The charge nurse on a medical-surgical unit is coordinating care for a group of clients. Based on National Council of State Boards of Nursing (NCSBN) guidelines, match each delegation or assignment decision (on the left) with the most accurate rationale regarding its appropriateness (on the right).
- Delegating the initial oral feeding of a client with profound dysphagia immediately following an acute ischemic stroke to an Unlicensed Assistive Personnel (UAP).Inappropriate Delegation: Task involves high physiological risk and requires initial comprehensive assessment by a Registered Nurse (RN).
- Assigning a Licensed Practical/Vocational Nurse (LPN/VN) to administer scheduled oral antibiotics and perform a focused respiratory assessment on a client with stable chronic asthma.Appropriate Assignment: Task falls within the scope for focused data collection and routine medication administration on a stable client.
- Delegating the measurement of routine vital signs and application of a condom catheter on a stable client who is two days post-operative to an Unlicensed Assistive Personnel (UAP).Appropriate Delegation: Task involves standard, unchanging procedures with predictable outcomes that do not require nursing judgment.
- Assigning a Licensed Practical/Vocational Nurse (LPN/VN) to titrate a continuous intravenous heparin infusion based on the client's most recent aPTT results.Inappropriate Assignment: Task requires complex evaluation, advanced pharmacological knowledge, and independent nursing judgment.
Cevap
Delegating the initial feeding post-stroke to a UAP is an inappropriate delegation due to high physiological risk. Assigning an LPN/VN to administer oral meds and perform a focused assessment on a stable asthma client is an appropriate assignment. Delegating routine vitals and a condom catheter to a UAP is an appropriate delegation of standard procedures. Assigning an LPN/VN to titrate IV heparin is an inappropriate assignment because it requires complex RN evaluation.
Safe delegation and assignment rely on the NCSBN Five Rights: Right Task, Right Circumstance, Right Person, Right Direction/Communication, and Right Supervision/Evaluation. The RN retains accountability for the overall nursing process. Initial comprehensive assessments (especially for unstable or high-risk clients) and complex evaluations (such as titrating high-alert IV medications) cannot be delegated or assigned to UAPs or LPN/VNs. However, LPN/VNs can safely perform focused assessments and administer routine medications to stable clients, and UAPs can perform standard, unchanging procedures that do not require nursing judgment.
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Anahtar Kavram
NCSBN Five Rights of Delegation and Scope of Practice Boundaries
Alternatif Yöntem
When evaluating delegation scenarios, remember the acronym 'TEA': Teaching, Evaluation, and Assessment. These three core components of the nursing process can NEVER be delegated to a UAP, and initial/comprehensive forms of these cannot be assigned to an LPN/VN.
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