What are 3 tasks that a registered nurse may assign to other assistive personnel?

b/What are the key principles that a registered nurse should consider when delegating tasks to other healthcare personnel? Registered nurses should be knowledgeable about the applicable state nurse practice act and regulations regarding delegation and supervision guidelines. They should consider providing clear directions when delegating a task, making sure it’s the appropriate task first and circumstances. They should take responsibility for periodic reassessment and evaluation of the outcome of the task. In addition, they must make sure that the person they are delegating the task to is legally

Terms in this set (18)

Wound care and routine medication administration are the most appropriate tasks to assign to the LPN. The LPN can perform sterile procedures and cleanse and dress wounds for which there is an established prescription plan (Option 4). Pain rated at 8/10 is an expected finding in a client with chronic back pain, and the oral analgesic may be administered as scheduled by the LPN (Option 1). If this client were experiencing new-onset, unexplained pain requiring intravenous analgesic administration, the client would need assessment by the RN.
(Option 2) The LPN may perform specific assessments, but evaluating the fluid volume status of a heart failure client is a comprehensive assessment involving multiple body systems (eg, heart and lung sounds, peripheral edema, adequacy of urine output). This client will also require discharge education on home management of heart failure, which is the responsibility of the RN.
(Options 3 and 5) UAP have the appropriate skills and knowledge to meet clients' elimination, hygiene, and comfort needs. Although these tasks could be safely carried out by an LPN, underutilizing UAP would be an ineffective use of resources.

Clients requiring mechanical ventilation receive care from many members of the health care team. Nurses must often delegate tasks to ensure that care is provided in a timely manner. When delegating, nurses must consider the stability of the client and the experience level of unlicensed assistive personnel (UAP). In accordance with the five rights of delegation, nurses may delegate the following client care tasks to the UAP:
Performing routine oral care, which will not affect medical stability in a client with a tracheostomy tube (Option 1)
Measuring and obtaining vital signs (Option 4)
Testing blood glucose (per hospital policy)
Performing personal hygiene and skin care (eg, bathing)
Performing passive and/or active range-of-motion exercises (Option 5)
Measuring output (eg, urinary, drainage)
(Option 2) The tracheostomy is a surgically created airway with a high risk of infection. Only licensed individuals (eg, registered nurse, licensed practical nurse) should perform tracheostomy care.
(Option 3) Although an elevated head of bed (HOB) is necessary to prevent ventilator-acquired pneumonia and improve chest expansion, teaching is not within the scope of the UAP and should be performed only by nurses. However, after nurses provide teaching, the UAP may remind the family to keep the HOB elevated.

To prepare a client for a bronchoscopy, the nurse must be able to perform basic assessment skills, such as assessing vital signs, lung sounds, ability to swallow, and gag reflex; maintain nothing-by-mouth status; prepare a checklist before the procedure; and monitor for respiratory difficulty after the procedure. Because these are skills a graduate nurse possesses, this is an appropriate assignment.
(Option 1) Initiating a heparin infusion according to institution protocol involves collecting baseline serum specimens (eg, partial thromboplastin time [aPTT], International Normalized Ratio [INR], prothrombin time, platelets, hemoglobin, hematocrit), calculating weight-based dosages, (eg, bolus dose, infusion rate in units/hr), and calculating intravenous infusion pump hourly rate. Serum aPTT and INR levels are monitored every 6 hours or according to protocol. Frequent changes in rate or dose based on these levels may be necessary to maintain a therapeutic level of heparin. For these reasons, this is not an appropriate assignment for a new graduate nurse.
(Option 2) A client with newly diagnosed cancer who is refusing radical surgery that will result in the loss of speech and inability to communicate normally is demonstrating fear and anxiety. This client needs preoperative teaching about the surgical procedure, what to expect immediately after surgery, methods for speech restoration, and general preoperative teaching (eg, deep breathing, suctioning, pain management). Emotional support, education, and advanced therapeutic communication skills are necessary to help allay fear and anxiety. For these reasons, this is not an appropriate assignment for a new graduate nurse.
(Option 4) The elderly client with new-onset confusion is at risk for developing hospital-induced delirium related to advanced age, surgery, hypoxia, fluid and electrolyte disturbances, immobility, pain, and/or drugs. The nurse must perform neurological assessments to determine the cause and intervene appropriately. For these reasons, it is not an appropriate assignment for a new graduate nurse.

The client with the cast applied 24-hours ago is stable and is the most appropriate assignment for the float nurse. This client requires the nurse to perform basic pain, peripheral vascular (eg, color, temperature, capillary refill, peripheral pulses, edema), and peripheral neurologic (eg, sensation and motor function) assessments, which should be familiar to a nurse who works on a general medical unit.
(Option 1) This client is unstable and requires frequent assessments to identify signs and symptoms of infection and changes in neurovascular status (for compartment syndrome). Pin care is needed as well.
(Option 2) The client waiting to be discharged requires extensive discharge teaching about using a continuous passive motion device, weight-bearing restrictions and assistive devices, anticoagulation prophylaxis, and rehabilitation.
(Option 3) The client scheduled for an amputation requires preoperative teaching and psychological support specific to this type of surgery (eg, phantom pain, change in body image). Therefore, this client should be assigned to a nurse who is familiar with preparing clients for orthopedic surgery.

When delegating tasks, the registered nurse (RN) should consider the 5 rights of delegation along with the scope of practice. The scope of practice for a practical nurse (PN) includes administering medications, although regulations related to narcotics and IV medications vary by state (Option 1). Based on staff member availability, it can also be appropriate to perform or delegate tasks below the scope of a given staff member (eg, delegating vital signs to a PN, an RN performing ostomy care) (Option 3). Measuring peak expiratory flow with a peak flow meter is also within the scope of practice for a PN (Option 4).
(Option 2) The PN can collect data (eg, auscultating breath sounds, observing for accessory muscle use). However, evaluation of the collected data (ie, determining the client's response to a bronchodilator medication) is the responsibility of the RN, as it requires use of the nursing process.
(Option 5) PNs are able to reinforce education initiated by the RN. However, providing teaching on new topics may not be delegated to the PN.

The UAP can be delegated tasks that do not require nursing judgment. Any task that involves the nursing process (assessment, diagnosis, planning, implementation, evaluation) requires the attention of the RN.
The UAP may gather information (eg, vital signs, intake and output) about stable clients, assist stable clients with activities of daily living, and retrieve necessary supplies, but the RN retains accountability for all of the delegated actions and outcomes (Options 3, 4, and 5). The RN is also responsible for determining the competency level of the UAP prior to delegating tasks.
(Option 1) Making staff lunch assignments is part of the management of the unit; therefore, the RN cannot delegate this task. The RN must ensure that there is adequate staff coverage to meet client needs during the assigned lunch times.
(Option 2) UAPs can give bed baths to stable, appropriate clients. The client with a new ostomy requires assessment and teaching about cleaning and caring for the ostomy; therefore, an RN must perform this task.

The UAP has the skills and knowledge to perform standard procedures to prevent immobility hazards for a client in traction (eg, pneumonia, pressure ulcers, foot drop, thromboembolism). When providing care for a stable client, the RN can safely delegate these tasks to the UAP:
Assist with active and passive ROM exercises after the client has been taught how to perform them by the RN or physical therapist (Option 1)
Notify the RN of client reports of pain, tingling, or decreased sensation in the affected extremity
Remind the client to use the incentive spirometer after the client has been taught proper use by the RN or respiratory therapist (Option 4)
Maintain proper use of pneumatic compression devices (Option 5)
Remind the client to move frequently using the overhead trapeze
(Option 2) The UAP changes the linens from the top to the bottom of the bed with assistance; clients are instructed to lift themselves using the overhead trapeze. This approach maintains immobilization of the injured extremity. Logrolling the client will require multiple staff members, including one person to stabilize weights.
(Option 3) The RN is responsible for peripheral circulation, neurovascular, and skin assessments.

Unlicensed assistive personnel (UAP) may perform routine tasks for stable clients under the direction of the registered nurse (RN). Tasks related to the nursing process (eg, assessment, planning, evaluation) require trained knowledge, critical thinking, and individualized application by the RN and cannot be delegated.
A client 1-day post chest tube placement must be assessed by the RN to establish safety and readiness for ambulation. However, the UAP can assist the RN in ambulating if appropriate (Option 1).
UAP can empty, measure, and record output from a surgical drain. However, the RN is responsible for assessing the drainage (eg, type, amount, odor, color) and maintaining the wound drainage device (Option 2).
As directed by the RN, UAP can courier blood products to and from the blood bank (Option 4). However, verification of any blood products must be performed by 2 RNs prior to transfusion.
UAP can carry out comfort measures such as escorting family members to the waiting area (Option 5).
(Option 3) Although UAP may report observations of abnormal physical signs to the nurse, it is the RN's responsibility to assess the client's ongoing condition. Monitoring of RN findings can be delegated to a licensed practical nurse but not to a UAP.

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