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Difficulty: MediumAssignment, Delegation and Supervision

A registered nurse (RN) on a medical-surgical unit is preparing to delegate the insertion of a straight urinary catheter for a client with acute urinary retention to a licensed practical/vocational nurse (LPN/VN). Arrange the following steps of the delegation process in the correct chronological order according to national delegation guidelines. (Place the first step at the top and the final step at the bottom.)

  1. 1Assess the client's current clinical stability and the complexity of the urinary catheterization.
  2. 2Verify the LPN/VN's scope of practice, education, and validated competency for performing straight catheterizations.
  3. 3Provide clear, specific instructions regarding the procedure, expected outcomes, and parameters for reporting back.
  4. 4Remain available to monitor the process, answer questions, and intervene if the client's condition changes.
  5. 5Review the task outcome, evaluate the client's response, and provide constructive feedback to the LPN/VN.

Answer

The correct sequence of delegation is to first assess the client, then verify the LPN/VN's competency, provide specific instructions, monitor the execution of the task, and finally evaluate the outcome and provide feedback.
Safe delegation requires a systematic, chronological approach. The RN must first assess the client's condition to determine if the task is safe to delegate (Assess). Next, the RN assesses the delegatee's competence (Plan). Then, clear communication is provided (Communicate), followed by active supervision during the task (Supervise). Finally, the RN evaluates the client's response and provides feedback (Evaluate).

Step-by-Step Solution

1
Assess the client's stability and the complexity of the task.
Determines if the specific situation is safe for delegation.
The RN maintains accountability for client safety; unstable clients or highly complex, unpredictable tasks should not be delegated.
2
Verify the delegatee's competence and scope of practice.
Ensures the selected staff member is legally and clinically capable.
Delegating to an unqualified individual violates the 'Right Person' principle and endangers the client.
3
Communicate clear instructions and expectations.
The delegatee understands exactly what to do, how to do it, and what to report.
Clear, two-way communication prevents errors and establishes boundaries for the delegated task.
4
Monitor and supervise the performance of the task.
Ensures the procedure is carried out safely according to facility policy.
The RN remains accountable for the task and must be available to intervene if complications arise.
5
Evaluate the results and provide feedback.
Closes the delegation loop and ensures the client's needs were met.
Evaluation is necessary to determine if the desired outcome was achieved and to promote the professional growth of the delegatee.

Key Concept

The National Council of State Boards of Nursing (NCSBN) decision-making process for safe delegation.
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Topics

Assignment, Delegation and Supervision

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