A registered nurse (RN) is working with unlicensed assistive personnel (UAP) on a medical-surgical unit. Which task can the RN safely delegate to the UAP according to the five rights of delegation?
1Assisting a stable post-operative patient with ambulation who has been cleared by physical therapy✓ 정답
2Administering oral medications to a patient with diabetes mellitus
3Performing initial assessment of a newly admitted patient with chest pain
4Teaching a patient about insulin injection techniques before discharge
해설
Delegation to UAP must follow the five rights: right task, right person, right circumstances, right direction/communication, and right supervision. Assisting a stable post-operative patient with ambulation is routine and predictable, making it safe to delegate. Other options involve assessment, medication administration, or teaching, which are outside UAP scope.
Understanding the Five Rights of Delegation
The NCLEX-RN frequently tests your ability to make safe delegation decisions. The "five rights of delegation" provide a critical framework: the right task, right circumstance, right person, right direction/communication, and right supervision/evaluation. When applying these rights, the RN must consider whether the task falls within the scope of practice for unlicensed assistive personnel (UAP), the stability and predictability of the patient's condition, and the level of clinical judgment required. A task that is routine, has a predictable outcome, and does not require nursing assessment or clinical decision-making is generally safe for delegation to a UAP who has been trained and demonstrated competency in that skill .
Analysis of the Correct Answer: Option 1
Assisting a stable post-operative patient with ambulation who has already been cleared by physical therapy is the most appropriate task to delegate. This is a standard, repetitive activity of daily living that does not require ongoing clinical assessment by the RN during its execution. The key safety elements are already established: the patient is designated as "stable," and the physical therapy team has performed the initial evaluation and determined the patient is safe to ambulate. The UAP's role here is to provide physical support and observe for immediate, obvious signs of distress (such as dizziness or a sudden change in condition), which they should be trained to report back to the RN. This aligns directly with the scoping review findings that effective teamwork between RNs and UAPs is built on clear role boundaries where UAPs perform delegated, predictable care tasks under the supervision of the RN, who retains accountability for the overall patient outcome [1, 3].
Why the Other Options Are Incorrect
- Option 2: Administering oral medications to a patient with diabetes mellitus. Medication administration is a core nursing responsibility that requires the RN's professional knowledge to assess the patient's need for the medication, evaluate its therapeutic and adverse effects, and make clinical judgments (e.g., holding a medication based on vital signs or blood glucose levels). This task cannot be delegated to a UAP, as it involves the core nursing functions of assessment and evaluation, which are outside the UAP's scope of practice [2, 4].
- Option 3: Performing the initial assessment of a newly admitted patient with chest pain. An initial assessment is a complex, high-stakes activity that requires the clinical judgment of an RN to analyze data, formulate a nursing diagnosis, and prioritize a plan of care. A patient with a potentially unstable condition like chest pain requires immediate and expert evaluation that cannot be delegated. The RN must perform this task personally, as it is the foundation for all subsequent care decisions .
- Option 4: Teaching a patient about insulin injection techniques before discharge. Patient education is a complex process that involves assessing the learner's readiness, cognitive ability, and psychomotor skills, then tailoring the teaching plan and evaluating the patient's understanding and return demonstration. This entire process requires the clinical judgment and therapeutic communication skills of the RN and cannot be delegated to a UAP. The RN is accountable for ensuring the patient can safely perform this skill at home .
Clinical Application of Delegation Principles
The decision to delegate is not simply about offloading a task; it is a professional judgment that considers the stability of the patient, the complexity of the task, and the competency of the team member. Research on RN-UAP teamwork emphasizes that delegation functions best when roles are clearly negotiated and the RN provides appropriate supervision . A scoping review on nursing assistant administration further supports that clear, standardized delegation protocols and communication are essential for safe patient care and positive outcomes . In a crisis or high-acuity setting, such as the surge conditions described during the COVID-19 pandemic, the principles of team nursing and delegation become even more critical, requiring the RN to thoughtfully assign tasks based on patient acuity and the skill mix of the available team . The RN always retains accountability for the outcome of the delegated task, making the initial decision to delegate a critical point of safety.
Clinical Delegation Guide: Assigning Ambulation to a UAP
Task Verification
Confirm the patient's activity order in the medical record, specifically the level of assistance required and any weight-bearing restrictions.
Verify physical therapy (PT) clearance documentation, noting the date, time, and any specific precautions such as the use of a gait belt or assistive device.
Ensure the task is routine and the patient's condition is stable, with no recent changes in vital signs, level of consciousness, or complaints of pain or dizziness.
Right Direction and Communication
Provide the UAP with a clear, concise report including the patient's name, room number, activity goal (e.g., walk to the nurses' station and back), and specific precautions.
Instruct the UAP to use a gait belt and to walk on the patient's strong side, slightly behind, for optimal support.
Clearly state what to report immediately: any complaint of chest pain, shortness of breath, dizziness, a sudden change in gait, or if the patient appears pale or diaphoretic.
Document the delegation communication, including the task, patient-specific instructions, and the UAP's acknowledgment of understanding.
Right Supervision and Evaluation
Follow up with the UAP promptly after the task is completed to receive a report on the patient's tolerance, distance ambulated, and any observed changes in condition.
Conduct a brief focused assessment of the patient post-ambulation, checking vital signs, oxygen saturation, and subjective reports of fatigue or pain.
Document the outcome of the delegated task and any nursing assessment findings in the patient's chart.
Provide feedback to the UAP to reinforce correct technique and address any performance issues, ensuring continuous competency.
Five Rights of Delegation — A framework used by RNs to ensure safe delegation, consisting of the right task, right circumstance, right person, right direction/communication, and right supervision/evaluation.
Unlicensed Assistive Personnel (UAP) — Healthcare staff who are not licensed but are trained to perform specific, routine tasks under the supervision of a licensed nurse, such as activities of daily living.
Scope of Practice — The range of responsibilities, activities, and tasks that a healthcare professional is legally permitted and trained to perform.
Clinical Judgment — The cognitive process by which a nurse interprets patient data, identifies problems, and makes decisions about care, a skill exclusive to licensed professionals.