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Difficulty: HardAssignment, Delegation and Supervision

At the start of the night shift on a specialized neurovascular unit, a registered nurse is distributing clinical tasks among the healthcare team, which includes a licensed practical nurse (LPN/VN) and an unlicensed assistive personnel (UAP). Which of the following assignments represent safe and appropriate delegation? Select all that apply.

  1. A
    Assigning the UAP to provide oral care for a client who arrived one hour ago with an expanding subdural hematoma
  2. Authorizing the LPN/VN to initiate a scheduled continuous enteral feeding via a healed gastrostomy stomaAnswer
  3. C
    Entrusting the LPN/VN to conduct the frequent neurological assessments for a client undergoing acute thrombolytic therapy
  4. Tasking the UAP with performing routine passive range-of-motion movements for a hemodynamically stable client 5 days post-infarctionAnswer
  5. E
    Instructing the LPN/VN to determine the clinical effectiveness of a recently modified dysphagia diet
  6. Directing the UAP to secure pneumatic compression sleeves on the legs of an immobile client with chronic polyneuropathyAnswer

Answer

The safe delegations are authorizing the LPN/VN to initiate enteral feeding via a healed stoma, tasking the UAP with passive range-of-motion exercises for a stable client, and directing the UAP to apply pneumatic compression sleeves.
The registered nurse must ensure that delegation aligns with both the client's acuity and the team member's scope of practice. Unlicensed assistive personnel (UAP) can perform routine, unchanging procedures for stable clients, such as performing passive range-of-motion exercises and applying pneumatic compression sleeves. Licensed practical nurses (LPN/VNs) can safely care for stable clients with predictable outcomes, which includes initiating continuous enteral feedings through a healed gastrostomy tube. None of these correct assignments require advanced clinical judgment, initial assessment, or evaluation.

Step-by-Step Solution

1
Identify the licensure and scope of practice for each team member.
The RN retains evaluation, assessment, teaching (EAT), and care of unstable clients. LPN/VNs care for stable clients and perform standard procedures. UAPs perform routine tasks of daily living.
Delegation must adhere to legal boundaries and the Five Rights of Delegation.
2
Evaluate the stability of the clients described in the options.
The client with an expanding subdural hematoma and the client on thrombolytic therapy are acutely unstable and require direct RN care.
Unstable clients can experience rapid physiological changes requiring immediate advanced clinical judgment.
3
Analyze the complexity of the delegated tasks for the remaining stable clients.
Evaluation of a modified diet requires RN judgment. Enteral feeding via a healed stoma, range-of-motion exercises, and applying compression sleeves are standard, non-evaluative tasks.
Delegating standard tasks for stable clients optimizes unit workflow while maintaining safety.

Key Concept

Assignment, Delegation and Supervision
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Topics

Assignment, Delegation and Supervision

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