A charge nurse is reviewing delegation assignments made by a new graduate nurse. Which delegation assignment requires immediate intervention by the charge nurse?

Delegating assessment of patient response to pain medication to UAP requires immediate intervention because assessment requires RN-level clinical judgment. Other options are appropriate as LPNs can administer oral meds and do wound care, and UAP can take vital signs.

Understanding the Delegation Framework

The core issue in this scenario revolves around the legal and professional boundaries of nursing delegation. As outlined in the provided rationale, the principle of delegation within a multiprofessional team hinges on matching the task to the education, competency, and legal scope of practice of the delegatee. A nursing assistant, or unlicensed assistive personnel (UAP), is trained to perform specific, basic healthcare tasks under formalized protocols and continuous supervision ^[1]. The delegation of a task that requires clinical judgment, assessment, or evaluation—skills reserved for licensed nurses—is a direct violation of this principle and poses a significant risk to patient safety.

Analysis of the Incorrect Options

The other assignments, while requiring oversight, fall within the expected scope of practice for the respective team members when appropriate conditions are met.

- Option 1: Assigning a licensed practical nurse (LPN) to administer oral medications to stable patients with diabetes is an appropriate delegation. Medication administration is a core function within the LPN scope of practice. The key qualifier here is "stable patients," which implies a predictable clinical course where the LPN's focused assessment skills are sufficient to monitor for expected therapeutic and adverse effects.
- Option 2: Delegating vital sign assessment for post-operative patients to an experienced unlicensed assistive personnel (UAP) is a standard and safe practice. Measuring and recording vital signs is a fundamental, task-oriented skill that does not require clinical judgment. The UAP’s role is data collection, not interpretation. The registered nurse (RN) retains the responsibility for analyzing the data to assess the patient's condition.
- Option 4: Having a licensed practical nurse (LPN) perform wound dressing changes for patients with chronic wounds is a clinically sound delegation. For a chronic, non-complex wound, a dressing change is a standardized procedure. An LPN is educated and licensed to perform such a task, including observing and reporting on the wound's appearance, which is a focused assessment within their scope.

Analysis of the Correct Option (Option 3)

- Option 3: Asking an unlicensed assistive personnel (UAP) to assess a patient's response to pain medication is the assignment that requires immediate intervention. This directive is fundamentally flawed because it delegates a core nursing function—clinical assessment—to an unlicensed individual. "Assessing a response" is not a single data point like a vital sign; it is a complex cognitive process. It requires the nurse to evaluate the effectiveness of a pharmacological intervention by integrating subjective data (patient's self-report of pain level, quality of pain) and objective data (changes in vital signs, non-verbal cues of discomfort, level of sedation). This synthesis of information to form a clinical judgment is the exclusive domain of the licensed nurse (RN or LPN). A UAP can be asked to report a specific observation, such as a patient's stated pain score on a numeric scale, but they cannot be delegated the act of assessment, which carries with it the responsibility of interpreting findings and deciding on a subsequent course of action. The delegation model explicitly limits unlicensed personnel to basic healthcare tasks under protocol, and this assignment crosses that boundary into a liability-laden, professional nursing responsibility ^[1].