2- Delegation

The registered nurse (RN) directs the licensed practical nurse (LPN) to assist with the care of a client who has a sacral ulcer. Which is the most appropriate activity for the RN to delegate to the LPN? 1.Place the client in a side-lying position. 2.Initiate wound care protocol for standardized ulcer care. 3.Meet with the wound specialist to identify measures to improve healing. 4.Determine which treatments would best meet the healing needs of the client.

1 The best task for the LPN is to place the client in the side-lying position. Proper positioning requires nursing skills and is within the LPN's abilities and scope of practice. Initiating a wound care protocol, meeting with the wound specialist to identify measures to improve healing, and determining which treatments would best meet the healing needs of the client are outside the LPN's scope of practice, even though the LPN may assist the RN in determining the plan of care. These activities are the RN's responsibilities.

The registered nurse (RN) is planning client assignments and cannot take a client assignment today. Two assistive personnel (AP) and a licensed practical nurse (LPN) also are assigned to the unit. Which client should the RN most appropriately assign to the LPN? 1.A client requiring frequent ambulation 2.A client scheduled for a cardiac catheterization 3.A client requiring range-of-motion (ROM) exercises 4.A client with a 24-hour urine collection who is on strict bed rest

2 The RN is legally responsible for client assignments and must assign tasks according to the guidelines of Nurse Practice Act and the job description of the employing agency. A client scheduled for a cardiac catheterization requires physiological needs and frequent nursing assessments; this is the most appropriate assignment for the LPN. The RN can work with the LPN and supervise care. The AP has been trained to care for a client on bed rest and on urine collection, provide assistance with ambulation, and perform ROM exercises. The RN would provide instructions to the AP regarding the tasks, but the tasks required for these clients are within the role description of a AP.

The registered nurse is planning the client assignments for the day. Which is the most appropriate assignment for an assistive personnel (AP)? 1.A client requiring a colostomy irrigation 2.A client receiving continuous tube feedings 3.A client who requires urine specimen collections 4.A client with difficulty swallowing food and fluids

3

The nurse is caring for a client with acute glomerulonephritis. The nurse instructs the assistive personnel (AP) to implement which action when caring for the client? 1.Ambulate the client frequently. 2.Encourage a diet that is high in protein. 3.Remove the water pitcher from the bedside. 4.Monitor the client's temperature every 2 hours.

3 The client with acute glomerulonephritis commonly experiences an excess of fluid volume and fatigue. Interventions include fluid restriction and monitoring weight, intake, and output. The diet is high in calories but low in protein. The client is placed on bed rest, or at least encouraged to rest, because there is a direct correlation between proteinuria and hematuria and increased activity levels. It is unnecessary to monitor the temperature as frequently as every 2 hours.

The nurse manager is planning the clinical assignments for the day. Which staff members cannot be assigned to care for a client with herpes zoster? Select all that apply. 1.The nurse who never had roseola 2.The nurse who never had mumps 3.The nurse who never had chickenpox 4.The nurse who never had German measles 5.The nurse who never received the varicella-zoster vaccine

3 and 5 The nurses who have not had chickenpox or did not receive the varicella zoster vaccine are susceptible to the herpes zoster virus and should not be assigned to care for the client with herpes zoster. Nurses who have not contracted roseola, mumps, or rubella are not necessarily susceptible to herpes zoster. Herpes zoster (shingles) is caused by a reactivation of the varicella zoster virus, the causative virus of chickenpox. Individuals who have not been exposed to the varicella zoster virus or who did not receive the varicella zoster vaccine are susceptible to chickenpox. Health care workers who are unsure of their immune status should have varicella titers done before exposure to a person with herpes zoster.

A nursing graduate is attending an agency orientation regarding the nursing model of practice implemented in the health care facility. The nurse is told that the nursing model is a team nursing approach. The nurse determines that which scenario is characteristic of the team-based model of nursing practice? 1.Each staff member is assigned a specific task for a group of clients. 2.A staff member is assigned to determine the client's needs at home and begin discharge planning. 3.A single registered nurse (RN) is responsible for providing care to a group of 6 clients with the aid of an assistive personnel (AP). 4.An RN leads 2 licensed practical nurses (LPNs) and 3 APs in providing care to a group of 12 clients.

4 In team nursing, nursing personnel are led by a registered nurse leader in providing care to a group of clients. Option 1 identifies functional nursing. Option 2 identifies a component of case management. Option 3 identifies primary nursing (relationship-based practice).

When creating an assignment for a team consisting of a registered nurse (RN), 1 licensed practical nurse (LPN), and 2 assistive personnel (AP), which is the best client for the LPN? 1.A client requiring frequent temperature checks 2.A client requiring assistance with ambulation every 4 hours 3.A client on a mechanical ventilator requiring frequent assessment and suctioning 4.A client with a spinal cord injury requiring urinary catheterization every 6 hours

4 The client on the mechanical ventilator requiring frequent assessment and suctioning should most appropriately be cared for by the RN. The LPN is skilled in urinary catheterization, so the client in option 4 would be assigned to this staff member.

The nurse is planning the client assignments for a group of clients and has a licensed practical nurse (LPN) and an assistive personnel (AP) on the nursing team. Which client would the nurse most appropriately assign to the LPN? 1.A client with stable heart failure who has early-stage Alzheimer's disease 2.A client who is scheduled for an electrocardiogram and a chest x-ray examination 3.A client who was treated for dehydration, is weak, and needs assistance with bathing 4.A client with emphysema who is receiving oxygen at 2 L/min by nasal cannula and becomes dyspneic on exertion

4 The nurse would most appropriately assign the client with emphysema to the LPN. This client has an airway problem and has the highest priority needs among the clients presented in the options. The clients described in options 1, 2, and 3 can appropriately be cared for by the AP.

The nurse employed in a long-term care facility is planning assignments for the clients on a nursing unit. The nurse needs to assign 4 clients and has 1 licensed practical nurse and 3 assistive personnel (APs) on a nursing team. Which client would the nurse most appropriately assign to the licensed practical nurse? 1.A client who requires a bed bath 2.An older client requiring frequent ambulation 3.A client who requires hourly vital sign measurements 4.A client requiring abdominal wound irrigations and dressing changes every 3 hours

4 When delegating nursing assignments, the nurse needs to consider the skills and educational level of the nursing staff. Giving a bed bath, assisting with frequent ambulation, and taking vital signs can be provided most appropriately by a AP. The licensed practical nurse is skilled in wound irrigations and dressing changes and most appropriately would be assigned to the client who needs this care.

Select all the task you could delegate to a nursing assistant as the RN:* A. Wound dressing change B. IV flush C. Collecting vital signs D. Weighing a patient E. Mouth care F. Suctioning a patient G. Applying oxygen to a patient H. Connecting a patient to their IV fluids I. Assisting a patient with a bath J. Applying denture paste to dentures

Answers C, D, E, I and J. These are all tasks the RN could delegate to a nursing assistant.

As the registered nurse, which tasks below should you NOT delegate to the LPN?* A. Performing an assessment on a new admission B. Collecting a urine sample from an indwelling Foley catheter C. Developing a plan of care for a patient who is admitted with Guillain-Barré Syndrome D. Educating a patient about how to monitor for side effects associated with Warfarin E. Auscultating lung and bowel sounds F. Starting a blood transfusion G. Administering IV Morphine 2 mg for pain H. Providing wound care to a stage 3 pressure injury

Answers are A, C, D, F, G....these are all out of the scope of practice for an LPN. Remember anything that deals with assessments, educating, evaluating, developing a plan of care, IV medications, unstable patients, or invasive/complex procedures where there is unpredictability the RN is responsible for doing it, and these tasks can't be delegated. An LPN can perform a focused assessment by listening to lung or bowel sounds and report the findings to the RN but a comprehensive assessment is done by the RN. In addition, the LPN can perform standard procedures that are predictable on stable patients like wound care for a pressure injury, Foley catheter insertion, obtaining an EKG, obtaining blood glucose level etc.

You're making the patient assignments for the next shift. On your unit there are three LPNs, two RNs, and two nursing assistants. Which patients will you assign to the LPNs? Select all that apply:* A. A 68 year-old male patient who is expected to be discharged home with IV antibiotic therapy. B. A 25 year-old female patient newly admitted with diabetic ketoacidosis. C. A 75 year-old male patient with dementia who has an ileostomy and scheduled tube feedings. D. A 65 year-old female patient who has an order to remove the Foley catheter.

Answers are C and D. Option A: An RN is the best for this patient because the patient will need discharge teaching AND the nurse will need to teach the patient how to self-administer antibiotics. Option B: This is a new admission and the patient is UNSTABLE. Most patients with DKA (diabetic ketoacidosis) require insulin drips along with close monitoring of the blood glucose levels, which requires critical thinking and interpretation. Options C and D are best for the LPNs: these are standard routine procedures the LPN can perform and these patient cases are stable.

On your unit there are two RNs: one is a new RN while the other is an experienced RN. In addition, there are three LPNs and two nursing assistants. Which tasks delegated to one of the nursing assistants by the new RN needs to be re-evaluated?* A. Apply hydrocortisone cream to eczema on skin after giving the patient a bath. B. Assist the patient with administering a Fleet Enema. C. Empty an ostomy bag. D. Collect and record patient's blood pressure, heart rate, temperature, oxygen saturation, respirations, and pain rating. E. Assist a patient with ambulating.

Answers: A and B Option A is a task for an LPN or RN...hydrocortisone cream is a medication and the nursing assistant can't administer medications. Option B: is a task for an LPN or RN....it is a procedure. Option C, D, and E are all delegated tasks a nursing assistant can perform.

An RN has a critical patient that needs constant monitoring. However, the RN also has other patients in need of care. Which tasks below could the RN delegate to the LPN to help continue the process of patient care?* A. Admitting and assessing the new admission B. Completing the discharge teaching to a patient going home C. Updating and evaluating the patient's plan of care D. Administering subcutaneous Heparin E. Obtaining a routine 12-lead EKG F. Collecting a stool specimen G. Flushing a central line with normal saline

Answers: D, E, and F...these are all tasks an LPN can perform. They are routine procedures that usually have predictable outcomes. RNs are responsible for performing assessments on new admissions, teaching, evaluating, flushing and maintain central lines, and updating the patient's plan of care.

True or False: An RN delegates to the LPN to administer a scheduled tube feeding to a patient. The RN has now transferred full accountability to the LPN for the task getting done, and the RN is no longer accountable for the task.* True False

FALSE: The RN can delegate this task to the LPN BUT the RN is still ACCOUNTABLE for the task getting done even though the RN is not the one performing it.

When delegating you know that as an RN you must follow the 5 Rights of Delegation to make sure you are delegating properly. Select all the 5 Rights of Delegation:* A. Right Credentials B. Right Direction/Communication C. Right Supervision D. Right Experience E. Right Task F. Right Person G. Right Patient H. Right Circumstance I. Right Time J. Right Order

The answers are: B, C, E, F, and H. The 5 Rights of Delegation are: Right Task, Right Circumstance, Right Person, Right Direction/Communication, and Right Supervision.

The nurse is planning the client assignments for the day. Which clients can be safely assigned to the assistive personnel (AP)? Select all that apply. 1.The client receiving a heparin infusion 2.The client receiving a blood transfusion 3.The client receiving continuous oxygen at 2 L/min 4.The client recovering from Guillain-Barré syndrome 5.The client who just returned from surgery for a hip repair 6.The client on isolation for methicillin-resistant Staphylococcus aureus

3,4, AND 6 APs cannot be assigned to a client requiring care that is more than basic. APs do not have the education to safely care for clients requiring more than basic care. Assigning a AP to these clients presents an unsafe situation. The client receiving a heparin infusion requires licensed personnel to monitor progress and for possible adverse reactions. The client receiving a blood transfusion requires monitoring for possible adverse reactions; licensed personnel are necessary. Unlicensed personnel cannot be assigned to a client who needs immediate postoperative assessment. These clients need to be cared for by a registered nurse (RN).

The nurse is developing a client care assignment for a group of assistive personnel (APs). What is the nurse's first step in planning and assigning clients? 1.Determine what skills can be delegated. 2.Determine the years of experience of each AP. 3.Determine how much supervision is required for each client assigned. 4.Determine how many clients the agency allows to be delegated to each AP.

1 Knowing what skills can be delegated is essential when nurses assign client care to other health care personnel. Nurses must be familiar with their state's Nurse Practice Act, institutional policies and procedures, and the institution's job description for APs. Information from these sources is necessary to define the level of competency of APs. Determining how many clients to delegate is not the first step, and in fact most agencies do not state a specific number of clients that may be assigned. Determining years of experience is also not a first step, although a AP's experience could affect the type of client assigned. How much supervision will be required is also important but, again, not the first step the nurse takes when delegating client assignment to the APs.

The charge nurse is planning the assignment for the day. Which factors should the nurse remain mindful of when planning the assignment? Select all that apply. 1. The acuity level of the clients 2.Specific requests from the staff 3.The clustering of the rooms in the unit 4. The number of anticipated client discharges 5. Client needs and workers' needs and abilities

1 and 5

Which patients below are best assigned to the LPN?* A. A 30-year-old male patient with active GI bleeding that requires multiple blood transfusions. B. A 78-year-old female with osteoporosis who needs assistance performing range of motion exercises and ambulating with a walker. C. A 29-year-old male patient who is post-op day 6 from a colostomy placement that is on a clear liquid diet. D. A 55-year-old male patient who reports chest pain and has ST segment elevation on his EKG.

Answers are B and C. LPNs should be assigned STABLE patients with predicable outcomes and cases that don't require critical thinking or complex analysis. The patients in options A and D are unstable and require constant care with decisions being based on how to interpret patient findings.