Five Rights of Delegation
(1) Right TASK: task can be delegated by policy and is within delegatee's scope. (2) Right CIRCUMSTANCE: appropriate setting and available resources. (3) Right PERSON: delegatee is competent, trained, and comfortable. (4) Right DIRECTION: clear, specific instructions provided. (5) Right SUPERVISION: RN monitors, evaluates, and remains accountable. Delegation does not transfer accountability — the RN remains responsible.
RN Scope of Practice
Cannot be delegated: initial assessment, nursing diagnosis, care planning, patient teaching, evaluation of outcomes, situations requiring nursing judgment, unstable patients, complex care, phone orders, medication administration requiring assessment (e.g., titration). RN can delegate tasks but NOT nursing judgment. Always: assess before delegating; supervise and evaluate.
LPN/LVN Scope
Can perform: routine assessments (not initial/complex), dressing changes, catheter care, routine medications (oral, SQ, IM — NOT IV push in most states), wound care, suctioning (established), monitoring and reporting. Under RN supervision. Cannot: perform initial assessment, care planning, IV push medications, blood transfusions. State practice acts vary — know your state.
UAP Scope
Unlicensed Assistive Personnel (CNA, PCT, PCA). Can perform: ADLs (bathing, feeding, toileting, positioning), vital signs (stable patients), I&O, ambulation with stable patients, specimen collection (non-invasive), transport. Cannot: perform any assessment, administer medications, document clinical findings (except I&O in some settings), perform sterile procedures. Must report ALL observations to RN.
NCLEX Delegation Questions
Safest to delegate to UAP: stable patient, routine task, predictable outcome, no clinical judgment required. Delegate to LPN: stable patient, established care, no complex assessment. Keep for RN: unstable, new diagnosis, complex assessment, teaching, judgment required. Wrong answer patterns: delegating complex/unstable patients to LPN/UAP, delegating assessment to anyone other than RN.
Important Notes
- The RN is ALWAYS accountable for delegated tasks — delegation transfers responsibility, not accountability.
- Never delegate the initial assessment of a new admit — always RN.
Clinical Tips
- STABLE + ROUTINE + PREDICTABLE = safe to delegate to UAP.
- On NCLEX: "Which task should the nurse delegate?" — ask "Does this require nursing judgment?" If yes → RN only.
Summary
Safe delegation requires application of the five rights, understanding of scope of practice for each provider level, and continuous RN supervision. NCLEX delegation questions test safe, legal, and ethical nursing practice.
