RN Delegation and supervision

A nurse is concerned about the risk of delegating tasks to licensed practical nurses and unlicensed assistive personnel. What is the best way for the nurse to determine competency of an inexperienced delegatee?

Actually observe the delegatee perform the assigned task.

Which task is most likely to be considered in a state's practice act as appropriate to delegate to a LPN/LVN if the patient's condition is stable and competence in the task has been established?

Administer an enema for an elective surgery patient.

An RN makes the following assignments at the beginning of the shift. Which assignment would be considered high-risk delegation?

An unlicensed assistive person is assigned the task of assisting a patient with late stages of Huntington's disease to ambulate a short distance in the hallway.

Which functions can be delegated only to another RN with appropriate experience and training? (select all that apply)

Assessment of skin integrity on third day of hospitalization Evaluation of patient teaching related to turn, cough, and deep breathing exercises Nursing judgment related to withholding medication based on vital signs Formulation of nursing diagnosis "potential for fall"

A nurse is delegating to the newly hired nursing unlicensed assistive personnel (UAP) the task of assisting with oral hygiene, knowing that this assignment "does not require decisions based on the nursing process." The nurse is correctly using which of the five rights of delegation?

Circumstance

An LPN/LVN has transferred to a nursing unit and arrives for the first day. The RN checks with the LPN/LVN often throughout the shift to provide support and determine if assistance is needed. The RN is providing which level of supervision?

Continual supervision is being provided until the RN determines competency.

Which task is appropriate for the RN to delegate to the unlicensed assistive personnel (UAP) provided the delegate has had experience and training?

Obtain a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system

A patient is admitted with hypotension, shortness of breath, flushing, and hives. All levels of staff have been trained to assess vital signs. Given budget restrictions and proper delegation rules, to which care provider would the RN delegate the task of obtaining the initial blood pressure reading?

RN

An RN is counseled by the nurse manager regarding inappropriate delegation when the:

RN assigns the float LPN/LVN the task of completing a plan of care for a stable patient who was admitted for routine replacement of a feeding tube.

An RN delegates to an experienced LPN/LVN the task of administering oral medications to a group of patients. The LPN/LVN accepts the assignment, and the RN knows that the LPN/LVN has had the training and has acquired the skills needed to complete the task. The RN then observes the LPN/LVN recording a patient's medication administration just before entering the patient's room. The priority intervention by the RN is to:

Stop the LPN/LVN immediately and discuss the possible consequences of his actions in a nonjudgmental manner.

Which of the following situations would be appropriate for the supervisory level of initial direction and/or periodic inspection?

The RN assigns the LPN tasks within her scope of practice and checks back during the shift to ensure the tasks are completed correctly.

Which statement related to delegation is correct?

The RN must be knowledgeable about the laws and regulations that govern nursing practice, as well as those that have no clearly defined parameters, such as for UAP.

Care delivery using the team-based approach is used on a telemetry nursing unit. The team consists of one registered nurse (RN), two licensed practical nurses (LPNs), and one unlicensed assistive personnel (UAP). Staff have been charged to improve quality of care while ensuring cost containment. Which assignments would meet both criteria?

The experienced UAP places telemetry electrodes and attaches to cardiac monitor.

During orientation, an RN learns that LPN/LVNs in the facility receive additional training to perform some tasks such as hanging continuously infusing intravenous fluids that have no additives. It is important for the RN to understand that:

The nurse practice act and state regulations related to delegation override the organization's policies.

Which statement made by an RN regarding delegation indicates the need for additional teaching? (select all that apply)

Unlicensed assistive personnel (UAP) can assess vital signs during the first 5 minutes for a patient who is receiving a blood transfusion because a reaction at this time is unlikely. An LPN/LVN can administer a PPD (tuberculin skin test) if there is no history of a positive PPD. When dopamine is ordered continuously, the LPN/LVN can administer dopamine at a low dose for the purpose of increasing renal perfusion.

A student nurse is concerned about delegation practices and wonders why hospitals employ unlicensed assistive personnel (UAP) and LPN/LVNs. The student nurse refers to the National Council of State Boards of Nursing and learns that the role of these personnel is to:

aid the RN by performing appropriately delegated care tasks.

A nurse moves from California to Arkansas and due to having 20 years of experience as a registered nurse is immediately placed in charge of the telemetry unit. The staffing consists of LPNs and two unlicensed assistive personnel. The RN is unsure of the scope of practice of the LPNs and reviews the nurse practice act for Arkansas, which lacks clarity on some tasks. The RN should:

contact the state board of nursing to determine legal scope of practice for LPNs.

The RN instructs the LPN to "Give an enema to the patient in room 327 who is being discharged but is complaining of being constipated. Then be sure to document on the medication administration record when given." Which of the five rights was missing in this situation? The right of:

direction and communication.

A nursing administrator who is considering the feasibility of an all-RN staff reviews the report, Keeping Patients Safe: Transforming the Work Environment of Nurses (2003) and determines that RNs: (select all that apply)

have a positive effect on patient outcomes when managing patient care. are effective overseers of patients' overall health condition.

An RN recently relocated to another region of the country and immediately assumed the role of charge nurse. When determining the appropriate person to whom to delegate, the RN knows that:

he or she must review the state's nurse practice act for LPN/LVNs, because each state defines the role and scope of practice of the LPN/LVN.

An RN delegates to the unlicensed assistive personnel (UAP) the task of performing blood pressure checks for a group of patients on a nursing unit. The UAP accepts the task and is responsible for:

keeping the RN informed of any abnormal blood pressure readings.

The task of completing and signing the initial assessment on a newly admitted patient who is about to undergo minimally invasive procedures on an outpatient basis can be delegated to:

the registered nurse (RN)

A registered nurse (RN) is assigned as charge nurse for the first time. She knows to consult the state board of nursing to determine scope of practice for licensed practical nurses (LPN) and unlicensed assistive personnel (UAP). She also realizes there are common policies which exist in most state practice acts that include:

to determine what tasks can be safely delegated, the RN must first assess the patient.