Client D
The unlicensed assistive personnel (UAP) is delegated to work in long-term care settings and extended-care settings as the clients are more stable. The UAP may not be delegated to work in acute care, emergency care, and intensive care settings. In dementia, the client experiences confusion, so long-term care is essential for this client. Since UAPs generally work in long-term care, client D is most appropriate to be delegated to a UAP. As severe diarrhea needs acute care, client A may not be delegated to a UAP. Though a hand fracture may require extended care, the client can do work on his or her own when compared to the client with dementia. Therefore, client B may not be delegated to a UAP. Clients with bronchitis need acute care as they may experience breathing difficulties. Therefore, client C is not delegated to a UAP.
The nurse at a long-term care facility is considering whether to delegate some tasks to nursing assistive personnel (NAP). Before doing so, the nurse must:
- know the NaP's legally defined scope of practice.
- be familiar with the naP's knowledge, skills, and experience.
- work alongside the NAP.
- explain why he or she is not personally doing the task herself.
- be familiar with the naP's knowledge, skills, and experience.
(In order to delegate safety and effectivly, the nurse must be familar with the other individuals skills, education, and experience. The nurse provides oversight and supervision but does not work alongside the NaP. A nurse who delegates does not necessarily have to justify why he or she is not personally doing the task. NAPs do not have legally defined scopes of practice, unlike RNs and LPN/LVNs.)
The nurse on a busy hospital unit is anticipating the arrival of an acutely ill patient. What task should the nurse delegate top unlicensed assistive personnel (UAP)?
- feeding a patient who is recovering from a stroke.
- lung auscultation
- teaching a patient
- documentation
- feeding a patient who is recovering from a stroke.
(Feeding a patient is an example of the task implemented that can be delegated to UAP. While some patients who have experienced a stroke have an increased risk for aspiration, the nurse could safely delegate this task if the UAP had the knowledge and experience to feed the patient safety. Lung auscultation is a form of assessment and cannot be delegated to UAP. Similarly, patient education and documentation should be performed by a licensed nurse and not delegated to UAP.)
Samatha delegated the administration of her 8:00 am meds to Betty so that she could assess Mary promptly. What criteria must be met for this example of delegation to be safe and appropriate?
- Betty must have sufficient time to give each patient his or her meds.
- Samantha must be able to confirm that Betty has given the meds.
- Samantha must be familiar with betty's scope of practice with regard to medications
(Safe and appropriate delegation requires that the nurse be familiar with the knowledge, skills, attitudes, and experience of the person to whom a task is being delegated. Additionally, the nurse must be certain that the task is within the person's scope of practice and that the timeline available for completing the task is sufficient. All of these considerations are examples of ensuring the right task, circumstance, person, communication, and supervision. Betty's ability to give the meds safely is not necessarily dependent on her personal familiarity with each of the patients. Supervision does not entail working alongside a person whom a task is delegated.)
Samantha communicated with dr. Gonzalez about Mary's health status using the SBAR technique. When applying this technique, a nurse should begin the communication by presenting what info?
- the specific reason why the nurse has contacted the provider.
(The S in SBAR stands for situation. In this component of the model, the nurse identifies the reason for calling, followed by any necessary background info for context. The clients relevant health history and assessment data are then presented and the nurses communication ends with a suggestion for action.)
Betty, a licensed practical nurse/licensed vocational nurse (LPN/LVN), took phone report from the ED and accepted a patient onto the floor. Which of the five rights of delegation does this action violate?
- right communication
- right person
- right task
-
right circumstance
- right level of supervision
- right person
(The five rights of delegation include right task, circumstance, person, communication, and level of supervision. In this instance, Betty's action violated the right of right person, because as an LPN/LVN it is beyond betty's scope of practice to accept and assess a new patient. Betty should have asked the charge nurse to take the call from the ED.)
Betty was willing to administer Samanthas 8:00 am meds. If Betty were unwilling to accept this delegated task, what would be Samantha's best action?
- document bettys response and ask another registered nurse to perform the task.
- assess the reasons why Betty is unable or unwilling to give the meds.
- involve the manager or leader
- remind Betty of her scope of practice
- assess the reasons why Betty is unable or unwilling to give the meds.
(The best initial response to a subordinate's reluctance to accept delegation is to assess the reasons why he or she is reluctant. The reasons may be varied, and the nurse should dialogue in order to avoid making assumptions. Initially, there is no need to involve the manager or leader. Reminding Betty of her scope of practice is an action based on assumption.)
Which of the following creates the potential for successful delegation an emphasized by the national council state board of nursing (NCSBN)?
- determining how to monitor and supervise
- effective communication
- effective communication.
(The NCSBN emphasizes that effective communication creates the perfect situation for successful delegation ensuring clear guidance and direction.)
Which of the following are delegation errors made by nurse leaders?
- failure to follow-up
- failure to provide clear directions.
- failure to delegate
- failure to release control of task
- failure to provide adequate directions
(The common errors noted in delegation include failure to delegate, failure to release control, inadequate or unclear directions, and lack or follow-up or supervision.)
A nurse informs the nurse leader that it would be beneficial to delegate more to the UAP, but the nurse leader is reluctant to do so, stating, "whenever i do, they always come back with so many questions. I need them to just do it!" What kind of delegation error is the nurse making ?
- underdelegating
- overdelegating
- improperly delegating
- improperly delegating
Which instruction provided by the nurse reflects effective communication regarding delegation to assistive personnel?
- please notify me of any clients whose vital signs or blood glucoses are significant.
- take vital signs very two hrs for the patient with the cholecystectomy in room 6022.
- take vital signs very two hrs for the patient with the cholecystectomy in room 6022.
(The goals of the delegated task should be communicated clearly, identifying any limitations and a time frame for completing the task. The charge nurse must communicate what, how, and by when the delegated task should be completed. Words such as "significant," "excessive," or "sometime" are not specific or clear enough.)
The charge nurse is developing patient care assignments for the evening shift and needs to assign clients to a LPN/LVN and a certified nursing assistant (CNA). Which clients should the nurse assign to the LPN/LVN based on skill level and scope of practice?
- a client requiring a
dressing change to the foot
- a client requiring frequent suctioning
- a client requiring reinforcement of teaching about a diabetic diet
- a client on bed rest requiring vital sign measurement every 4 hrs
- a client requiring ROM exercises twice daily
- a client requiring collection of a urine specimen for urinalysis testing.
- a client requiring a dressing change to the foot
- a client requiring frequent suctioning
- a client
requiring reinforcement of teaching about a diabetic diet
(Appropriate tasks to assign to an LPN/LVN include tasks for stable patients with predictable outcomes such as suctioning, reinforcing patient teaching performed by an RN, performing sterile and unsterile dressing changes, and administering nonparenteral meds. Nursing assistants are considered unlicensed assistive personal (UAP), and as such, the RN must carefully consider the strategies for successful delegation to UAP. Tasks such as performing ROM exercises and collecting a urine specimen are appropriate to delegate to the CNA as they do not involve assessment, interpretation, or decision making.)
which task is appropriate for the nurse to delegate to the experienced nursing assistant?
- obtain a urine specimen from a client with an in dwelling Foley catheter
- assist a patient with select fluid replacement
- collect NG drainage for a patient whose NG tube is
connected to intermittent suction
- observe a client practice self-admin of injection meds.
- obtain a urine specimen from a client with an in dwelling Foley catheter.
(The charge nurse should delegate activities to the UAP as suggested by the NCSBN (2010). Collecting a urine specimen from a closed in dwelling catheter is a routine procedure that does not involve teaching, assessing, interpretation, or decision making, and therefore is an appropriate task to delegate to the nursing assistant. Assisting a patient with select fluid replacement involves patient teaching and is not appropriate for UAP such as a nursing assistant. Collecting of NG drainage for a patient whose NG tube is connected to intermittent suction Is an inappropriate delegation, as the UAP cannot disconnect the suction to empty the NG suction container. Observing a client practicing any self-med injections requires both assessment and patient teaching, and thus cannot be delegated.)
Which pediatric client care assignment is most appropriate for the charge nurse to delegate to the LPN/LVN?
- an infant with congestive heart failure
- a school-aged child with a fractured femur who is in balanced suspension traction.
- toddler with laryngotracheobronchitis (croup)
- child requiring a gastric lavage
- a school-aged child with a fractured femur who is in balanced suspension traction.
(The child with a fractured femur who is on bed rest due to balanced suspension traction is the least acute patient., and therefore should be assigned to the LPN/LVN. That patient has a problem with a predictable outcome. The toddler with laryngotracheobronchitis (croup) requires airway assessment. The infant with congestive heart failure also requires frequent assessment, as does the child requiring a gastric lavage. Thus, these patients are unstable and should be assigned to an RN. The LPN/LVN should be assigned to a stable patient with a predictable outcome.)
The charge nurse of a step-down coronary care unit has 24 clients in varying degrees of cardiac rehabilitation. The charge nurse must assign the clients to a team consisting of RNs, LPN/LVNs, and one CNA. What is the primary factor for the charge nurse to consider when delegating care?
- skill level and scope of practice of each staff member
(The scope of practice and the level of competence are the most important considerations when delegating patient care assignments. The individual state practice act as well as the ANA and the NCSBN all contain scope of practice and delegation information.)
A charge nurse is planning client activities for the day. Which tasks should the charge nurse delegate to the nursing assistant?
- take and record
temps, pulses, respiration's, and BPs on all assigned patients
- assist with delivering breakfast trays to clients after checking for correct patient, room number, and diet.
- restock pediatric patient care rooms with oral rehydration fluids using a standardized check list.
- empty and record the amt of urine out of Foley bags at the end of each shift.
- check the emergency crash cart for necessary supplies using a checklist.
- assist the pharmacy technician in refilling the
automatic medication dispenser.
- take and record temps, pulses, respiration's, and BPs on all assigned patients
- assist with delivering breakfast trays to clients after checking for correct patient, room number, and diet.
- restock pediatric patient care rooms with oral rehydration fluids using a standardized check list.
- empty and record the amt of urine out of Foley bags at the end of each shift.
(Assisting the pharmacy technician is outside of the scope of an ULAP; any aspect of med preparation and/or administration is not allowed by state board of nursing policy. The emergency cart contains medications, so it would be outside the scope of practice for the ULAP to check or refill meds. All other patient care activities can be safely delegated to UAP.)
the charge nurse is determining morning care assignment for several elderly clients awaiting discharge to an assisted living facility, including a client on bed rest with a skin tear and hematoma from a fall 5 days ago. what is the best care assignment for this client?
- assigning a nursing assistant to help the client with self-care activities.
(the goals of the delegated task should ficus on the right circumstance, which in this case is a patient with a risk for falls.)
the charge nurse (an RN) must determine how best to assign another Rn and one LPN/LVN to provide care to a group of clients on the day shift. what is the appropriate assignment?
- The RN is assigned to obtain vital signs on all patients on the unit because one of the nursing assistants will not be into work until 11 am.
- the RN Is assigned to care for an unemployed 26 year old woman, newly diagnosed with AIDS.
- the RN Is assigned to care for an unemployed 26 year old woman, newly diagnosed with AIDS.
(recall that the RN is assigned to care for the most acute patient, and the RN should be assigned to those patients requiring assessment, interpretation, teaching, or decision making. A patient with a newly diagnosed disease and requiring physical, psychosocial, and financial supports is the most complicated patient and should be assigned to the RN. assigning an RN to obtain VS is overdelegation. an LPN/LVN should not be assigned to a patient requiring surgical assessment, discharge teaching, or teaching about an acute disease such as malignant melanoma.)
during the admission of pediatric client with a compound fracture of the right femur following a sports injury, which delegation by the charge nurse is most appropriate?
- request that the nursing assistant obtain equipment for the client's care while the RN talks with the client and the family.
the charge nurse is preparing the patient care assignments for the day shift, assigning clients to a LPN/LVN and a CNA. which clients should be assigned to the CNA?
- a client pending discharge after a laparoscopic hernia repair who is requesting to ambulate to the bathroom.
- a client requesting assistance packing his belongings for discharge later today.
- a client requesting to use a bedpan after a lumbar puncture procedure.
- a client requiring a sterile dressing change to a
decubitus ulcer.
- a client with throat cancer and a tracheostomy requiring frequent suctioning.
- a client pending discharge after a laparoscopic hernia repair who is requesting to ambulate to the bathroom.
- a client requesting assistance packing his belongings for discharge later today.
(UAP such as a CNA cannot apply sterile dressings, suction, or care for patients post-procedure (such as a lumbar puncture); these patient care assignments are beyond the scope of a ULAP. reinforcing diabetic teaching and suctioning a patient should be delegated to the LPN/LVN, not the CNa. assisting a patient packing for discharge and assisting with ambulation are part of a CNA's scope of work.)
The nurse manager explains to the new charge nurse which critical guiding principle with regard to developing patient care assignments?
- the nurse shares accountability for delegated tasks