Case Study
Concept: Managing Care
Exemplar: Delegation
Course: NUR 213
Delegation: You are the registered nurse (RN) and you will have a group of ten clients on a
medical surgical unit in an acute care setting. There is also assigned a licensed practical nurse
(LPN) and unlicensed assistive personnel (UAP) to this same group.
The clients are as follows:
Room 101: A 48 year old female with breast cancer one day post bilateral mastectomy that
has been crying all night and is asking that no visitors be allowed. She refuses to get out of
bed and refuses to look at her bandages.
Room 102: A 92 year old male with dementia and pneumonia. He has a bed alarm and has a
history of falls. He has a large list of medications to be administered daily crushed and in
applesauce.
Room 103: An obese 72 year old female with a diabetic foot ulcer. Blood sugars have been
250-400 mg/dL since admission and her family continues to bring her food from fast food
restaurants. She is on a calorie and carbohydrate restricted diet which she eats in addition to
the food her family brings.
Room 104: A 36 year old male three days status post open spleenectomy following a motor
vehicle accident. He is anxious to get home and back to work for fear he will lose his job. He
is being discharged today. He is employed as a stone worker where he lifts heavy stones
every day.
Room 105: A 54 year old female three days status post abdominal hysterectomy with
subsequent dehiscence of wound 12 hours post op. The wound is being packed with normal
saline soaked Nugauze three times a day.
Room 106: A 67 year old male with Clostridium Difficile and Vancomycin Resistant
Enterococcus (VRE). He has been complaining of abdominal cramps and diarrhea all night.
The stools have subsided and he has just gone to sleep.
Room 107: A newly admitted 55 year old female with anemia and possible gastrointestinal
(GI) bleed that has not been assessed. She does not have an IV access. She will be receiving
2 units packed red blood cells (PRBC) ASAP.
Room 108: An 89 year old male with resolving pneumonia that is being discharged back to
the nursing home later this afternoon. He requires turning, feeding, and bathing.
Room 109: A 49 year old male with hypertension and resolved stroke for possible discharge
today.
Room 110: A 43 year old female with new onset Type II diabetes mellitus. She has met with
the diabetic educator and has been checking her own blood sugars and ordering her own
meals.
I tell my students that this is their group so there is not one exact answer, but they must
provide rationale to back up anything different than what I consider to be correct.
A) Which duties cannot be delegated, therefore, the RN must complete? Provide rationale.
The RN must do the admission assessment and initiate the plan of care on the client in Room
107. This client is potentially unstable due to the GI bleed and will need frequent
reassessment throughout the day. The client will be receiving blood so the RN must initiate
that as well. The LPN may cosign if the hospital’s policy allows, but the RN must be there
for the first 30 minutes to ensure no reaction occurs.
The RN must do the discharge teaching on Rooms 104, 108, and 109.
The RN must be available for therapeutic communication with the client in Room 101 who
probably needs changes to nursing diagnoses on her plan of care.
The RN must complete further teaching and documentation on the client in Room 103 who is
being noncompliant with her diet and still has blood sugars out of control. These blood
sugars are potentially impeding the wound healing.
B) Which clients or tasks should be delegated to the LPN? Provide rationale.
The RN may delegate to the LPN the PO, IM, and SQ medications – IV if the LPN is IV
certified.
The LPN may be delegated the dressing changes to the client in Room 105
The LPN may be delegated the general care of Rooms 102, 104, 105, 106, 108, 109, 110. The
discharge teaching still must be completed by the RN.
C) Which tasks should be delegated to the UAP? Provide rationale.
The vital signs on the stable clients may be delegated to the UAP.
The blood vital signs after the RN has initiated the blood may be delegated to the UAP.
The UAP may be assigned hygiene duties for each client, but the rest of the team will need to
assist after the prioritized duties are complete.
D) What is the RN’s responsibility before the end of the shift in reference to the delegated
activities? Provide rationale.
The RN should review documentation of tasks completed by UAP and LPN, gain report on
delegated duties from each and know the condition of each client before proceeding to give
report to the next shift.