A charge nurse on a medical-surgical unit is making assignments for the day shift. The team includes one registered nurse (RN), one licensed practical nurse (LPN/LVN), and one unlicensed assistive personnel (UAP). Which client assignments are appropriate to delegate to the LPN? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
An LPN/LVN can care for stable clients with predictable outcomes and perform established tasks: administer scheduled medications, reinforce teaching initiated by the RN, provide established tube feedings, and perform clean dressing changes (Choices 2, 3, and 6). The RN retains the initial comprehensive assessment and care planning (Choice 1), initial complex teaching about end-of-life decisions (Choice 5), and initial verification and the first 15 minutes of a blood transfusion (Choice 4). Delegation must also follow state law and facility policy.
Clinical Judgment LPN can manage stable clients with predictable outcomes: routine PO meds, established dressing changes, scheduled tube feedings, routine VS, and reinforcement teaching.
RN-Only Tasks Initial assessment · care plan creation · initial complex teaching · blood transfusion start — these require RN clinical judgment and cannot be delegated.
Memory Tip "A · P · E · T": Assess (initial), Plan (care), Educate (initial), Transfuse (start) — keep with the RN.
Caution LPN can reinforce teaching but not initiate it. After the first 15 minutes of a transfusion, LPN may continue monitoring per most state Nurse Practice Acts.
ScenarioMedical-surgical day shift, 6 clients, team = 1 RN + 1 LPN + 1 UAP. Charge nurse must match acuity and complexity to scope of practice.
Team Roles- RN: complex/initial assessments, care plan, initial teaching, transfusion start, IV push meds, unstable clients- LPN: stable client routine care, PO meds, established dressings, scheduled tube feedings, reinforcement teaching- UAP: ADLs, hygiene, stable VS, ambulation, intake & output recording
Decision RuleDelegate to the lowest qualified team member who can safely perform the task within scope.
5 Rights of Delegation (NCSBN) — Right Task / Right Circumstance / Right Person / Right Direction & Communication / Right Supervision & Evaluation. All delegation decisions must satisfy these five criteria.
LPN/LVN scope of practice — LPN provides routine care for stable clients with predictable outcomes: PO/IM meds, established dressings, scheduled tube feedings, routine vital signs, reinforcement of teaching. LPN cannot perform initial assessments, develop care plans, or initiate blood transfusions.
RN-only tasks — Initial admission assessment, creation/revision of nursing care plan, initial complex teaching (advance directives, new diagnosis, discharge planning), blood transfusion verification and first 15-minute monitoring, IV push of high-alert medications.