HESI Exit (RN)

Delegation is the transfer of responsibility for performing a nursing task from a licensed nurse to a competent individual while retaining accountability for the outcome. Effective delegation is essential for safe, efficient patient care delivery in healthcare settings.

The National Council of State Boards of Nursing (NCSBN) identifies five rights that guide appropriate delegation decisions.

Registered Nurses (RNs) can perform all nursing functions including assessment, diagnosis, planning, implementation, and evaluation. RNs are responsible for tasks requiring specialized nursing knowledge and clinical judgment.

Licensed Practical Nurses (LPNs/LVNs) work under RN or physician supervision. They can perform focused assessments, administer most medications (with some state-specific restrictions on IV push medications), reinforce teaching, and provide direct patient care. LPNs cannot perform initial assessments, develop care plans, or evaluate patient responses to interventions.

Unlicensed Assistive Personnel (UAP) includes nursing assistants, patient care technicians, and certified nursing assistants. UAP can perform routine tasks such as vital signs on stable patients, hygiene care, ambulation assistance, intake and output measurement, and specimen collection. UAP cannot assess, interpret data, administer medications, or perform any task requiring nursing judgment.

Assessment and reassessment of patient status require professional nursing judgment and cannot be delegated. Initial patient assessments, pain assessments, and evaluation of patient responses must be performed by licensed nurses.

Nursing diagnosis involves clinical judgment based on assessment data and remains exclusively within the RN scope of practice.

Care planning requires analysis and synthesis of patient data to develop individualized interventions.

Patient and family teaching requires assessment of learning needs, development of teaching plans, and evaluation of understanding.

Evaluation of patient outcomes requires comparison of patient status to expected outcomes and modification of the care plan.

Any task requiring sterile technique, complex procedures, or unstable patient monitoring should not be delegated to UAP.

Direct supervision means the nurse is physically present and observes the task being performed. This is required for new staff, complex procedures, or when delegatee competence is uncertain.

Indirect supervision means the nurse is available for consultation and monitors outcomes without being physically present during task performance. This is appropriate for experienced staff performing routine tasks.

Effective supervision includes initial direction, periodic check-ins, availability for questions, and outcome evaluation. The nurse must intervene immediately if patient safety is compromised.