Overview
This lecture reviews delegation in nursing, outlining what tasks RNs can delegate to LPNs and unlicensed assistive personnel (UAPs), factors affecting delegation, and practice questions for exams like NCLEX.
Delegation in Nursing
- Delegation is when a registered nurse (RN) transfers responsibility for a task to someone competent (e.g., LPN or UAP).
- RNs delegate to LPNs or UAPs to manage workload and focus on critical or complex care.
- Not all tasks can be delegated; core RN duties must remain with the RN.
Factors Determining Delegation
- Use the "TAPE" mnemonic: do not delegate Teaching, Assessment, Planning, or Evaluation.
- Always consider state and facility protocols for what LPNs and UAPs can perform.
- Check the individual's competency and scope of practice before delegating.
Five Rights of Delegation
- Right Task: Only delegate low-risk, routine tasks; do not delegate tasks requiring TAPE.
- Right Circumstance: Delegate only for stable patients; consider the current workload of staff.
- Right Person: Ensure the delegatee is trained and competent to perform the task.
- Right Direction/Communication: Give clear instructions and expectations.
- Right Supervision/Evaluation: Follow up to ensure the task is completed properly; RN retains accountability.
Roles and Duties
Unlicensed Assistive Personnel (UAP/CNA)
- Perform basic care: ambulation, hygiene, I&O (not IV), vital signs on stable patients, feeding (unless aspiration risk), linen changes.
- Cannot administer medications or perform tasks on unstable/post-op patients.
- Cannot delegate to others.
Licensed Practical Nurse (LPN)
- Supervised by the RN; specific tasks depend on state/protocol.
- Duties: basic care, gather data for assessments, routine procedures (e.g., EKG, Foley, wound/ostomy care), administer non-IV medications and vaccines, assist with care plan implementation.
- Cannot perform comprehensive assessments, plan care, educate, or administer blood products/IV meds.
Registered Nurse (RN)
- Delegates tasks but retains accountability.
- Performs all duties of LPNs/UAPs plus: comprehensive assessments, care planning, teaching, evaluation, administration of IV meds, blood products, invasive procedures, and handling unstable/complex patients.
Practice Question Highlights
- Assign stable, chronic, predictable patients to LPNs (e.g., Alzheimer's with colostomy).
- Do not assign complex cases, new admissions, or patients needing IV meds/blood to LPNs.
- UAPs can empty ostomy bags or record vital signs but cannot apply medications or assist with enemas.
Key Terms & Definitions
- Delegation — Assigning responsibility for a task to another person while retaining accountability.
- TAPE — Tasks not delegated: Teaching, Assessment, Planning, Evaluation.
- Five Rights of Delegation — Guidelines ensuring safe and appropriate delegation.
Action Items / Next Steps
- Take the free quiz on delegation for more practice.
- Review your state and facility delegation protocols.
- Study the TAPE mnemonic and Five Rights of Delegation.