A charge nurse is working with a team that includes two registered nurses (RNs), one licensed practical nurse (LPN), and two unlicensed assistive personnel (UAPs). The charge nurse must assign care for four patients: a post-operative patient requiring pain assessment and medication administration, a stable diabetic patient needing blood glucose monitoring, a patient with a new tracheostomy requiring suctioning, and a patient needing assistance with activities of daily living. Which task assignment demonstrates the most appropriate delegation based on scope of practice and patient safety?
1Assign the LPN to perform tracheostomy suctioning for the patient with a new tracheostomy
2Delegate blood glucose monitoring of the stable diabetic patient to the UAP
3Assign the RN to assess pain and administer medications to the post-operative patient✓ 정답
4Have the UAP assist with tracheostomy care and suctioning procedures
해설
Proper delegation matches tasks to scope of practice. Option 3 assigns pain assessment and medication to an RN, which is within their scope. Other options delegate tasks like tracheostomy suctioning or blood glucose monitoring to LPN or UAP, which may exceed their scope or require RN-level assessment.
Core Nursing Explanation
This question tests the critical nursing skill of appropriate delegation based on the scope of practice for each team member. The core principle is that the RN is responsible for assessment, planning, evaluation, and complex nursing interventions, while tasks can be delegated to LPNs/LVNs and UAPs based on patient stability, task complexity, and the delegatee's competency.
Key Concept Analysis
The scenario presents a classic delegation challenge. The RN must consider the "Five Rights of Delegation": Right Task, Right Circumstance, Right Person, Right Direction/Communication, and Right Supervision/Evaluation. Here, we focus on matching the Right Task to the Right Person based on their legal scope and required skill level.
Answer RationaleKey Point! Option ③ is correct because it assigns pain assessment and medication administration to the RN. Assessment (especially of a subjective symptom like pain in a post-operative patient) is a core, non-delegable RN function. Administering medications, particularly opioids or other controlled substances for post-op pain, requires RN-level judgment regarding dosage, side effects, and evaluation of effectiveness. This assignment perfectly aligns with the RN's scope.
Distractor AnalysisWatch out for confusion!
Option ①: Assigning tracheostomy suctioning for a new tracheostomy to an LPN is inappropriate. A new tracheostomy is an unstable, high-risk situation. Suctioning requires ongoing assessment of respiratory status, secretion characteristics, and potential complications (like bleeding or dislodgement). This requires the comprehensive assessment skills of an RN. An LPN may perform suctioning on a stable patient with a well-established tracheostomy under specific protocols, but the keyword "new" changes the circumstance.
Option ②: Delegating blood glucose monitoring to a UAP is often incorrect. While a UAP might be trained to perform the fingerstick and use the glucometer in some states/facilities, the act of monitoring implies more than just the test. It involves recognizing abnormal values (hypoglycemia or hyperglycemia) and knowing when to report. This task is more safely and commonly assigned to an LPN, who can perform the procedure and report results to the RN, or to the RN directly. The NCLEX typically views this as an LPN/RN task, not a UAP task.
Option ④: Having a UAP assist with tracheostomy care and suctioning is a clear violation of scope. UAPs (Nursing Assistants, Aides) are not trained in sterile/aseptic procedures, managing artificial airways, or assessing respiratory distress. This is a high-risk, invasive procedure far beyond their role of assisting with Activities of Daily Living (ADLs) like bathing or feeding.
Related Concepts
Delegation is a top-priority NCLEX topic. Remember the hierarchy: RNs perform assessment, analysis, planning, evaluation, and complex procedures. LPNs/LVNs provide direct care, administer most medications (often excluding IV push in many states), and monitor stable patients. UAPs assist with basic, non-invasive care like ADLs, vital signs (on stable patients), and positioning.
Concept Summary RN (Registered Nurse): Assessment, Diagnosis, Planning, Evaluation, Teaching, Complex Procedures (IV starts, blood transfusions, central line care), Unstable patient management.
LPN/LVN (Licensed Practical/Vocational Nurse): Stable patient care, Medication administration (oral, SQ, IM; often not IV push), Data collection (vitals, I&O), Reinforcing teaching, Performing specific procedures per protocol.
UAP (Unlicensed Assistive Personnel): ADLs (bathing, feeding, ambulating), Simple vital signs, I&O measurement, Making beds, Transporting stable patients.
Side-by-Side Comparison!
Task
Appropriate Delegatee
Rationale & Caution
Pain Assessment
RN only
Requires clinical judgment, analysis of subjective data, and evaluation of intervention. Non-delegable.
Blood Glucose Check (Stable Patient)
LPN (or RN)
LPN can perform skill and report results. UAP may do in some settings, but NCLEX favors LPN assignment.
Tracheostomy Suctioning (New/Unstable)
RN only
High-risk, requires continuous assessment of airway and patient response.
Assist with Bathing & Feeding (ADLs)
UAP
Core UAP function. RN/LPN supervises and addresses any issues noted by UAP.
Anatomy, Physiology & Pharmacology Points
While this is a management question, understanding the underlying needs is key: The post-operative patient needs pain management (often opioids - monitor for respiratory depression). The diabetic patient needs glucose monitoring to prevent hypo/hyperglycemia. The tracheostomy patient has a compromised airway (bypasses upper airway warming/filtering) and is at risk for infection and mucus plugs.
Memory Tips
RN = "Assess, Plan, Evaluate" (APE) – These are the core, non-delegable functions.
LPN = "Look, Perform, Note" – They look for changes, perform assigned tasks, and note/report findings.
UAP = "Assist with Basics" (Aid) – They aid with basic care and comfort.
Ask: "Is this an assessment or evaluation?" If yes → RN. "Is the patient stable and the task routine?" If yes → May be LPN. "Is it non-invasive, basic care?" If yes → May be UAP.
High-Frequency NCLEX Topics
Delegation and assignment questions are extremely common. The NCLEX wants to ensure you know how to protect patient safety by assigning tasks legally and appropriately. They often include keywords like "new," "unstable," "change in condition," or "complex" to signal that an RN is required. They also test knowledge of specific state/facility limits (e.g., LPNs often cannot give IV push meds or perform initial assessments).
Watch Out for Question Variations!
Priority Setting: "Which patient should the charge nurse assign to the most experienced RN?" (Answer: The unstable or most complex patient, e.g., the new tracheostomy).
Supervision: "The LPN reports a blood glucose of 50 mg/dL for the diabetic patient. What is the RN's priority action?" (Assess the patient and intervene for hypoglycemia).
UAP Reporting: "A UAP informs the RN that the post-op patient is restless and pulling at the sheets. What should the RN do first?" (Assess the patient for pain, as this is a potential sign the UAP correctly identified but cannot interpret).
Nursing Clinical Practice GuideClinical Scenario: You are the charge nurse on a medical-surgical unit. Your team today consists of yourself (RN), another RN, one LPN, and two nursing assistants (NAs/UAPs). You receive report on the four patients described. You must create the assignment sheet for the shift.
Nursing Intervention Strategy:
Assessment & Triage (RN Role): First, you mentally triage. The new tracheostomy patient is your highest acuity. They require frequent respiratory assessment, suctioning, stoma care, and teaching. This patient should be assigned to an RN (likely yourself or the other RN).
Planning the Assignment:
RN 1: Takes the new tracheostomy patient (for assessment, complex care) and the post-operative patient (for pain assessment, medication administration, post-op monitoring).
RN 2 (or yourself): Takes the stable diabetic patient (for assessment, care planning, evaluation of glucose trends) and admits any new patients.
LPN: Can be assigned to the stable diabetic patient for tasks like blood glucose checks, administering routine insulin (per protocol), and assisting the RN. The LPN can also help monitor the post-op patient's vital signs and I&O, reporting to the RN.
UAPs: Assigned to assist all patients with ADLs (bathing, toileting, ambulation), take routine vital signs on stable patients, and assist with feeding the patient needing help.
Communication & Supervision: You clearly communicate the plan, specifying what to report immediately (e.g., pain score >7, respiratory distress, hypoglycemia). You ensure the LPN and UAPs know you are available for questions and that you will be regularly evaluating the patients.
Patient Safety and Precautions
Never delegate assessment, teaching, or evaluation.
Only delegate tasks for which the delegatee has demonstrated competency.
Consider patient acuity first. An "unstable diabetic" or a "post-op patient with suspected bleeding" becomes an RN assignment.
Know your State Nurse Practice Act and facility policy regarding LPN IV medications, blood draws, etc.
Nursing Procedure & Medication Flow
While delegation itself isn't a procedure, the RN's process is:
1. Assess all patients' needs and team members' competencies. 2. Plan assignments matching tasks to scope. 3. Communicate clearly: "LPN, please check Mr. Smith's blood glucose at 11 AM and report the result to me. If it is below 70 mg/dL or above 250 mg/dL, report immediately." 4. Supervise and be available. 5. Evaluate both patient outcomes and the delegation process.
A Word from Your Senior Nurse
"Delegation is one of the hardest but most essential skills you'll learn. It's not about dumping work; it's about leading a team to provide safe, efficient care. Your license is on the line for every task you delegate. If you feel uneasy about assigning something, don't. Do it yourself or get help from another RN. In the real world, you'll also consider personalities and workloads—a fantastic UAP might be great with a confused patient, while a new LPN might need simpler tasks. Always think: 'What does this patient need, and who on my team is best qualified to meet that need safely?' That's the heart of nursing leadership."
Delegation — The process by which a registered nurse (RN) directs another person (LPN, UAP) to perform nursing tasks and activities while retaining accountability for the outcome. It follows the "Five Rights."
Scope of Practice — The range of duties and actions a healthcare professional is legally permitted and educated to perform, as defined by state law (Nurse Practice Act) and professional standards.
Five Rights of Delegation — A framework for safe delegation: Right Task, Right Circumstance, Right Person, Right Direction/Communication, and Right Supervision/Evaluation.
LPN/LVN (Licensed Practical/Vocational Nurse) — A nurse with 1-2 years of education licensed to provide basic nursing care under the direction of an RN or physician. Scope includes stable patient care and medication administration (with limitations).
UAP (Unlicensed Assistive Personnel) — Healthcare staff without a professional license (e.g., Nursing Assistant, Patient Care Technician) who perform delegated, basic, non-invasive tasks to assist with patient care, such as ADLs and vital signs.