🚦 Who Do You See First? · Lesson 5 of 6 · 7 min
The Five Rights of Delegation
👥 You cannot do it all, and the exam knows it. It will hand you a nursing assistant and a practical nurse and ask what you can give away. Give the wrong thing and the client gets hurt. Keep everything and the unit collapses.
💡 Key idea
Delegate the stable and the predictable. Keep assessment, teaching, evaluation, judgment and unstable clients. The RN remains accountable for the outcome.
🧠 Why it matters
The FIVE RIGHTS OF DELEGATION: right TASK, right CIRCUMSTANCE, right PERSON, right DIRECTION and communication, right SUPERVISION and evaluation. The RN never delegates the nursing process itself: initial ASSESSMENT, care PLANNING, initial TEACHING, EVALUATION of outcomes, and any NURSING JUDGMENT. UNLICENSED ASSISTIVE PERSONNEL (UAP) can do routine, predictable tasks for stable clients: hygiene, feeding, ambulating, turning, intake and output, vital signs on stable clients, and reporting what they see. An LPN/LVN cares for STABLE clients with PREDICTABLE outcomes: oral and many injectable medications, sterile dressing changes, reinforcing teaching the RN already gave, and focused data collection. Unstable clients, new admissions, clients with changing conditions and anything requiring an initial assessment stay with the RN. Rules on LPN IV medications and blood products vary by state, so the exam avoids those edge cases.
🏥 In the real world
🧯 An RN delegates 'take vital signs on the new admission with chest pain' to a UAP. The UAP records a heart rate of 134 and moves on to the next room. Nobody assesses the client for 40 minutes. The task was routine, but the CIRCUMSTANCE was not: a new, unstable client needs the RN's assessment. Delegation is about the client's stability, not the task's simplicity.
📌 Takeaways
- RN keeps assessment, planning, teaching, evaluation and judgment
- UAP: ADLs, vital signs and I&O on STABLE clients, and reporting
- LPN: stable, predictable clients; meds; reinforcing teaching
📖 Terms in this lesson
Delegation: Assigning a task to another person while the registered nurse remains accountable for the outcome.
Five rights of delegation: Right task, right circumstance, right person, right direction and right supervision.
Unlicensed assistive personnel (UAP): Staff such as nursing assistants who do routine, predictable tasks for stable clients under the nurse's direction.
✅ Test yourself
Which task is appropriate to delegate to unlicensed assistive personnel?
- Evaluating whether a client's pain medication was effective
- Teaching a newly diagnosed client how to use an inhaler
- Assisting a stable client with a bath and a walk in the hall
- Assessing a client who has just returned from surgery
Answer: C · Assisting a stable client with a bath and a walk in the hall
Hygiene and ambulation for a stable client are routine, predictable tasks. The other three are assessment, teaching and evaluation, which stay with the RN.
Which client is most appropriate to assign to an LPN/LVN?
- A client whose blood pressure has dropped 30 points this shift
- A client requiring initial diabetes education
- A client with stable COPD receiving scheduled oral medications
- A client admitted an hour ago with chest pain
Answer: C · A client with stable COPD receiving scheduled oral medications
LPNs care for stable clients with predictable needs and administer routine medications. The others are unstable or need initial RN assessment or teaching.
A UAP reports that a client's oxygen saturation is 86%. What is the RN's responsibility?
- Document the value and continue with other tasks
- Ask the UAP to recheck in an hour
- Delegate oxygen titration to the UAP
- Assess the client personally
Answer: D · Assess the client personally
An abnormal finding changes the circumstance. The RN must assess and intervene; UAPs cannot assess or adjust oxygen.
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