing the LPN/VN to insert a nasogastric tube for gastric decompression in a client experiencing a partial small bowel obstruction.Answer
  4. Requesting the UAP to apply a routine, non-medicated moisture barrier cream to the intact perineal skin of an incontinent client.Answer
  5. Delegating the UAP to assist with oral feeding for a client who sustained an ischemic stroke 24 hours ago and has successfully passed a formal dysphagia screening.Answer
  6. F
    Directing the LPN/VN to complete the comprehensive admission nursing assessment for a client transferring from a skilled nursing facility.

Answer

The appropriate tasks to delegate are inserting the nasogastric tube (to the LPN/VN), applying barrier cream to intact skin (to the UAP), and feeding the stable stroke client who passed a swallow screen (to the UAP).
Safe delegation requires matching the complexity of the task and the stability of the client to the caregiver's scope of practice. Inserting a nasogastric tube is a technical skill within the LPN/VN scope. Applying non-medicated barrier creams to intact skin and feeding a client who has already passed a dysphagia screen are standard, predictable activities of daily living appropriate for UAP delegation.

Step-by-Step Solution

1
Analyze each proposed task assignment to determine if it involves assessment, clinical judgment, teaching, or evaluation.
Identified that admission assessments and titrating high-alert IV medications require independent RN clinical judgment.
The RN cannot delegate the core nursing process (Evaluate, Assess, Teach).
2
Evaluate the clinical stability and safety implications of the tasks delegated to the UAP.
Identified that performing passive range-of-motion on a new deep vein thrombosis is a severe safety risk (potential pulmonary embolism) and outside standard routine care.
Delegated tasks must be predictable and safe. A UAP lacks the clinical training to recognize and manage the complications of manipulating an acute clot.
3
Verify if the remaining tasks fit the established scope of practice for LPN/VNs and UAPs.
Confirmed that NG tube insertion (LPN/VN), feeding a cleared stroke client (UAP), and applying non-medicated cream to intact skin (UAP) are all safe, standard procedures.
These tasks have predictable outcomes and do not require ongoing independent nursing judgment during their execution.

Key Concept

Delegation and Scope of Practice Guidelines
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Topics

Assignment, Delegation and Supervision

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