Nursing Delegation 🏥

Introduction

• Focus: Delegation in nursing for exams and practice (including NCLEX)
• Goals: Understand key delegation concepts and answer practice questions
• Additional Resources: Free quiz for more practice

What is Delegation?

• Definition: Transfer of responsibility from a registered nurse (RN) to a competent person (LPN or CNA)
• Purpose: Frees up RN to handle more critical tasks and patients
• Scope of Practice: Teaching, education, assessment, planning, and evaluating care are RNs’ responsibilities

Factors Determining Delegation

• TAPE Concept:
  • Teaching: Only RNs
  • Assessment: Comprehensive assessments by RNs
  • Planning: Patient care and nursing diagnosis
  • Evaluation: Assessing care and making necessary adjustments
• State and Facility Protocols: Vary by state; always verify specific tasks allowed for LPNs and CNAs
• 5 Rights of Nursing Delegation:
  • Right Task: Within RN's ability to delegate and low-risk
  • Right Circumstance: Assess patient stability and workload of delegatee
  • Right Person: Competency and scope of practice
  • Right Direction/Communication: Clear instructions and expectations
  • Right Supervision: RN is still accountable; follow-up and ensure proper completion

Accountability in Delegation

• RNs Maintain Accountability: Even after delegating tasks, accountability remains with the RN
• CNA Limitations: Cannot re-delegate tasks
• LPN Delegation: Varies by state; some can delegate to CNAs

Roles and Responsibilities

• Unlicensed Assistive Personnel (CNA)
  • Tasks: Basic care (ambulation, hygiene, intake/output, stable patient vitals)
  • Restrictions: No medication administration or complex care
  • Examples of Delegation: Feeding a low-risk patient, collecting stable patient’s vitals
• Licensed Practical Nurse (LPN)
  • Tasks: More advanced than CNAs but not as complex as RNs (EKGs, wound care, routine procedures)
  • Restrictions: No complex/critical care, no new admissions, no discharge education
  • Examples of Delegation: Routine procedures with predictable outcomes
• Registered Nurse (RN)
  • Tasks: Comprehensive assessments, IV medications, central line procedures, developing care plans
  • Role: Consider most critical and complex care, including new admissions and postoperative patients

Delegation Example Questions

Question 1: Patient Assignments

• Choose LPN Assignment: Patient with Alzheimer’s disease, colostomy, and tube feedings
  • Rationale: Stable, predictable condition
  • Incorrect Choices: Cardiac patients, newly admitted patients, IV drips

Question 2: Task Assignment

• Tasks Delegated to LPN:
  • Collecting a urine sample
  • Auscultating lung and bowel sounds
  • Administering a flu vaccine
  • Incorrect Choices: Admission assessments, developing care plans, educating on medication side effects

Question 3: Nursing Assistant Delegation

• Tasks Requiring Reevaluation: Applying hydrocortisone cream and assisting with fleet enema
  • Rationale: Medication administration and more complex procedures are outside nursing assistants' scope