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Difficulty: Very hardAssignment, Delegation and Supervision

A staffing shortage on an acute medical-surgical unit requires the immediate reassignment of several clients. The interdisciplinary care team available consists of a registered nurse (RN) floated from the maternal-newborn unit, an experienced licensed practical nurse (LPN/VN), and an unlicensed assistive personnel (UAP). Which client care assignment demonstrates the safest and most appropriate application of delegation principles?

  1. Assigning the maternal-newborn float registered nurse (RN) to administer a prescribed unit of packed red blood cells to a client with stable, chronic anemia.Answer
  2. B
    Assigning the experienced licensed practical nurse (LPN/VN) to administer intravenous (IV) push diltiazem to a client experiencing new-onset atrial fibrillation with a rapid ventricular response.
  3. C
    Delegating to the unlicensed assistive personnel (UAP) the initial oral feeding of a client who sustained an acute ischemic stroke two days ago and exhibits unilateral facial paralysis.
  4. D
    Assigning the maternal-newborn float registered nurse (RN) to perform the admission assessment and manage a continuous regular insulin infusion for a client with severe diabetic ketoacidosis.

Answer

Assigning the maternal-newborn float registered nurse (RN) to administer a prescribed unit of packed red blood cells to a client with stable, chronic anemia.
The safest and most appropriate assignment involves matching the client's acuity with the nurse's scope of practice and core competencies. A float registered nurse, regardless of their home unit, possesses core nursing competencies which include the administration of blood products. Because the client has chronic anemia, their condition is stable and predictable. Assigning a stable client to a float RN perfectly aligns with the principles of safe delegation and prioritization.

Step-by-Step Solution

1
Analyze the competencies and scope of practice for the available staff: a maternal-newborn float RN, an experienced LPN/VN, and a UAP.
Float RNs can perform core RN skills (like blood administration) for stable clients; LPN/VNs care for stable clients but generally cannot administer high-alert IV push medications; UAPs assist with standard activities of daily living but cannot perform initial clinical assessments.
Delegation requires matching the task to the right person based on their legal scope of practice and demonstrated competency.
2
Evaluate the acuity and stability of each client in the proposed assignments.
The chronic anemia client is stable. The atrial fibrillation client (rapid ventricular response) and the diabetic ketoacidosis client (insulin infusion) are highly unstable. The stroke client has a high aspiration risk, making the initial feeding an unstable task requiring assessment.
The 'Right Circumstance' of delegation dictates that unstable clients with unpredictable outcomes must be cared for by an RN with appropriate, unit-specific expertise.
3
Match the safest staff member to the appropriate client based on the evaluations.
The stable client with chronic anemia receiving blood is the only assignment that safely aligns client stability with the core competencies of the assigned staff member (the float RN).
This ensures adherence to the NCSBN guidelines for safe delegation and supervision while appropriately utilizing available staff.

Key Concept

Delegation and Scope of Practice for Float Nurses and Assistive Personnel
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Topics

Assignment, Delegation and Supervision

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