# Situation: A nurse is the charge nurse of a 20-bed pediatric ward staffed by registered nurses, nursing attendants, and nursing students on clinical duty. The charge nurse is assigning tasks at 0900. Which task should she delegate to a trained nursing attendant?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629661  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A nurse is the charge nurse of a 20-bed pediatric ward staffed by registered nurses, nursing attendants, and nursing students on clinical duty.

The charge nurse is assigning tasks at 0900. Which task should she delegate to a trained nursing attendant?

## 보기

1. Taking the vital signs of a 7-year-old whose blood pressure fell from 100/64 to 86/50 mmHg
2. Bathing a 9-year-old on day 3 after an uncomplicated appendectomy who walks unaided **✔ 정답**
3. Walking a 12-year-old to the bathroom for the first time after spinal surgery yesterday
4. Feeding a 4-year-old with cerebral palsy who coughed and gurgled during lunch yesterday

**정답: 2**

## 해설

Nurses delegate routine tasks with predictable outcomes for stable clients, and the same task can be safe for one child and unsafe for another. Feeding a child with signs of aspiration, measuring vital signs of a child whose pressure is falling, and first ambulation after major surgery all involve unstable or unpredictable situations. Bathing a stable child on day 3 after an uncomplicated appendectomy fits the attendant's role.

## 심화 해설

Delegation framework: stability and predictability

Delegation to a trained nursing attendant is appropriate when the client is hemodynamically stable, the task is routine, and the outcome is predictable. The charge nurse must evaluate each child individually because the same task can be safe for one child and unsafe for another depending on the clinical trajectory.

The decision to delegate is not about the task name but about the stability of the client and the predictability of the response. A bath for a child who is recovering well after an uncomplicated appendectomy is a low-risk, routine activity. In contrast, measuring vital signs for a child with a falling blood pressure, assisting first ambulation after spinal surgery, and feeding a child with suspected aspiration all carry a high risk of sudden deterioration or injury.

| Client situation | Why not delegate to an attendant | Nursing implication |
| --- | --- | --- |
| 7-year-old with BP falling from 100/64 to 86/50 mmHg | Unstable; requires ongoing assessment and possible intervention | Registered nurse must monitor trends and notify the provider |
| 9-year-old, day 3 post-appendectomy, walks unaided | Stable; routine hygiene care with predictable outcome | Safe to delegate to a trained nursing attendant |
| 12-year-old, first ambulation after spinal surgery | High risk for orthostatic intolerance, pain, or neurologic change | Registered nurse must assess and supervise the first mobilization |
| 4-year-old with cerebral palsy who coughed and gurgled during lunch | Signs of possible aspiration; swallowing safety is uncertain | Registered nurse or speech therapy evaluation before feeding is resumed |

Watch out! A task that is delegable in one child may be unsafe in another. The charge nurse must assess each child’s current status, not rely on the task label alone.

Key point! Delegation to a nursing attendant is appropriate only when the client is stable, the task is routine, and the outcome is predictable. Any sign of hemodynamic instability, new mobility restriction, or swallowing difficulty requires registered nurse involvement.

Time-use studies in acute care settings show that registered nurses spend substantial time on indirect care and documentation, which can contribute to missed direct care when staffing is constrained . Effective delegation of routine, low-risk tasks to trained attendants helps preserve registered nurse time for assessment, monitoring, and care of unstable or high-risk clients. However, this delegation must be selective: the charge nurse’s role is to match the complexity and stability of the client with the appropriate level of caregiver. When a child shows a falling blood pressure, first-time mobility after major surgery, or signs of aspiration during feeding, the registered nurse retains responsibility because these situations require clinical judgment and rapid intervention that are outside the attendant’s scope.

## 임상 시나리오

Pediatric Delegation GuideStable client, routine task, predictable outcome
Delegate to a trained nursing attendant only when the child is hemodynamically stable, the task is routine, and the response is predictable. Bathing a child on day 3 after an uncomplicated appendectomy who walks unaided fits this role.

Do not delegate when the same task involves an unstable child. Vital signs with a BP drop from 100/64 to 86/50 mmHg, first ambulation after spinal surgery, and feeding a child with coughing or gurgling all require registered nurse assessment and supervision.

CautionEvaluate each child individually. The task name is less important than the child's clinical trajectory and the predictability of the response.

## 핵심 개념

- **delegation** — transferring responsibility for a task while retaining accountability, appropriate only for stable clients with routine, predictable outcomes
- **nursing attendant** — unlicensed assistive personnel trained to perform routine, low-risk care such as bathing stable clients
- **stability** — hemodynamic and clinical steadiness indicating low risk of sudden deterioration
- **predictable outcome** — expected response to a task with minimal chance of unexpected complications

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