| Course | NR 446 Collaborative Healthcare |
|---|---|
| Week | 4 |
| Paper type | Delegation scenario analysis |
| Length | About 1,330 words, 6 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | RN-to-BSN |
| Updated | October 2026 |
Free sample paper for NR 446 Week 4
Six Patients, One Licensed Practical Nurse and One Assistant: A Delegation Analysis of a Night Shift on a Medical-Surgical Unit
Student Name
College of Nursing, Chamberlain University
NR 446: Collaborative Healthcare
Instructor Name
Month Day, Year
Six Patients, One Licensed Practical Nurse and One Assistant: A Delegation Analysis of a Night Shift on a Medical-Surgical Unit
The Scenario, Restated as Facts
The assigned scenario places me as the registered nurse responsible for six patients on a medical-surgical unit from 1900 to 0700, working with one licensed practical nurse and one unlicensed assistive personnel. The licensed practical nurse has worked on the unit for four years and is signed off on the unit's competencies for oral and subcutaneous medications, dressing changes and enteral feedings; the unit does not permit licensed practical nurses to give intravenous push medications. The assistant has worked on the unit for eight months and is signed off on vital signs, blood glucose checks, intake and output, ambulation and hygiene. At 1930, after report, the patients are as follows.
Bed 1: a 58-year-old man two days after a laparoscopic colectomy, stable vital signs, pain controlled with oral medication, needs ambulation and a dressing check. Bed 2: an 81-year-old woman admitted today with pneumonia, oxygen at 3 liters, confused this evening when she was not confused this morning. Bed 3: a 45-year-old man with type 1 diabetes admitted for cellulitis, needing blood glucose checks before meals and at bedtime and a subcutaneous insulin dose. Bed 4: a 67-year-old woman going home in the morning after a hip replacement, needing discharge teaching on her new anticoagulant. Bed 5: a 72-year-old man with heart failure receiving intravenous furosemide, needing strict intake and output and a daily weight at 0500. Bed 6: a 34-year-old woman with a new tube feeding after a stroke, needing her feeding advanced overnight and a gastric tube site check.
The Standard I Decide Against
Each allocation below is measured against the five rights of delegation in the national guidelines issued jointly by the National Council of State Boards of Nursing and the American Nurses Association: the right task, under the right circumstances, to the right person, with the right directions and communication, and with the right supervision and evaluation (National Council of State Boards of Nursing & American Nurses Association, 2016). The same guidelines state that the registered nurse cannot delegate assessment, clinical judgment, patient teaching or evaluation, and that the nurse remains accountable for any task delegated. Every decision below answers four questions in the same order: to whom, on what demonstrated grounds, with what instruction and checked when.
What I Delegate, and Why
Bed 1, ambulation and vital signs, to the assistant. The patient is stable, the task is routine, and the assistant is signed off on ambulation. Instruction: walk him in the hallway at 2000 and again at 0600 with a gait belt, stop if he reports dizziness, and tell me his heart rate and any pain above 5 out of 10 after each walk. I will look at his dressing myself at 2100, because deciding whether a wound looks right is assessment.
Bed 3, blood glucose check at bedtime, to the assistant; insulin to the licensed practical nurse. Both are signed off, and the patient is stable. Instruction to the assistant: check glucose at 2100 and tell me the number directly, not only in the chart, if it is below 70 or above 250. Instruction to the licensed practical nurse: give the bedtime insulin per the sliding scale once the assistant reports the glucose, and tell me the dose given. I check the chart at 2130 to confirm both.
Bed 5, intake and output and the 0500 weight, to the assistant. These are measurements within the assistant's competency. Instruction: record every void in the urinal, empty and measure at 2400 and 0400, and weigh him at 0500 on the standing scale in the same gown, before breakfast. Tell me at once if urine output is under 30 milliliters in any hour after the furosemide dose or if the weight is more than 1 kilogram different from yesterday. I will give the intravenous furosemide myself.
Bed 6, tube feeding advance and site care, to the licensed practical nurse. She is signed off on enteral feedings, the patient's neurological status has been stable for two days, and advancing on a written protocol is a task with a predictable outcome. Instruction: advance by 10 milliliters an hour every four hours per the order, check residual per protocol before each advance, and stop and call me if residual exceeds the protocol limit, if the patient coughs during feeding, or if the site is red or leaking. I assess her swallowing and lung sounds myself at 2000 and 0400.
What Never Leaves Me
Three kinds of work stay with me, and so do two patients in full. Bed 2 stays with me entirely, including her vital signs, because new confusion in an older woman with pneumonia is a change in condition until proven otherwise. It may be delirium, which often announces an underlying illness in older inpatients before other signs do (Marcantonio, 2017), or hypoxia or sepsis, and each vital sign is part of an assessment I need to interpret in real time rather than receive as a number. The assistant may help me reposition her, but the checks are mine. Bed 4's discharge teaching stays with me because teaching on a new anticoagulant is patient education, which the national guidelines reserve to the registered nurse, and because I need to evaluate whether she understood it, not just whether she heard it.
The pattern behind these choices is that I keep anything whose outcome is unpredictable or that requires judgment about what a finding means. Measuring a blood pressure can be delegated; deciding whether a blood pressure means a patient is getting worse cannot. That is why the intravenous furosemide stays with me as well: the drug is within my scope, and its effect on a patient with heart failure needs someone to interpret the output and the weight together.
Supervision With Times Attached
Supervision is planned rather than promised. At 2000 I round with the assistant and the licensed practical nurse together for five minutes to confirm the plan for each patient and the thresholds that would bring them to me. At 2130 I review the glucose, insulin and ambulation documentation. At 2400 and 0400 I check intake and output totals for Bed 5 and the feeding rate and residuals for Bed 6. At 0530 I review the morning weight before the day team arrives. Between those times, the thresholds I gave with each instruction are the triggers for either of my colleagues to find me at once. I would take a task back if the patient's condition changed, for example if Bed 6 began coughing during feeds, or if a threshold was crossed and not reported to me.
Where Accountability Stayed
If a delegated task goes wrong tonight, I answer for three things: whether it was the right task to delegate, whether I gave the delegate the information needed to do it safely, and whether I supervised it as planned. The assistant and the licensed practical nurse answer for doing the task correctly and for reporting what I asked them to report. If Bed 5's output falls below the threshold at 0200 and nobody tells me until 0500, the missed report is the assistant's, but the decision to rely on that report without an intermediate check is mine, which is why I scheduled one at 2400 and 0400. Delegation moved the tasks to my colleagues. It did not move my responsibility for the patients, and every decision above was written so that I could defend it if one of them went wrong. The Code of Ethics for Nurses places this obligation plainly: the nurse keeps accountability for decisions to delegate and for the care that results from them (American Nurses Association, 2015).
References
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements.
Marcantonio, E. R. (2017). Delirium in hospitalized older adults. New England Journal of Medicine, 377(15), 1456-1466. https://doi.org/10.1056/NEJMcp1605501
National Council of State Boards of Nursing & American Nurses Association. (2016). National guidelines for nursing delegation. Journal of Nursing Regulation, 7(1), 5-14. https://doi.org/10.1016/S2155-8256(16)31035-3
Reading the NR 446 Week 4 instructions
The Week 4 analysis has you work through a delegation scenario and justify each decision. Course materials usually specify the scenario facts, the standard you apply, the tasks delegated with rationale, the tasks retained, supervision and accountability, in APA. Restate the scenario as facts you will need, including what each delegate has demonstrated and how stable each patient is. Name the standard you decide against, such as the five rights. Give every handover the same reasons: the task, the delegate's competence, the patient's stability, an instruction with thresholds and when you will check. Keep assessment, teaching and evaluation, and any patient whose condition is changing. Put times on supervision. Say what you answer for.
How this NR 446 Week 4 example is built
The scenario section lists the shift, the staff and their competencies and each of six beds, from a stable colectomy patient to a woman with pneumonia and new confusion. The standard section introduces the national guidelines. Delegated tasks follow: ambulation and vital signs for Bed 1 to the assistant with thresholds, a bedtime glucose check to the assistant and insulin to the licensed practical nurse for Bed 3, intake, output and the 0500 weight for Bed 5, and tube feeding care for Bed 6 to the licensed practical nurse. The retained section keeps Bed 2 entirely, along with assessment, teaching and evaluation. Supervision starts with a 2000 round with both delegates. The accountability section lists three things the nurse answers for.
Where the points sit in the NR 446 Week 4 rubric
Delegation analysis rubrics generally reward accurate facts, application of a recognized standard, appropriate delegation decisions with rationale, clear instructions, retained responsibilities, planned supervision, accountability and APA. Each decision's rationale carries the largest share of points, so the paper gives every handover the same five-part reason. The standard is credited because the five rights frame every choice. Instructions score when they include thresholds and times. Retained work earns points because the changing patient stays with the registered nurse and the reason is stated. Supervision with set times meets the next row. Accountability is credited for separating what the nurse answers for from what delegates answer for. Marcantonio and the Code of Ethics support the paper.
NR 446 Week 4 help from the desk
The costliest error on this analysis is delegating by workload, handing tasks to whoever is free with no sentence about what that person has demonstrated. Another is keeping everything, which shows the nurse cannot delegate at all. Students also give instructions without thresholds, promise to supervise without times or delegate assessment of a changing patient. State scope rules vary, so name the assumption you are using. If your scenario has an LPN rather than an aide, the same reasoning applies with different competencies. Some sections assign a conflict resolution paper this week instead, so check your syllabus. Send your scenario and an NR 446 delegation analysis can give each task its reasons.
Get a NR 446 Week 4 example written to your instructions
Send the delegation scenario exactly as your classroom worded it, along with the rubric and any scope of practice source you are told to use. A custom example is written to those instructions and returns inside 24 to 48 hours. The first one is free, and the reasoning arrives in a shape you can defend in class.
More NR 446 papers and RN-to-BSN samples
- NR 446 Week 1: Interprofessional Team Stall Post
- NR 446 Week 2: Communication Style Self-Assessment
- NR 446 Week 3: Sample Paper, in Real Form
- NR 446 Week 5: Interprofessional Team Analysis
- NR 446 Week 6: Leadership Style Analysis
- NR 446 Week 7: Change Project Proposal
- NR 446 Week 8: Reflection
- NR 447 Week 4: Delegation Write-up
- NR 442 Week 4: Infant Mortality Disparity Analysis
- NR 449 Week 4: Stakeholder Analysis
- NR 441 Week 4: Neonatal Mortality System Comparison
NR 446 Week 4 questions, answered
Will the example use my state's scope of practice rules?
Send the language your classroom supplies and we decide against that. Scope differs by state and by facility policy, and a paper arguing from the wrong source is easy to mark down. Where your prompt gives no source, the example works from widely published national delegation standards and names them, so you can substitute your own without touching the reasoning.
My scenario has an LPN rather than an aide. Does that change the sample?
Yes, and it should. The tasks a practical nurse may accept differ from those a nursing assistant may accept, and the paper's reasoning changes with them, particularly around medication administration and reinforcing teaching already given. Send the scenario as written and the example allocates against the staff it actually names, with reasons drawn from that difference.
Some sections run a conflict resolution paper this week instead.
That happens, and prompts move between weeks from term to term. The genre published for this page is the delegation scenario analysis, so that is what the example holds. If your classroom assigns conflict work at this point, send the prompt and we write to it, treating the disagreement as two defensible priorities meeting rather than as one person behaving badly.
Where can I find a free NR 446 Week 4 sample paper?
This page shows the complete Week 4 delegation analysis, the scenario facts, the five rights, each delegated task with its instruction, the retained patient, timed supervision, accountability and three references.
Why does Bed 2 stay with the registered nurse in the NR 446 Week 4 analysis?
Because new confusion in an 81-year-old woman with pneumonia is a change in condition that needs ongoing assessment and judgment, which cannot be delegated, so the nurse keeps all of her care, including vital signs.