A charge nurse is making delegation assignments for the evening shift. Which assignment demonstrates the most appropriate delegation based on safety priorities?
1Assigning an LPN to administer oral medications to a stable diabetic patient and monitor vital signs✓ 정답
2Delegating an LPN to perform initial admission assessments for two new patients being admitted from the emergency department
3Assigning an LPN to titrate insulin drips for a patient in diabetic ketoacidosis and monitor a patient with unstable vital signs
4Delegating an LPN to discharge a patient with new tracheostomy care instructions and teach family members about home care
해설
Assigning an LPN to administer oral medications and monitor vital signs for a stable diabetic patient is appropriate delegation because these tasks are within LPN scope of practice for predictable, routine care. Other options involve tasks requiring RN-level assessment, critical thinking, or patient education, which are unsafe for LPN delegation.
The charge nurse must match the task to the appropriate nursing team member based on legal scope of practice, institutional policies, and patient acuity. The research by Corazzini et al. highlights that effective delegation is not simply about "following the job description" but requires a deeper "consider the scope of practice" approach, where the RN evaluates the complexity and stability of the patient condition before assigning a task [1].
Correct Answer Rationale
Option 1 is the most appropriate delegation. Administering oral medications to a stable patient and monitoring vital signs falls squarely within the LPN/LVN scope of practice. These tasks are standardized, predictable, and involve a patient whose condition is not fluctuating. This aligns with the "consider the scope of practice" approach, where the RN leader assesses that the task complexity and patient stability are a safe match for the LPN's educational preparation and legal boundaries [1].
Analysis of Incorrect Options
Option 2: Initial Admission Assessment
Performing an initial admission assessment is a complex, non-delegable duty that requires the clinical judgment and comprehensive knowledge base of an RN. An LPN can collect data, but the initial analysis, synthesis of findings, and formulation of a nursing diagnosis are legally and professionally the RN's responsibility. Delegating this to an LPN violates the core principle of matching the task to the appropriate scope of practice, a key barrier to effective delegation identified in long-term care settings [1].
Option 3: Titrating IV Insulin Drips and Unstable Patients
This assignment is profoundly unsafe. Titrating a continuous IV insulin drip requires moment-to-moment critical assessment and adjustment based on frequent blood glucose monitoring, a task far beyond the LPN scope. Furthermore, caring for a patient with diabetic ketoacidosis and another with unstable vital signs demands the high-level assessment and intervention skills of an RN. This represents a failure in the delegation process where the RN leader did not accurately perceive the high acuity and instability, a critical component of the "consider the scope of practice" approach [1].
Option 4: Discharge Teaching for New Tracheostomy
Discharge planning and teaching, especially for a complex, new skill like tracheostomy care, is a core RN function. This process involves initial learning assessment, complex psychomotor skill instruction, and evaluation of the learner's understanding and ability. An LPN can reinforce teaching that has already been initiated and structured by an RN, but they cannot perform the initial, comprehensive teaching. This assignment fails to consider the complexity of the task relative to the LPN's scope of practice [1].
References (research sources)
[1]
Delegation in Long-term Care: Scope of practice or job description?Research articleCorazzini KN, Anderson RA, Rapp CG, Mueller C, McConnell ES, Lekan D. (2010) · DOI: 10.3912/ojin.vol15no02man04
Clinical Delegation Guide: Matching Tasks to LPN Scope
The charge nurse's primary safety responsibility is ensuring the right task is assigned to the right team member. The following guide clarifies appropriate delegation to an LPN/LVN based on patient stability and task complexity.
Appropriate LPN Assignments
Administering oral, subcutaneous, and intramuscular medications (excluding IV push) for stable patients.
Monitoring vital signs and reporting changes for patients with predictable outcomes.
Performing sterile and non-sterile dressing changes on chronic, stable wounds.
Collecting data such as intake and output or fingerstick blood glucose.
Developing or initiating the initial teaching plan for complex home care (e.g., new tracheostomy).
Providing care for a patient with an acutely unstable or rapidly changing condition.
Administering IV push medications or blood products.
Delegation — The transfer of responsibility for the performance of a task from one individual to another while retaining accountability for the outcome.
LPN/LVN Scope of Practice — Focuses on providing basic nursing care under the direction of an RN or physician, typically for stable patients with predictable outcomes.
Initial Admission Assessment — A comprehensive evaluation performed by an RN to collect and analyze patient data, formulate nursing diagnoses, and establish a care plan.