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Difficulty: MediumAssignment, Delegation and Supervision

A registered nurse (RN) on a neurology step-down unit is assigning tasks for the upcoming shift. The nursing team includes the RN, a licensed practical nurse (LPN), and an unlicensed assistive personnel (UAP). Which of the following tasks are appropriate for the RN to delegate? Select all that apply.

  1. Assigning the UAP to reposition a bedbound client who is receiving continuous enteral feedingsAnswer
  2. Assigning the LPN to administer scheduled oral antiepileptic medications to a client who had an ischemic stroke three days agoAnswer
  3. C
    Asking the UAP to perform an initial bedside swallow screen for a client newly admitted with facial droop
  4. D
    Directing the LPN to develop the discharge teaching plan for a client with a new diagnosis of multiple sclerosis
  5. Instructing the UAP to empty and document the fluid volume in a closed-wound surgical drainage deviceAnswer
  6. F
    Assigning the LPN to formulate the initial nursing care plan for a client admitted with acute bacterial meningitis

Answer

The RN can safely delegate repositioning a stable client and documenting drainage volume to the UAP, and administering oral medications to a stable client to the LPN.
Delegating routine care such as repositioning a client and documenting drainage volume is appropriate for a UAP because these tasks do not require nursing judgment. Assigning an LPN to administer scheduled oral medications to a client who is clinically stable (three days post-stroke) is also safe and aligns directly with their authorized scope of practice.

Step-by-Step Solution

1
Evaluate each task to determine if it involves initial assessment, clinical judgment, or initial teaching.
Tasks involving swallow screens, developing teaching plans, and formulating care plans require RN judgment and cannot be delegated.
The National Council of State Boards of Nursing (NCSBN) strictly prohibits delegating assessment, teaching, and evaluation to LPNs or UAPs.
2
Determine the appropriate scope of practice for the UAP in the remaining tasks.
Repositioning a client and emptying/documenting drainage are routine tasks safely delegated to a UAP.
UAPs are trained to assist with activities of daily living and basic data collection.
3
Determine the appropriate scope of practice for the LPN in the remaining tasks.
Administering scheduled oral medications to a stable, three-day post-stroke client is an appropriate LPN task.
LPNs are licensed to administer routine oral medications to clients with predictable outcomes.

Key Concept

The RN must retain tasks requiring clinical judgment, comprehensive assessment, and initial teaching, while delegating routine, predictable tasks to LPNs or UAPs based on their established scopes of practice.
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Topics

Assignment, Delegation and Supervision

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