Six Clients, One Float LPN: Prioritizing and Delegating on Night Shift
You are the LPN in charge of a 24-bed medical-surgical unit on the 2300-0700 shift. Staffing is one UAP, one float LPN who has never worked this unit, and you. You have six clients:
- Mr. A, 2 days after an open colectomy: BP 96/58, HR 112, urine 15 mL/hr for the past 2 hours, abdomen firm and distended.
- Ms. B, being discharged at 0800; needs her first dressing change and wound-care teaching.
- Mr. C, on fall precautions after a syncopal episode; wants to walk to the bathroom now.
- Ms. D, admitted yesterday with cellulitis; IV antibiotics due at 2400.
- Mr. E, requesting PRN oxycodone for pain 6/10.
- Ms. F, newly admitted 20 minutes ago with dehydration; new orders just received.
1. Which client do you see first, and which assessment findings would make you escalate immediately?
Read the worked answer
See Mr. A first.
Reasoning: he is the only client with signs of an evolving complication rather than a stable, predictable need.
- Tachycardia (112) with a narrowed pressure (96/58) and MAP near 70 = early compensated shock until proven otherwise.
- Urine output 15 mL/hr x 2 hours = oliguria (<0.5 mL/kg/hr), a concrete marker that perfusion is inadequate, not just a vital-sign blip.
- Firm, distended abdomen on POD 2 = think hemorrhage, anastomotic leak, or ileus, not "gas pain."
Actions: stay with him, repeat full vitals, check the incision and drain output/character, palpate the abdomen gently, check the last hemoglobin, keep the IV patent, and notify the provider/rapid response. Ms. F (new admission) is second priority for a head-to-toe and initial assessment - new does not equal unstable, but she must not be handed off unassessed.
2. Which tasks will you delegate to the UAP, and which will you keep? Give your rationale for each.
Read the worked answer
Delegate to the UAP (stable, standardized, no clinical judgment):
- Vital signs and SpO2 on stable clients (Ms. D, Mr. E), reporting values outside parameters you specify.
- Intake and output records, weights, and reminding Mr. E to call before getting up.
- Answering call lights and assisting with hygiene for stable clients.
Keep for yourself or the LPN (requires assessment, teaching, or nursing judgment):
- The initial assessment of Ms. F - an admission assessment cannot be delegated.
- Ms. B's first dressing change and wound-care teaching - teaching and evaluating a new wound are nursing functions.
- Any decision to ambulate Mr. C: the nurse assesses orthostatic vitals and stability first; the UAP may then walk him if you have cleared him.
- Mr. A's focused reassessment.
Key principle: delegation is based on the task, not the client - the same UAP can take a blood pressure on a stable client but cannot decide what an abnormal one means.
3. How will you assign and support the float LPN, who has never worked this unit?
Read the worked answer
Give the float LPN the most predictable, least fluid assignments - Ms. D (scheduled IV antibiotic) and Mr. E (PRN analgesic) - and hold Mr. A and Ms. F yourself until the float has been oriented.
Reasoning:
- Match acuity to competence. Unfamiliarity with the unit (supply locations, IV pump, pyxis, call system) is a patient-safety variable even when the LPN's skills are solid.
- Verify scope and skills for anything non-routine (e.g., IV push policy, blood administration) before assigning it.
- Give explicit parameters: "Call me for a temp over 38.3 C, HR over 110, or SBP under 90."
- Be reachable and check in at least once early in the shift; supervise, do not simply hand off.
- Do not assign her the discharge teaching for Ms. B unless you can verify the teaching was completed and document it yourself.
The charge nurse remains accountable for the whole unit, so the assignment must include a plan for how you will oversee unfamiliar work.