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Difficulty: MediumAssignment, Delegation and Supervision

A registered nurse (RN) on a surgical step-down unit plans to delegate a sterile wound dressing change to a licensed practical/vocational nurse (LPN/VN). Place the RN's actions in the correct chronological order according to the National Council of State Boards of Nursing (NCSBN) delegation process.

  1. 1Assess the client's wound complexity and overall clinical stability.
  2. 2Verify the LPN/VN's documented competency and facility policy regarding sterile dressing changes.
  3. 3Provide specific instructions to the LPN/VN, including what wound abnormalities to report immediately.
  4. 4Observe the LPN/VN periodically during the shift to ensure the task is performed correctly.
  5. 5Review the client's wound healing progress and discuss the LPN/VN's performance with them.

Answer

The correct sequence is: Assess the client, verify competency, provide specific instructions, observe/supervise periodically, and finally evaluate outcomes and provide feedback.
According to the NCSBN National Guidelines for Nursing Delegation, the delegation process follows a systematic sequence: 1) Assess and plan (evaluating client stability), 2) Communicate (providing clear directions to a competent delegatee), 3) Surveillance and supervision (monitoring the performance), and 4) Evaluation and feedback (reviewing the outcomes). Verifying competency is a critical component that immediately follows client assessment to ensure the 'Right Person' is chosen before providing instructions.

Step-by-Step Solution

1
Assess the client
Determines client stability and task appropriateness.
Delegation must always begin with an assessment of the client's current needs.
2
Verify competency
Confirms the delegatee is legally and institutionally permitted to perform the task.
The RN is responsible for ensuring the right person is assigned the right task.
3
Provide instructions
Establishes clear expectations and communication parameters.
The delegatee needs to know exactly what to do and when to report back (Right Direction/Communication).
4
Supervise periodically
Ensures the task is being executed safely and correctly.
The RN retains accountability and must provide appropriate surveillance (Right Supervision).
5
Evaluate and give feedback
Closes the delegation loop by reviewing outcomes and performance.
Evaluation is an exclusive RN responsibility that cannot be delegated.

Key Concept

NCSBN Delegation Process
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Topics

Assignment, Delegation and Supervision

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