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Difficulty: MediumAssignment, Delegation and Supervision

A charge nurse on a combined orthopedic and medical unit is establishing the daily care assignments. The staffing mix includes registered nurses (RNs), licensed practical/vocational nurses (LPN/VNs), and unlicensed assistive personnel (UAP). Which of the following task assignments are clinically appropriate? Select all that apply.

  1. Directing the UAP to measure and document the oral fluid intake for a client with chronic kidney disease.Answer
  2. B
    Assigning the LPN/VN to develop the initial discharge education plan for a client recovering from a total hip arthroplasty.
  3. C
    Directing the UAP to assist with the first oral feeding of a client admitted with an acute stroke and new-onset dysphagia.
  4. Assigning the LPN/VN to administer scheduled oral antihypertensive medications to a client with stable, chronic hypertension.Answer
  5. E
    Directing the LPN/VN to complete the comprehensive admission assessment for a client arriving from an outpatient clinic.
  6. Assigning the UAP to perform routine passive range-of-motion exercises for a clinically stable client who is on bed rest.Answer

Answer

The clinically appropriate assignments include directing the UAP to measure fluid intake, assigning the LPN/VN to administer scheduled oral medications, and assigning the UAP to perform routine range-of-motion exercises.
The registered nurse (RN) safely delegates routine, standard tasks to UAP and LPN/VNs. Measuring and documenting intake, performing range-of-motion exercises for stable clients, and administering routine oral medications to stable clients fall within the established scope of practice for these roles. These tasks have predictable outcomes and do not require the RN's complex clinical judgment, comprehensive assessment, or initial teaching.

Step-by-Step Solution

1
Analyze each assigned task against the registered nurse (RN) scope of practice.
Identify which tasks require RN-level clinical judgment, initial assessment, or teaching.
The RN cannot delegate the core components of the nursing process, often summarized as EAT (Evaluate, Assess, Teach).
2
Evaluate the acuity and clinical stability of the clients described in each option.
Identify the client with new-onset dysphagia as unstable and at high risk for aspiration.
Tasks involving high-risk or acutely unstable clients must be retained by the RN and cannot be safely delegated.
3
Determine if the remaining tasks fall within the standard scope for UAPs and LPN/VNs.
Routine intake measurement, passive range of motion, and administration of scheduled oral medications are confirmed as appropriate.
These tasks involve predictable outcomes and standard procedures suitable for delegation to trained personnel.

Key Concept

The RN must delegate tasks based on the Five Rights of Delegation, ensuring that initial assessments, care planning, teaching, and care for unstable clients remain with the RN.
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Topics

Assignment, Delegation and Supervision

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