Never delegate assessment, evaluation, teaching, or care of an unstable/unpredictable patient to an LPN or UAP.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A nurse is delegating tasks but remains accountable for the outcomes. Which statement best reflects the nurse's accountability in delegation?
Answer: A. The nurse who delegates remains accountable for the appropriateness of the delegation, adequate supervision, and the overall client outcome. Delegation does not transfer professional accountability to the UAP or LPN/LVN.
Question 2 of 5
A nurse is delegating to a UAP at the start of the shift. Which instruction reflects appropriate delegation?
Answer: B. Appropriate delegation includes a specific task, the parameters, and what to report. Telling the UAP to report a temperature above 38.5 degrees Celsius gives a clear limit and reporting expectation. Vague directions, delegating assessment-level judgment, or delegating teaching are inappropriate.
Question 3 of 5
The nurse delegates a task to UAP. Which statement reflects an appropriate element of the delegation process?
Answer: A. Effective delegation includes clear, specific directions and the expectation that the UAP reports findings back to the nurse. The nurse remains accountable for the outcome, so simply assuming completion or delegating without instruction is unsafe.
Question 4 of 5
After delegating a task to a UAP, the RN remains responsible for:
Answer: B. The RN retains accountability for the outcome and must supervise, follow up, and verify the task was done correctly. Delegation does not transfer the RN's accountability.
Question 5 of 5
A nurse delegates vital signs to a UAP but the client is unstable. The nurse should:
Answer: B. Unstable clients require RN assessment — the nurse takes/verifies the vitals and assesses the unstable client rather than relying on delegation, because interpretation and judgment are needed.
Keep the streak going with more questions like these, each with a full rationale.
What is delegation principles?
The RN cannot delegate the nursing process steps that require clinical judgment: assessment, analysis, planning, evaluation, and teaching. Safe delegation follows the Five Rights (right task, right circumstance, right person, right direction/communication, right supervision) and matches stable, predictable, routine tasks to the appropriate licensed or unlicensed staff.
Key points to remember
- The RN never delegates assessment, evaluation, nursing judgment, the initial teaching, or care of an unstable/unpredictable patient.
- LPN/LVNs can perform many stable tasks: administering most medications, routine dressing changes, tube feedings, and monitoring stable patients, but not IV push in many states, blood administration, or initial assessment.
- UAP/assistive personnel handle stable ADLs and basic data collection: bathing, feeding, ambulating, vital signs, intake/output, and positioning.
- Tasks delegated to UAP must be standardized, predictable, and have a known outcome with no need for nursing judgment.
- The Five Rights of Delegation are right task, right circumstance, right person, right direction/communication, and right supervision.
- Accountability for the outcome stays with the delegating RN even after the task is delegated.
Nursing priorities
- Assess patient stability and complexity first; keep unstable, newly admitted, or unpredictable patients and any first-time teaching for the RN.
- Match the task to the scope and competency of the person (RN, LPN/LVN, or UAP).
- Give clear, specific directions including what to do, expected outcomes, limits, and when to report back.
- Supervise, follow up, and verify the task was completed correctly and the patient's outcome.
- Evaluate the patient's response; the RN retains accountability regardless of who performed the task.
Red flags: report now
- Never delegate assessment, evaluation, teaching, or care of an unstable/unpredictable patient to an LPN or UAP.
- Do not delegate a task that exceeds the delegatee's legal scope of practice or documented competency.
- If a delegatee reports an abnormal finding or change, the RN must reassess; the UAP cannot interpret findings.
- The RN cannot transfer accountability by delegating; an unsafe delegation that harms a patient is the RN's responsibility.
References
Clinical references for this topic
