Case: A personal care assistant on a busy aged care ward offers to perform a blood glucose level measurement because the registered nurse is attending to another patient. Which consideration should the registered nurse prioritise before accepting this offer?

Question

BlackTom AI · Accepted Answer

Delegation and scope-of-practice principles require the registered nurse to evaluate policy, role boundaries, competence, and supervision before accepting the personal care assistant’s offer.

1) Relevant knowledge points and concepts
- Professional accountability: the registered nurse (RN) retains overall accountability for nursing care delegated to others.  
- Scope of practice and role boundaries: personal care assistants (PCAs) are often unregulated workers with variable permitted tasks defined by organisational policy and law.  
- Competence and assessment: delegation is only appropriate if the delegatee is competent, trained, and assessed for the specific task.  
- Supervision and monitoring: RNs must ensure appropriate supervision, provide advice, and be available to intervene.  
- Informed consent and documentation: patients should consent and the RN must document delegation and outcomes.

2) Step-by-step reasoning process
- Step 1: Check organisational policy and relevant regulatory guidance to see if PCAs may perform blood glucose monitoring in that setting.  
- Step 2: Verify the PCA’s documented training, demonstrated competence, and any competency assessment for blood glucose measurement.  
- Step 3: Assess the clinical complexity and risk for this patient (e.g., unstable diabetes, altered consciousness)—higher risk may preclude delegation.  
- Step 4: Ensure appropriate supervision arrangements: RN availability, review of results, and contingency plans for abnormal values.  
- Step 5: Obtain patient consent for the person performing the procedure and document delegation, competence evidence, supervision plan, consent, and results.

3) Intermediate steps and checks
- Review training records and competency checklist; confirm recent supervised practice.  
- Evaluate patient risk factors (medication changes, symptoms) that might make RN performance necessary.  
- Confirm RN can provide timely oversight and follow-up.

4) Why the correct answer is correct
This option incorporates all legal and professional obligations: it prioritises checking policy, role boundaries, competence, and supervision—factors that determine safe, lawful delegation and protect patient safety and RN accountability.

5) Why other options are incorrect
- Option A (consent alone) is insufficient because patient consent doesn’t override scope-of-practice, competence, or policy limits.  
- Option B (absolute prohibition) is incorrect because some jurisdictions and organisations allow PCAs to perform certain tasks if trained and supervised.  
- Option C (workload justification) is unsafe: workload pressure does not justify delegating clinical tasks without verifying competence and policy compliance.

6) Conclusion
Therefore, the RN should assess policy, role boundaries, competence verification, and supervision requirements before deciding—confirming the provided correct answer.

Case: A personal care assistant on a busy aged care ward offers to perform a blood glucose level measurement because the registered nurse is attending to another patient. Which consideration should the registered nurse prioritise before accepting this offer?单项选择题

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