Management of Care
What this domain tests
Management of care tests delegation, prioritization, advocacy, and coordination. You must decide what a nurse can delegate, to whom, and in what order care should be delivered.
Concepts to master
- The five rights of delegation: right task, circumstance, person, direction/communication, and supervision. The nurse retains accountability.
- Scope of practice: unlicensed assistive personnel (UAP) can perform tasks like vital signs and hygiene for stable clients; they cannot assess, teach, or evaluate. LPN/LVNs have a defined scope that varies but generally excludes complex assessment and care planning.
- Prioritization frameworks: ABCs (airway, breathing, circulation), Maslow, and the stable versus unstable rule. Acute and unstable problems outrank chronic and stable ones.
- Advocacy and client rights: informed consent, privacy, and speaking up for the client.
- Coordination: handoff communication (SBAR), interdisciplinary collaboration, and discharge planning.
- Ethical principles: autonomy, beneficence, nonmaleficence, justice, and confidentiality.
Traps
Never delegate assessment, teaching, or evaluation. Do not delegate to a UAP a client who is unstable or whose condition is changing. When ranking clients, do not be distracted by a dramatic but stable situation - find the client whose airway, breathing, or circulation is threatened. Do not assume a provider's order removes the nurse's responsibility to question an unsafe order.
Rule of thumb
For prioritization, ask: Who will deteriorate first? For delegation, ask: Does this task require nursing judgment? If yes, it stays with the nurse.
Worked example: A nurse has four clients: one with new shortness of breath, one requesting a bath, one with stable chronic pain, and one awaiting discharge teaching. The nurse sees the client with new shortness of breath first, delegates the bath to the UAP, and performs the discharge teaching personally because teaching requires nursing judgment.