Fundamentals · 11 min read
Delegation & Scope of Practice
What the registered nurse may hand off, to whom, and what never leaves the RN.
The five rights of delegation
Right task, right circumstance, right person, right direction and communication, right supervision and evaluation. If any one of the five fails, the delegation is unsafe regardless of how busy the unit is.
Who can do what
Unlicensed assistive personnel may take routine vital signs on stable clients, assist with hygiene, ambulation and feeding of clients without swallowing difficulty, measure intake and output, and perform basic positioning. They may report findings but may not interpret them.
Licensed practical and vocational nurses may administer most medications, perform sterile dressing changes, insert urinary catheters, monitor findings and reinforce teaching the RN has already provided. Scope varies by state, but the NCLEX-consistent boundaries are IV push medications, blood product administration, initial assessment, initial teaching and care planning — all of which remain with the RN.
Test pattern
If an option has an LPN or assistive person performing the first assessment, developing a plan, or providing new teaching, eliminate it immediately.
Assignment logic
When distributing a patient load, match acuity to competence. A newly graduated nurse receives stable, predictable clients. A float nurse from another specialty receives clients within their familiar scope. The unstable post-operative client with a chest tube does not go to either.
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