# A charge nurse is reviewing delegation assignments made by a new graduate nurse. Which delegation assignment requires immediate intervention by the charge nurse? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542784 > language: ko > subject: Leadership Management ## 문제 A charge nurse is reviewing delegation assignments made by a new graduate nurse. Which delegation assignment requires immediate intervention by the charge nurse? The new graduate nurse has made the following delegation assignments during the day shift on a medical-surgical unit. ## 보기 1. Assigning a licensed practical nurse (LPN) to administer oral medications to stable patients with diabetes 2. Delegating vital sign assessment for post-operative patients to an experienced unlicensed assistive personnel (UAP) 3. Asking an unlicensed assistive personnel (UAP) to assess a patient's response to pain medication **✔ 정답** 4. Having a licensed practical nurse (LPN) perform wound dressing changes for patients with chronic wounds **정답: 3** ## 해설 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. ## 심화 해설 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].References (research sources) - [1]Nursing Assistant in Italy: The Principle of Delegation of Health Activities and Liability Profiles.Research articleTRonconi LP, Bolcato V, Bianco Prevot L, Basile G. (2025) · DOI: 10.3390/nursrep15120443 ## 임상 시나리오 Clinical Practice Guide: Delegation and the Nursing Process The Five Rights of Delegation Before delegating any task, the nurse must verify the **Right Task**, **Right Circumstance**, **Right Person**, **Right Direction/Communication**, and **Right Supervision/Evaluation**. The task must be within the delegatee's legal scope and the patient's condition must be stable and predictable. Critical Distinction: Tasks That CANNOT Be Delegated to a UAP The core principle is that any component of the nursing process requiring clinical judgment, assessment, or evaluation must be performed by a licensed nurse (RN or LPN). Do not delegate the following to a UAP: - **Initial or ongoing assessments:** This includes assessing a patient's response to treatment, such as pain medication effectiveness, as it requires clinical judgment to interpret findings and modify the plan of care. - **Evaluation of patient outcomes:** Determining if a patient is progressing toward goals is a nursing evaluation function. - **Patient education and teaching:** Formal health teaching requires a comprehensive assessment and knowledge base held by licensed personnel. - **Formulation of the nursing care plan:** Care planning is a complex, analytical process exclusive to the RN. Safe Delegation to an LPN An LPN can perform tasks requiring focused assessment and technical skills for patients with predictable outcomes. Appropriate tasks include: - Administering oral, subcutaneous, and intramuscular medications (excluding IV push in most jurisdictions). - Performing sterile and non-sterile wound dressing changes for chronic, stable wounds. - Monitoring patient status and reporting changes to the RN. - Reinforcing previously taught patient education. Safe Delegation to a UAP UAPs are essential for providing direct, hands-on care for stable patients. Tasks appropriate for delegation include: - Measuring and recording vital signs (temperature, pulse, respiration, blood pressure). - Measuring intake and output. - Assisting with activities of daily living (bathing, ambulation, toileting, feeding). - Performing basic hygiene and comfort measures. - Reporting subjective complaints or objective changes to the nurse. Immediate Intervention Trigger The charge nurse must intervene immediately when a delegation assignment violates legal scope of practice or places a patient at risk. Asking a UAP to "assess" a patient's response is a direct violation because it demands the clinical judgment to evaluate the effectiveness of a pharmacological intervention, a function strictly reserved for the licensed nurse. ## 핵심 개념 - **Delegation** — The process of transferring the authority and responsibility to another team member to complete a task while retaining accountability for the outcome. - **Unlicensed Assistive Personnel (UAP)** — Individuals trained to function in an assistive role to licensed nurses by performing delegated, basic nursing tasks that do not require clinical judgment or assessment. - **Licensed Practical Nurse (LPN)** — A licensed nurse who provides basic medical care under the direction of an RN or physician, including medication administration and focused assessments for stable patients. - **Nursing Process** — A systematic, critical-thinking method used by nurses that includes assessment, diagnosis, planning, implementation, and evaluation; assessment and evaluation cannot be delegated to UAPs. - **Scope of Practice** — The legal boundaries and range of activities, procedures, and processes that a healthcare professional is permitted to perform based on their license and education. ## 같은 주제 문제 - [A nurse manager is making assignments for the upcoming shift in a cardiac unit. Which assi…](https://mymerci.kr/pages/nclex_q.php?qn_id=542785) - [A charge nurse is reviewing delegation assignments made by a new graduate nurse. Which del…](https://mymerci.kr/pages/nclex_q.php?qn_id=542786) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._