DELEGATION

Question: A 7 year old boy with a compound fracture is being admitted to a pediatric
unit. Which of the following actions is best for the nurse to take?

(1) Ask the nursing assistant to obtain the child's VS while the nurse obtains a
history from the parents
(2) Ask the LPN/LVN to assess the peripheral pulses of the child's left leg while the
nurse completes the admission forms
(3) Ask the LPN/LVN to stay with the child and his parents while the nurse obtains
phone orders from the physician
(4) Ask the nursing assistant to obtain equipment for the child's care while the
nurse talks with the child and his parents

***You may be thinking, "Why are they asking me this? I have never had the
opportunity to ask the LPN/LVN or nursing assistant to do anything!" Every
three years, the National Council of State Boards of Nursing conducts a job
analysis study to determine the activities required of a newly licensed
registered nurse.
Based on this study, National Council adjusts the content of the test to accurately
reflect what is happening in the work place. This ensures that the NCLEX test is
what is needed to be a safe and effective nurse.

With recent changes in health care, the role of the nurse has expanded. In
addition to providing quality patient care, the nurse is also responsible for coordination
and supervision of care provided by other health care workers. Many health care
settings are staffed by registered nurses licensed vocational nurses/licensed practical
nurses and unlicensed assistive personnel (UAP) such as nursing assistants and
support staff. It is the responsibility of the registered nurse to coordinate the efforts of
these health care workers to provide affordable quality patient care. Appropriate
supervision of the LPN/LVN and/or unlicensed assistive personnel by the registered
professional nurse is essential for safe and effective patient care.

To reflect these changes, the NCLEX test plan now contains questions about
delegation and assignment of patient care. There are several reasons why you may find
these questions difficult to correctly answer on the NCLEX. You might not have any
practice answering multiple choice questions about management. Many nursing schools
test the content presented in the management course with essay questions rather than
multiple-choice questions. You have received lectures regarding management of care,
but your clinical rotation in management may have been less than ideal. Your
experience may have been restricted to caring for one or two patients without any
opportunity to supervise others, or you may have spent time on a hospital unit providing
patient care under the supervision of a preceptor. These experiences don't necessarily
prepare you to answer the management of care questions you will see on the NCLEX.
 Don't despair. Her are some rules of management that will help you choose the
right answers when answering management of care questions on the NCLEX.

The Rules of Management

Rule #1: Do not delegate the functions of assessment, evaluation and nursing judgment.
During your nursing education, you learned that assessment, evaluation and nursing
judgment are the responsibility of the registered professional nurse. You cannot give
this responsibility to someone else.

Rule #2: This is not the real world. Do not make decisions regarding management of care
issues based on decisions you may have observed during your clinical experience in
the hospital or clinic setting. Remember, the NCLEX is ivory tower nursing. The
answers to the questions are found in nursing test books or journals. Always ask
yourself, "Is this textbook nursing care?"

Rule #3: Delegate activities for stable patients with predictable outcomes. If the patient is
unstable, or the outcome of an activity not assured, it should not be delegated.

Rule #4: Delegate activities that involve standard, unchanged procedures. Activities that
frequently reoccur in daily patient care can be delegated. Bathing, feeding, dressing
and transferring patients are examples. Activities that are complex or complicated
should not be delegated.

Rule #5: Remember Priorities! Remember Maslow, the ABC's, and stable versus unstable
when determining which patient the RN should attend to fist. Keep in mind that you
can see only one patient or perform one activity when aswering questions that
require you to establish priorities.

Lets take a closer look at the question above and use these rules to eliminate answer
choices .........

Question: A 7 year old boy with a compound fracture of the left femur is being
admitted to a pediatric unit. Which of the following actions is best for the nurse to
take?

A. Ask the nursing assistant to obtain the child's VS while the nurse obtains a
history from the parents

B. Ask the LPN/LVN to assess the peripheral pulses of the child's left leg while the
nurse completes the admission forms

C. Ask the LPN/LVN to stay with the child and his parents while the nurse obtains
phone orders from the physician
 D. Ask the nursing assistant to obtain equipment for the child's care while the nurse
talks with the child and his parents

On first glance, all the answers seem possible. Lets look at this question using the steps
outlined in this book.

Step 1. Reword the question in your own words. It asks what the nurse should do when a
child with a fractured femur is first admitted. That question is a very broad question.
To establish exactly what is being asked, you must read the answer choices. In each
answer, the RN is delegating tasks to the LPN/LVN or nursing assistant. The real
question is, "What is appropriate delegation?"

Step 2. Eliminate answer choices based on the Rules of Management.

(A) Ask the nursing assistant to obtain the child's VS while the nurse obtains a history from
the parents. Obtaining vital signs is an important part of assessment. According to Rule
#1, the registered nurse cannot delegate assessment. Elimated this answer choice.

(B) Ask the LPN/LVN to assess the peripheral pulses of the child's left leg while the nurse
completes the admission forms. Checking the peripheral pulses is an important
assessment for this patient because of the diagnosis of a fractured left femur. The nurse
needs to assess the patient before delegating activities to someone else. Assessment
of the patient is much more important than completing paperwork. Eliminate it.

(C) Ask the LPN/LVN to stay with the child and his parents while the nurse obtains phone
orders from the physician. There is no assessment, evaluation or nursing judgment
involved in this option so leave it in for consideration.

(D) Ask the nursing assistant to obtain equipment for the child's care while the