# A charge nurse is working with a team that includes two registered nurses (RNs), one licensed practical nurse (LPN), and two unlicensed assistive personnel (UAPs). The unit has multiple patients with varying acuity levels: a post-operative patient requiring frequent vital sign monitoring and pain assessment, a diabetic patient needing blood glucose monitoring and insulin administration, a stable patient requiring assistance with activities of daily living, and a patient with a new tracheostomy requiring suctioning and assessment. Which delegation decision demonstrates the most appropriate understanding of scope of practice and patient safety principles?

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> subject: Next Gen NCLEX

## 문제

A charge nurse is working with a team that includes two registered nurses (RNs), one licensed practical nurse (LPN), and two unlicensed assistive personnel (UAPs). The unit has multiple patients with varying acuity levels: a post-operative patient requiring frequent vital sign monitoring and pain assessment, a diabetic patient needing blood glucose monitoring and insulin administration, a stable patient requiring assistance with activities of daily living, and a patient with a new tracheostomy requiring suctioning and assessment. Which delegation decision demonstrates the most appropriate understanding of scope of practice and patient safety principles?

## 보기

1. Assign the UAP to perform blood glucose monitoring and administer insulin to the diabetic patient
2. Delegate tracheostomy suctioning and respiratory assessment to the LPN
3. Assign the RN to care for the post-operative patient and the patient with the new tracheostomy **✔ 정답**
4. Have the LPN perform initial post-operative assessments and pain management for the surgical patient

**정답: 3**

## 해설

Proper delegation matches patient needs to team members' scope of practice. RNs should care for complex patients (post-operative and tracheostomy) requiring critical assessments. UAPs can assist stable patients with ADLs. LPNs and UAPs cannot perform tasks like insulin administration or tracheostomy assessment that require advanced nursing judgment.

## 심화 해설

Core Principle: Delegation and the Five Rights

Effective delegation in nursing hinges on matching the task to the team member's scope of practice, documented competency, and the patient's acuity level. The decision must always align with the Five Rights of Delegation: right task, right circumstance, right person, right direction/communication, and right supervision/evaluation. The charge nurse's primary legal and ethical duty is to ensure patient safety by assigning responsibilities that do not exceed a team member's legal or educational boundaries.

The scoping review by Wong et al. (2025) highlights that a critical factor influencing teamwork between registered nurses (RNs) and unlicensed assistive personnel (UAPs) is the clear delineation of roles and responsibilities . When RNs delegate tasks appropriately, it strengthens the collaborative dynamic; however, assigning tasks that require nursing judgment to UAPs blurs professional boundaries and creates significant safety risks . This principle is the foundation for analyzing the delegation options in this scenario.

Analysis of Incorrect Options

**Option 1:** Assigning a UAP to perform blood glucose monitoring and administer insulin is a serious violation of scope of practice. While a UAP may perform a fingerstick glucose check after being trained and having their competency validated, the act of administering insulin is strictly outside their legal scope. Insulin administration is a high-alert medication task that requires the clinical judgment of a licensed nurse (RN or LPN) to assess the patient, evaluate the current blood glucose result, and determine the correct dose. This option violates the "right person" and "right task" principles.

**Option 2:** Delegating tracheostomy suctioning and respiratory assessment to an LPN is inappropriate for a patient with a new tracheostomy. A new tracheostomy is an unstable, high-acuity condition. The initial assessment and complex intervention of suctioning a new stoma require the advanced assessment skills of an RN to monitor for complications like subcutaneous emphysema, hemorrhage, or tube dislodgement. While an experienced LPN may perform tracheostomy care and suctioning on a stable, established tracheostomy under specific state board guidelines, the "right circumstance" here—a new, unstable airway—demands an RN's expertise.

**Option 4:** Having the LPN perform the initial post-operative assessment and pain management for a surgical patient is a misassignment. The initial assessment of a patient upon arrival from the PACU is a complex, comprehensive evaluation that falls within the RN's scope of practice. The RN must synthesize data from vital signs, surgical site, level of consciousness, and pain status to establish a baseline and plan of care. LPNs contribute by gathering data and monitoring for changes, but the initial, foundational assessment and the clinical judgment required for titrating pain management protocols are the RN's responsibility.

Why Option 3 is Correct

**Assigning the RN to care for the post-operative patient and the patient with the new tracheostomy** is the most appropriate decision because it clusters the two highest-acuity patients under the care of the team member with the broadest scope of practice and highest level of critical thinking skills. Both patients require continuous, complex assessment and interventions that cannot be delegated to an LPN or UAP.

The post-operative patient requires frequent monitoring for complications such as hemorrhage, hemodynamic instability, and uncontrolled pain, necessitating an RN's ability to perform a comprehensive assessment and intervene rapidly. The patient with a new tracheostomy represents an unstable airway requiring expert respiratory assessment and sterile suctioning technique. By assigning both high-acuity patients to the RN, the charge nurse ensures that the "right person" is matched with the "right circumstance," concentrating the highest level of nursing judgment where the risk of clinical deterioration is greatest. This decision model reflects the findings of van Esch et al. (2026), which emphasize that successful integration of support roles depends on a deliberate skill mix where RNs retain responsibility for complex, unstable patients while delegating appropriate tasks to assistive personnel . The remaining stable patient and the diabetic patient (with tasks within the LPN scope, such as insulin administration after an RN's initial assessment) can then be safely assigned to the LPN and UAP under the RN's supervision.

## 임상 시나리오

Delegation Based on Acuity & ScopeMatching High-Acuity Patients to RN-Level Care
The Registered Nurse (RN) must be assigned to patients requiring comprehensive assessment, clinical judgment, and complex interventions. This includes unstable post-operative patients needing frequent monitoring and pain management, and patients with a new tracheostomy requiring suctioning and respiratory assessment.

The Licensed Practical Nurse (LPN) can care for stable patients with predictable outcomes, such as a diabetic patient requiring routine blood glucose monitoring and insulin administration. The Unlicensed Assistive Personnel (UAP) can assist stable patients with activities of daily living (ADLs) and perform tasks like routine vital signs that do not require assessment or judgment.

CautionNever delegate tasks requiring clinical judgment (e.g., initial assessment, high-alert medication administration, care of an unstable patient) to a UAP or LPN. Administering insulin is a high-alert task strictly within the RN scope.

## 핵심 개념

- **Delegation** — Delegation. The process by which a nurse maintains responsibility and authority for specific patient care tasks while allowing another qualified person to perform the task.
- **Scope of Practice** — Scope of practice. The range of activities, functions, and responsibilities that each nursing license (e.g., RN, LPN/LVN) or role (e.g., UAP) is permitted to perform according to laws and regulations.
- **Unlicensed Assistive Personnel** — Unlicensed assistive personnel. Staff who do not hold a nursing license but have received training to assist with specific nursing tasks (e.g., nursing assistants, nurse aides).
- **Patient Acuity** — Patient acuity. A scale indicating the patient's condition and the amount, complexity, and intensity of nursing care required. A key consideration when delegating.
- **Tracheostomy Care** — Tracheostomy care. Airway management including skin care around the tracheostomy tube, inner cannula exchange, suctioning, etc. A new tracheostomy requires particularly complex assessment and management.

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