Lesson: Safe Delegation and Task Assignment for LPNs in the NCLEX® PN Exam
- Delegation Principles and Client Assignments
- Understand the role and responsibilities of LPNs/LVNs in delegation and task assignment.
- Recognize that tasks should be delegated based on the individual’s level of expertise and licensure.
- Assign tasks to assistive personnel (AP) that are appropriate for their skill level and within their scope of practice.
Below is a table outlining the general scope of practice for CNAs (Certified Nursing Assistants) or UAPs (Unlicensed Assistive Personnel), LPNs (Licensed Practical Nurses) or LVNs (Licensed Vocational Nurses), and RNs (Registered Nurses). Please note that the scope of practice may vary depending on individual state regulations and institutional policies.
| Role | Scope of Practice |
|---|---|
| CNA or UAP | – Basic care: bathing, dressing, grooming, ambulation, and feeding clients. |
| – Measuring and recording vital signs. | |
| – Assisting with mobility and transfers. | |
| – Changing linens and maintaining cleanliness in the client’s environment. | |
| – Reporting any changes in clients’ condition to the supervising nurse. | |
| LPN or LVN | – Performing assessments under the supervision of an RN. |
| – Administering medications (excluding some IV medications, depending on state regulations). | |
| – Monitoring and reporting changes in clients’ conditions. | |
| – Wound care and dressing changes. | |
| – Assisting with the development and implementation of care plans under the supervision of an RN. | |
| – Collaborating with the interdisciplinary team. | |
| – Supervising CNAs or UAPs. | |
| RN | – Conducting comprehensive client assessments. |
| – Developing, implementing, and evaluating care plans. | |
| – Administering a wide range of medications, including IV medications. | |
| – Performing advanced nursing procedures, such as starting IVs, administering blood products, and managing central lines. | |
| – Collaborating with the interdisciplinary team to coordinate and manage client care. | |
| – Supervising and delegating tasks to LPNs/LVNs, CNAs, and UAPs. | |
| – Providing client and family education. | |
| – Participating in quality improvement initiatives and evidence-based practice. |
By mastering these principles in your nursing practice, you can delegate tasks effectively, ensure efficient care delivery, and maintain a high level of client safety, ultimately helping you succeed in the NCLEX® PN exam.
- Appropriate Tasks for Assistive Personnel (AP)
- Examples of appropriate tasks for AP include:
- Ambulating clients who require assistance
- Answering call lights promptly
- Assisting with activities of daily living (ADLs)
| Activity of Daily Living (ADL) | Description | AP (Assistive Personnel) Responsibilities |
|---|---|---|
| Personal Hygiene | Assisting clients with grooming and maintaining cleanliness. | – Helping with bathing, showering, or bed baths. |
| – Assisting with oral care, including brushing teeth and denture care. | ||
| – Providing hair care, such as brushing, shampooing, and styling. | ||
| Dressing | Helping clients with dressing and undressing. | – Assisting clients in putting on or taking off clothing, including support with adaptive clothing. |
| Toileting | Assisting clients with using the toilet or managing incontinence. | – Helping clients get to the bathroom or providing bedpans or urinals. |
| – Assisting with perineal care and changing incontinence products. | ||
| Eating | Helping clients with feeding and maintaining proper nutrition. | – Assisting clients with eating, including cutting food or providing feeding assistance. |
| – Monitoring food intake and reporting concerns to the supervising nurse. | ||
| Mobility | Assisting clients with moving, transferring, and ambulation. | – Helping clients with repositioning in bed, turning, and maintaining proper body alignment. |
| – Assisting clients with transferring (e.g., from bed to chair) and using mechanical lifts if necessary. | ||
| – Encouraging and supporting clients during ambulation and providing assistance with walking aids. |
- Inappropriate Tasks for Assistive Personnel (AP)
- Examples of inappropriate tasks for AP include:
- Witnessing clients signing procedure consent forms
- Assessing clients’ understanding of instructions
- Performing nursing tasks that require the skill of a licensed nurse, such as dressing changes and medication administration
- Primary Responsibility of the Nurse after Delegation
- The ultimate responsibility for a delegated task lies with the person who delegated it.
- The nurse must follow up with each staff member regarding the performance and outcomes of the task.
- Ensure proper documentation of the completed task after evaluating the performance and outcomes.
- Pain Management and Assessment
- Recognize that pain is a highly individual experience and that the nurse should not assume a client is exaggerating their pain.
- Assess pain using a number-based scale or a picture-based scale for clients who cannot verbally describe their pain.
| Scale Type | Scale Name | Description |
|---|---|---|
| Number-Based Scale | Numeric Pain Rating Scale (NPRS) | Clients rate their pain on a scale of 0 to 10, with 0 indicating no pain and 10 being the worst pain possible. |
| Picture-Based Scale | Wong-Baker FACES Pain Rating Scale | Clients select a face that best represents their pain level, ranging from a smiling face (0, no pain) to a crying face (10, worst pain). |
These two scales, the Numeric Pain Rating Scale (NPRS) and the Wong-Baker FACES Pain Rating Scale, are commonly used to assess pain in clients. The NPRS is a number-based scale, while the Wong-Baker FACES scale is a picture-based scale suitable for clients who cannot verbally describe their pain or have difficulty understanding numeric scales.
- Be aware of how pain may manifest differently in older clients, such as sleep disturbances or depression.
- Provide appropriate interventions, both nonpharmacological and pharmacological, to manage pain and follow up with the client to ensure the effectiveness of the intervention.
By understanding these key concepts and applying them to nursing practice, LPNs/LVNs can effectively delegate tasks to assistive personnel and ensure the safety and well-being of their clients. Practicing questions related to these topics will help prepare for the NCLEX® PN exam.
Knowledge Check
Enroll TODAY in our NCLEX® PN – Next Generation Bilingual Review. Get ready with our Video Library, Study Calendars, and Question Banks!
See you in class!