Delegation in NCLEX Preparation

Delegation Overview

• Presentation by Susan Blake, Kaplan Nursing Instructor.

• Focus on delegation in context of NCLEX exam (18% of exam).

Objectives

• Identify RN scope of practice for NCLEX.

• Identify LPN, LVN, and UAP scope of practice.

• Recognize nursing interventions for scope of practice violations emphasizing client safety.

Client Assignment Examples

• Appropriate LPN assignments: Stable patients with predictable outcomes (e.g., Clients 1, 3, 6).

• Appropriate RN assignments: Unstable patients requiring assessments (e.g., Clients 2, 4, 5).

• UAP tasks: Assist with ADLs and basic vital sign checks for stable clients.

Kaplan Decision Tree Steps for Questions

1. Identify the Topic: Establish need for intervention regarding scope of practice.

2. Determine the Question Type: Use elimination strategy for evaluation questions.

3. Analyze Outcomes: Select incorrect actions based on scope of practice.

RN Scope of Practice

• Only RN can:

  • Perform patient assessments.

  • Plan care and initial teaching.

  • Care for unstable clients.

• Important nursing functions include measuring vital signs and assessing post-procedure patients (e.g., after cardiac catheterization).

Five Rights of Delegation

1. Right Task: Ensure task can be appropriately assigned to UAP/LPN.

   • Example: UAP can do bed baths; cannot do discharge teaching.

2. Right Person: Task must be within receiver's scope of practice.

3. Right Circumstances: Consider client stability before delegating tasks.

4. Right Communication: Provide clear instructions.

5. Right Supervision: Monitor performance of the task and ensure it's done correctly.

LPN, LVN, and UAP Scope of Practice

• LPN/LVN: Care for stable clients, can administer routine medications, unable to handle unstable clients.

• UAP: Performs ADLs and collects non-complex data, cannot make assessments or judgments.

• Consider uniformity in UAP tasks (repetition and standardization).

Interventions for Scope of Practice Violations

• RNs must ensure safe care and check five rights of delegation.

• Follow nursing chain of command for reporting issues (abuse, confidentiality, legal, safety concerns).

• Unlicensed assistants cannot delegate their tasks.

Recap of Learning Objectives

• Identified RN, LPN/LVN, and UAP scopes of practice for NCLEX.

• Discussed appropriate interventions for scope of practice violations focused on client safety.