A charge nurse is reviewing delegation assignments made by a new graduate nurse. Which delegation assignment requires immediate intervention by the charge nurse?
1Delegating vital sign assessment of stable postoperative patients to an experienced unlicensed assistive personnel (UAP)
2Assigning medication administration to a licensed practical nurse (LPN) for patients with stable chronic conditions
3Delegating initial assessment of a newly admitted patient with chest pain to an experienced unlicensed assistive personnel (UAP)✓ 정답
4Assigning wound dressing changes for chronic wounds to an LPN with appropriate training
해설
Initial assessment of a patient with chest pain requires RN-level judgment and is outside UAP scope, requiring immediate charge nurse intervention. Other delegations (vital signs, medication, wound care) are appropriate for the assigned personnel.
Analysis of the Delegation Error
The assignment that requires immediate intervention is delegating the initial assessment of a newly admitted patient with chest pain to an unlicensed assistive personnel (UAP). This represents a critical violation of the nursing scope of practice and delegation principles. The initial patient assessment is a complex task that requires the clinical judgment and critical thinking of a registered nurse (RN). It is a core function of the nursing process that cannot be delegated to a UAP, whose role is limited to tasks involving stable, predictable conditions with no need for clinical reasoning .
Why This is Unsafe and a Legal Violation
A patient presenting with chest pain is inherently unstable. The symptom could indicate a life-threatening condition such as an acute myocardial infarction. The initial assessment involves more than just taking vital signs; it requires the RN to perform a focused history, interpret the character and radiation of pain, evaluate for associated symptoms, and make rapid, high-stakes clinical decisions. Delegating this to a UAP is a failure to adhere to the fundamental principle that the assessment, evaluation, and judgment components of the nursing process cannot be delegated. The scoping review by Chaney et al. underscores that a lack of targeted education on such delegation principles is a key challenge for nursing students and newly graduated nurses, who may not yet fully grasp the legal and safety boundaries of task assignment .
Analysis of Incorrect Options
Option 1: Delegating vital sign assessment of stable postoperative patients to an experienced UAP
This is an appropriate delegation. Taking vital signs is a routine, standardized task. For a patient who is documented as stable and post-operative, the task does not require ongoing clinical judgment during its performance. The RN remains responsible for analyzing the data the UAP collects, but the task of collection itself is within a UAP's scope of practice. This aligns with the principle that tasks for stable patients with predictable outcomes can be delegated .
Option 2: Assigning medication administration to an LPN for patients with stable chronic conditions
This is an appropriate assignment within the scope of a licensed practical nurse (LPN). Administering medications, including oral, topical, and certain injectable routes, is a standard function of an LPN, provided the patient's condition is stable and the medication regimen is not complex or high-risk. The key qualifier here is stable chronic conditions, which indicates a predictable clinical course, making this a safe and legally sound assignment .
Option 4: Assigning wound dressing changes for chronic wounds to an LPN with appropriate training
This is an appropriate assignment. Performing a sterile wound dressing change is a psychomotor task that falls well within the LPN's educational preparation and scope of practice. The specification of chronic wounds implies a non-emergent, predictable situation, and the note of appropriate training confirms the LPN has the verified competency to perform the task safely. This reflects the delegation principle of assigning the right task to the right person under the right circumstances .
Key Delegation Principle for the NCLEX-RN
The core concept tested here is the five rights of delegation, with a specific focus on the "right task" and "right person." The RN must always analyze whether a task requires nursing judgment. Any activity that involves the initial assessment, evaluation of a patient's condition, or creation of a plan of care is the exclusive domain of the RN and must never be delegated to a UAP or an LPN. For a newly graduated nurse, distinguishing between a routine data-gathering task (like vital signs on a stable patient) and a comprehensive clinical assessment (like the initial workup for chest pain) is a critical skill that requires deliberate educational reinforcement to prevent patient harm .
Clinical Delegation Decision-Making for Chest Pain
The following framework guides the registered nurse in safe delegation practices, specifically addressing the critical error of assigning an initial assessment for a patient with chest pain to unlicensed assistive personnel.
Non-Delegable: Initial Assessment
The initial assessment of a newly admitted patient with chest pain is a core registered nurse (RN) function and must never be delegated. The patient's condition is inherently unstable, and the task requires complex clinical judgment to differentiate life-threatening etiologies like acute coronary syndrome from less critical causes.
RN Responsibility: Perform a focused history, characterize pain (quality, radiation, timing), interpret vital signs in context, and initiate immediate interventions (e.g., ECG, oxygen, medication orders).
Rationale: The assessment, evaluation, and judgment components of the nursing process are legally and ethically non-delegable. A UAP lacks the education and licensure to make clinical decisions based on assessment data.
Delegable Tasks for Stable Patients
Tasks that are routine, standardized, and performed on patients with predictable outcomes can be delegated to appropriately trained UAPs or assigned to LPNs, provided the RN retains accountability for supervision and outcome evaluation.
UAP Example: Vital sign measurement for a stable postoperative patient. The task is repetitive, the patient's condition is predictable, and the UAP can report findings without interpreting them.
LPN Example: Administration of routine oral medications to a patient with stable, chronic hypertension. This falls within the LPN scope of practice under RN supervision.
Immediate Charge Nurse Intervention
The charge nurse must immediately intervene, reassign the task to an RN, and use the event as a teaching moment to reinforce the Five Rights of Delegation (Right Task, Right Circumstance, Right Person, Right Direction/Communication, Right Supervision/Evaluation). The new graduate nurse must understand that a patient with an acute, undifferentiated symptom like chest pain is never in the "right circumstance" for UAP delegation.
Delegation — The process by which a registered nurse transfers the authority to perform a specific nursing task to a competent individual while retaining accountability for the outcome.
Unlicensed Assistive Personnel (UAP) — Individuals trained to function in an assistive role to nurses in the provision of patient care activities as delegated by and under the supervision of the registered nurse; their role is limited to tasks without a need for clinical judgment.
Initial Assessment — The comprehensive first evaluation of a patient upon admission or change in status, requiring clinical judgment and critical thinking to establish a baseline and identify problems; this is a core RN function that cannot be delegated.
Nursing Process — A systematic, problem-solving framework used by registered nurses comprising assessment, diagnosis, planning, implementation, and evaluation; the assessment and evaluation steps are non-delegable.
Scope of Practice — The range of roles, functions, responsibilities, and activities which a registered nurse is educated, competent, and has the authority to perform, as defined by state nurse practice acts.