Question

Which action can a nurse delegate to assistive personnel \((\mathrm{AP}) ?\) a. Performing glucose monitoring every 6 hours on a patient b. Teaching the client about the need for enteral feeding c. Administering enteral feeding bolus after tube placement has been verified d. Evaluating the client's tolerance of the enteral feeding

Short answer

A nurse can delegate performing glucose monitoring every 6 hours on a patient to assistive personnel.

Step-by-step solution

Understand the Scope of Practice for Assistive Personnel

Recognize that assistive personnel, such as a nursing assistant, can perform direct patient care tasks that do not require nursing judgment. APs typically perform tasks that are routine, unchanging, and do not require assessment, planning, or evaluation by licensed nursing staff.

Evaluate the Complexity of the Task

Assess whether the task is routine and repetitive and does not require nursing judgment. Tasks that involve client education, assessment, planning, intervention, or evaluation typically fall outside the scope of an AP.

Identify the Delegable Task

Option a involves performing routine glucose monitoring, which is a task that does not require nursing judgment once the AP has been trained and is deemed competent. Option b involves teaching, which is not within the AP's scope of practice. Option c involves administering a feeding, which could be within the AP's scope if competency is established, but verifying tube placement requires nursing judgment. Option d involves evaluating client tolerance, which is a form of assessment and is not within the AP's scope of practice.

Key concepts

Scope of Practice for Assistive Personnel

Understanding the scope of practice for assistive personnel (AP) is crucial in ensuring that patient care tasks are delegated appropriately. The scope of practice defines the activities that APs are legally permitted to perform, based on their level of training and qualifications.

APs, such as certified nursing assistants (CNAs), often assist with basic patient care tasks that are well-defined and routine. Examples of these tasks include measuring vital signs, helping patients with activities of daily living, and performing glucose monitoring, as seen in the textbook exercise. These tasks are generally considered to be within the scope of practice for APs because they do not require complex nursing assessments or interventions.

However, tasks that go beyond basic care—such as teaching patients, making clinical assessments, or performing invasive procedures—typically fall outside of APs' scope and must be handled by licensed nursing staff. It's important for nurses to be familiar with their state's regulations and their workplace policies to ensure tasks are delegated appropriately.

Nursing Judgment

Nursing judgment is a critical component of the nursing practice that incorporates expertise, clinical decision-making, and the ability to assess and respond to changes in a patient's condition. It involves a complex interplay of knowledge, experience, critical thinking, and analytical skills. In the context of the example given, evaluating enteral feeding tolerance or verifying tube placement after it has been inserted requires a high level of nursing judgment.

When determining if a task requires nursing judgment, consider whether it involves assessment, planning, intervention, evaluation, or any form of clinical decision-making. These tasks are inherently non-delegable to APs because they require the nurse's specialized training and licensure to ensure patient safety and quality care. Nurses must use their judgment to differentiate between tasks that require their unique expertise and those that can be safely performed by assistive personnel.

Delegation in Healthcare

Delegation in healthcare is an essential skill for registered nurses (RNs). It enables efficient workflow and optimal patient care by allocating specific tasks to members of the team, which often includes assistive personnel (AP). The key to effective delegation is understanding which tasks are appropriate to delegate while considering patient safety and the competence of the AP.

When delegating, nurses must evaluate several factors: the stability of the patient’s condition, the complexity of the task, potential for harm, and the AP's proven competency. For example, performing routine glucose monitoring (option a from the exercise) is generally considered simple and repetitive once the AP has demonstrated competency, making it a suitable task for delegation.

Ultimately, the delegating nurse retains accountability for the outcome of the delegated task. Therefore, the nurse must provide clear instructions, ensure proper follow-up, and be available for support, thereby fostering a safe and collaborative care environment for patients.