# 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?

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> subject: Leadership Management

## 문제

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?

## 보기

1. Assigning the LPN to perform initial admission assessment on a newly admitted patient with multiple comorbidities.
2. Delegating vital sign monitoring for stable postoperative patients to the UAP while retaining responsibility for interpretation and follow-up. **✔ 정답**
3. Having the UAP administer oral medications to patients who have been on the unit for more than 24 hours and are stable.
4. Asking the LPN to develop and modify the nursing care plan for patients with complex medical conditions.

**정답: 2**

## 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.

## 심화 해설

Correct Answer: 2

Explanation of the Best Practice

The core principle of effective and safe delegation in nursing, particularly within a team nursing model, is the alignment of a task with the legal scope of practice and demonstrated competency of the team member. The integrative review by Beckett et al. (2021) highlights that during resource-intensive periods, such as the COVID-19 pandemic, the successful implementation of team nursing hinges on a clear understanding of delegation principles to reimagine and allocate patient care responsibilities safely [1]. The correct assignment in this scenario is delegating vital sign monitoring for stable postoperative patients to the UAP while the RN retains responsibility for interpretation and follow-up.

This is appropriate because the task of measuring vital signs is a standard, routine procedure with a predictable outcome for a stable patient, which falls within the training and scope of a UAP. The critical safety net is the RN's retention of accountability for the clinical judgment component—analyzing the data and deciding on the necessary actions. This reflects the delegation process where the RN transfers the authority for a task but not the ultimate accountability for the patient's outcome. The review underscores that delegation is not simply task distribution but a complex process requiring the RN to assess the patient's stability, the competency of the delegatee, and the level of supervision required [1].

Analysis of Incorrect Options

Option 1: Assigning the LPN to perform an initial admission assessment on a newly admitted patient with multiple comorbidities is incorrect. An initial assessment is a comprehensive, complex evaluation that requires the advanced clinical judgment and knowledge base of an RN. This activity is outside the LPN's scope of practice, as LPNs contribute to the assessment process by collecting data but cannot perform the initial, in-depth analysis and synthesis required to establish a baseline for a complex patient. The team nursing model relies on the RN to perform these high-level functions to ensure patient safety [1].

Option 3: Having the UAP administer oral medications is a serious safety violation. Medication administration, regardless of the patient's stability, is a core nursing function that requires the specialized knowledge of pharmacokinetics, pharmacodynamics, potential adverse effects, and patient-specific contraindications. This task is strictly outside the legal scope of practice for a UAP and cannot be delegated. The Beckett et al. (2021) review emphasizes that delegation must always respect legal scopes of practice to prevent harm [1].

Option 4: Asking the LPN to develop and modify the nursing care plan for patients with complex medical conditions is incorrect. The development and ongoing modification of a comprehensive nursing care plan is a responsibility exclusive to the RN. This process requires synthesizing complex assessment data, formulating nursing diagnoses, setting patient-centered goals, and evaluating outcomes—all of which demand the critical thinking and clinical judgment of the RN. While an LPN can contribute data and implement specific interventions from the plan, they cannot independently create or alter the overarching plan of care for a complex patient. Effective team nursing differentiates these distinct roles to optimize patient care delivery [1].References (research sources)

- [1]An Integrative Review of Team Nursing and Delegation: Implications for Nurse Staffing during COVID-19.Research articleBeckett CD, Zadvinskis IM, Dean J, Iseler J, Powell JM, Buck-Maxwell B. (2021) · DOI: 10.1111/wvn.12523

## 임상 시나리오

Clinical Delegation Guide: Team Nursing Model

Effective delegation requires matching patient needs with staff competency. The Five Rights of Delegation provide a framework for safe practice.

- **Right Task:** Assign routine, standardized tasks with predictable outcomes (e.g., vital signs for stable patients) to UAPs. Reserve complex assessments and care planning for the RN.

- **Right Circumstance:** Evaluate patient stability before delegating. A postoperative patient with stable vitals is appropriate for UAP monitoring; a newly admitted patient with multiple comorbidities requires RN assessment.

- **Right Person:** Verify the delegatee's training, competency, and legal scope. UAPs cannot administer medications; LPNs cannot perform initial assessments or develop care plans independently.

- **Right Direction/Communication:** Provide clear, specific instructions including frequency, parameters for reporting, and expected timeframes. Document the delegation.

- **Right Supervision/Evaluation:** The RN retains ultimate accountability. Monitor task completion, interpret collected data (e.g., vital signs), and intervene as needed. Follow-up is a non-delegable RN responsibility.

Remember: You can delegate the task, but you cannot delegate the accountability for the patient's overall care and clinical judgment.

## 핵심 개념

- **Delegation** — The process by which a registered nurse transfers the authority to perform a specific task while retaining accountability for the overall patient outcome.
- **Scope of Practice** — The range of responsibilities, activities, and procedures that a healthcare professional is legally permitted and educated to perform.
- **Unlicensed Assistive Personnel (UAP)** — Healthcare staff who are not licensed but are trained to perform specific, routine, non-invasive tasks under the supervision of a licensed nurse.
- **Accountability** — The nurse's obligation to answer for the outcomes of their actions, including the supervision and evaluation of delegated tasks.

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