Which of the following tasks would you be willing to delegate to a nursing assistive personnel or licensed practical nurse/licensed vocational nurse? Use your state’s Nurse Practice Act or a decision tree created by the National Council of State Boards of Nursing or a State Board of Nursing as a reference for this case.
Uncomplicated wet-to-dry dressing change on a patient 3 days post-hip replacement
Every 2 hours checks on a patient with soft wrist restraints to assess circulation, movement, and comfort
Cooling measures for a patient with a temperature of 104°F
Calculation of intravenous (IV) credits, clearing IV pumps, and completing shift intake/output totals
Completing phlebotomy for daily drawing of blood
Holding pressure on the insertion site of a femoral line that has just been removed
Educating a patient about components of a soft diet
Conducting guaiac stool tests for occult blood
Performing electrocardiographic testing
Feeding a patient with swallowing precautions (high risk of choking post-cardiovascular accident [CVA])
Oral suctioning
Tracheostomy care
Ostomy care
Key Takeaway: The ultimate decision rests with the Registered Nurse, who is accountable for ensuring the delegated task is appropriate for the individual patient's stability and the delegatee's competence, as required by the state's Nurse Practice Act. The LPN/LVN scope typically includes stable, routine tasks requiring technical skill, while the RN retains tasks requiring complex assessment, teaching, or judgment in unstable situations.Key Takeaway: The ultimate decision rests with the Registered Nurse, who is accountable for ensuring the delegated task is appropriate for the individual patient's stability and the delegatee's competence, as required by the state's Nurse Practice Act. The LPN/LVN scope typically includes stable, routine tasks requiring technical skill, while the RN retains tasks requiring complex assessment, teaching, or judgment in unstable situations.
Sample Answer
When considering delegation to Nursing Assistive Personnel (NAP) or Licensed Practical Nurses/Licensed Vocational Nurses (LPN/LVNs), the decision must strictly adhere to the Nurse Practice Act (NPA) of the specific state, organizational policy, and the Five Rights of Delegation (Right Task, Right Circumstance, Right Person, Right Direction/Communication, Right Supervision/Evaluation).
Since a specific state NPA cannot be consulted, the analysis below is based on the general scope of practice defined by the National Council of State Boards of Nursing (NCSBN) principles and common state regulations, which often categorize tasks based on their requirement for complex assessment, clinical judgment, or sterile technique.