Mastering Nursing Delegation skills for NCLEX-RN

Proper delegation is a skill in itself. Whether it’s delegating tasks to a Licensed Practical Nurse (LPN) or a Certified Nursing Assistant (CNA), delegation done right ensures better patient care. This speaks for the significance of mastering delegation. However, we have noticed many of our students struggling with this concept. Hence, we have put together this blog to help them master the concept of delegation. We will also share strategies to approach delegation nursing NCLEX questions the right way.

What is Delegation?

Delegation is a common topic in many NCLEX online coaching classes. But what exactly does it entail?

The term ‘delegation’ means to give someone the power to act on behalf of another. In healthcare, delegation allows a registered nurse (RN) to assign specific tasks to other healthcare team members. In other words, an RN can assign tasks to an LPN or CNA.     

Delegation demonstrates leadership and good judgment. An RN needs this skill to ensure the best patient care. Indeed, both the registered nurses as well as patients stand to gain from proper delegation of tasks. Some of these benefits of delegation are listed below:

• Frees up the RN to care for other critical patients.
• Each patient gets better care.
• Improves the teamwork of the healthcare team.
• Gives your team a chance to grow and sharpen their skills.
• Decreases the chance of burnout for all members.
• Improves job satisfaction.
• Builds trust.

Principles in Delegation

To make delegation of authority effective, managers need to follow certain principles. These are some principles of delegation

1. The Five Rights of Delegation

• Right Task: Ensure the task is appropriate for delegation based on patient condition and staff competence.
• Right Circumstance: Only delegate when the patient’s condition is stable and the task does not require clinical judgment.
• Right Person: Delegate to individuals who have the necessary training, knowledge, and skills.
• Right Direction/Communication: Provide clear, specific instructions and expectations, ensuring the delegatee fully understands.
• Right Supervision/Evaluation: Monitor the delegatee’s progress, provide feedback, and assess outcomes.

2. Accountability and Responsibility

• The RN retains accountability for the overall care plan and the outcomes of the delegated task.
• Delegate tasks only to individuals who are competent and confident in performing them.
• Ensure continuous supervision and support, intervening as necessary.

3. Building Trust and Teamwork

• Delegation requires a relationship of mutual trust between the RN and team members.
• Promote an environment where staff feel comfortable seeking clarification or reporting challenges.
• Use delegation as an opportunity to develop team members’ skills and confidence.

4. Recognizing Limitations

• Avoid delegating tasks requiring critical thinking, clinical judgment, or nursing assessments.
• Do not delegate activities that require specialized knowledge, such as patient education or managing a deteriorating patient.

5. Effective Supervision

• Regularly check on progress and provide guidance as needed.
• Evaluate outcomes and use them as a basis for improving future delegation practices.
• Offer feedback and acknowledgment to foster staff motivation and growth.

Delegation of Tasks

Tasks Delegated to a UAP

UAPs provide essential support in patient care. Tasks typically delegated to UAPs include:

• Wellness Care: UAPs can assist clients with hygiene (bathing and toileting) as well as feeding.
• Assisting with Ambulation: Helping clients move safely prevents falls and encourages mobility, aiding in recovery and well-being.
• Vital Signs and Monitoring: While UAPs can take vital signs and obtain blood glucose levels, RNs must interpret these measurements and decide on care adjustments.

Tasks Delegated to an LPN/VN

Licensed Practical Nurses and Vocational Nurses handle more complex tasks than UAPs, such as:

• Medication Administration: LPNs can administer most medications, excluding high-risk medications that require precise titration or special monitoring.
• Basic Wound Care: LPNs can perform wound dressing changes or manage uncomplicated wounds.
• Patient Monitoring: LPNs can monitor clients post-surgery or during treatment, reporting changes to RNs for further assessment.

Tasks Delegated to an RN

Registered nurses have the skillset to perform a wide range of complex tasks, including:

• Initial Assessments: RNs conduct comprehensive assessments to establish baseline data and develop care plans.
• Patient Education: Educating clients and families about care plans, medications, and procedures.
• Complex Medication Administration: Administering intravenous (IV) push medications, high-risk, or those requiring titration is typically reserved for RNs due to potential risks.

Tasks That Cannot be Delegated

Some tasks can only be carried out by an RN. These tasks cannot be delegated under any circumstance. Any task that requires TAPE cannot be delegated. TAPE is a mnemonic for Teaching, Assessment, Planning, and Evaluating. If the tasks require these, delegation is not possible. 

The following are some further examples of tasks that cannot be delegated:

• Initial assessment of patients.
• Evaluation of patient data.
• Nursing diagnosis or nursing care planning.
• Charting.
• Patient/family education.
• Invasive procedures.

How to Approach a Delegation Question in NCLEX-RN

When you get a delegation question in the NCLEX-RN how would you approach it? The CNA and LPN can only perform basic tasks. The question might ask you to choose a task that can be safely delegated to an LPN or CNA. The options might confuse you, but relax. There’s an easy way to approach each question. Let us guide you:

• Eliminate all tasks that require TAPE (Teaching, Assessment, Planning, Evaluating).
• Eliminate tasks that include invasive procedures.
• Eliminate tasks with the words ‘teach’, ‘educate’, ‘assess’, or ‘explain’.
• Eliminate complex cases and critical patients.
• Eliminate fresh post-op cases.
• Eliminate unstable patients.

You can use this strategy when faced with any delegation nursing NCLEX questions. 

A Few Things to Remember

• The LPN and CNA can only handle stable patients with predictable conditions.
• The CNA can only handle basic tasks like housekeeping, stocking, bathing, turning, and mouthcare.
• The LPN can gather data, perform routine procedures, and reinforce the teachings of the RN.

Keep these points in mind as you approach a delegation question. Also make sure to work with an online NCLEX-RN review resource to reinforce your knowledge.

Examples

Example 1: Prioritizing Care in a Multi-Patient Assignment

An RN is managing a medical-surgical unit with a mix of stable and unstable patients. The RN assigns the care of two stable postoperative patients to the LPN. These patients require routine medication administration and basic wound care. The RN retains responsibility for a critically ill patient who requires frequent monitoring, titration of IV medications, and assessments. This prioritization ensures that complex tasks requiring clinical judgment are handled by the RN, while routine care is safely assigned to the LPN.

Example 2: Delegating Non-Clinical Tasks to UAPs

During a busy shift, the RN delegates non-clinical tasks such as assisting patients with bathing, feeding, and ambulation to the UAP. The RN provides clear instructions, such as reporting any changes in the patient’s condition (e.g., difficulty breathing during ambulation). This delegation allows the RN to focus on higher-priority clinical tasks, such as administering medications and assessing unstable patients.

Example 3: Managing a Patient Discharge

The RN is preparing a patient for discharge. The RN retains responsibility for providing discharge teaching, including medication instructions and follow-up care, as this task requires clinical judgment and patient education. RN delegates the task of gathering the patient’s belongings and escorting them to their transportation to the UAP. This ensures efficient workflow while maintaining high-quality patient care.

Example 4: Handling a Code Situation

During a cardiac arrest in the unit, the RN takes charge of the situation, directing the resuscitation efforts and administering critical medications. The RN delegates tasks such as compressions to a trained UAP and asks an LPN to monitor and document the patient’s vital signs and response during the event. Effective communication and supervision ensure that each team member performs their role appropriately, contributing to the patient’s survival.

Example 5: Delegating Routine Procedures

The RN assigns the task of inserting a urinary catheter for a stable patient to the LPN, as this task falls within the LPN’s scope of practice. The RN ensures the LPN understands the procedure and the expected outcomes. After the task is completed, the RN evaluates the patient’s response to the intervention, maintaining accountability for the overall care.

Practice Questions

Question 1

A registered nurse (RN) is delegating tasks to a licensed practical nurse (LPN) and unlicensed assistive personnel (UAP). Which task should the RN delegate to the UAP?

A. Administering oral medications to a stable patient
B. Performing a sterile dressing change on a post-operative patient
C. Assisting a patient with ambulation to the bathroom
D. Conducting a focused assessment on a patient with chest pain

Answer: C. Assisting a patient with ambulation to the bathroom

Explanation:

• UAP Scope of Practice: UAPs are trained to perform non-clinical, routine tasks that do not require clinical judgment, such as ambulating, bathing, and feeding patients.
• LPN Responsibilities: Administering oral medications (A) and performing sterile dressing changes (B) fall within the scope of LPN practice.
• RN Responsibilities: Conducting focused assessments (D) involves clinical judgment, which is the responsibility of the RN.
• Delegating ambulation to the UAP allows the RN to focus on tasks requiring higher-level decision-making.

Question 2

The RN on a medical-surgical unit is assigning patients to the care team. Which patient should the RN assign to the LPN?

A. A patient admitted with unstable angina who is scheduled for a stress test
B. A Client receiving IV chemotherapy with a history of allergic reactions
C. A patient requiring frequent blood glucose monitoring and insulin administration
D. A patient newly diagnosed with a pulmonary embolism receiving IV heparin

Answer: C. A patient requiring frequent blood glucose monitoring and insulin administration

Explanation:

• Stable Patient: LPNs can care for stable patients with predictable outcomes, such as monitoring blood glucose and administering subcutaneous insulin.
• Critical and Complex Care: Patients with unstable angina (A), potential chemotherapy reactions (B), or a new pulmonary embolism on IV heparin (D) require ongoing assessment and critical thinking, which are within the RN’s scope.
• Assigning stable patients to the LPN ensures safe delegation and prioritizes the RN’s role in handling higher-acuity cases.

Question 3

Which of the following statements indicates the RN understands the “Right Supervision/Evaluation” principle of delegation?

A. “I will provide detailed instructions to the LPN and let them complete the task independently.”
B. “I will verify that the task was completed correctly and provide feedback as necessary.”
C. “I will assume the LPN knows how to handle the task because they are experienced.”
D. “I will only follow up with the LPN if the patient complains about the task.”

Answer: B. “I will verify that the task was completed correctly and provide feedback as necessary.”

Explanation:

• Right Supervision/Evaluation: Delegation requires the RN to monitor the task’s completion, ensure it was performed correctly, and provide guidance or feedback as needed.
• Option A: While detailed instructions are important, supervision and follow-up are still necessary.
• Option C: Assumptions about the delegatee’s experience without verification can compromise patient safety.
• Option D: Waiting for a patient complaint to evaluate task performance neglects the RN’s responsibility for oversight.

REFERENCES

1. Journal of Nursing Regulation. (2022). National Guidlelines for Nursing Delegation [Ebook] (p. 8). Retrieved from https://www.ncsbn.org/NCSBN_Delegation_Guidelines.pdf
2. Assignment/Delegation retrieved from https://www.examples.com/nclex-rn/assignment-delegation

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