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Difficulty: MediumAssignment, Delegation and Supervision

A care team on a medical neurology unit consists of a registered nurse, a licensed practical nurse, and an unlicensed assistive personnel. When distributing the workload for the shift, which task assignment by the registered nurse demonstrates safe and appropriate delegation?

  1. A
    Instructing the unlicensed assistive personnel to assist with the first meal for a client admitted with an acute brainstem infarction
  2. B
    Delegating the admission assessment of a client who recently arrived from the emergency department with altered mental status to the licensed practical nurse
  3. Asking the licensed practical nurse to perform a sterile intermittent urinary catheterization for a client with a chronic neurogenic bladderAnswer
  4. D
    Assigning the unlicensed assistive personnel to determine the effectiveness of non-pharmacological pain interventions for a client with severe trigeminal neuralgia

Answer

The correct delegation decision is asking the licensed practical nurse to perform a sterile intermittent urinary catheterization for a client with a chronic neurogenic bladder.
The correct delegation decision is assigning the sterile intermittent catheterization to the licensed practical nurse. This client has a chronic neurogenic bladder, meaning their condition is stable and the outcomes are predictable. Sterile procedures, such as urinary catheterization, fall safely within the legal and educational scope of practice for a licensed practical nurse when caring for stable clients.

Step-by-Step Solution

1
Analyze the client acuity and condition stability presented in each proposed task.
Identify that the clients with the brainstem infarction and altered mental status are acute and unstable, whereas the client with the chronic neurogenic bladder is stable.
Delegation requires ensuring the 'Right Circumstance' and 'Right Person' based on the stability and predictability of the client's condition.
2
Apply the principles of the nursing process regarding delegation limits.
Determine that tasks requiring initial assessment (admission assessment), clinical judgment (initial feeding of a stroke client), and evaluation (checking pain intervention effectiveness) must remain with the registered nurse.
The registered nurse cannot delegate tasks that fall under the core components of nursing judgment, often remembered by the acronym EAT (Evaluate, Assess, Teach).
3
Evaluate the recognized scope of practice for the licensed practical nurse and unlicensed assistive personnel.
Conclude that a sterile procedure on a stable, chronic client is safely within the scope of the licensed practical nurse.
Licensed practical nurses are trained and licensed to perform sterile procedures and care for clients with chronic, stable conditions with predictable outcomes.

Key Concept

NCSBN Principles for Assignment, Delegation, and Supervision
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Topics

Assignment, Delegation and Supervision

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