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Difficulty: MediumAssignment, Delegation and Supervision

While organizing the morning workflow on an acute care floor, a registered nurse (RN) must assign interventions among available staff members, including a licensed practical/vocational nurse (LPN/VN) and an assistive personnel (AP). Which specific client care activities fall within the safe scope of practice to delegate to the LPN/VN? Select all that apply.

  1. Administering a scheduled subcutaneous injection of enoxaparin.Answer
  2. Performing a sterile dressing change on a healing abdominal surgical incision.Answer
  3. C
    Conducting the comprehensive admission assessment for a client arriving from the post-anesthesia care unit.
  4. D
    Initiating the first teaching session regarding new dietary restrictions for a client with heart failure.
  5. Inserting a prescribed indwelling urinary catheter for a client requiring strict intake and output monitoring.Answer
  6. F
    Determining if a client's respiratory status has improved following a nebulizer treatment.

Answer

The appropriate tasks to delegate to the LPN/VN are administering the scheduled subcutaneous injection, performing the sterile dressing change, and inserting the indwelling urinary catheter.
The RN may safely delegate tasks that involve standard, unchanging procedures with predictable outcomes. Administering subcutaneous medications, performing sterile dressing changes on healing wounds, and inserting urinary catheters are all standard clinical skills taught in practical nursing programs and do not require the advanced clinical judgment of a registered nurse.

Step-by-Step Solution

1
Analyze the legal principles and rules of nursing delegation.
Identify that the RN retains core responsibilities that cannot be delegated, commonly remembered by the EAT acronym (Evaluate, Assess, Teach).
Safe delegation requires matching the task to the legal scope of practice and competencies of the team member.
2
Evaluate the clinical complexity of each proposed task.
Determine that routine medication administration, sterile procedures on stable wounds, and urinary catheter insertions have predictable outcomes and involve standard steps.
Tasks delegated to an LPN/VN should not require independent, advanced nursing judgment.
3
Identify the tasks that require advanced clinical judgment.
Eliminate the comprehensive assessment, initial dietary teaching, and the evaluation of respiratory status.
These specific activities require synthesis of data, critical thinking, and the formulation of a care plan, which must remain with the RN.

Key Concept

The RN cannot delegate assessments, clinical judgments, initial teaching, or evaluation of care outcomes to an LPN/VN or AP. LPN/VNs can perform routine procedures, administer most medications, and gather data on stable clients.
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Topics

Assignment, Delegation and Supervision

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