# A charge nurse is reviewing task assignments for a team including an LPN and UAP on a pediatric unit. Which task assignment demonstrates the most appropriate delegation based on scope of practice and patient safety principles?

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## 문제

A charge nurse is reviewing task assignments for a team including an LPN and UAP on a pediatric unit. Which task assignment demonstrates the most appropriate delegation based on scope of practice and patient safety principles?

The RN must assign tasks for four patients: a post-operative patient requiring initial pain assessment, a stable diabetic patient needing routine blood glucose monitoring, a patient with a new tracheostomy requiring suctioning, and a patient needing assistance with activities of daily living.

## 보기

1. Assign the LPN to perform initial post-operative pain assessment and administer PRN pain medication as ordered.
2. Delegate tracheostomy suctioning to the UAP who has completed competency training for this procedure
3. Assign routine blood glucose monitoring to the LPN and activities of daily living assistance to the UAP. **✔ 정답**
4. Have the UAP collect vital signs on the post-operative patient and report any abnormal findings to the RN.

**정답: 3**

## 해설

Assigning routine blood glucose monitoring to LPN and ADL assistance to UAP aligns with their scopes, as both are predictable tasks. Other options involve initial assessments or complex procedures (tracheostomy suctioning) that require RN-level judgment.

## 심화 해설

Understanding the Scope of Practice and Delegation Principles

The foundation of safe and effective nursing delegation rests on a clear understanding of each team member's legally defined scope of practice. The registered nurse (RN) retains accountability for the nursing process, which includes initial assessments, care planning, and evaluation. A licensed practical nurse (LPN) functions in a more focused role, caring for stable patients with predictable outcomes and performing specific, standardized procedures. Unlicensed assistive personnel (UAP) are trained to assist with non-invasive, routine tasks that do not require clinical judgment or assessment. This hierarchical structure is critical because assigning a task that exceeds a team member's scope is a patient safety violation, as highlighted by research on the impact of non-nursing tasks on healthcare delivery [1]. When nurses are forced to manage duties outside their professional scope, it compromises patient-centered care and can lead to adverse outcomes.

Analysis of the Task Assignments

The correct assignment, option 3, aligns each task with the appropriate team member's scope of practice. Routine blood glucose monitoring on a stable diabetic patient is a standardized, technical procedure with a predictable outcome, making it an appropriate task for the LPN. Assisting a patient with activities of daily living (ADLs) is a non-invasive, fundamental care task that falls squarely within the UAP's role. This division of labor respects the distinct scopes of practice between registered and non-registered nurses, ensuring that each professional works to the full extent of their authorized and competent role without crossing into duties that require a higher level of assessment or decision-making authority [3].

The other options contain significant delegation errors:

- Option 1 is incorrect because an initial post-operative pain assessment requires the clinical judgment of an RN to analyze the nature, quality, and severity of pain, rule out complications, and evaluate the patient's response. This is a core component of the nursing process that cannot be delegated to an LPN.

- Option 2 is a critical safety violation. Tracheostomy suctioning is an invasive, sterile procedure that requires ongoing respiratory assessment to determine the need for, effectiveness of, and patient response to suctioning. This level of assessment and clinical decision-making is outside the UAP's scope of practice, even with competency training, as it is not a routine, predictable task.

- Option 4 incorrectly delegates the first step of the nursing process. While a UAP can collect vital signs, the initial post-operative assessment on a new patient must be performed by the RN. The RN must directly gather and interpret all clinical data, including vital signs, to form a baseline and make subsequent clinical decisions. Delegating the collection of this initial data removes the RN from a critical point of direct patient assessment.

Connecting Delegation to System Safety and Quality

Effective delegation is not just a managerial task; it is a direct application of patient safety principles. The development of quality improvement frameworks in healthcare, such as those for preventing hospital-onset infections, relies on analyzing system factors and team member roles to identify opportunities for error prevention . A delegation error, such as assigning a complex assessment to a UAP, represents a breakdown in the care system's design. By correctly delegating tasks to the LPN and UAP, the charge nurse creates a safer care environment where each team member operates within their defined competencies, reducing the risk of missed assessments or improperly performed procedures. This systematic approach ensures that the RN’s cognitive and decision-making skills are reserved for the complex, unstable patients who require comprehensive evaluation, directly supporting the delivery of high-quality, patient-centered care.References (research sources)

- [1]Beyond the bedside: unravelling the impact of non-nursing tasks on clinical nurses and healthcare delivery.Research articleSaifan AR, Aldarawsheh AA, Al-Yateem N, Alharbi HF, Ahmed FR, Saleh ZT, Al-Ryahna S, Rezq KA, Abujaber DA. (2025) · DOI: 10.1186/s12912-025-03943-8

- [3]Exploring Nurse Dyads' experiences of scope of practice in nursing homes: A qualitative descriptive study from the FLORENCE project.Research articleNordaunet OM, Aagaard H, Olsson C, Gjevjon ER, Borglin G. (2025) · DOI: 10.1371/journal.pone.0334124

## 임상 시나리오

Clinical Practice Guide: Delegation in Pediatric Nursing

The registered nurse must assign tasks based on each team member's legal scope of practice, patient stability, and the complexity of the required intervention. The RN retains full accountability for the nursing process, including initial assessments, care planning, and outcome evaluation.

Key Delegation Principles

- Assign LPNs to stable patients with predictable outcomes and standardized, technical procedures such as routine medication administration or monitoring.

- Delegate only non-invasive, repetitive tasks that do not require clinical judgment or assessment to UAPs, such as activities of daily living, basic hygiene, and ambulation.

- Reserve initial assessments, invasive procedures, and care of unstable patients for the RN, who must interpret clinical data and modify the care plan.

- Competency validation does not expand a UAP's legal scope; invasive procedures like suctioning remain outside their permitted duties.

Task Assignment Decision Tree

- **Step 1:** Determine if the task requires nursing judgment or assessment. If yes, assign to RN.

- **Step 2:** If the task is standardized and the patient is stable, consider assignment to LPN.

- **Step 3:** If the task is non-invasive and routine, delegate to UAP with clear, specific instructions and parameters for reporting.

- **Step 4:** Provide supervision and follow-up evaluation for all delegated tasks to ensure patient safety and quality care.

Common Delegation Errors to Avoid

- Assigning an initial post-operative pain assessment to an LPN, which requires comprehensive RN evaluation.

- Delegating invasive airway procedures like tracheostomy suctioning to a UAP, regardless of training.

- Expecting UAPs to interpret vital sign data and independently identify abnormal findings, which constitutes clinical judgment.

## 핵심 개념

- **Delegation** — The process by which an RN transfers the authority to perform a specific nursing task to a competent individual while retaining accountability for the outcome.
- **Scope of Practice** — The range of responsibilities, activities, and procedures that a licensed healthcare professional is legally permitted and educated to perform.
- **Licensed Practical Nurse (LPN)** — A nurse who provides basic medical care under the direction of an RN or physician, focusing on stable patients with predictable outcomes and standardized procedures.
- **Unlicensed Assistive Personnel (UAP)** — Healthcare staff trained to assist with non-invasive, routine tasks such as bathing, feeding, and ambulation, but who do not perform assessments or clinical judgments.
- **Nursing Process** — A systematic problem-solving framework used by RNs involving assessment, diagnosis, planning, implementation, and evaluation, which cannot be fully delegated.

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