A nurse educator is teaching a group of new graduate nurses about delegation principles in a long-term care facility. The educator presents a scenario involving four residents: one with advanced dementia requiring behavioral monitoring, one with stable hypertension needing daily blood pressure checks, one with a recent stroke requiring mobility assistance, and one with a feeding tube requiring care. Which assignment by a charge nurse demonstrates the most appropriate delegation based on scope of practice and resident safety?
1Assign a patient requiring frequent neurological assessments post-craniotomy to a licensed practical nurse (LPN).
2Assign a stable patient with diabetes requiring routine blood glucose monitoring and insulin administration to a licensed practical nurse (LPN).✓ 정답
3Assign a patient with a new tracheostomy requiring suctioning and teaching to an unlicensed assistive personnel (UAP).
4Assign a patient with multiple IV drips requiring titration based on hemodynamic parameters to an unlicensed assistive personnel (UAP).
해설
Proper delegation matches patient needs to scope of practice. Option 2 assigns a stable diabetic patient to an LPN for routine care, which is appropriate. Other options assign complex tasks like neurological assessments or tracheostomy suctioning to LPN or UAP, which exceed their scope and risk patient safety.
Clinical Judgment
This question assesses the core principles of delegation. The key is matching patient acuity and care complexity with the staff member's scope of practice. Correct delegation means assigning the "right task to the right person, in the right situation." In option 2, the 'stable diabetic patient' requires predictable care, which perfectly aligns with the typical scope of practice where an LPN/LVN can perform blood glucose monitoring and insulin administration under RN supervision. The other options depict risky situations where patients with complex or unstable conditions, new procedures, or requiring advanced skills are assigned to personnel with a limited scope of practice (UAP).
Memory Tip:
Remember the keywords for delegation judgment: Stable patients can be delegated to an LPN/LVN, while Unstable conditions, New procedures/statuses, Assessment, Teaching, and IV titration are the RN's responsibility. You can organize this with the acronym SUN ATI.
KR vs US:
In Korea, the role and legal scope of a 'Nursing Assistant' are similar to, yet different from, the UAP (Unlicensed Assistive Personnel) in the US. For the NGN, you must base your judgment on the clear scope-of-practice distinctions between RNs, LPNs/LVNs, and UAPs according to US standards. This is a key area where directly applying Korean experience can lead to errors.
Clinical Practice GuideConsiderations for delegation:1. RN-only tasks: Initial/comprehensive assessment, nursing diagnosis, care plan development, patient/family education, titration of IV medications, management of unstable or unpredictable patient conditions.2. LPN/LVN tasks: Routine care of stable patients under the plan established by the RN, vital sign checks, administration of oral/subcutaneous/intramuscular medications (excluding certain IV medications), basic dressing changes.3. UAP tasks: Non-nursing, routine tasks (vital sign measurement, assistance with personal hygiene/grooming, feeding assistance, mobility assistance, data collection).
Caution:In SATA (Select All That Apply) questions, the most common pitfall is the option "Have the UAP measure vital signs." This falls within the UAP's scope of practice, so it is highly likely to be the correct answer. The option "Have the UAP measure blood glucose" may also be correct, but it requires the prerequisite that education and competency evaluation on device use and result reporting have been completed. Do not automatically judge it as incorrect.
Delegation — Delegation. The process by which an RN assigns specific patient care tasks to other healthcare team members (LPN/LVN, UAP) while retaining accountability and supervisory authority.
Scope of Practice — Scope of practice. The limits of activities that a healthcare professional with a specific license or qualification can perform according to laws, regulations, education, and competence.
LPN/LVN (Licensed Practical/Vocational Nurse) — Licensed Practical Nurse. A nurse who provides basic patient care under the supervision of an RN. Responsible for routine management of stable patients and administration of certain medications.
UAP (Unlicensed Assistive Personnel) — Unlicensed assistive personnel. Staff who do not have a nursing license but have received training to support non-nursing, routine patient care tasks under the supervision of an RN (e.g., nursing assistants, nurse aides).
Patient Acuity — Patient acuity. The classification of a patient's care needs based on their condition and the complexity, intensity, and time required for nursing care. A key factor in delegation decisions.