# A registered nurse on a medical-surgical unit is delegating tasks at the start of shift. Which task is most appropriate for the nurse to delegate to an unlicensed assistive personnel (UAP)?

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> subject: Assignment/Delegation/Supervision  
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## Question

A registered nurse on a medical-surgical unit is delegating tasks at the start of shift. Which task is most appropriate for the nurse to delegate to an unlicensed assistive personnel (UAP)?

## Option

1. Administer the first dose of an oral medication to a client newly diagnosed with hypertension
2. Assess the surgical incision site of a client returning from the recovery room
3. Reinforce a sterile dressing on a postoperative client receiving wound vacuum therapy
4. Take routine vital signs on a stable client admitted for elective hip arthroplasty preoperative teaching **✔ Correct answer**

**Correct answer: 4**

## Explanation

Taking routine vital signs on a stable client is a standardized, predictable task that may be delegated to a trained UAP, with the nurse responsible for interpreting and following up on the findings. A UAP does not administer a first antihypertensive dose, assess a fresh surgical incision, or manage a sterile dressing around negative-pressure wound therapy. Those tasks require medication authority, assessment, or sterile nursing judgment.

## In-depth explanation

Correct Answer Rationale

The most appropriate task to delegate to an unlicensed assistive personnel (UAP) is taking routine vital signs on a stable client. Delegation in nursing requires the nurse to consider the condition of the client, the competence of the UAP, and the degree of stability and predictability inherent in the task. The client described is admitted for elective hip arthroplasty and is currently engaged in preoperative teaching, which indicates a stable, predictable clinical status. Measuring vital signs on a stable client is a standardized, routine task with minimal risk for variation, falling squarely within the scope of practice for a trained UAP [3]. The registered nurse retains the responsibility for analyzing the data the UAP collects, but the act of data gathering itself is appropriate for delegation.

In-depth Analysis of Delegation Principles

Effective delegation is a critical skill for ensuring quality nursing care and patient safety, yet it operates as a double-edged sword. When performed correctly, it optimizes the skill-mix within a healthcare team, allowing nurses to focus on complex clinical judgments and interventions [1]. However, inappropriate delegation can lead to missed or rationed nursing care, directly threatening patient outcomes [4]. The decision to delegate a task must be grounded in a systemic approach that focuses not just on staff types, but on the actual skills required and the effective use of those skills [3].

The stability of the client is the paramount factor in this scenario. A client in a preoperative teaching phase is, by definition, not in an acute or rapidly changing physiological state. This predictability makes the task of measuring vital signs a low-risk, routine activity. This directly contrasts with tasks that require ongoing assessment, critical thinking, or intervention, which must remain the exclusive domain of the registered nurse. Research on patient safety outcomes has established a clear association between the appropriate balance of nurse and healthcare assistant skill mix and the prevention of adverse events [2]. Delegating a stable task to a UAP helps maintain this balance by ensuring the nurse is available for complex patient needs and clinical oversight, rather than being consumed by a task that can be safely performed by another team member.

The nurse's role in delegation does not end with assigning the task. It includes verifying the UAP's competency, providing clear instructions regarding the task and any parameters to report, and crucially, performing follow-up and analysis of the data collected. The registered nurse must interpret the vital signs within the context of the client's overall clinical picture, a step that requires the clinical reasoning skills of a licensed professional. This structured approach, moving beyond a simple staff-mix model to a true skill-mix model, is essential for delivering high-quality care in the face of workforce shortages [3]. The delegation of a routine task on a stable client is a practical application of this model, enabling the nurse to manage the unit's workload effectively without compromising patient safety [1,4].참고 문헌 (논문 출처)

- [1]Delegating care as a double-edged sword for quality of nursing care: a qualitative study일반논문Tayebeh Moradi, Mahboubeh Rezaei, Negin Masoudi Alavi (2024) · DOI: 10.1186/s12913-024-11054-4

- [2]The association between patient safety outcomes and nurse/healthcare assistant skill mix and staffing levels and factors that may influence staffing requirements일반논문Peter Griffiths, Jane Ball, Jonathan Drennan, Liz James, Jeremy Jones, Alejandra Recio‐Saucedo (2014)

- [3]From staff-mix to skill-mix and beyond: towards a systemic approach to health workforce management일반논문Carl‐Ardy Dubois, Debbie Singh (2009) · DOI: 10.1186/1478-4491-7-87

- [4]Rationed or missed nursing care: Report to the ANMF (Victorian Branch)일반논문Eileen Willis, Ian Blackman, Julie Henderson, Lily Dongxia Xiao, Luisa Toffoli (2015)

## Clinical scenario

Clinical Delegation Guide: UAP Task Assignment

This guide outlines the principles of safe delegation to Unlicensed Assistive Personnel (UAP) on a medical-surgical unit, using a stable preoperative client as a case example.

Delegation Decision Framework

When delegating to a UAP, the registered nurse must evaluate three critical factors simultaneously:

- **Client Stability:** The patient's condition must be predictable and non-acute. A client admitted for elective hip arthroplasty and currently undergoing preoperative teaching is hemodynamically stable and at low risk for sudden deterioration.

- **Task Complexity:** The task must be routine, standardized, and require no clinical judgment or modification. Taking vital signs on a stable client is a perfect example of a low-risk, repetitive task.

- **UAP Competence:** The nurse must confirm the UAP has been trained and validated in the specific task, such as proper use of a vital signs monitor and documentation procedures.

Appropriate vs. Inappropriate Tasks

Tasks to Delegate

- Routine vital signs on a stable client

- Ambulation of a stable client with a known activity order

- Hygiene care and activities of daily living (ADLs)

- Intake and output measurement for a stable client

- Stocking linens or supplies

Tasks Never to Delegate

- Initial or ongoing client assessment (e.g., surgical site inspection)

- Medication administration of any kind

- Sterile procedures or complex wound care (e.g., vacuum therapy)

- Client education or discharge teaching

- Any task requiring clinical judgment or modification

Nursing Accountability and Follow-Up

Delegation does not transfer accountability. The registered nurse remains responsible for the overall care and must:

- **Communicate Clearly:** Provide specific instructions on what to report, such as a systolic blood pressure outside the 100-160 mmHg range.

- **Supervise and Validate:** Ensure the UAP documents the vital signs promptly and correctly in the electronic health record.

- **Analyze the Data:** The nurse must interpret the vital signs, compare them to the baseline, and determine if any intervention is needed. The UAP collects the data; the nurse makes the clinical decision.

**Key Takeaway:** Safe delegation focuses on matching a stable client with a routine, low-risk task that falls within the UAP's validated training, while the nurse retains full responsibility for clinical analysis and patient outcomes.

## Key concepts

- **Delegation** — The process by which a registered nurse directs another person to perform nursing tasks and activities, while retaining accountability for the outcome.
- **Unlicensed Assistive Personnel (UAP)** — Healthcare staff who are not licensed but are trained to perform specific, routine tasks under the supervision of a registered nurse, such as taking vital signs or assisting with activities of daily living.
- **Scope of Practice** — The range of activities and responsibilities that a healthcare professional is legally permitted and competent to perform based on their license and training.
- **Clinical Judgment** — The cognitive process used by nurses to observe, interpret, and respond to a patient's needs, which involves critical thinking and decision-making and cannot be delegated.
- **Stable Client** — A patient whose health status is predictable and not at immediate risk for deterioration, making routine monitoring tasks appropriate for delegation to a UAP.

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