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
When you start practicing nursing, it’s very important that you are always familiar with your facilities and state’s nursing protocols. For example, in some states LPNs are allowed to give IV medications and start IVs if they have completed a certification course. While in some states this is prohibited. In addition, in some states certified nursing assistants (CNAs) can draw blood, obtain EKGs, or check blood glucose levels if they have completed a certification course. Therefore, as you can see delegated tasks can vary depending on where the RN works.
What tasks can NOT be delegated by the RN? Remember these categories for when you are answering those NCLEX style questions!
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
- Right Task: As the nurse can you actually delegate this task?
- Is this task within your scope of practice to delegate to the LPN or UAP?
- Is this a task only the RN can do? Make sure the task doesn’t require critical thinking or assessment, planning, evaluation or teaching!
- 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 too. Are they stretched thin and it would be too much on the person to ask them to do the task? Don’t delegate!
- Right Person: Are you asking a person who has demonstrated competency in this task (knows how to complete this task because they have done it before), and it is within their scope of practice deemed by your state and facilities protocols?
- 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 Guidlelines 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)
- mouth care
- 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)
- The gathered data is used to contribute to the patient’s assessment for the RN (RNs completes the comprehensive nursing head-to-toe assessment)
- 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.