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.
Core Nursing ExplanationKey Concept Analysis: This question tests the core nursing principle of Delegation and Supervision. Effective delegation is critical for patient safety and team efficiency. The RN (Registered Nurse) must assign tasks based on the Scope of Practice of the delegatee (e.g., LPN/LVN, UAP/CNA), the stability of the patient, and the complexity of the task. Tasks requiring Key Point!nursing judgment, assessment, or evaluation cannot be delegated to unlicensed personnel.
Answer Rationale: Option ③ requires immediate intervention because it involves delegating the initial assessment of a newly admitted patient with chest pain to a UAP. This is a high-risk, unstable situation. Chest pain is a potential symptom of acute coronary syndrome (ACS), myocardial infarction (MI), or other life-threatening conditions. The initial assessment requires critical thinking, clinical judgment, interpretation of symptoms, and possibly immediate intervention—all of which are outside the legal and educational scope of an unlicensed assistive personnel. The RN must perform this assessment.
Distractor Analysis:
Option ①: Delegating vital signs for stable postoperative patients to an experienced UAP is appropriate. Vital sign measurement is a routine, data-collection task within a UAP's scope, provided they are trained and the patient's condition is stable.
Option ②: Assigning medication administration to an LPN for patients with stable chronic conditions is generally within an LPN's scope in many states, depending on facility policy. LPNs are licensed to administer most medications (excluding IV push meds in many cases) under RN supervision.
Option ④: Assigning wound dressing changes for chronic wounds to an LPN with appropriate training is appropriate. This is a skilled task within an LPN's scope of practice. The key factors are the LPN's competency and the non-complex, chronic nature of the wound.
Related Concepts: The "Five Rights of Delegation" (Right Task, Right Circumstance, Right Person, Right Direction/Communication, Right Supervision/Evaluation) are a fundamental framework. This scenario violates the "Right Task" (assessment is not a UAP task) and "Right Circumstance" (unstable patient with chest pain).
Concept Summary
Role
Key Responsibilities (Examples)
Tasks NOT to Delegate to This Role
RN (Registered Nurse)
Nursing process (Assessment, Diagnosis, Planning, Evaluation), Initial assessments, Patient education, Complex procedures, IV push medications, Care planning.
N/A (The delegator)
LPN/LVN (Licensed Practical/Vocational Nurse)
Administering most medications (oral, IM, SQ), Dressing changes, Monitoring stable patients, Data collection.
Initial/ongoing assessments requiring RN judgment, Developing care plans, Patient education requiring complex judgment, IV push meds (varies by state).
Activities of Daily Living (ADLs) (bathing, feeding), Vital signs (on stable pts), Ambulation, Specimen collection, Making beds.
Any assessment, evaluation, interpretation, teaching, sterile procedures, medication administration.
Side-by-Side Comparison!
Scenario
Appropriate Delegation?
Rationale
UAP repositions a stable patient to prevent pressure ulcers.
YES
Basic care and mobility are within UAP scope.
UAP informs the RN that a patient's blood pressure is 80/50 mmHg.
YES
UAP can measure and report data. The RN must assess and interpret it.
UAP decides to withhold a patient's pain medication because they appear sleepy.
NO
Assessment and medication decisions require nursing judgment. UAP should report sleepiness to the RN.
LPN administers scheduled insulin to a diabetic patient.
YES (Typically)
Medication administration is within LPN scope under RN supervision.
LPN completes the admission assessment for a new patient with respiratory distress.
NO
Initial assessment of an unstable patient requires RN-level judgment and licensure.
Anatomy, Physiology & Pharmacology Points
While this is a management question, understanding chest pain pathophysiology is key to grasping the risk. Chest pain can originate from cardiac (myocardial ischemia due to blocked coronary arteries), pulmonary (pulmonary embolism), musculoskeletal, or gastrointestinal causes. An RN's assessment includes evaluating pain characteristics (location, radiation, quality, duration, precipitating/alleviating factors), associated symptoms (dyspnea, diaphoresis, nausea), and vital signs—a complex process essential for triage and preventing patient deterioration.
Memory Tips
Mnemonic: RN = Really Necessary for Assessment, Planning, Evaluation, and teaching.
UAP Rule of Thumb: If the task involves "thinking, interpreting, or deciding," it's likely an RN task. If it's "doing, measuring, or reporting," it may be delegatable.
High-Frequency NCLEX Topics
Delegation and assignment questions are extremely high-yield on the NCLEX-RN. The exam tests your ability to prioritize patient safety and apply scope of practice knowledge. Always ask yourself: "Is this task within this person's license/role? Is the patient stable enough for this delegation? Is supervision adequate?"
Watch Out for Question Variations!
The NCLEX can test this concept in many ways:
Priority: "Which patient should the RN assess first?" vs. "Which delegation is most appropriate?"
Supervision: "Which statement by a UAP requires immediate follow-up by the RN?" (e.g., "The patient in room 4 has crushing chest pain, but I took his vitals and they were fine.").
Assignment vs. Delegation: Understanding that you assign tasks to other RNs (who have the same scope) and delegate tasks to LPNs/UAPs (who have a different scope).
Nursing Clinical Practice GuideClinical Scenario: You are the charge nurse on a medical-surgical unit. A new graduate nurse tells you, "I've asked the CNA (UAP) to go get the initial set of vitals and ask about the pain history for Mr. Smith in 322, he just came up from the ED with chest pain. I'm swamped with these discharge summaries."
Nursing Intervention Strategy:
Immediate Intervention & Education: Politely but firmly intervene. "I'll take over Mr. Smith's assessment. For patients with new-onset chest pain, the RN needs to do the initial, comprehensive assessment. It's a patient safety issue. Let's review the delegation guidelines together later."
Perform the RN Assessment: Use a systematic approach (e.g., ABCs – Airway, Breathing, Circulation). Assess pain (PQRST), vital signs, lung sounds, heart sounds, skin color/diaphoresis, and review the ED transfer summary and orders.
Appropriate Re-delegation: Once the patient is assessed, stabilized, and a plan of care is established, you can then appropriately delegate subsequent tasks. For example: "CNA, please obtain Mr. Smith's vital signs every 30 minutes as ordered and report any changes to me immediately."
Patient Safety and Precautions: The greatest risk is a delay in recognizing a deteriorating condition (e.g., an evolving MI). A UAP may not recognize the significance of subtle changes or know which questions to ask. The RN's assessment drives all subsequent interventions (EKG, labs, medications).
Nursing Procedure & Medication Flow
While not a specific procedure, the principle applies to medication administration: Never delegate the assessment required prior to medication administration. For example, assessing pain level before giving an analgesic, or assessing apical pulse before giving digoxin, is an RN responsibility. The LPN may administer the drug, but the RN must ensure the assessment justifying its administration has been completed.
A Word from Your Senior Nurse
"Delegation is one of the hardest skills to master as a new nurse. You want to be a team player and you're often overwhelmed. But remember, your license and, more importantly, your patient's well-being are on the line. When in doubt, ask yourself: 'If this goes wrong, who is ultimately accountable?' The answer is always the RN. Protect your license by protecting your patients. Know your team's strengths and scopes, supervise effectively, and never delegate what you haven't assessed yourself first. This mindset builds a safe, effective, and trusting team environment."