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Difficulty: MediumAssignment, Delegation and Supervision

The charge nurse at an inpatient neurological rehabilitation center is coordinating care for several clients recovering from brain injuries. The nursing team consists of a Registered Nurse (RN), a Licensed Practical Nurse (LPN/VN), and an Unlicensed Assistive Personnel (UAP). Which of the following task assignments are safe and appropriate? Select all that apply.

  1. Assigning the LPN/VN to administer enteral tube feedings via an established percutaneous endoscopic gastrostomy (PEG) tubeAnswer
  2. B
    Assigning the UAP to monitor the neurological status of a client who recently experienced a transient ischemic attack
  3. C
    Assigning the LPN/VN to update and modify the nursing care plan for a client with progressive multiple sclerosis
  4. D
    Assigning the UAP to feed a client who has severe dysphagia and a high risk for aspiration
  5. Assigning the UAP to apply bilateral sequential compression devices (SCDs) to a client with limited mobilityAnswer
  6. Assigning the LPN/VN to insert an indwelling urinary catheter for a client experiencing acute urinary retentionAnswer

Answer

The appropriate assignments are having the LPN/VN administer enteral tube feedings, having the UAP apply sequential compression devices, and having the LPN/VN insert an indwelling urinary catheter.
Delegation must align with the legal scope of practice and the client's stability. LPNs/VNs possess the necessary licensure to execute routine sterile procedures (such as urinary catheter insertion) and administer therapies via established routes (such as PEG tube feedings). UAPs are trained to perform standard, non-invasive tasks on stable clients, such as applying sequential compression devices, which have predictable outcomes and require no clinical judgment.

Step-by-Step Solution

1
Analyze the scope of practice for an Unlicensed Assistive Personnel (UAP).
Identify that UAPs can perform standard, non-invasive tasks with predictable outcomes on stable clients, such as applying sequential compression devices, but cannot perform tasks requiring clinical assessment, such as monitoring neurological status or feeding a high-risk dysphagia client.
Delegating tasks that require clinical judgment to UAPs compromises client safety and violates the principles of delegation.
2
Analyze the scope of practice for a Licensed Practical Nurse (LPN/VN).
Identify that LPNs/VNs can perform routine sterile procedures (like catheterization) and administer medications or feedings through established routes, but they cannot independently modify care plans.
The RN retains the ultimate responsibility for the nursing process, including assessment, planning, and evaluation.
3
Evaluate each assignment against the Five Rights of Delegation.
Determine that assigning PEG tube feedings and catheterization to the LPN/VN, and SCD application to the UAP, represents the right task, right circumstance, and right person.
Matching the complexity of the task and the stability of the client to the competency of the healthcare worker ensures safe and effective care.

Key Concept

Scope of Practice and Delegation Principles
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Topics

Assignment, Delegation and Supervision

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