Overview
This lecture covers the principles and rules of nursing delegation, focusing on what tasks registered nurses (RNs) can delegate, who they can delegate to, and how to answer exam questions on this topic.
What is Delegation in Nursing?
- Delegation is when an RN assigns responsibility for a task to a competent person, such as an LPN or unlicensed assistive personnel (UAP).
- RNs delegate to free themselves for more critical patient care and tasks unique to their scope (teaching, assessing, planning, evaluating).
- Not all tasks are delegable; RNs must know what can and cannot be delegated.
Factors Affecting Delegation
- Consider "TAPE": Teaching, Assessment, Planning, Evaluation—if a task involves any of these, only the RN should perform it.
- State laws and facility protocols can affect what LPNs and UAPs are allowed to do.
- Always refer to local guidelines for task delegation.
Five Rights of Delegation
- Right Task: Is the task appropriate to delegate based on its risk and complexity?
- Right Circumstance: Is the patient stable, and does the delegatee have a manageable workload?
- Right Person: Is the person competent and within their scope of practice?
- Right Direction/Communication: Clear instructions must be given.
- Right Supervision: RN must follow up and remains accountable for the task.
Roles & Scope of Practice
- UAP/CNA: Provide basic care—ambulation, hygiene, vital signs (for stable patients), feeding (except aspiration risk), I&O calculations (not IV-related), and collect weights.
- LPN: Supervised by RN; can provide routine care to stable patients, gather data, perform some procedures (Foley insertion, wound care), administer non-IV medications, but not IV meds or blood products, and do not interpret data or conduct education.
- RN: Manages complex/unpredictable patients, new admissions, discharges, comprehensive assessments, IV meds, blood products, invasive procedures, care plan development, and holds ultimate accountability for delegated tasks.
Exam Strategies & Question Examples
- Assign stable, chronic patients to LPNs and basic care to UAPs.
- Never delegate TAPE tasks or complex/unstable patient care to LPNs or UAPs.
- Example tasks appropriate for LPNs: collecting urine samples, auscultating lungs/bowel, administering vaccines.
- Tasks inappropriate for UAP: applying medicated creams, giving enemas.
Key Terms & Definitions
- Delegation — Transferring responsibility for a task to another qualified individual.
- TAPE — Teaching, Assessment, Planning, Evaluation; tasks reserved for RNs only.
- Five Rights of Delegation — Framework to ensure safe and legal delegation in nursing.
Action Items / Next Steps
- Take the free delegation quiz for more practice.
- Review state and facility policies on delegation.
- Study the Five Rights and TAPE mnemonic for exams.