Right Person
A 68-year-old patient with stable hypertension needs routine blood pressure checks every 4 hours. Who is the most appropriate person to perform this task?
A CNA or UAP can perform this task because it is routine, non-invasive, and does not require nursing judgment.
What type of task should NOT be delegated under the Right Task?
Tasks involving initial assessment, planning, or evaluation that require nursing judgment fall into this category.
What is the Right Circumstance?
This “right” requires the nurse to assess the patient’s condition and setting before giving a medication.
The delegator should have the delegatee, do what after performing the delegated task?
Report back
An RN delegates routine vital signs on a stable post-op patient to a CNA. Thirty minutes later, the CNA reports the patient’s blood pressure is 86/50. What is the RN’s best action?
The RN should immediately assess the patient and evaluate for signs of bleeding, shock, or complications, then notify the provider if needed.
A patient admitted for pneumonia suddenly becomes confused and disoriented. The nurse needs the patient’s vital signs taken immediately. Who should complete this task?
The RN should assess the patient because new-onset confusion is a change in condition that requires clinical judgment and further assessment.
Delegation is inappropriate when it requires what element?
Clinical Judgment
A stable patient needs assistance with ambulation to the bathroom while the unit is busy. What is the appropriate delegation decision?
The task can be delegated to a CNA, since the patient is stable and the activity is routine and low risk.
For time-sensitive tasks, the delegator must include this in the communication so the delegatee knows when the task must be done.
A deadline for task completion
An RN asks a CNA to check a diabetic patient’s blood glucose before lunch. The CNA reports a reading of 68 mg/dL. What should the RN do first?
The RN should assess the patient and initiate the hypoglycemia protocol (such as giving fast-acting carbohydrates) and continue to monitor blood glucose.
A patient is being discharged after a new diagnosis of diabetes and needs instruction on how to administer insulin injections. Who should provide this teaching?
The RN should perform this task because patient education and medication administration teaching require nursing knowledge and evaluation of understanding.
A nurse must verify that a task is allowed by what state-specific laws before delegating?
The Nurse Practice Act
A nurse is caring for a patient with a newly placed central line who needs a dressing change. Should this be delegated, and to whom?
This should be done by an RN or appropriately trained LPN, because it involves sterile technique and risk for infection.
Delegation is unsafe when the nurse fails to explain this part of the task, even if the delegatee has done it before.
How to perform the task
An RN delegates oral medication administration to an LPN for a stable patient. Later, the patient complains of dizziness and nausea after receiving the medication. What is the RN’s responsibility?
The RN should assess the patient for adverse effects, review the medication given, and determine if the provider needs to be notified.
A stable, alert patient who is awaiting discharge later today needs a bed bath and fresh linens. Who is the most appropriate person to delegate this task to?
A CNA or UAP can perform this task because it is basic care and does not require clinical judgment.
Delegating a task involving a patient in this condition, violates the Right Task of Delegation.
An unstable patient
A patient with a history of falls is dizzy after receiving a new blood pressure medication and wants to get out of bed. What is the best nursing action regarding delegation?
The RN should assist or closely supervise, as the patient’s condition increases the risk of harm and requires nursing judgment.
When delegating, this is communicated to ensure the delegatee knows what is important to do first.
The priority
A CNA reports that a patient’s surgical dressing is “soaked with blood.” What is the RN’s best response?
The RN should go to the bedside to assess the wound and dressing immediately and take appropriate action to control bleeding and notify the provider.
A nurse is caring for a 45-year-old patient who is 1 day post-op after an abdominal surgery. The patient needs assistance ambulating to the bathroom for the first time after surgery. Who should the nurse delegate this task to?
The RN should perform this task because the first ambulation after surgery requires assessment of tolerance, dizziness, pain level, and risk for falls.
What type of task cannot be delegated to a CNA/UAP?
Invasive Task - Examples: Wound care, suctioning, inserting foleys, IVs, med administration
A nurse is deciding whether to delegate vital signs on a patient who just returned from surgery and is showing signs of hypotension. What should the nurse do?
The nurse should perform the assessment personally because the patient’s condition is unstable and requires clinical judgment.
This type of communication is recommended to ensure the delegatee repeats back critical instructions, fostering shared understanding
Closed-Loop communication (the message is sent, repeated back, and confirmed so everyone knows it was heard and understood correctly)
An RN delegates ambulation of a stable patient to a CNA. The CNA reports the patient became dizzy and had to sit down. What should the RN do next?
The RN should assess the patient’s vital signs, oxygen status, and overall tolerance before allowing further ambulation.