# Situation: The adult medical-surgical ward of a 150-bed provincial hospital has 28 clients on the day shift. The charge nurse works with three staff nurses and two nursing attendants. The nursing attendants are unlicensed workers trained through a health care services program and the hospital's orientation. The charge nurse reviews the morning tasks. Which task is appropriate to delegate to a nursing attendant?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630353  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: The adult medical-surgical ward of a 150-bed provincial hospital has 28 clients on the day shift. The charge nurse works with three staff nurses and two nursing attendants. The nursing attendants are unlicensed workers trained through a health care services program and the hospital's orientation.

The charge nurse reviews the morning tasks. Which task is appropriate to delegate to a nursing attendant?

## 보기

1. Help with breakfast for a client who coughed on water during this morning's swallow screen
2. Obtain the admission history of a client who arrived from the emergency room 10 minutes ago
3. Measure and record the urine output of a stable client 3 days after a knee replacement **✔ 정답**
4. Explain the discharge instructions to a client who is going home this afternoon

**정답: 3**

## 해설

Tasks delegated to unlicensed workers are routine, have a predictable outcome, and involve stable clients; measuring and recording intake and output of a stable client fits, and the nurse interprets the values. Feeding a client with aspiration risk, the admission assessment of a new client, and health teaching need professional judgment and stay with the registered nurse.

## 심화 해설

Delegation to Unlicensed Assistive Personnel

The charge nurse must match each task to the legal scope and clinical stability of the client. Delegation to a nursing attendant is appropriate only when the task is routine, has a predictable outcome, and involves a stable client. The nurse retains responsibility for assessment, interpretation, and clinical judgment.

Measuring and recording urine output for a client who is three days post–knee replacement and hemodynamically stable is a task with a predictable, objective result and does not require independent clinical decision-making at the point of collection. The nursing attendant can read the markings on the collection device and document the number; the registered nurse then reviews that value and interprets whether it is within the expected range for the client’s fluid balance and renal function.

The other options involve professional judgment that cannot be transferred to an unlicensed worker. A client who coughed on water during a swallow screen has demonstrated aspiration risk, so feeding requires ongoing clinical observation and rapid intervention if swallowing deteriorates. Obtaining an admission history is a comprehensive assessment that shapes the entire plan of care and must be performed by the registered nurse. Discharge teaching requires health education, evaluation of understanding, and adaptation to the client’s learning needs, all of which remain within the professional nursing role.

| Task | Delegable to nursing attendant? | Reason |
| --- | --- | --- |
| Measure and record urine output of a stable client | Yes | Routine, objective, predictable outcome; nurse interprets the value |
| Feed a client who coughed during swallow screen | No | Aspiration risk requires continuous nursing assessment and judgment |
| Obtain admission history from the emergency room | No | Initial assessment and data synthesis are professional nursing responsibilities |
| Explain discharge instructions | No | Health teaching and evaluation of learning are not delegable |

Key point! Delegation does not transfer accountability. The registered nurse who delegates a task remains responsible for ensuring the nursing attendant is competent, the task is performed correctly, and the resulting data are interpreted and acted upon.

Watch out! A stable client today can become unstable quickly. The nurse must reassess the client’s condition before delegating and must be available to receive and evaluate the reported output value.

The evidence supports this framework. Wagner notes that effective delegation between nurses and unlicensed assistive personnel improves outcomes such as falls and patient satisfaction, but the decision to delegate must be deliberate and grounded in clear communication about what is expected [1]. Wong and colleagues highlight that teamwork between registered nurses and unlicensed assistive personnel in acute care settings depends on role clarity and mutual understanding of scope boundaries [2]. Gonella and colleagues found that nurses perceive certain activities as delegable when they are repetitive, do not require interpretation, and involve clients whose condition is predictable [3]. Plawecki and Amrheim emphasize that unlicensed assistive personnel are a fixed part of the care team, which makes disciplined delegation decisions a professional obligation [4].

The safest delegation choice is the one where the task is mechanical, the client is stable, and the nurse still interprets the result. In this situation, measuring and recording urine output meets all three criteria, while feeding a client with aspiration risk, performing an admission assessment, and providing discharge teaching each require the clinical reasoning that defines registered nursing practice.References (research sources)

- [1]Improving Patient Care Outcomes Through Better Delegation-Communication Between Nurses and Assistive Personnel.Research articleWagner EA (2018) · DOI: 10.1097/NCQ.0000000000000282

- [2]Teamwork between registered nurses and unlicensed assistive personnel in acute care settings: A scoping review.Research articleWong KL, Chua WL, Griffiths P, Goh QLP, Low KWC, Tan JQA, Liaw SY. (2025) · DOI: 10.1016/j.ijnsa.2025.100293

- [3]Experiences of Activities Perceived as Delegable Among Nurses in Medical and Surgical Settings Can Help to Guide Health Care Policies: A Qualitative Phenomenological Study.Research articleGonella S, Conti A, Arlorio M, Cuoghi P, Dimonte V, Campagna S. (2025) · DOI: 10.1097/pts.0000000000001389

- [4]A question of delegation: unlicensed assistive personnel and the professional nurse.Research articlePlawecki LH, Amrheim DW (2010) · DOI: 10.3928/00989134-20100712-01

## 임상 시나리오

Delegation to Unlicensed Assistive PersonnelMatching tasks to scope and client stability
Delegate only tasks that are routine, have a predictable outcome, and involve a stable client. The nurse retains accountability for assessment and interpretation of results.

Measuring and recording urine output in a client 3 days post–knee replacement is appropriate because the result is objective and does not require independent clinical decision-making at the point of collection.

CautionNever delegate feeding with aspiration risk, admission assessment, or discharge teaching—these require professional nursing judgment and remain with the registered nurse.

## 핵심 개념

- **Delegation** — The transfer of responsibility for a specific task while retaining accountability for the outcome; must match the worker's scope and client stability.
- **Unlicensed Assistive Personnel** — Workers trained to perform routine, predictable tasks under nurse supervision; cannot perform assessments, teaching, or tasks requiring clinical judgment.
- **Scope of Practice** — The legal and professional boundaries of what a given healthcare worker is permitted to do based on education, training, and licensure.
- **Aspiration Risk** — Increased likelihood of food, fluid, or secretions entering the airway; requires skilled observation during oral intake.
- **Clinical Judgment** — The nurse's professional reasoning process used to interpret data, identify problems, and make decisions; cannot be delegated.

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