Safe and Effective Care Environment: Coordinated Care
The Coordinated Care domain tests how the PN organizes client care, communicates within the interprofessional team, delegates legally, and protects continuity and client rights.
Scope and delegation
- The PN collects focused data, contributes to the care plan, reinforces teaching, and implements interventions. The RN performs the initial comprehensive assessment, establishes nursing diagnoses, and evaluates outcomes.
- Delegate only after checking the five rights: right task, circumstance, person, direction/communication, and supervision/evaluation. UAP may take vital signs on stable clients and assist with ADLs, ambulation, intake/output, and routine specimens. They may not teach, assess, evaluate, or perform invasive nursing procedures.
- Use SBAR for handoffs: situation, background, assessment, recommendation. Include allergies, code status, isolation, fall risk, and pending results.
Worked example
A PN delegates morning vital signs to a UAP for four stable clients. The UAP reports that one client is newly confused and has a BP of 168/94. The PN reassesses the client, checks glucose and oxygen saturation per protocol, notifies the RN or provider, and documents the findings and actions. Reasoning: vital signs on stable clients can be delegated, but interpreting a change and deciding what to do next require nursing judgment. New confusion is not a routine finding and must be escalated.
Traps
Assuming the PN can complete the admission assessment alone; delegating care of an unstable client; accepting a verbal order without a read-back; charting 'anxious' without observed data; placing an incident report in the progress notes; promising a referral will be done without following up.