Ch. 14 Zerwekh Delegation in the Clinical Setting

A nurse is feeling overwhelmed and has determined to delegate some of the tasks to the LPN he//she is working with. Which of the following would be most appropriate for the nurse to delegate? a. An initial assessment on a new patient b. Educational teaching on diabetes management c. Creating a care plan for a patient d. Updating the care plan for a patient who is postop day 2

ANS: D The nurse could delegate updating the care plan for a patient who is postop day 2. The nurse should not delegate an initial assessment, educational teaching, or creating a care plan for a patient. These responsibilities are not within the scope of practice for the LPN and must be completed by the nurse.

Based on the goal of making optimal use of the level of preparation of the licensed practical nurse (LPN), which task should the nurse (RN) delegate to the LPN? a. Assisting with a lumbar puncture b. Transporting a patient to the radiology department c. Restocking the sterile supplies d. Distributing afternoon nutrition supplements

ANS: A Assisting with procedure, such as a lumbar puncture, is within the scope of practice of the LPN. The nurse must select the right task for a competent person in a selected situation. Transporting clients, restocking supplies, and passing nutrition supplement are nursing interventions that can be carried out by a certified nursing assistant (CNA).

What should the nurse do to assess competence before delegating a task to an LPN? a. Ask if the LPN has previous experience performing the task. b. Ask if the LPN is willing to perform the task. c. Ask another nurse if the LPN is competent. d. Assume the LPN is competent due to her years of service.

ANS: A In order to assess competence, the nurse should ask the LPN if he or she has experience performing the task. Based on the answer, the nurse can then ask more questions if needed to determine competency.

The nurse is preparing assignments in a pediatric unit for the night shift. Which of the following would be appropriate to assign the LPN/LVN? a. A 5-year-old child who had an appendectomy about 6 hours ago b. A 4-year-old child admitted for severe epiglottis who is running a fever of 102° F c. A 6-year-old child admitted with dehydration and receiving IV therapy d. A 7 year old child who has inhalation burns 2day ago and has a tracheostomy

ANS: A The child who is postoperative for the appendectomy would be an appropriate assignment for the LVN/LPV. This child's problem has a predictable outcome. The question doesn't mention any unstable symptoms that would have to be handled outside the LVN/LPN's scope of practice. The children with epiglottis, dehydration, and burns will need to be evaluated and monitored for complications, which is the scope of practice and responsibility of the nurse.

A female patient in the medical-surgical unit is diagnosed with anemia and complains of weakness. Which of the following assignments could be given to the nursing assistant? a. Organize the patient's meal tray for dinner. b. Talk with the patient about managing her rest and activities. c. Get a diet history and list of the patient's favorite foods. d. Take an apical pulse and listen to the lungs for crackles.

ANS: A The only assignment that fits the scope of practice for the nursing assistant would be to organize the patient's tray. Talking with the patient and obtaining a diet history would be nurse functions, as would listening to the lungs for crackles.

What would be the best example of supervision? a. Assigning nursing care for a group of five patients to a nurse b. Following up with a CNA on the assigned task of ambulation and feeding of two patients c. Assigning a urinary catheterization and collection of sterile culture to an LPN d. Scheduling the LPN to administer medications on the unit for the afternoon

ANS: B Supervision is the provision of guidance, direction, and follow-up for the accomplishment of an assigned task. The nurse would follow up with the CNA to determine whether the tasks were completed and whether any problems occurred. Assigning nursing care for a group of patients or a specific procedure are examples of delegation, as is scheduling an LPN to administer medications.

What would be the best example of delegation? a. Transferring to another nurse the responsibility of caring for a patient requiring a blood transfusion b. Providing guidance to an LPN to hang blood on a patient c. Assigning a series of nursing unit tasks to the certified nursing assistant d. Assisting a new nurse to understand the rules and regulations of the Nurse Practice Act

ANS: A Transferring to another nurse the responsibility of caring for a patient requiring a blood transfusion is the best example of delegation. Delegation involves transferring to a competent nurse a specific task or responsibility for nursing care. The person who delegated the responsibility maintains responsibility for following guidelines for appropriate delegation. Providing guidance to an LPN and explaining to a new nurse about the Nurse Practice Act would be teaching and/or supervision rather than delegating a specific task or responsibility. Assigning to a CNA certain tasks is not delegation because there is no transferring of a specific task or responsibility of nursing care to that person.

Which actions by the nurse show an understanding of what the nurse is accountable for? (Select all that apply.) a. Assessing patients according to priority b. Determining the need to delegate a task to a nursing assistant c. Deciding that the nursing assistant is competent to perform the task delegated d. Following up to determine completion of the task that was delegated e. Delegating assessments of low-acuity patients to the nursing eassistant

ANS: A, B, C, D Nurses show understanding of what they are accountable for by assessing patients according to priority, determining the need to delegate, deciding whether the nursing assistant is competent to perform that task, and following up to determine completion of the task that was delegated. Nurses should not delegate assessment of any patient to a nursing assistant. Assessment must be completed by the nurse.

The charge nurse is determining tasks that can be delegated to keep the unit running smoothly. What factors should the charge nurse consider before delegating? (Select all that apply.) a. Staff who are working b. Acuity of patients c. Community needs d. Teaching obligations of the nurses e. How many patients are waiting for beds on the unit

ANS: A, B, C, D The charge nurse should consider other factors such as the staff that are working, acuity of patients, community needs, and teaching obligations of the nurses before beginning to delegate. These factors will determine what kind of delegation can be safely handled by the staff.

A nurse manager is discussing the "five rights of clinical delegation?" Which statement indicates understanding? (Select all that apply.) a. "The nurse should determine if the task can safely be delegated." b. "The nurse should determine if this is a task that will fit into schedule." c. "The nurse should delegate the task to the right person." d. "The nurse should determine whether this is a task that would enhance learning." e. "The nurse should provide feedback to the delegate."

ANS: A, C, E To safely delegate, the nurse manager should determine the following: The right task—determining whether the task can be delegated The right circumstance—according to the NCSBN, the appropriate client setting, available resources, and consideration of other relevant factors The right person—matching the task to the right (qualified) person The right direction and communication—clear expectations of what needs to be done The right supervision and evaluation—acknowledgment that the person understands the information and is capable of completing the task and giving them feedback and evaluation

To optimally use the level of preparation of the LPN, which task should the nurse delegate to the LPN? a. Transporting a patient to the laboratory b. Assisting with a thoracentesis c. Restocking and counting the sterile supplies d. Passing afternoon nutrition supplements and waters

ANS: B Although the LPN/LVN could be delegated appropriately to do all of these tasks, assisting with procedures (e.g., the thoracentesis) would make best use of the LPN's emergency department educational preparation. The other activities would be appropriate to delegate to a nursing assistant.

There is a temporary agency registered nurse assigned to the nursing unit. You have no knowledge of this nurse's skills, and you want to assign the nurse to a patient who has a fresh tracheostomy. How should you handle this situation? a. Assign the nurse to the patient with the tracheostomy and hope for the best. b. Ask the nurse about his or her competency to care for the patient with the tracheostomy. c. Assign the patient to another nurse and use the temporary agency nurse to do simple care tasks. d. Call the agency and ask for a nurse skilled in the care of a patient with a tracheostomy.

ANS: B Float and temporary nurses should be asked about their competency at the beginning of a shift or assignment. Never assume that an individual knows something; be sure and ask. Delegation of an activity should always be followed by an anticipated response from that nurse as to whether or not he or she feels capable of performing the task. It is important to determine the competency of the nurse as well as to make sure the nurse indicates he or she is competent to carry out the delegated activity. It would be appropriate to check on this nurse frequently to evaluate their delivery of care or to offer assistance. It would be okay to call the agency and verify the nurse's skilled competencies, but talking with the nurse would still be the first action.

The nurse needs to discuss a problem with the nursing assistant. The nursing assistant has left several rooms cluttered with trash and not cleaned appropriately. Which comment by the nurse would be the best way to approach the problem? a. "I checked on the four rooms you were assigned, and they are really a mess." b. "Have you had a problem completing your work assignment today?" c. "All four of the patient rooms assigned to you today are messy with a lot of trash in them." d. "Family members have been really upset today. Why have you not cleaned up the rooms assigned to you?"

ANS: B Providing an open-ended question to determine if there was some difficulty with an assignment is an appropriate method to assess this situation. When correcting or telling a person that they did something wrong, it is best to start by giving that person an opportunity to provide some input into the situation. This can be accomplished by asking the nursing assistant if there were any problems completing the assignment today. Asking "why" type questions can put the person on defensive and does not allow the CNA to provide an explanation of why the rooms were cluttered. Telling the CNA that the rooms were cluttered and messy does not address the issue of how it occurred.

Which of the following statements indicate the nurses understanding of accountability in the delegation process? a. "I am solely accountable for the actions of the delagetee." b. "I am accountable for assessing the delegatee's competency before delegation." c. "The delegate is responsible for telling them if they are competent." d. "The manager is responsible for providing feedback to the delegate."

ANS: B The nurse is accountable for assessing the delegatee's competency before delegation and providing feedback after the task has been completed. The delegate is solely responsible for his or her actions, not the nurse.

The charge nurse is assigning patients for care. There are two nurses, a LPN, and a certified nursing assistant (CNA). The charge nurse would assign which of the following patients to the LPN? a. An older adult who is receiving IV chemotherapy through a central line and will need a dressing change b. An adult patient diagnosed with insulin-dependent diabetes who will need dressing changes on several stasis ulcers on the lower extremities c. An adult patient with a right fractured femur and right arm in a cast who needs to urinate d. An older patient with terminal cancer who will be transferred to hospice

ANS: B The patient with diabetes will need stasis ulcer care, which is within the scope of practice of the LPN. The patient receiving chemotherapy through a central line would be assigned to the nurse. The nursing assistant would help the female patient with the fractures with the bedpan. The nurse should facilitate the transfer of the hospice patient.

A nurse is reviewing delegation with a graduate nurse. The nurse knows that the teaching has been successful when the graduate nurse states which of the following? a. "The nurse can delegate assessments to the nurse assistants." b. "The nurse must create the care plan based on assessment findings." c. "The nursing assistants cannot perform bed baths on postsurgical patients." d. "The LPN can perform discharge teaching."

ANS: B The teaching has been successful when the graduate nurse states: "The nurse must create the care plan based on assessment findings." The nurse is solely responsible for this action. The nurse cannot delegate assessments to the nursing assistants; this must be completed by the nurse. Performing discharge teaching is a requirement of the nurse, not the LPN. Nursing assistants can perform bed baths on postsurgical patients.

Which of the following statements made by the charge nurse indicates appropriate delegation? (Select all that apply.) a. The LPN can delegate dressing changes to the nursing assistant. b. The LPN can administer a DPT immunization to a child. c. The LPN can add a dose of Bleomycin to an existing IV infusion. d. The nursing assistant can transfer a paraplegic patient from a wheelchair to the bed using a lift, as long as the nursing assistant has received training and demonstrated competency. e. The nursing assistant can assess vital signs on a patient 15 minutes after the transfusion has been started.

ANS: B, D Only nurses can delegate to other personnel. LPNs can administer routine medications, such as immunization, but not chemotherapy drugs (Bleomycin). A nursing assistant can transfer patients, provide basic hygiene measures, and assess vital signs. (The patient has been receiving blood, so the nurse needs to monitor the first 50 mL that is given because this is when a transfusion reaction is most likely to occur.)

Which task could a staff nurse delegate to a certified nursing assistant (CNA)? a. Evaluating a patient's response to pain b. Making rounds with a physician c. Feeding a stroke patient who has minimal dysphagia d. Assessing a patient's central venous line site

ANS: C Feeding a stroke patient who has minimal dysphagia is an appropriate delegation of a nursing intervention to a CNA. The majority of state boards have addressed the issue of delegation and have developed rules that offer specific guidelines regarding who can do what. The scope of practice for each level of care provider usually includes a description of the tasks that may be performed at that level. The nurse cannot delegate the task of assessing the patient or making rounds with the physician to the CNA. Nursing interventions such as assessment and evaluation of pain, management of central line sites, or performing tracheotomy or colostomy care are within the scope of professional nursing, as is making rounds with a physician.

Which of the following represents appropriate feedback for an assignment to an LPN? a. "Did you understand the assignment that you received in the staff report?" b. "Have you completed the urinary catheterization and care of the new patient?" c. "The patient in Room 430 looks much better, and you did a good job of making the patient comfortable." d. "I know you are busy; however, you need to get caught up with your pain medications."

ANS: C Telling the LPN that they did a good job of making a patient comfortable is appropriate feedback on an assignment. Feedback is a process of informing someone of how well or how poorly a delegated task was performed. Asking understanding of an assignment or whether a procedure was performed is not giving feedback but determining if what is supposed to be done is understand or whether the task (urinary catheterization) has been completed. The pain medications may have been delegated; however, if this task was delegated, the feedback does not tell the LPN what her or she is doing right or wrong.

Which of the following task can the nurse safely delegate to the nursing assistant? a. Assessing the patients who are being discharge later today b. Give discharge instructions to a patient c. Help a patient select food according to their diet d. Educating the patient on what foods to eat for his diet plan

ANS: C The nurse can safely delegate the job of helping the patient select food according to his diet. The nurse is responsible for assessing patients, giving discharge instructions, and educating the patient on what foods to eat for his diet plan.

An experienced nursing assistant could be assigned by the nurse to do which of the following? a. Help in the teaching of new diabetic clients to give themselves injections. b. Report on quality and quantity of urine and adjust drip rate on continuous bladder irrigation. c. Assist the client to obtain a clean-catch urine specimen. d. Chart the dietary intake for a client with an eating disorder.

ANS: C The nursing assistant can be assigned activities that involve standard, unchanging procedures, such as helping to obtain a clean-catch urine specimen from a client. Teaching, working with complicated procedures (continuous bladder irrigation), and monitoring dietary intake with a person having an eating disorder would need to be assigned to the nurse because they involve assessment and evaluation.

The nurse is making assignments for the team. There are 2 LPNs and a nursing assistant on the team. Which of the following assignments would the nurse choose for themself? a. A patient who had a cerebrovascular accident (CVA) with left- sided paralysis who will need help with bathing b. A patient with a chest tube who is ambulating in the hall c. A patient receiving chemotherapy for bone cancer d. A patient receiving tube feedings with a J-tube

ANS: C The patient with the highest acuity would be the patient receiving chemotherapy for bone cancer. The nurse would be managing delivery of chemotherapy drugs and pain control with narcotics as ordered. The other patients are within the scope of care for the LVN and the nursing assistant.

A day shift nurse has come into work and notices that the glucometers were not tested overnight as they typically are. What is the best way for the nurse to question the nurse assistant, in order to give feedback? a. "Why didn't you test the glucometers?" b. "What did you do last night?" c. "How was your night? I noticed the glucometers weren't tested." d. "Couldn't you have asked one of the nurses to check the glucometers if you were busy?"

ANS: C When giving an individual negative feedback, the nurse should also ask for the nurse assistant's feedback. If the nurse becomes accusatory, the nursing assistant may become defensive, which does not help solve the issue of the glucometers not being tested. Asking, "How was your night? I noticed the glucometers weren't tested" gives the nursing assistant a chance to responds and explain what happened.

The nurse has a full assignment. The charge nurse adds a newly admitted patient who will require close monitoring. Which task can the nurse delegate to the CNA who is co-assigned to the same patients? a. Teaching Mr. Z insulin self-administration b. Updating Mrs. W's care plan c. Evaluating goal attainment for Mr. Y, who is learning to walk with a below-the-knee prosthesis d. Bathing Miss X, an unconscious patient

ANS: D Bathing a patient is an appropriate nursing intervention within the role and responsibilities and scope of practice of the CNA. The nurse must determine what needs to be done and then identify whether this is a task that can be delegated to someone else. The role of the nurse involves the coordination and planning of care, with the primary focus on identifying with the patient and the physician the desired outcomes for the patients. Teaching clients, updating nursing care plans, and evaluating patient responses to treatment plans are within the scope of practice of the registered professional nurse.

The nurse has just given a patient a narcotic for pain relief. Because the nurse must leave the unit for lunch and a 1-hour meeting, the task of evaluating the patient's response to the pain medication must be delegated. To whom should the nurse delegate this responsibility? a. Nursing assistant b. Student nurse c. Licensed practical nurse d. Nurse manager

ANS: D Evaluating the patient's response to pain medication is an activity within the scope of the registered professional nurse (who in this situation is the nurse manager). Many states are very specific in their description of what cannot be delegated and belongs only to the nurse's scope of practice. The licensed practical nurse can administer the pain medication. The student nurse could assist the professional nurse in the evaluation of the patient's response to the pain medication; however, the nurse leaving the unit cannot delegate this responsibility to a student. This nursing intervention is outside the scope of practice of the nursing assistant.

12. Determine how the nurse's role is different from that of the LPN in assessment of the patient. a. Collects data during the health history and physical exam b. Contributes to the development of the care plan c. Assist in updating the care plan d. Uses findings from the assessment to create a care plan

ANS: D The nurse differs from the LPN in that the nurse uses assessment findings to create a care plan for the patient. The LPN focuses on collecting data during the health history and exam, contributes to the development of the care plan, and assists in updating the care plan.

What are potential causes of performance inadequacies? a. The person to whom the task was assigned had appropriate educational qualifications to complete the task. b. The task was assigned to a person capable of carrying out the assignment. c. The person who delegated the task confirmed the recipient's ability to perform the task. d. The person to whom the task was assigned did not understand what the task involved.

ANS: D When a person who was assigned a task and did not understand it, this would be a potential cause of a performance inadequacy. A principle of delegation, the person to whom the task is assigned, should verify that they understand and can perform the task. If the person is capable, has appropriate educational qualifications, and the nurse has confirmed that they are able to perform the task, then there should not be performance inadequacy.