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Difficulty: MediumAssignment, Delegation and Supervision

A registered nurse (RN) is preparing to delegate the transfer of a client who had a total knee arthroplasty 2 days ago from the bed to a chair to an unlicensed assistive personnel (UAP). In what order should the RN perform the following actions to safely complete the delegation process? Arrange the actions from first to last.

  1. 1Assess the client's current pain level, weight-bearing status, and hemodynamic stability.
  2. 2Confirm the UAP's documented competency and prior experience with orthopedic transfers.
  3. 3Provide explicit parameters for the transfer technique and when to call for RN assistance.
  4. 4Remain available on the unit to provide support and supervise the transfer process as needed.
  5. 5Review the client's physiological response to the transfer and provide feedback to the UAP.

Answer

The correct sequence is: Assess the client, confirm the UAP's competency, provide explicit instructions, supervise during the transfer, and evaluate the final outcome.
The National Council of State Boards of Nursing (NCSBN) delegation process follows a systematic sequence: Assessment of the client to ensure the Right Circumstance and Task, verification of the delegatee's competence for the Right Person, clear communication of expectations for the Right Direction, ongoing availability for the Right Supervision, and final evaluation of the outcome for Right Evaluation and Feedback. Following this exact order ensures safe, effective, and legally sound delegation.

Step-by-Step Solution

1
Identify the first requirement before any delegation can occur.
The RN must first perform a clinical assessment of the client.
Delegation cannot occur until the RN ensures the client is physiologically stable and the task is appropriate for their current condition.
2
Determine the next action after ensuring the client is stable.
The RN verifies that the UAP is qualified to perform the task.
The RN must ensure the right person is assigned by verifying the delegatee's specific competency and experience.
3
Identify the action required immediately before the task begins.
The RN communicates specific instructions and reporting parameters to the UAP.
Clear communication sets exact expectations, techniques, and safety limits for the task.
4
Determine the RN's responsibility during task execution.
The RN remains available and monitors the situation.
The RN retains ultimate accountability and must provide appropriate supervision while the task is performed.
5
Identify the final step in the delegation process.
The RN evaluates the client and provides feedback to the UAP.
Evaluation ensures the task was completed safely, the client tolerated the activity, and allows for delegatee growth.

Key Concept

The nursing delegation process and the Five Rights of Delegation (Task, Circumstance, Person, Direction/Communication, Supervision/Evaluation).
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Topics

Assignment, Delegation and Supervision

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