Delegation is a fundamental aspect of nursing practice, involving the transfer of responsibility and accountability for specific tasks to another individual while maintaining overall responsibility for the outcome. Registered Nurses (RNs) frequently delegate tasks to Licensed Practical Nurses (LPNs) and Unlicensed Assistive Personnel (UAPs). Effective delegation requires careful consideration of various factors, including the scope of practice, task complexity, potential risks, and critical thinking requirements.
Key Facts
- Delegation Overview:
- Delegation is the act of transferring responsibility and accountability to another person to carry out a task while maintaining accountability for the action and the outcome.
- Registered Nurses (RNs) most frequently delegate tasks to Licensed Practical Nurses (LPNs) and UAP.
- RN’s Scope of Practice:
- RNs can delegate appropriate tasks to both LPNs and UAP.
- They can independently assess, monitor, and revise the nursing plan of care for patients of any kind.
- RNs can initiate, administer, and titrate both routine and complex medications.
- They can perform education with patients about the plan of care.
- RNs can admit, discharge, and refer patients to other providers.
- They can perform any tasks that may be performed by LPNs or UAPs.
- LPN’s Scope of Practice:
- LPNs can assist RNs by performing routine tasks with predictable outcomes.
- They can assist RNs with collecting data and monitoring client findings.
- LPNs can reinforce an RN’s patient teaching but not perform independent patient education or assessments.
- LPNs can perform tasks that UAPs are permitted to perform.
- They can delegate tasks to UAPs.
- LPNs may administer medications that are not high-risk, such as standard oral medications.
- They can administer a nasogastric (NG) tube feeding, perform wound dressing changes, monitor blood products, do tracheostomy care, perform suctioning, check nasogastric tube patency, administer enteral feedings, and insert a urinary catheter.
- With further education and certification, LPNs may administer maintenance IV fluids, IV medications via piggy-back, and monitor infusions of IV fluids.
- LPNs cannot administer high-risk medications, administer IV push medications, titrate medications, independently provide patient education, or perform or chart admissions or discharges of patients.
- UAP’s Scope of Practice:
- UAPs can assist patients with activities of daily living (ADLs) such as eating, bathing, toileting, and ambulating.
- They can perform routine procedures that do not require clinical assessment or critical thinking, such as phlebotomy (except for arterial punctures), taking vital signs, and monitoring intake and output.
- UAPs cannot perform assessments, delegate tasks, perform patient education, or perform tasks that require clinical expertise, including administering medications, administering tube feedings, and performing wound care or dressing changes.
RNs’ Scope of Practice and Delegation
RNs possess a broad scope of practice that encompasses the ability to:
- Independently assess, monitor, and revise nursing care plans for patients of varying acuity levels.
- Initiate, administer, and titrate both routine and complex medications.
- Educate patients about their care plan and provide necessary instructions.
- Admit, discharge, and refer patients to appropriate healthcare providers.
- Delegate appropriate tasks to LPNs and UAPs based on their respective scopes of practice.
LPNs’ Scope of Practice and Delegation
LPNs play a crucial role in supporting RNs by performing routine tasks with predictable outcomes. Their scope of practice includes:
- Assisting RNs with data collection and monitoring patient findings.
- Reinforcing patient teaching provided by RNs, but not conducting independent patient education or assessments.
- Performing tasks within the scope of UAPs, as outlined below.
- Delegating tasks to UAPs based on their specific training and capabilities.
LPNs may perform various tasks, including:
- Administering non-high-risk medications, such as standard oral medications.
- Note: Some states may restrict LPNs from administering intravenous (IV) medications.
- Providing nasogastric (NG) tube feedings.
- Performing wound dressing changes.
- Monitoring blood products (excluding the initiation of blood product infusions).
- Providing tracheostomy care.
- Performing suctioning procedures.
- Checking nasogastric tube patency.
- Administering enteral feedings.
- Inserting urinary catheters.
With additional education and certification, LPNs may be authorized to perform the following tasks:
- Administering maintenance IV fluids.
- Administering IV medications via piggyback.
- Monitoring infusions of IV fluids.
UAPs’ Scope of Practice and Delegation
UAPs provide valuable assistance in patient care activities, focusing on tasks that do not require clinical assessment or critical thinking. Their scope of practice includes:
- Assisting patients with activities of daily living (ADLs), such as eating, bathing, toileting, and ambulating.
- Performing routine procedures that do not require clinical judgment, such as phlebotomy (excluding arterial punctures), taking vital signs, and monitoring intake and output.
UAPs are not permitted to perform the following tasks:
- Conducting patient assessments.
- Delegating tasks to others.
- Providing patient education.
- Performing tasks that require clinical expertise, including administering medications, providing tube feedings, and performing wound care or dressing changes.
Conclusion
Effective delegation in nursing requires a thorough understanding of the scope of practice for RNs, LPNs, and UAPs. RNs must carefully assess the appropriateness of delegating tasks based on the patient’s condition, the task’s complexity, and the capabilities of the assigned personnel. By adhering to these principles, nurses can ensure safe and efficient patient care while optimizing the utilization of healthcare resources.
References
- Cox, S. S. (2006). How to delegate to UAPs. Nursing, 36(6), 10-11.
- Nursing OnPoint. (2022). Delegation & scope of practice for nurses. Retrieved from https://nursingonpoint.com/education/nursing-degrees-guides-to-practice/delegation-scope-of-practice-worksheet/
FAQs
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What is delegation in nursing?
Delegation is the transfer of responsibility and accountability for specific nursing tasks to another individual, while the nurse retains overall responsibility for the outcome.
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Who can RNs delegate tasks to?
RNs can delegate tasks to LPNs and UAPs, based on their respective scopes of practice and the patient’s condition.
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What factors should RNs consider when delegating tasks?
RNs should consider the patient’s condition, the complexity of the task, the potential risks involved, and the capabilities of the individual to whom the task is being delegated.
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What tasks can LPNs perform?
LPNs can perform routine tasks with predictable outcomes, such as administering non-high-risk medications, providing NG tube feedings, performing wound dressing changes, monitoring blood products, and inserting urinary catheters.
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What additional tasks can LPNs perform with further education and certification?
With additional education and certification, LPNs may be authorized to administer maintenance IV fluids, IV medications via piggyback, and monitor infusions of IV fluids.
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What tasks can UAPs perform?
UAPs can assist with ADLs, such as eating, bathing, toileting, and ambulating, and perform routine procedures that do not require clinical judgment, such as taking vital signs and monitoring intake and output.
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What tasks cannot UAPs perform?
UAPs cannot conduct patient assessments, delegate tasks, provide patient education, or perform tasks that require clinical expertise, such as administering medications, providing tube feedings, and performing wound care.
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Why is delegation important in nursing?
Delegation allows RNs to focus on more complex tasks and patient care activities that require their expertise, while UAPs and LPNs can provide support and perform routine tasks, optimizing the use of healthcare resources and improving patient care efficiency.