which assignment should not be given to a licensed practical nurse

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Assignment, Delegation and Supervision: NCLEX-RN

Identifying tasks for delegation based on client needs, the "right task" and the "right person": identifying tasks for delegation based on client needs, ensuring the appropriate education, skills, and experience of personnel performing delegated tasks, assigning and supervising the care provided by others, communicating tasks to be completed and report client concerns immediately, organizing the workload to manage time effectively, utilizing the five rights of delegation, evaluating delegated tasks to ensure the correct completion of the activity or activities, evaluating the ability of staff members to perform the assigned tasks for the position, evaluating the effectiveness of staff members' time management skills.

In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of assignment, delegation, and supervision in order to:

• Identify tasks for delegation based on client needs
• Ensure appropriate education, skills, and experience of personnel performing delegated tasks
• Assign and supervise care provided by others (e.g., LPN/VN, assistive personnel, other RNs)
• Communicate tasks to be completed and report client concerns immediately
• Organize the workload to manage time effectively
• Utilize the five rights of delegation (e.g., right task, right circumstances, right person, right direction or communication, right supervision or feedback)
• Evaluate delegated tasks to ensure correct completion of activity
• Evaluate the ability of staff members to perform assigned tasks for the position (e.g., job description, scope of practice, training, experience)
• Evaluate the effectiveness of staff members' time management skills

The assignment of care to others, including nursing assistants, licensed practical nurses, and other registered nurses, is perhaps one of the most important daily decisions that nurses make.

Proper and appropriate assignments facilitate quality care. Improper and inappropriate assignments can lead to poor quality of care, disappointing outcomes of care, the jeopardization of client safety, and even legal consequences.

For example, when a registered nurse delegates aspects of patient care to a licensed practical nurse that are outside of the scope of practice of the licensed practical nurse, the client is in potential physical and/or psychological jeopardy because this delegated task, which is outside of the scope of practice for this licensed practical nurse, is something that this nurse was not prepared and educated to perform. This practice is also illegal and it is considered practicing outside of one's scope of practice when, and if, this licensed practical nurse accepts this assignment. All levels of nursing staff should refused to accept any assignment that is outside of their scope of practice.

• How is the Scope of Practice Determined for a Nurse?
• Scope of Practice vs Scope of Employment
• RN Scope of Practice

Delegation, simply defined, is the transfer of the nurse's responsibility for the performance of a task to another nursing staff member while retaining accountability for the outcome. Responsibility can be delegated. Accountability cannot be delegated. The delegating registered nurse remains accountable for all client care despite the fact that some of these aspects of care can, and are, delegated to others.

Appropriate decisions relating to the successful assignment of care are accurately based on the needs of the patient, the skills of the staff, the staffs' position description or job descriptions, the employing facility's policies and procedures, and legal aspects of care such as the states' legal scopes of practice for nurses, nursing assistants and other members of the nursing team.

The " Five Rights of Delegation " that must be used when assigning care to others are:

• The "right" person
• The "right" task
• The "right" circumstances
• The "right" directions and communication and
• The "right" supervision and evaluation

In other words, the right person must be assigned to the right tasks and jobs under the right circumstances. The nurse who assigns the tasks and jobs must then communicate with and direct the person doing the task or job. The nurse supervises the person and determines whether or not the job was done in the correct, appropriate, safe and competent manner.

The client is the center of care. The needs of the client must be competently met with the knowledge, skills and abilities of the staff to meet these needs. In other words, the nurse who delegates aspects of care to other members of the nursing team must balance the needs of the client with the abilities of those to which the nurse is delegating tasks and aspects of care, among other things such as the scopes of practice and the policies and procedures within the particular healthcare facility.

Some client needs are relatively predictable; and other patient needs are unpredictable as based on the changing status of the client. Some needs require high levels of professional judgment and skill; and other patient needs are somewhat routinized and without the need for high levels of professional judgment and skill. Some client needs are acute, ever changing and/or rarely encountered; and other patient needs are chronic, relatively stable, more predictable, and more frequently encountered.

Based on these characteristics and the total client needs for the group of clients that the registered nurse is responsible and accountable for, the registered nurse determines and analyzes all of the health care needs for a group of clients; the registered nurse delegates care that matches the skills of the person that the nurse is delegating to.

For example, a new admission who is highly unstable should be assigned to a registered nurse; the care of a stable chronically ill patient who is relatively stable and more predictable than a serious ill and unstable acute client can be delegated to the licensed practical nurse; and assistance with the activities of daily living and basic hygiene and comfort care can be assigned and delegated to an unlicensed assistive staff member like a nursing assistant or a patient care technician. Lastly, the care of a client with chest tubes and chest drainage can be delegated to either another registered nurse or a licensed practical nurse, therefore, the registered nurse who is delegating must insure that the nurse is competent to perform this complex task, to monitor the client's response to this treatment, and to insure that the equipment is functioning properly.

The staff members' levels of education, knowledge, past experiences, skills, abilities, and competencies are also evaluated and matched with the needs of all of the patients in the group of patients that will be cared for. Some staff members may possess greater expertise than others. Some, such as new graduates, may not possess the same levels of knowledge, past experiences, skills, abilities, and competencies that more experienced staff members possess. Some may even be more competent in some aspects of client care than other aspects of client care. For example, a licensed practical nurse on the medical surgical floor may have more knowledge, skills, abilities, and competencies than a registered nurse in terms of chest tube maintenance and care because they may have, perhaps, had years of prior experience in an intensive care area of another healthcare facility before coming to your nursing care facility.

Delegation should be done according to the differentiated practice for each of the staff members. A patient care technician, a certified nursing assistant, a licensed practical nurse, an associate degree registered nurse and a bachelor's degree registered nurse should not be delegated to the same aspects of nursing care. Based on the basic entry educational preparation differences among these members of the nursing team, care should be assigned according to the level of education of the particular team member.

Also, staff members differ in terms of their knowledge, skills, abilities and competencies. A staff member who has just graduated as a certified nursing assistant and a newly graduated registered nurse cannot be expected to perform patient care tasks at the same level of proficiency, skill and competency as an experienced nursing assistant or registered nurse. It takes time for new graduates to refine the skills that they learned in school.

Validated and documented competencies must also be considered prior to assignment of patient care. No aspect of care can be assigned or delegated to another nursing staff member unless this staff member has documented evidence that they are deemed competent by a registered nurse to do so. For example, a newly hired certified nursing assistant cannot perform bed baths until a supervising registered nurse has observed this certified nursing assistant provide a bed bath and has decided that they are now competent to do this task without direct supervision.

All healthcare facilities and agencies must assess and validate competency before total care or any aspect of care is performed by an individual without the direct supervision of another, regardless of their years of experience. Competency checklists are used to document the competency of the staff; they must be referred to as assignments are made. Care can be delegated to another only when that person is deemed competent to perform the role or task and this competency is documented.

Scopes of practice are also considered prior to the assignment of care. All states have scopes of practice for advanced nurse practitioners, registered nurses, licensed practical nurses and unlicensed assistive personnel like nursing assistants and patient care technicians.

The job of the registered nurse is far from done after client care has been delegated to members of the nursing team. The delegated care must be followed up on and the staff members have to be supervised as they deliver care. The registered nurse remains responsible for and accountable for the quality, appropriateness, completeness, and timeliness of all of the care that is delivered.

The supervision of the care provided by others includes the monitoring the care, coaching and supporting the staff member who is providing the care, assisting the staff member with priority setting and time management skills, as indicated, educating the staff member about the proper provision of care, as indicated by a knowledge or skills deficit, and also praising and positively reinforcing the staff for a job well done.

Remember, the delegating registered nurse is still responsible and accountable for all of the client care that is delegated to others.

Registered nurses who assign, delegate and/or provide nursing care to clients and groups of clients must report all significant changes that occur in terms of the client and their condition. For example, a significant change in a client's laboratory values requires that the registered nurse report this to the nurse's supervisor and doctor.

They must also communicate and document all tasks that were completed and the client's responses to this treatment. As the old adage says, "If it wasn't documented, it wasn't done."

Time is finite and often the needs of the client are virtually infinite. Time management, organization, and priority setting skills, therefore, are essential to the complete and effective provision of care to an individual client and to a group of clients.

Priorities of care, as previously discussed, are established using a number of methods and frameworks including the ABCs, Maslow's Hierarchy of Needs and the ABCs/MAAUAR method of priority setting.

Some time management techniques, in addition to priority setting, that you may want to consider using to insure that you manage your workload and time effectively include:

• Clarifying your assignment as necessary
• Planning your work in an orderly and systematic manner knowing that priorities and clients' status change frequently
• Avoiding all unnecessary interruptions
• Learning how to say no to others when they ask you for help and you have priority patient needs that would not be addressed if you helped another

As previously discussed, all delegation may be based on the "Five Rights of Delegation" which are:

• The "right" directions and communication

In addition to the supervision of delegated tasks in terms of quality, appropriateness, and timeliness, the registered nurse who has delegated tasks must insure that the assigned activities have been correctly completed.

When assignments are made, the registered nurse must insure that the staff member will have ample time during the shift to complete the assignment and, then, the registered nurse must monitor and measure the staff members' progress toward the completion of assigned tasks throughout the duration of the shift.

This monitoring must be done in an ongoing and continuous manner and not at the end of the shift when it is too late to make corrections.

As previously discussed, staff members should have documented competency for all tasks that are assigned to them. All nursing team members have the responsibility, however, to refuse an assignment if they believe that they cannot do it properly. When this occurs, the registered nurse should either teach the staff member how to perform the task and then document their competency in terms of this assigned task or assign the task to another nursing team member who has documented competency and is sure that they can perform the task in a correct manner.

Part of supervision entails the ongoing evaluation of staff's ability by the registered nurse to perform assigned tasks using direct observations and with indirect observations of patient safety, the quality of the care provided, the appropriateness of care provided, and the timeliness of care provided. For example, the registered nurse can directly observe the performance of the nursing assistant while the client is being transferred from the bed to the chair; and the registered nurse can review the medication administration record to determine if the licensed practical nurse has administered medications in a timely manner which is an example of indirect observation.

The ability of a staff member to perform a specific task is not only based on their competency but it is also based on their:

• Legal scope of practice,
• Documented competency,
• Education and training,
• Past experiences,
• Position description which is also referred to as the job description and
• Healthcare facility specific policies and procedures.

All states throughout our nation have legally legislated scopes of practice for registered professional nurses, licensed practical or vocational nurses, and advanced nursing practice nurses; and they also have legal guidelines related to what an unlicensed, assistive staff member, such as a student nurse technician, patient care aide, patient care technician or nursing assistant, can and cannot legally perform regardless of whether or not the healthcare provider or the delegating nurse believes that they are competent to do.

Although these legal, legislated scopes of practice may vary a little from state to state, they share a lot of commonalities and similarities. For example:

• The scope of practice for the registered nurse will most likely include the legal ability of the registered professional nurse to perform all phases of the nursing process including assessment, nursing diagnosis, planning, implementation and evaluation.
• The scope of practice for the licensed practical or vocational nurse will most likely include the legal ability of this nurse to perform data collection, plan, implement and evaluate care under the direct supervision and guidance of the registered nurse.
• The scope of practice for an advanced practice nurse, such as a nurse practitioner, will most likely include the legal ability of the advanced practice registered professional nurse to perform all phases of the nursing process including assessment, nursing diagnosis, planning, implementation and evaluation in addition to prescribing some medications.

Nurses violate scope of practice statutes, or laws, when they function in roles and aspects of care that are above, beyond and/or not included in their scope of practice. Permanent license revocation may occur when a nurse practices outside of the legally mandated scope of practice. Additionally, licensed nurses who have failed to either reapply for their license or have had it revoked as part of a state disciplinary action cannot and continue to practice nursing are guilty of practicing nursing without a license.

Among the tasks that CANNOT be legally and appropriately delegated to nonprofessional, unlicensed assistive nursing personnel, such as nursing assistants, patient care technicians, and personal care aides, include assessments, nursing diagnosis, establishing expected outcomes, evaluating care and any and all other tasks and aspects of care including but not limited to those that entail sterile technique, critical thinking, professional judgment and professional knowledge.

Some examples of tasks and aspects of care that can be delegated legally to nonprofessional, unlicensed assistive nursing personnel, provided they are competent in these areas, under the direct supervision of the nurse include:

• Assisting the client with their activities of daily living such as ambulation, dressing, grooming, bathing and hygiene
• Measuring and recording fluid intake and output
• Measuring and recording vital signs, height and weight
• The provision of nonpharmacological comfort and pain relief interventions such as establishing and maintaining an environment conducive to comfort and providing the client with a soothing and therapeutic back rub
• Observation and reporting changes in and the current status of the patient’s condition and reactions to care
• The transport of clients and specimens and other errands and tasks such as stocking supplies
• Assistance with transfers, range of motion, feeding, ambulation, and other tasks such as making beds and assisting with bowel and bladder functions

In addition to the legally mandated state scopes of practice, the registered nurse must also insure that the delegated tasks are permissible according to the nursing team members' position description which is also referred to as the job description, and the particular facility's specific policies and procedures relating to client care and who can and who cannot perform certain tasks.

For example, intravenous bolus and push medications may be permissible for only licensed registered nurses in certain areas of the healthcare facility such as the intensive care units; the administration of blood and blood components may be restricted to only registered nurses; and the care of a client who is receiving conscious sedation may be restricted to only a few registered nurses in the particular healthcare facility, according to these job descriptions, policies and procedures.

As previously mentioned, the registered nurse must allot a reasonable amount of time for staff members to complete their assignments when care and tasks are delegated. The staff should be able to complete their assignments within the allocated period of time. When an assignment is not done as expected, the delegating nurse should determine why this has occurred and they must take corrective actions to insure task completion.

One of the things that the delegating nurse will want to consider when an assignment is not completed within the allotted time frame is determining whether or not the staff member is organizing their work and using effective time management skills. If the staff member is not using effective time management skills, the nurse must teach and assist the staff member about better time management and priority setting skills.

RELATED NCLEX-RN MANAGEMENT OF CARE CONTENT:

• Advance Directives
• Assignment, Delegation and Supervision (Currently here)
• Case Management
• Client Rights
• Collaboration with Interdisciplinary Team
• Concepts of Management
• Confidentiality/Information Security
• Continuity of Care
• Establishing Priorities
• Ethical Practice
• Informed Consent
• Information Technology
• Legal Rights and Responsibilities
• Performance Improvement & Risk Management (Quality Improvement)

SEE – Management of Care Practice Test Questions

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Chapter 3 - Delegation and Supervision

3.1. delegation & supervision introduction, learning objectives.

• Identify typical scope of practice of the RN, LPN/VN, and assistive personnel roles

• Identify tasks that can and cannot be delegated to members of the nursing team

• Describe the five rights of effective delegation

• Explain the responsibilities of the RN when delegating and supervising tasks

• Explain the responsibilities of the delegatee when performing delegated tasks

• Outline the responsibilities of the employer and nurse leader regarding delegation

• Describe supervision of delegated acts

As health care technology continues to advance, clients require increasingly complex nursing care, and as staffing becomes more challenging, health care agencies respond with an evolving variety of nursing and assistive personnel roles and responsibilities to meet these demands. As an RN, you are on the frontlines caring for ill or injured clients and their families, advocating for clients’ rights, creating nursing care plans, educating clients on how to self-manage their health, and providing leadership throughout the complex health care system. Delivering safe, effective, quality client care requires the RN to coordinate care by the nursing team as tasks are assigned, delegated, and supervised.  Nursing team members  include advanced practice registered nurses (APRN), registered nurses (RN), licensed practical/vocational nurses (LPN/VN), and assistive personnel (AP).[ 1 ]  Assistive personnel (AP)  (formerly referred to as ‘‘unlicensed” assistive personnel [UAP]) are any assistive personnel trained to function in a supportive role, regardless of title, to whom a nursing responsibility may be delegated. This includes, but is not limited to, certified nursing assistants or aides (CNAs), patient-care technicians (PCTs), certified medical assistants (CMAs), certified medication aides, and home health aides.[ 2 ] Making assignments, delegating tasks, and supervising delegatees are essential components of the RN role and can also provide the RN more time to focus on the complex needs of clients. For example, an RN may delegate to AP the attainment of vital signs for clients who are stable, thus providing the nurse more time to closely monitor the effectiveness of interventions in maintaining complex clients’ hemodynamics, thermoregulation, and oxygenation. Collaboration among the nursing care team members allows for the delivery of optimal care as various skill sets are implemented to care for the patient.

Properly assigning and delegating tasks to nursing team members can promote efficient client care. However, inappropriate assignments or delegation can compromise client safety and produce unsatisfactory client outcomes that may result in legal issues. How does the RN know what tasks can be assigned or delegated to nursing team members and assistive personnel? What steps should the RN follow when determining if care can be delegated? After assignments and delegations are established, what is the role and responsibility of the RN in supervising client care? This chapter will explore and define the fundamental concepts involved in assigning, delegating, and supervising client care according to the most recent joint national delegation guidelines published by the National Council of State Boards of Nursing (NCSBN) and the American Nurses Association (ANA).[ 3 ]

3.3. ASSIGNMENT

Nursing team members working in inpatient or long-term care settings receive patient assignments at the start of their shift.  Assignment  refers to routine care, activities, and procedures that are within the legal scope of practice of registered nurses (RN), licensed practical/vocational nurses (LPN/VN), or assistive personnel (AP).[ 1 ] Scope of practice for RNs and LPNs is described in each state’s Nurse Practice Act. Care tasks for AP vary by state; regulations are typically listed on sites for the state’s Board of Nursing, Department of Health, Department of Aging, Department of Health Professions, Department of Commerce, or Office of Long-Term Care.[ 2 ]

See Table 3.3a for common tasks performed by members of the nursing team based on their scope of practice. These tasks are within the traditional role and training the team member has acquired through a basic educational program. They are also within the expectations of the health care agency during a shift of work. Agency policy can be more restrictive than federal or state regulations, but it cannot be less restrictive.

Patient assignments are typically made by the charge nurse (or nurse supervisor) from the previous shift. A charge nurse is an RN who provides leadership on a patient-care unit within a health care facility during their shift. Charge nurses perform many of the tasks that general nurses do, but also have some supervisory duties such as making assignments, delegating tasks, preparing schedules, monitoring admissions and discharges, and serving as a staff member resource.[ 3 ]

Nursing Team Members’ Scope of Practice and Common Tasks[ 4 ]

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An example of a patient assignment is when an RN assigns an LPN/VN to care for a client with stable heart failure. The LPN/VN collects assessment data, monitors intake/output throughout the shift, and administers routine oral medication. The LPN/VN documents this information and reports information back to the RN. This is considered the LPN/VN’s “assignment” because the skills are taught within an LPN educational program and are consistent with the state’s Nurse Practice Act for LPN/VN scope of practice. They are also included in the unit’s job description for an LPN/VN. The RN may also assign some care for this client to AP. These tasks may include assistance with personal hygiene, toileting, and ambulation. The AP documents these tasks as they are completed and reports information back to the RN or LPN/VN. These tasks are considered the AP’s assignment because they are taught within a nursing aide’s educational program, are consistent with the AP’s scope of practice for that state, and are included in the job description for the nursing aide’s role in this unit. The RN continues to be accountable for the care provided to this client despite the assignments made to other nursing team members.

Special consideration is required for AP with additional training. With increased staffing needs, skills such as administering medications, inserting Foley catheters, or performing injections are included in specialized training programs for AP. Due to the impact these skills can have on the outcome and safety of the client, the National Council of State Board of Nursing (NCSBN) recommends these activities be considered delegated tasks by the RN or nurse leader. By delegating these advanced skills when appropriate, the nurse validates competency, provides supervision, and maintains accountability for client outcomes. Read more about delegation in the “ Delegation ” section of this chapter.

When making assignments to other nursing team members, it is essential for the RN to keep in mind specific tasks that cannot be delegated to other nursing team members based on federal and/or state regulations. These tasks include, but are not limited to, those tasks described in Table 3.3b .

Examples of Tasks Outside the Scope of Practice of Nursing Assistive Personnel

As always, refer to each state’s Nurse Practice Act and other state regulations for specific details about nursing team members’ scope of practice when providing care in that state.

Find and review Nurse Practice Acts by state at  www.ncsbn.org/npa. Read more about the Wisconsin’s Nurse Practice Act and the standards and scope of practice for RNs and LPNs  Wisconsin’s Legislative Code Chapter N6. Read more about scope of practice, skills, and practices of nurse aides in Wisconsin at  DHS 129.07 Standards for Nurse Aide Training Programs.

3.4. DELEGATION

There has been significant national debate over the difference between assignment and delegation over the past few decades. In 2019 the National Council of State Boards of Nursing (NCSBN) and the American Nurses Association (ANA) published updated joint National Guidelines on Nursing Delegation (NGND).[ 1 ] These guidelines apply to all levels of nursing licensure (advanced practice registered nurses [APRN], registered nurses [RN], and licensed practical/vocational nurses [LPN/VN]) when delegating when there is no specific guidance provided by the state’s Nurse Practice Act (NPA).[ 2 ] It is important to note that states have different laws and rules/regulations regarding delegation, so it is the responsibility of all licensed nurses to know what is permitted in their jurisdiction.

The NGND defines a  delegatee  as an RN, LPN/VN, or AP who is delegated a nursing responsibility by either an APRN, RN, or LPN/VN, is competent to perform the task, and verbally accepts the responsibility.[ 3 ] D elegation  is allowing a delegatee to perform a specific nursing activity, skill, or procedure that is beyond the delegatee’s traditional role and not routinely performed, but the individual has obtained additional training and validated their competence to perform the delegated responsibility.[ 4 ] However, the licensed nurse still maintains accountability for overall client care.  Accountability  is defined as being answerable to oneself and others for one’s own choices, decisions, and actions as measured against a standard. Therefore, if a nurse does not feel it is appropriate to delegate a certain responsibility to a delegatee, the delegating nurse should perform the activity themselves.[ 5 ]

Delegation is summarized in the NGND as the following[ 6 ]:

• A delegatee is allowed to perform a specific nursing activity, skill, or procedure that is outside the traditional role and basic responsibilities of the delegatee’s current job.
• The delegatee has obtained the additional education and training and validated competence to perform the care/delegated responsibility. The context and processes associated with competency validation will be different for each activity, skill, or procedure being delegated. Competency validation should be specific to the knowledge and skill needed to safely perform the delegated responsibility, as well as to the level of the practitioner (e.g., RN, LPN/VN, AP) to whom the activity, skill, or procedure has been delegated. The licensed nurse who delegates the “responsibility” maintains overall accountability for the client, but the delegatee bears the responsibility for completing the delegated activity, skill, or procedure.
• The licensed nurse cannot delegate nursing clinical judgment or any activity that will involve nursing clinical judgment or critical decision-making to AP.
• Nursing responsibilities are delegated by a licensed nurse who has the authority to delegate and the delegated responsibility is within the delegator’s scope of practice.

An example of delegation is medication administration that is delegated by a licensed nurse to AP with additional training in some agencies, according to agency policy. This task is outside the traditional role of AP, but the delegatee has received additional training for this delegated responsibility and has completed competency validation in completing this task accurately.

An example illustrating the difference between assignment and delegation is assisting patients with eating. Feeding patients is typically part of the routine role of AP. However, if a client has recently experienced a stroke (i.e., cerebrovascular accident) or is otherwise experiencing swallowing difficulties (e.g., dysphagia), this task cannot be assigned to AP because it is not considered routine care. Instead, the RN should perform this task themselves or delegate it to an AP who has received additional training on feeding assistance.

The delegation process is multifaceted. See Figure 3.2 [ 7 ] for an illustration of the intersecting responsibilities of the employer/nurse leader, licensed nurse, and delegatee with two-way communication that protects the safety of the public. “Delegation begins at the administrative/nurse leader level of the organization and includes determining nursing responsibilities that can be delegated, to whom, and under what circumstances; developing delegation policies and procedures; periodically evaluating delegation processes; and promoting a positive culture/work environment. The licensed nurse is responsible for determining client needs and when to delegate, ensuring availability to the delegatee, evaluating outcomes, and maintaining accountability for delegated responsibility. Finally, the delegatee must accept activities based on their competency level, maintain competence for delegated responsibility, and maintain accountability for delegated activity.”[ 8 ]

Multifaceted Delegation Process

Five Rights of Delegation

How does the RN determine what tasks can be delegated, when, and to whom? According to the National Council of State Boards of Nursing (NCSBN), RNs should use the five rights of delegation to ensure proper and appropriate delegation: right task, right circumstance, right person, right directions and communication, and right supervision and evaluation[ 9 ]:

• Right task:  The activity falls within the delegatee’s job description or is included as part of the established policies and procedures of the nursing practice setting. The facility needs to ensure the policies and procedures describe the expectations and limits of the activity and provide any necessary competency training.
• Right circumstance:  The health condition of the client must be stable. If the client’s condition changes, the delegatee must communicate this to the licensed nurse, and the licensed nurse must reassess the situation and the appropriateness of the delegation.[ 10 ]
• Right person:  The licensed nurse, along with the employer and the delegatee, is responsible for ensuring that the delegatee possesses the appropriate skills and knowledge to perform the activity.[ 11 ]
• Right directions and communication:  Each delegation situation should be specific to the client, the nurse, and the delegatee. The licensed nurse is expected to communicate specific instructions for the delegated activity to the delegatee; the delegatee, as part of two-way communication, should ask any clarifying questions. This communication includes any data that need to be collected, the method for collecting the data, the time frame for reporting the results to the licensed nurse, and additional information pertinent to the situation. The delegatee must understand the terms of the delegation and must agree to accept the delegated activity. The licensed nurse should ensure the delegatee understands they cannot make any decisions or modifications in carrying out the activity without first consulting the licensed nurse.[ 12 ]
• Right supervision and evaluation:  The licensed nurse is responsible for monitoring the delegated activity, following up with the delegatee at the completion of the activity, and evaluating client outcomes. The delegatee is responsible for communicating client information to the licensed nurse during the delegation situation. The licensed nurse should be ready and available to intervene as necessary. The licensed nurse should ensure appropriate documentation of the activity is completed.[ 13 ]

Simply stated, the licensed nurse determines the right person is assigned the right tasks for the right clients under the right circumstances. When determining what aspects of care can be delegated, the licensed nurse uses clinical judgment while considering the client’s current clinical condition, as well as the abilities of the health care team member. The RN must also consider if the circumstances are appropriate for delegation. For example, although obtaining routine vitals signs on stable clients may be appropriate to delegate to assistive personnel, obtaining vitals signs on an unstable client is not appropriate to delegate.

After the decision has been made to delegate, the nurse assigning the tasks must communicate appropriately with the delegatee and provide the right directions and supervision. Communication is key to successful delegation. Clear, concise, and closed-loop communication is essential to ensure successful completion of the delegated task in a safe manner. During the final step of delegation, also referred to as  supervision , the nurse verifies and evaluates that the task was performed correctly, appropriately, safely, and competently. Read more about supervision in the following subsection on “ Supervision .” See Table 3.4 for additional questions to consider for each “right” of delegation.

Rights of Delegation[ 14 ]

Keep in mind that any nursing intervention that requires specific nursing knowledge, clinical judgment, or use of the nursing process can only be delegated to another RN. Examples of these types of tasks include initial preoperative or admission assessments, client teaching, and creation and evaluation of a nursing care plan. See Figure 3.3 [ 15 ] for an algorithm based on the 2019 National Guidelines for Nursing Delegation that can be used when deciding if a nursing task can be delegated.[ 16 ]

Delegation Algorithm

Responsibilities of the Licensed Nurse

The licensed nurse has several responsibilities as part of the delegation process. According to the NGND, any decision to delegate a nursing responsibility must be based on the needs of the client or population, the stability and predictability of the client’s condition, the documented training and competence of the delegatee, and the ability of the licensed nurse to supervise the delegated responsibility and its outcome with consideration to the available staff mix and client acuity. Additionally, the licensed nurse must consider the state Nurse Practice Act regarding delegation and the employer’s policies and procedures prior to making a final decision to delegate. Licensed nurses must be aware that delegation is at the nurse’s discretion, with consideration of the particular situation. The licensed nurse maintains accountability for the client, while the delegatee is responsible for the delegated activity, skill, or procedure. If, under the circumstances, a nurse does not feel it is appropriate to delegate a certain responsibility to a delegatee, the delegating nurse should perform the activity.[ 17 ]

The licensed nurse must determine when and what to delegate based on the practice setting, the client’s needs and condition, the state’s/jurisdiction’s provisions for delegation, and the employer’s policies and procedures regarding delegating a specific responsibility. The licensed nurse must determine the needs of the client and whether those needs are matched by the knowledge, skills, and abilities of the delegatee and can be performed safely by the delegatee. The licensed nurse cannot delegate any activity that requires clinical reasoning, nursing judgment, or critical decision-making. The licensed nurse must ultimately make the final decision whether an activity is appropriate to delegate to the delegatee based on the “Five Rights of Delegation.”

• Rationale:  The licensed nurse, who is present at the point of care, is in the best position to assess the needs of the client and what can or cannot be delegated in specific situations.[ 18 ]

The licensed nurse must communicate with the delegatee who will be assisting in providing client care.  This should include reviewing the delegatee’s assignment and discussing delegated responsibilities, including information on the client’s condition/stability, any specific information pertaining to a certain client (e.g., no blood draws in the right arm), and any specific information about the client’s condition that should be communicated back to the licensed nurse by the delegatee.

• Rationale:  Communication must be a two-way process involving both the licensed nurse delegating the activity and the delegatee being delegated the responsibility. Evidence shows that the better the communication between the nurse and the delegatee, the more optimal the outcome. The licensed nurse must provide information about the client and care requirements. This includes any specific issues related to any delegated responsibilities. These instructions should include any unique client requirements. The licensed nurse must instruct the delegatee to regularly communicate the status of the client.[ 19 ]

The licensed nurse must be available to the delegatee for guidance and questions, including assisting with the delegated responsibility, if necessary, or performing it themselves if the client’s condition or other circumstances  warrant doing so.

• Rationale:  Delegation calls for nursing judgment throughout the process. The final decision to delegate rests in the hands of the licensed nurse as they have overall accountability for the client.[ 20 ]

The licensed nurse must follow up with the delegatee and the client after the delegated responsibility has been completed.

• Rationale:  The licensed nurse who delegates the “responsibility” maintains overall accountability for the client, while the delegatee is responsible for the delegated activity, skill, or procedure.[ 21 ]

The licensed nurse must provide feedback information about the delegation process and any issues regarding delegatee competence level to the nurse leader. Licensed nurses in the facility need to communicate to the nurse leader responsible for delegation any issues arising related to delegation and any individual whom they identify as not being competent in a specific responsibility or unable to use good judgment and decision-making.

• Rationale:  This will allow the nurse leader responsible for delegation to develop a plan to address the situation.[ 22 ]

The decision of whether or not to delegate or assign is based on the RN’s judgment concerning the condition of the client, the competence of the nursing team member, and the degree of supervision that will be required of the RN if a task is delegated.[ 23 ]

Responsibilities of the Delegatee

Everyone is responsible for the well-being of clients. While the nurse is ultimately accountable for the overall care provided to a client, the delegatee shares the responsibility for the client and is fully responsible for the delegated activity, skill, or procedure.[ 24 ] The delegatee has the following responsibilities:

The delegatee must accept only the delegated responsibilities that they are appropriately trained and educated to perform and feel comfortable doing given the specific circumstances in the health care setting and client’s condition. The delegatee should confirm acceptance of the responsibility to carry out the delegated activity. If the delegatee does not believe they have the appropriate competency to complete the delegated responsibility, then the delegatee should not accept the delegated responsibility. This includes informing the nursing leadership if they do not feel they have received adequate training to perform the delegated responsibility, do not perform the procedure frequently enough to do it safely, or their knowledge and skills need updating.

• Rationale:  The delegatee shares the responsibility to keep clients safe, and this includes only performing activities, skills, or procedures in which they are competent and comfortable doing.[ 25 ]

The delegatee must maintain competency for the delegated responsibility.

• Rationale:  Competency is an ongoing process. Even if properly taught, the delegatee may become less competent if they do not frequently perform the procedure. Given that the delegatee shares the responsibility for the client, the delegatee also has a responsibility to maintain competency.[ 26 ]

The delegatee must communicate with the licensed nurse in charge of the client.  This includes any questions related to the delegated responsibility and follow-up on any unusual incidents that may have occurred while the delegatee was performing the delegated responsibility, any concerns about a client’s condition, and any other information important to the client’s care.

• Rationale:  The delegatee is a partner in providing client care. They are interacting with the client/family and caring for the client. This information and two-way communication are important for successful delegation and optimal outcomes for the client.[ 27 ]

Once the delegatee verifies acceptance of the delegated responsibility, the delegatee is accountable for carrying out the delegated responsibility correctly and completing timely and accurate documentation per facility policy.

• Rationale:  The delegatee cannot delegate to another individual. If the delegatee is unable to complete the responsibility or feels as though they need assistance, the delegatee should inform the licensed nurse immediately so the licensed nurse can assess the situation and provide support. Only the licensed nurse can determine if it is appropriate to delegate the activity to another individual. If at any time the licensed nurse determines they need to perform the delegated responsibility, the delegatee must relinquish responsibility upon request of the licensed nurse.[ 28 ]

Responsibilities of the Employer/Nurse Leader

The employer and nurse leaders also have responsibilities related to safe delegation of client care:

The employer must identify a nurse leader responsible for oversight of delegated responsibilities for the facility.  If there is only one licensed nurse within the practice setting, that licensed nurse must be responsible for oversight of delegated responsibilities for the facility.

• Rationale:  The nurse leader has the ability to assess the needs of the facility, understand the type of knowledge and skill needed to perform a specific nursing responsibility, and be accountable for maintaining a safe environment for clients. They are also aware of the knowledge, skill level, and limitations of the licensed nurses and AP. Additionally, the nurse leader is positioned to develop appropriate staffing models that take into consideration the need for delegation. Therefore, the decision to delegate begins with a thorough assessment by a nurse leader designated by the institution to oversee the process.[ 29 ]

The designated nurse leader responsible for delegation, ideally with a committee (consisting of other nurse leaders) formed for the purposes of addressing delegation, must determine which nursing responsibilities may be delegated, to whom, and under what circumstances. The nurse leader must be aware of the state Nurse Practice Act and the laws/rules and regulations that affect the delegation process and ensure all institutional policies are in accordance with the law.

• Rationale:  A systematic approach to the delegation process fosters communication and consistency of the process throughout the facility.[ 30 ]

Policies and procedures for delegation must be developed.  The employer/nurse leader must outline specific responsibilities that can be delegated and to whom these responsibilities can be delegated. The policies and procedures should also indicate what may not be delegated. The employer must periodically review the policies and procedures for delegation to ensure they remain consistent with current nursing practice trends and that they are consistent with the state Nurse Practice Act. (Institution/employer policies can be more restrictive, but not less restrictive.)

• Rationale:  Policies and procedures standardize the appropriate method of care and ensure safe practices. Having a policy and procedure specific to delegation and delegated responsibilities eliminates questions from licensed nurses and AP about what can be delegated and how they should be performed.[ 31 ]

The employer/nurse leader must communicate information about delegation to the licensed nurses and AP and educate them about what responsibilities can be delegated. This information should include the competencies of delegatees who can safely perform a specific nursing responsibility.

• Rationale:  Licensed nurses must be aware of the competence level of staff and expectations for delegation (as described within the policies and procedures) to make informed decisions on whether or not delegation is appropriate for the given situation. Licensed nurses maintain accountability for the client. However, the delegatee has responsibility for the delegated activity, skill, or procedure.

In summary, delegation is the transfer of the nurse’s responsibility for a task while retaining professional accountability for the client’s overall outcome. The decision to delegate is based on the nurse’s judgment, the act of delegation must be clearly defined by the nurse, and the outcomes of delegation are an extension of the nurse’s guidance and supervision. Delegation, when rooted in mutual respect and trust, is a key component to an effective health care team.

3.5. SUPERVISION

The licensed nurse has the responsibility to supervise, monitor, and evaluate the nursing team members who have received delegated tasks, activities, or procedures. As previously noted, the act of supervision requires the nurse to assess the staff member’s ability, competency, and experience prior to delegating. After the nurse has made the decision to delegate, supervision continues in terms of coaching, supporting, assisting, and educating as needed throughout the task to assure appropriate care is provided.

The nurse is accountable for client care delegated to other team members. Communication and supervision should be ongoing processes throughout the shift within the nursing care team. The nurse must ensure quality of care, appropriateness, timeliness, and completeness through direct and indirect supervision. For example, an RN may directly observe the AP reposition a client or assist them to the bathroom to assure both client and staff safety are maintained. An RN may also indirectly evaluate an LPN’s administration of medication by reviewing documentation in the client’s medical record for timeliness and accuracy. Through direct and indirect supervision of delegation, quality client care and compliance with standards of practice and facility policies can be assured.

Supervision also includes providing constructive feedback to the nursing team member.  Constructive feedback  is supportive and identifies solutions to areas needing improvement. It is provided with positive intentions to address specific issues or concerns as the person learns and grows in their role. Constructive feedback includes several key points:

• Was the task, activity, care, or procedure performed correctly?
• Were the expected outcomes involving delegation for that client achieved?
• Did the team member utilize effective and timely communication?
• What were the challenges of the activity and what aspects went well?
• Were there any problems or specific concerns that occurred and how were they managed?

After these questions have been addressed, the RN creates a plan for future delegation with the nursing team member. This plan typically includes the following:

• Recognizing difficulty of the nursing team member in initiating or completing the delegated activities.
• Observing the client’s responses to actions performed by the nursing team member.
• Following up in a timely manner on any problems, incidents, or concerns that arose.
• Creating a plan for providing additional training and monitoring outcomes of future delegated tasks, activities, or procedures.
• Consulting with appropriate nursing administrators per agency policy if the client’s safety was compromised.

3.6. SPOTLIGHT APPLICATION

You are an RN and are reporting to work on a 16-bed medical/renal unit in a county hospital for the 0700 – 1500 shift today. The client population is primarily socioeconomically disadvantaged. Staff for the shift includes four RNs, one LPN/VN, and two AP.

You are a new RN graduate on the unit, and your orientation was completed two weeks ago. The LPN/VN has been working on the unit for ten years. Both AP have been on the unit for six months and are certified nursing assistants after completing basic nurse aide training. You, as one of four RNs on the unit, have been assigned four clients. You share the LPN with the other RNs, and there is one AP for every two RNs.

The charge nurse has assigned you the following four clients. Scheduled morning medications are due at 0800 and all four require some assistance with their ADLs.

• Client A:  An obese 52-year-old male with hypertension and diabetes requiring insulin therapy. He has been depressed since recently being diagnosed with end-stage renal disease requiring hemodialysis. He needs his morning medications and assistance getting dressed for transport to hemodialysis in 30 minutes.
• Client B:  A 83-year-old female client with acute pyelonephritis admitted two days ago. She has a PICC line in place and is receiving IV vancomycin every 12 hours. The next dose is due at 0830 after a trough level is drawn.
• Client C:  A 78-year-old male recently diagnosed with bladder cancer. He has bright red urine today but reports it is painless. He has surgery scheduled at 0900 and the pre-op checklist has not yet been completed.
• Client D:  A malnourished 80-year-old male client admitted with dehydration and imbalanced electrolyte levels. He is being discharged home today and requires patient education.

Reflective Questions

At the start of the shift, you determine which tasks, cares, activities, and/or procedures you will delegate to the LPN and AP. What factors must you consider prior to delegation?

What tasks will you delegate to the LPN/VN?

What tasks will you delegate to the AP?

3.7. LEARNING ACTIVITIES

Learning activities.

(Answers to “Learning Activities” can be found in the “Answer Key” at the end of the book. Answers to interactive activities are provided as immediate feedback.)

Review the following case studies regarding nurse liability associated with inappropriate delegation:

• Nurse Case Study: Wrongful delegation of patient care to unlicensed assistive personnel
• Nurse Video Case Study: Failure to assess and monitor

Reflective Questions:  What delegation errors occurred in each of these scenarios and what were the repercussions of these errors for the nurses involved?

III. GLOSSARY

Being answerable to oneself and others for one’s own choices, decisions, and actions as measured against a standard.

Routine care, activities, and procedures that are within the authorized scope of practice of the RN, LPN/VN, or routine functions of the assistive personnel.

Any assistive personnel (formerly referred to as ‘‘unlicensed” assistive personnel [UAP]) trained to function in a supportive role, regardless of title, to whom a nursing responsibility may be delegated. This includes, but is not limited to, certified nursing assistants or aides (CNAs), patient-care technicians (PCTs), certified medical assistants (CMAs), certified medication aides, and home health aides. [1]

A process that enables the person giving the instructions to hear what they said reflected back and to confirm that their message was, in fact, received correctly.

Supportive feedback that offers solutions to areas of weakness.

An RN, LPN/VN, or AP who is delegated a nursing responsibility by either an APRN, RN, or LPN/VN who is competent to perform the task and verbally accepts the responsibility.

Allowing a delegatee to perform a specific nursing activity, skill, or procedure that is beyond the delegatee’s traditional role but in which they have received additional training.

An APRN, RN, or LPN/VN who requests a specially trained delegatee to perform a specific nursing activity, skill, or procedure that is beyond the delegatee’s traditional role.

Right task, right circumstance, right person, right directions and communication, and right supervision and evaluation.

Advanced practice registered nurses (APRN), registered nurses (RN), licensed practical/vocational nurses (LPN/VN), and assistive personnel (AP).

Procedures, actions, and processes that a health care practitioner is permitted to undertake in keeping with the terms of their professional license.

Appropriate monitoring of the delegated activity, evaluation of patient outcomes, and follow-up with the delegatee at the completion of the activity.

Making adjustments to medication dosage per an established protocol to obtain a desired therapeutic outcome.

Licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/ .

• Cite this Page Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors. Nursing Management and Professional Concepts [Internet]. Eau Claire (WI): Chippewa Valley Technical College; 2022. Chapter 3 - Delegation and Supervision.
• PDF version of this title (18M)

In this Page

• DELEGATION & SUPERVISION INTRODUCTION
• SUPERVISION
• SPOTLIGHT APPLICATION
• LEARNING ACTIVITIES

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Delegation Nursing NCLEX Review

What is delegation in nursing ?

It’s where a licensed nurse (RN) transfers responsibility to a person, who is competent, to perform a certain task.

What’s the overall purpose of delegation in nursing? It frees up the RN to care for a more critical patient or complete other necessary tasks that only the registered nurse can perform.

REMEMBER: The RN is ACCOUNTABLE (liable or responsible) for the delegated task getting done even though they are not the one doing the task. So, in other words, the accountability is NOT transferred to that person completing the task.

***However, not all tasks can be delegated to other nursing staff, such as the LPN/LVN or UAP (nursing assistant) because some tasks can only be done by the registered nurse. This is where you need to know what factors determine delegation in nursing.

Video on Nursing Delegation for NCLEX

What tasks can NOT be delegated by the RN? Remember these categories for when you are answering those NCLEX style questions!

• A ssessment
• E valuating

An easy way I remember it: Don’t delegate a task to the LPN or UAP if the task requires TAPE !!

Some factors that you need to keep in mind before delegating a task as a registered nurse:

• Your states and facilities protocols
• Always follow the:

5 Rights of Nursing Delegation 

• Is this task within your scope of practice to delegate to the LPN or UAP?
• Does the task require TAPE?? If so, don’t delegate it!
• Right Circumstance : look at what is going on with the patient (are they stable or unstable). If the patient is unstable ALWAYS do the task yourself…NEVER DELEGATE IT! Also, assess the current workload of the person you are delegating to. Are they stretched thin and it would be too much on the person to ask them to do the task? Don’t delegate!
• Note: if the person has never done the task before you will need to either do it yourself or be right there with them as they do it. Remember even though they can technically do the task, you should always make sure they are COMPETENT to do it because you are still accountable for the task!
• Right Direction/Communication : Are you explaining in a very clear way how to perform this task and what to expect or report to you?
• Right Supervision : Always follow-up with evaluating and supervising how the task was completed and ensure it was performed correctly (don’t forget about it). Remember you are ACCOUNTABLE for the task!

Source for 5 Rights: (National Guidelines for Nursing Delegation, 2016)

Other important details: the person who received the delegated task can NOT go and delegate it to someone else. UAP can NOT delegate.  Only RNs can delegate. Please note that in most states LPNs can delegate to UAP, but this may NOT be the case in all states (always check your state board of nursing’s rules for this).

RN vs LPN vs UAP Roles

Below are the “most common” duties each position can perform. This is not a complete list, but the list will give you an idea of the differences between each profession when you are studying for the NCLEX exam.

UAP (unlicensed assistive personnel)

• Under the supervision of the RN
• Can’t delegate duties
• Duties depend on state’s protocol. In some states, the CNA can take classes and become certified to check blood glucose/draw blood, EKG etc.
• intake and output (expect IV)
• toileting (include basic ostomy care)
• linen changes
• vital signs (patient unstable RN needs to do)
• Does NOT give medications or perform invasive procedures (enemas, Foley catheters etc.)

Don’t delegate tasks for unstable patients (ex: patient has a new ostomy…RN needs  to be assessing and monitoring/measuring stool rather than delegating this task or if patient is post-opt from open heart surgery….the RN should be getting the patient out of bed to ambulate the first time due to the unforeseen complications that can arise.

LPN (licensed practical nurse)

• In some states, LPNs can delegate tasks to the UAP…but not in all states.
• Duties depend on the state’s protocol and the LPNs training.
• Gathers data (doesn’t analyze and make decisions based on data findings…this in the RNs job)
• Example: The LPN can listen to lung, bowel, heart sounds and report the findings to the RN.
• Performs routine procedures (ostomy care, catheter insertion, wound care, check blood glucose, obtaining EKG etc.)
• Reports to a RN or MD
• Always assign patients who are predictable (stable), NOT fresh post-opt patients, doesn’t require invasive procedures at the bedside, is a new admission, or requires discharge teaching.
• Help assists with care plan by implementing the interventions (as within scope of practice) but does NOT develop the nursing diagnosis or interventions or evaluate the care plan
• Does NOT evaluate patient care, teach, assesses (RN does)
• Give medications (not IV meds)
• Doesn’t give blood transfusions or blood products
• Performs all the duties of UAP

RN (registered nurse)

• Delegates to LPNs and CNAs (accountable for the task still)
• Supervises the LPN and CNA
• Completes the assessment: assesses, plans, implements, and evaluates patient care
• Assign critical patients unstable, unpredictable, post-op patients 1-3 days, IVs drips, patient’s with new diagnoses, needs education
• Develops the nursing care and initiates it…nursing diagnosis, interventions (complete that comprehensive assessment)
• Uses critical thinking to interpret patient findings to develop the patient’s nursing plan of care based on the patient health needs
• Collaborates with other member of the health care team to ensure proper patient care
• Responsible for teaching (discharge teaching, new medications etc.)
• Perform invasive procedures that are complex (accessing ports, central lines (removing), administering blood/blood products/chemo, and assist MD with invasive procedures
• Gives all type of medications including IV and blood products
• Position requires critical thinking and nursing judgment
• Perform all the duties of an LPN and UAP

Never delegate: avoid options on exams that deal with assessment, critical patient cases (requires you to understand the disease process), education, or evaluation of patient care

Delegation NCLEX Practice Questions

1. You’re making the patient assignments for the next shift. On your unit there are three LPNs, two RNs, and two nursing assistants. Which patients will you assign to the LPNs?

A. A 68 year-old male patient who is expected to be discharged home with IV antibiotic therapy.

B. A 25 year-old female patient newly admitted with diabetic ketoacidosis.

C. A 75 year-old male patient with dementia who has an ileostomy and scheduled tube feedings.

D. A 65 year-old female patient who has an order to remove a Foley catheter.

Answers are C and D. Option A: An RN is the best for this patient because the patient will need discharge teaching AND the nurse will need to teach the patient how to self-administer antibiotics. Option B: This is a new admission and the patient is UNSTABLE. Most patients with DKA (diabetic ketoacidosis) require insulin drips along with close monitoring of the blood glucose levels, which requires critical thinking and interpretation. Options C and D are best for the LPNs: these are standard routine procedures the LPN can perform and these patient cases are stable.

2. As the registered nurse, which tasks below should you NOT delegate to the LPN?

A. Performing an assessment on a new admission

B. Collecting a urine sample from an indwelling Foley catheter

C. Developing a plan of care for a patient who is admitted with Guillain-Barré  Syndrome

D. Educating a patient about how to monitor for side effects associated with Warfarin

E. Auscultating lung and bowel sounds

F. Starting a blood transfusion

G. Administering IV Morphine 2 mg for pain

H. Providing wound care to a stage 3 pressure injury

Answers are A, C, D, F, G….these are all out of the scope of practice for an LPN. Remember anything that deals with assessments, educating, evaluating, developing a plan of care, IV medications, unstable patients, or invasive/complex procedures where there is unpredictability the RN is responsible for doing it, and these tasks can’t be delegated. An LPN can perform a focused assessment by listening to lung or bowel sounds and report the findings to the RN but a comprehensive assessment is done by the RN. In addition, the LPN can perform standard procedures that are predictable on stable patients like wound care for a pressure injury, Foley catheter insertion, obtaining an EKG, obtaining blood glucose level etc.

More delegation NCLEX questions

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Delegation and the NCLEX

Contrary to what we like to tell ourselves, no nurse can do it all alone. Inevitably, you will need to work closely with LPN/LVNs, unlicensed assistive personnel, nurses from other units, and other nurses with varying degrees of experience to provide the best care possible to your patients. In fact, we all (patients and employees) benefit from strong teamwork. The trick is, which patient assignments are appropriate for these individuals? Delegation involves assigning appropriate patient care tasks to members of the nursing care team that are within their scope of practice. It’s not fair to patients or your coworkers to ask them to perform tasks that are outside of their abilities. However, you wouldn’t want to waste the skills of an experienced nurse on tasks a new nurse can perform with ease. Effectively, delegation is the process of finding the right person for the job and is a common topic of NCLEX questions.

In general, unlicensed assistive personnel refers to patient care technicians, certified nursing assistants, and other individuals who have not graduated from a nursing program. Although their scope of practice can vary between states, you should assume that, in the NCLEX hospital, they are able to obtain vitals and blood glucose levels and ambulate, bathe, feed and assist with the toileting of stable patients. Of course, this is not an exhaustive list. The term stable is quite important here. Unstable patients, like those who are freshly post-op and those in the intensive care units, should be cared for more closely by the RN. Assessments are outside of the UAP’s scope of practice and should never be delegated to them. UAPs can count the heart rate and respiratory rate, but they cannot decide if it is appropriate for the patient. That is your job.

Licensed practical nurses and licensed vocational nurses are able to administer medications, reinforce the teachings of the RN, provide wound care, carry out the interventions in the nursing care plan, and evaluate patients. Additionally, they can perform all the UAP’s tasks. The RN must perform the initial assessment, but the LPN/LVN can perform follow-up assessments and alert the RN to changes in the patient.

Here’s an example:

Which task is appropriate to delegate to an unlicensed assistive personnel?

A. Check pre-prandial blood glucose level of the diabetic patient B. Administer PRN Tylenol to the patient complaining of increased pain C. Reposition the patient with increased intracranial pressure and ICP monitoring D. Assist the patient to use a bedpan following a femoral arterial catheterization

What is this question really asking? You know that unlicensed assistive personnel are allowed to obtain certain vital statistics of patients and provide assistance with activities of daily living to stable patients. With this in mind, we can rephrase the question to say, “Which task is something an unlicensed assistive personnel can successfully do for a stable patient?” We can rule out the Tylenol administration right away because, duh. Medication administration. Big no-no. Also, the patient’s pain is increasing – the nurse needs to assess this patient to determine why the patient’s pain is getting worse. Following a femoral arterial catheterization, patients are at heightened risk for exsanguination should the pressure dressing and clot be dislodged. This patient is not stable. The nurse should assist this patient to use the bedpan if necessary. Although repositioning a patient is within the scope of practice a UAP, a patient ICP monitoring is unstable and should be repositioned by a nurse. By process of elimination, the UAP can be instructed to check the blood glucose level of a diabetic patient before he or she eats.

Here’s another example:

The charge nurse is planning patient care assignments for the day for an unlicensed assistive personnel, a licensed practical nurse, and a nurse who floated to the neurology unit from the medical surgical floor. Which patient assignment is appropriate for the LPN?

A. The patient who requires vitals checks every 2 hours B. The newly admitted patient who came in through the ED with a stroke C. The patient with a peripherally inserted central catheter who requires IV push medications D. The patient with a nasogastric tube who requires NG tube nutrition and medications

You may find it easiest to rank the available nursing care team staff by the level of acuity they can handle and match it to the patient’s acuity and needs. The unlicensed assistive personnel can manage vitals every two hours. An LPN cannot administer IV push medications; therefore, the LPN cannot care for the patient with the PICC and multiple IV push medications. That assignment would be appropriate for the nurse from the med/surg floor. The LPN should be assigned the patient with an NG tube who requires tube feeding and medications.

Ultimately, you are matching the level of care required by the patient with the health care team member who can provide that care. For the NCLEX, it is important to familiarize yourself with the scopes of practice of the UAP, LPN, and RN. With a solid base of this knowledge, dissect each delegation question to determine exactly what the test writers want to know. Are they simply asking, “Which patient is least/ stable?” Or, “Which healthcare team member has the appropriate background to care for this patient?” By breaking the question into manageable parts, you can avoid getting lost in the minutiae. Further, you will use your skills and knowledge of appropriate delegation for the rest of your nursing career.

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Prioritization, Delegation, and Assignment in Nursing NCLEX Practice Questions (100 Items)

In this NCLEX guide , we’ll help you review and prepare for prioritization, delegation, and assignment in your nursing exams. For this nursing test bank , improve your prioritization, delegation, and patient assignment skills by exercising with these practice questions. We will also be teaching you test-taking tips and strategies so you can tackle these questions in the NCLEX with ease. The goal of these practice quizzes and reviewers is to help student nurses establish a foundation of knowledge and skills on prioritization, delegation, and assignment.

Quiz Guidelines

Before you start, here are some examination guidelines and reminders you must read:

• Practice Exams : Engage with our Practice Exams to hone your skills in a supportive, low-pressure environment. These exams provide immediate feedback and explanations, helping you grasp core concepts, identify improvement areas, and build confidence in your knowledge and abilities.
• You’re given 2 minutes per item.
• For Challenge Exams, click on the “Start Quiz” button to start the quiz.
• Complete the quiz : Ensure that you answer the entire quiz. Only after you’ve answered every item will the score and rationales be shown.
• Learn from the rationales : After each quiz, click on the “View Questions” button to understand the explanation for each answer.
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Prioritization, Delegation, and Assignment Practice Quiz

This section contains the practice questions to exercise your knowledge on nursing prioritization, delegation, and assignment. As with other quizzes, be sure to read and understand the question carefully. For prioritization, delegation, and assignment questions, read each choice carefully before deciding on your answer. Good luck and answer these questions at your own pace. You are here to learn.

Quizzes included in this guide are:

Nursing Prioritization, Delegation and Assignment Reviewer for Nurses

This is your guide to help you answer NCLEX priority, delegation, and assignment style questions.

NCLEX Tips for Nursing Prioritization, Delegation, and Assignment questions:

Here are six tips and strategies to help you ace NCLEX questions about delegation, assignment, and prioritization.

1. Do not make decisions based on resolutions

Do not make decisions concerning the management of care issues based on resolutions you may have witnessed during your clinical experience in the hospital or clinic setting. As a student nurse, you are constantly reminded that NCLEX questions are to be solved and responded to in the context of “Ivory Tower Nursing.” That is, if you only had one patient at a time, loads of assistive personnel, countless supplies, and equipment. This is what people mean when they refer to “ textbook nursing .” But when you’re in the real world without the time and resources, you adjust. Your clinical rotation in management may have been less than ideal but remember that in NCLEX, the answers to the questions are seen in nursing textbooks or journals. Always bear in mind, “Is this textbook nursing care?”

2. Never delegate the functions of assessment, evaluation and nursing judgment.

Throughout your nursing education, you learned that assessments, nursing diagnosis , establishing expected outcomes, evaluating care and any other tasks and aspects of care including but not limited to those that entail sterile technique, critical thinking, professional judgment, and professional knowledge are the responsibilities of the registered professional nurse. You cannot give these responsibilities to nonprofessional, unlicensed assistive nursing personnel, such as nursing assistants, patient care technicians, and personal care aides.

3. Identify tasks for delegation based on the client’s needs.

Delegate activities for stable patients because some of these needs are relatively predictable and more frequently encountered. These are somewhat routinized and without the need for high levels of professional judgment and skill. But if the patient is unstable, the needs are acute and become unpredictable, ever-changing, and rarely encountered based on the patient’s changing status. These needs should not be delegated.

4. Ensure the appropriate education, skills, and experience of personnel performing delegated tasks.

Delegate activities that involve standard, consistent, and unchanged systems and procedures. The care of a patient with chest tubes and chest drainage can be delegated to either another RN or a licensed practical nurse. Therefore, the authorizing RN must ensure that the nurse is qualified, skilled, and competent to perform this intricate task, observe the patient’s response to this treatment, and ensure that the equipment is operating suitably and accurately.

The care of a stable chronically ill patient who is comparatively stable and more anticipated than a seriously ill and unstable acute patient can be assigned to the licensed practical nurse, and assistance with the activities of daily living and basic hygiene and comfort care can be assigned and delegated to an unlicensed assistive staff member like a nursing assistant or a patient care technician. Activities that frequently occur in daily patient care can be delegated. Bathing, feeding , dressing, and transferring patients are examples.

Procedures that are complex or complicated should not be delegated, especially if the patient is highly unstable.

5. Remember priorities!

Recall and understand Maslow’s Hierarchy of Needs , the ABCs (Airway, Breathing, Circulation), and stable versus unstable. It is necessary to know and understand the priorities when deciding which patient the RN should attend to first. Remember that you can see only one patient or perform one activity when answering questions that require you to establish priorities.

Always keep in mind that improper and inappropriate assignments can lead to inadequate quality of care, unexpected care outcomes, the jeopardization of client safety, and even legal consequences. Right assignment of care to others, including nursing assistants, licensed practical nurses, and other registered nurses, is certainly one of the most significant daily decisions nurses make.

6. Additional Test Taking Tips and Strategies

• Questions using keywords such as “ best ,” “ essential ,” “ highest priority ,” “ primary ,” “ immediate ,” “ first ,” or “ initial response ” are asking for your prioritizing skills.
• Know the patient’s purpose of care, current clinical condition, and outcome of care in order to determine and plan priorities.
• Identify the priority patient based on the following: patient’s age, day of admission/ surgery , or the number of body systems involved.
• Unlicensed assistive personnel (UAP) such as nurses’ aides, certified nursing assistants, attendants, health aides are not allowed to delegate. Only a registered nurse can delegate tasks. 
• In some states, Licensed Practical Nurses ( LPN ) may delegate to a UAP depending on the state nursing practice.   
• Ensure the appropriate knowledge, skills, and experience of personnel performing the delegated tasks.
• Do not delegate teaching, assessment , planning , evaluating, and nursing judgment to an unlicensed nurse.
• A client with an unstable and unpredictable condition cannot be delegated to a UAP’s or LPNs.
• Delegate tasks that involve standard, simple procedures such as bathing, dressing, feeding, and transferring patients.
• Student nurses, float nurses, personal assistants, and other personnel may require levels of guidance and supervision.

Nursing Prioritization

Prioritization is deciding which needs or problems require immediate action and which ones could be delayed until later because they are not urgent. In the NCLEX, you will encounter questions that require you to use the skill of prioritizing nursing actions. These nursing prioritization questions are often presented using the multiple-choice format or via ordered-response format. For a review, in an ordered-response question format , you’ll be asked to use the computer mouse to drag and drop your nursing actions in order or priority. Based on the information presented, determine what you’ll do first, second, third, and so forth. Directions are provided with the question. To help you answer nursing prioritization questions, remember the three principles commonly used:

1. Remember ABC’s (airway, breathing, and circulation).

Patients with obvious respiratory problems or interventions to provide airway management are given priority.

2. Maslow’s Hierarchy of Needs

Use Maslow’s hierarchy of needs as a guide to prioritize by determining the order of priority by addressing the physiological needs first.

There are five different levels of Maslow’s hierarchy of needs:

• Physiological Needs. The basic physiological needs have the highest priority and must be met first. Some examples of physiological needs include oxygen, food, fluid, nutrition , shelter, sleep , clothing, and reproduction.
• Safety Needs. Safety can be divided into physical and physiological. These include health, property, employment, security of the environment, and resources.
• Social Needs. These include love, family, friendship, and intimacy.
• Esteem. These include confidence, self-esteem , respect, and achievement.
• Self-actualization. These include creativity, morality, and problem-solving.

3. Using the Nursing Process

The nursing process is a systematic approach to assess and give care to patients. Assessment should always be done first before planning or providing interventions.

Delegation in Nursing

Delegation is the transference of responsibility and authority for an activity to other health care members who are competent to do so. The “delegate” assumes responsibility for the actual performance of the task and procedure. The nurse (delegator) maintains accountability for the decision to delegate and for the appropriateness of nursing care rendered to the patient. The role of a registered nurse also includes delegating care, assigning tasks, organizing and managing care, supervising care delivered by other health care providers while effectively managing time! The NCLEX includes questions related to this unique nursing role of delegation.

5 Rights of Delegation in Nursing

The following are the five rights of delegation in nursing:

• Right Person. The licensed nurse and the employer and the delegatee are responsible for ensuring that the delegatee possesses the appropriate skills and knowledge to perform the activity.
• Right Tasks. The activity falls within the delegatees’ job description or is included as part of the nursing practice settings established written policies and procedures. The facility needs to ensure the policies and procedures describe the expectations and limits of the activity and provide any necessary competency training.
• Each delegation situation should be specific to the patient, the licensed nurse, and the delegatee.
• The licensed nurse is expected to communicate specific instructions for the delegated activity to the delegatee; the delegatee should ask any clarifying questions as part of two-way communication. This communication includes any data that needs to be collected, the method for collecting the data, the time frame for reporting the results to the licensed nurse, and additional information pertinent to the situation.
• The delegatee must understand the terms of the delegation and must agree to accept the delegated activity.
• The licensed nurse should ensure that the delegatee understands that she or he cannot make any decisions or modifications in carrying out the activity without first consulting the licensed nurse.
• Right Circumstances. The health condition of the patient must be stable. If the patient’s condition changes, the delegatee must communicate this to the licensed nurse, and the licensed nurse must reassess the situation and the appropriateness of the delegation.
• The licensed nurse is responsible for monitoring the delegated activity, following up with the delegatee at the completion of the activity, and evaluating patient outcomes. The delegatee is responsible for communicating patient information to the licensed nurse during the delegation situation. The licensed nurse should be ready and available to intervene as necessary.
• The licensed nurse should ensure appropriate documentation of the activity is completed.

Recommended Resources

Recommended books and resources for your NCLEX success:

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy .

Saunders Comprehensive Review for the NCLEX-RN Saunders Comprehensive Review for the NCLEX-RN Examination is often referred to as the best nursing exam review book ever. More than 5,700 practice questions are available in the text. Detailed test-taking strategies are provided for each question, with hints for analyzing and uncovering the correct answer option.

Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items Next Generation NCLEX®-style practice questions of all types are illustrated through stand-alone case studies and unfolding case studies. NCSBN Clinical Judgment Measurement Model (NCJMM) is included throughout with case scenarios that integrate the six clinical judgment cognitive skills.

Saunders Q & A Review for the NCLEX-RN® Examination This edition contains over 6,000 practice questions with each question containing a test-taking strategy and justifications for correct and incorrect answers to enhance review. Questions are organized according to the most recent NCLEX-RN test blueprint Client Needs and Integrated Processes. Questions are written at higher cognitive levels (applying, analyzing, synthesizing, evaluating, and creating) than those on the test itself.

NCLEX-RN Prep Plus by Kaplan The NCLEX-RN Prep Plus from Kaplan employs expert critical thinking techniques and targeted sample questions. This edition identifies seven types of NGN questions and explains in detail how to approach and answer each type. In addition, it provides 10 critical thinking pathways for analyzing exam questions.

Illustrated Study Guide for the NCLEX-RN® Exam The 10th edition of the Illustrated Study Guide for the NCLEX-RN Exam, 10th Edition. This study guide gives you a robust, visual, less-intimidating way to remember key facts. 2,500 review questions are now included on the Evolve companion website. 25 additional illustrations and mnemonics make the book more appealing than ever.

NCLEX RN Examination Prep Flashcards (2023 Edition) NCLEX RN Exam Review FlashCards Study Guide with Practice Test Questions [Full-Color Cards] from Test Prep Books. These flashcards are ready for use, allowing you to begin studying immediately. Each flash card is color-coded for easy subject identification.

Recommended Links

An investment in knowledge pays the best interest. Keep up the pace and continue learning with these practice quizzes:

• Nursing Test Bank: Free Practice Questions UPDATED ! Our most comprehenisve and updated nursing test bank that includes over 3,500 practice questions covering a wide range of nursing topics that are absolutely free!
• NCLEX Questions Nursing Test Bank and Review UPDATED! Over 1,000+ comprehensive NCLEX practice questions covering different nursing topics. We’ve made a significant effort to provide you with the most challenging questions along with insightful rationales for each question to reinforce learning.

10 thoughts on “Prioritization, Delegation, and Assignment in Nursing NCLEX Practice Questions (100 Items)”

Very helpful. A LPN graduate who has taken the nclex four times. It gives me a quick overview. Thanks

Love it!!! These made me think. They up there with ReMar and uWorld.

Very helpful thanks

In which order will the nurse perform the following actions as she prepares to leave the room of a client with airborne precautions after performing oral suctioning?

please your order for this question is wrong

I have learned a lot from the NursesLabs. Love it!

Nurse Pietro receives an 11-month old child with a fracture of the left femur on the pediatric unit. Which action is important for the nurse to take FIRST? First- Speak with parents as to how injury occurred??? Yes, this is going to take place but this the first thing to do? Perhaps the wording needs to change as I have been “textbook” taught, treat first, then question in cases of suspected abuse.

good questions which test your analyzing and critical thinking skils

Thank you for making this free. It is my additional resources. This has been very helpful. I really appreciate that you are helping all future nurses to be at their best .

I’m really grateful for this excercise which aids in preparing for the NCLEX. Thanks

This has help me pass my nclex !! Thanks

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Nurse Practice Standards

NURSE PRACTICE STANDARDS FOR THE LICENSED PRACTICAL & LICENSED VOCATIONAL NURSE

“NURSE PRACTICE STANDARDS” for the LPN/LVN “Nursing Practice Standards” for the Licensed Practical Nurse/Licensed Vocational Nurse (LPN/LVN) is an avenue that NALPN meets the goals of its By-Laws to address Ethical and Principle Standards and to meet “Article II Objective“ of the NALPN By-Laws as well, to explicate the Standards of Practical/Vocational Nursing. In our everchanging world, LPN’s and LVN’s have adjusted their practice to support those changes. As LPN’s/LVN’s practice in expanding roles in health care, “Nursing Practice Standards” are an imperative practice for LPN’s, LVN’s, as well as PN and VN students and their educators; all who practice with LPN’s and LVN’s.

PREFACE The Standards of Practice were developed and incorporated by the NALPN Board of Directors to provide an essential benchmark to deliver the quality of health services, nursing care, and nursing services given by LPN’s/LVN’s which may be measured and assessed. These “Nurse Practice Standards” are applicable in all practice settings. The individual needs of the patient, the particular type of health care agency or other services, and the community resources, will vary according to the degree to which individual standards are applied. The “Scope of Practice” of the Licensed Practical Nurse/Licensed Vocational Nurse has extended into specialized nursing services. These specialized fields of nursing services are provided below.

CODE The code for the Licensed Practical Nurse/Licensed Vocational Nurse was incorporated by NALPN in 1961 with a revision in 1979. The code provides a motivation for establishing, maintaining, and elevating professional nurse standards. As set forth in this code, upon entering the profession, each LPN/LVN, has the responsibility to adhere to the standards of ethical practice and conduct. Each are to:

• Know the “Scope of Practice” to maximize utilization of the LPN/LVN, as specified by the Nursing Practice Act and function within this “Scope of Practice”.
• Provide health care to all patients regardless of race, creed, cultural background, disease, or lifestyle.
• In personal appearance, language, dress, and demeanor, uphold the highest standards.
• Accept the responsibility for safe nursing by keeping mentally and physically fit and up to date educationally to practice safely.
• Stay informed about issues affecting the practice of nursing, the delivery of health care. Where appropriate, participate in government and policy decisions.
• Accept responsibility of membership of NALPN, participate to maintain the “Nurse Practice Standards”, and employment of policies which lead to quality patient care.
• Safeguard confidential information about the patient acquired from any source.

SCOPE Licensed Practical Nurses/Licensed Vocational Nurses are a specialized field who represent the entry into the nursing practice profession. Practicing in places exists where different professions unite in their particular skills in a team effort. This effort is set to improve a patient’s function and to protect the health and safety of the patients. Career advancement opportunities are present within the profession academic education, expansion of knowledge, expertise through both academic/continuing education and certification.

EDUCATION STANDARDS The “Licensed Practical Nurse/Licensed Vocational Nurse”

• Shall complete an educational program approved by the state nursing authority in practical nursing.
• Shall successfully pass the National Council Licensure Examination for Practical Nurses.
• Shall participate in the employing institution an initial orientation.

LEGAL & ETHICAL The “Licensed Practical Nurse/Licensed Vocational Nurse”

• Shall recognize and have a commitment to meet the moral and ethical practice of nursing obligations.
• Shall not perform or accept professional responsibilities/duties which (s)he knows is not competent to perform.
• Shall take responsibility in actions should situations arise where there is unprofessional conduct by a peer or other health care provider.
• Shall hold a current LPN/LVN license to practice nursing in accordance with the law of their employment state.
• Shall know and practice the scope of nursing practice instated by the Nursing Practice Act in their employment state.
• Shall have a personal commitment to conform to the legal responsibilities essential for good nursing practice.

PRACTICE The “Licensed Practical Nurse/Licensed Vocational Nurse”

• As an accountable member of the health care team; shall accept assigned responsibilities.
• As related to the assigned duties; shall function within the limits of educational preparation and experience.
• With other members of the health care team; shall function in promotion of and in maintenance of good health. Shall aide in preventing disease and disability. Shall care for and rehabilitate individuals who are experiencing an altered state of health. Shall contribute to the ultimate quality of life until death.
• For the individual patient or group; shall know and utilize the nursing process in planning, implementing, evaluating. a. Planning: The planning of nursing includes: • assessment and data collection of health status of the patient, the family, and community groups.
 • reporting information received from assessment. • identifying health goals. b. Implementation: The plan for nursing care is put into practice to achieve the stated goals and this includes: • Observing, reporting and recording significant changes which require different goals or intervention.
 • Apply skills and nursing knowledge to help promote and maintain health, to help prevent disease and disability, and to optimize functional capabilities of a patient.
 • Encouraging self-care as appropriate and assisting the patient and family with activities of daily living.
 • Carrying out therapeutic protocols and regimens prescribed by personnel in conjunction to state law.

c. Evaluations: The plan for nursing care and its implementations are evaluated to measure the progress toward the stated goals and will include appropriate person and/or groups to determine:
 • The relevancy of current goals in relation to the progress of the patient. • The recipient’s involvement of care in the evaluation process.
 • The nursing action quality in implementation of the plan.
 • New goal setting or changing priorities in the care plan.
 • Shall participate in peer review and other evaluation processes.
 • Shall participate in the development of policies concerning the health, nursing needs of society, and in the roles and functions of the LPN/LVN.

CONTINUING EDUCATION The “Licensed Practical Nurse/Licensed Vocational Nurse”

• Shall seek and participate in continuing education activities that are accredited and offered by the National Association of Licensed Practical Nurses (NALPN) or other accredited organizations.
• Shall take advantage of continuing education and/or certification opportunities which will lead to professional development and personal growth.
• Shall regularly review career goals and choose continuing education activities that help to achieve these goals.
• Shall be responsible for maintaining the highest possible level of professional capacity at all times.

SPECIALIZED NURSING PRACTICE The “Licensed Practical Nurse/Licensed Vocational Nurse”

• As set forth in this document, shall meet all standards of practice.
• For practice in the chosen specialized nursing area, candidate shall present personal qualifications that demonstrate potential abilities.
• At the staff level, shall have had at least one year nursing experience.
• Shall provide documentation of completion of an approved agency course or program providing the knowledge and skills necessary for adequate nursing services in the specialized field.

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Leadership Management - Delegating