A registered nurse (RN) is working with a licensed practical nurse (LPN) and unlicensed assistive personnel (UAP) on a medical-surgical unit. Which task assignment demonstrates appropriate delegation according to scope of practice and safety principles?
1Assigning the LPN to perform initial admission assessment on a newly admitted patient with multiple comorbidities.
2Delegating vital sign monitoring for stable postoperative patients to the UAP while retaining responsibility for interpretation and follow-up.✓ 정답
3Having the UAP administer oral medications to patients who have been on the unit for more than 24 hours and are stable.
4Asking the LPN to develop and modify the nursing care plan for patients with complex medical conditions.
해설
Delegating vital signs to UAP is appropriate as it is routine data collection within their scope under RN supervision. Other options involve tasks requiring nursing judgment (assessment, medication administration, care planning) that exceed LPN/UAP scope.
Core Nursing ExplanationKey Concept Analysis: This question tests the core nursing leadership skill of appropriate delegation. Delegation involves transferring the authority to perform a selected nursing task to a competent individual while the RN retains accountability for the outcome. The guiding principles are the Key Point! "Five Rights of Delegation": Right Task, Right Circumstance, Right Person, Right Direction/Communication, and Right Supervision/Evaluation. Tasks must be matched to the scope of practice of the delegatee (LPN/LVN or UAP/NA).
Answer Rationale: Option ② is correct because it perfectly illustrates these principles. Vital sign monitoring is a routine, standardized task of data collection that falls within the scope of a UAP when the patients are stable. The RN's critical role is retained: Key Point! The RN is responsible for interpreting the data, making clinical judgments, and initiating any necessary follow-up. This is safe, appropriate delegation.
Distractor Analysis: Watch out for confusion! Option ① is incorrect because the initial admission assessment requires comprehensive nursing judgment, analysis, and synthesis of data to identify patient problems—this is a core RN function that cannot be delegated to an LPN.
Option ③ is incorrect because medication administration, even oral medications to stable patients, involves the "rights" of medication administration (right patient, drug, dose, route, time) and assessment for side effects. This requires nursing judgment and licensure, placing it outside the UAP's scope.
Option ④ is incorrect because developing and modifying the nursing care plan is a component of the nursing process (specifically planning) that requires advanced assessment, diagnosis, and goal-setting skills. While an LPN can contribute data and implement parts of the plan, the creation and modification of the overall plan is an RN responsibility.
Related Concepts: Understanding delegation is intertwined with knowledge of the nursing process. Assessment and Planning phases are generally RN-only functions. Implementation can often be delegated for tasks within the delegatee's scope, while Evaluation always remains with the RN. State Nurse Practice Acts provide the legal framework for scope, so always consider local regulations.
Concept Summary
Role
Key Responsibilities (Can Do)
Limitations (Cannot Do)
Registered Nurse (RN)
Initial/comprehensive assessment, Nursing diagnosis, Care plan development/evaluation, Administer IV push/chemotherapy meds, Patient education, Complex wound care, Delegation & supervision.
Cannot perform initial assessment, develop care plans, administer IV push meds or blood, or receive delegation of RN-only tasks.
Unlicensed Assistive Personnel (UAP/CNA)
Activities of daily living (ADLs: bathing, feeding), Vital signs, I&O measurement, Ambulation, Specimen collection, Simple dressing changes (non-sterile).
Cannot assess, interpret data, administer medications, perform sterile procedures, or provide patient education.
Side-by-Side Comparison!
Task
Appropriate to Delegate to UAP?
Rationale
Vital sign monitoring for stable patients
YES
Routine data collection. RN must interpret.
Feeding a patient with dysphagia
NO
Requires assessment of swallow (nursing judgment). UAP can feed patients WITHOUT swallowing issues.
Ambulating a post-op day 1 patient
Maybe, with specific parameters
Can delegate if patient is stable, and UAP is instructed to report dizziness/pain immediately. Requires clear communication.
Documenting an intake & output (I&O) total
YES
Simple measurement and recording. RN analyzes the trend.
Anatomy, Physiology & Pharmacology Points
Delegation itself doesn't involve direct A&P, but safe task assignment requires understanding the patient's condition. For example, delegating ambulation to a UAP for a patient with orthostatic hypotension requires the RN to first assess and then give specific safety instructions. Delegating medication-related tasks requires understanding drug mechanisms and potential side effects that need monitoring by a licensed nurse.
Memory Tips
RN = Right Now (Assessment, Diagnosis, Planning, Evaluation): These are the RN's core, non-delegable functions.
LPN = Licensed for Practical Needs: Focused tasks, stable patients, meds (but not IV push).
UAP = Unlicensed for Assisting with Performance of basic, non-judgmental tasks.
The 5 Rights of Delegation (DELEG): Right Direction, Right Evaluation/Supervision, Right Licensed person (task match), Right Environment/Circumstance, Right Goal/Task.
High-Frequency NCLEX Topics
Delegation and assignment are Key Point! consistently among the top-tested topics on the NCLEX-RN. The exam tests your ability to prioritize patient safety by assigning tasks to the most appropriate team member. Expect questions that mix delegation with prioritization (e.g., "Which patient should the RN assign to the LPN?").
Watch Out for Question Variations!
The same concept can be tested by: 1) Asking which task is inappropriate to delegate. 2) Presenting a scenario with multiple staff and asking which assignment the RN should make. 3) Combining with a patient condition (e.g., a diabetic patient—can the UAP check the blood glucose? Often yes, but the RN must interpret the result and decide on insulin). 4) Testing supervision principles (e.g., "The UAP reports abnormal vitals. What should the RN do first?").Nursing Clinical Practice GuideClinical Scenario: You are the charge RN on a busy 30-bed medical-surgical unit. Your team includes two LPNs and three UAPs. You receive a report that includes: Mr. Jones (post-op day 2 from hip replacement, stable, needs ambulation), Mrs. Smith (new admission with COPD exacerbation, dyspneic, needs assessment), and Mr. Lee (stable, awaiting discharge, needs discharge teaching).
Nursing Intervention Strategy:
Assessment & Prioritization (RN): You personally assess Mrs. Smith (the unstable new admission). You analyze the needs of all patients.
Delegation & Assignment: You assign one LPN to administer the 0900 medications to a group of stable patients, including Mr. Jones. You delegate to a UAP: "Please ambulate Mr. Jones in the hallway. He is stable post-op. Stop immediately and call me if he has severe pain, dizziness, or shortness of breath." You ask another UAP to obtain vital signs on all patients and report them to you.
Supervision & Evaluation (RN): You evaluate Mrs. Smith's respiratory status and develop her care plan. You review the vital signs reported by the UAP, noting Mr. Lee has a slightly elevated BP—you go to reassess him. You check on Mr. Jones after ambulation.
Patient Education (RN): You provide discharge teaching to Mr. Lee about his medications.
Patient Safety and Precautions: Never delegate an unstable patient's assessment or care. Never delegate a task you haven't first assessed the patient for (e.g., don't delegate feeding without first assessing swallow). Provide clear, specific instructions including what to report and when. Follow up on all delegated tasks.
Nursing Procedure & Medication Flow
When delegating medication-related tasks: The LPN can administer most non-IV-push medications. The RN must ensure the LPN is competent for specific drugs (e.g., insulin, anticoagulants per facility policy). The UAP can only remind a patient to take their own pre-poured medications (in some settings) but cannot administer them. The RN is always responsible for the initial assessment before and after medication administration.
A Word from Your Senior Nurse
"Team nursing is a reality, and safe delegation is your superpower! It allows you to focus your advanced skills where they're most needed. Remember, you are legally accountable for every task you delegate. If you wouldn't trust the UAP to recognize a problem with the task, don't delegate it. In clinicals and on the NCLEX, always ask yourself: 'Does this task require nursing judgment or follow-up assessment?' If yes, it stays with the RN. Mastering this protects your license and, most importantly, your patients."