A nurse manager is making assignments for the upcoming shift in a cardiac unit. Which assignment demonstrates an unsafe delegation practice that could result in patient harm?

The initial nursing assessment is a foundational step that establishes the patient's baseline, identifies problems, and drives the plan of care. It must never be delegated to a licensed practical nurse (LPN) or unlicensed assistive personnel (UAP).

• RN Responsibility: The registered nurse (RN) is solely responsible for performing the initial assessment. This involves analyzing data, formulating nursing diagnoses, and determining the appropriate interventions for patients with unstable or unpredictable conditions.
• LPN Role in Data Collection: An LPN can collect data, such as vital signs or pain levels, and report findings to the RN. However, the LPN cannot interpret this data to perform the initial, comprehensive clinical judgment required for a new or deteriorating patient.
• Focus on Stability: Tasks delegated to an LPN or UAP must be for patients with a stable, predictable status and an established plan of care. A patient with acute chest pain is, by definition, unstable.

Do not delegate any task that requires the specialized knowledge, skill, or judgment of an RN. This is especially critical in the following situations:

• The patient is hemodynamically unstable or exhibiting acute changes in status, such as new-onset chest pain, respiratory distress, or altered mental status.
• The task involves complex clinical reasoning, such as titrating intravenous medications or analyzing a cardiac rhythm strip for the first time.
• The patient's outcome is unpredictable, requiring continuous reassessment and modification of the care plan.