NCLEX-RN

Management of Care is the largest client needs category on the NCLEX-RN, at 15–21% of scored items. It measures the nurse's ability to provide and direct nursing care that enhances the care delivery setting to protect clients and health care personnel: delegating and supervising safely, practicing within ethical and legal boundaries, advocating for clients, setting priorities, and managing resources. Expect "which client first," "which task can be delegated," and "what should the nurse do" items built around realistic unit scenarios.

Principles of Delegation

Delegation is the transfer of responsibility for performing a nursing activity to another person while retaining accountability for the outcome. The registered nurse keeps ultimate accountability no matter who performs the delegated task. The Five Rights of Delegation guide every decision.

Right	WhattheRNConsiders
Righttask	Thetaskcanbedelegatedunderthestatenursepracticeactandinstitutionalpolicy
Rightcircumstance	Theclient'sconditionisstableandtheresourcesandsettingareappropriate
Rightperson	Thedelegatehastheeducation training anddemonstratedcompetencyforthisspecifictask , ,
Rightdirectionand	Clear conciseinstructions expectedoutcomes timeframes andwhattoreport , , , ,
communication
Rightsupervisionand	Appropriate monitoring feedback and follow-up evaluation of the outcome , ,
evaluation

Scope of Practice Considerations

RNs delegate based on the delegate's scope of practice, education, training, and demonstrated competency. The tasks that remain with the RN are those that require assessment, clinical judgment, or evaluation.

Role	TypicalTasks
Unlicensedassistive	Vitalsignsonstableclients hygieneandbathing ambulation positioning feedingclientswithout , , , ,
personnel(UAP)	swallowingrisk measuringandrecordingintakeandoutput ,
Licensedpracticalnurse	Medicationadministrationandwoundcareforstableclients datacollection reinforcingteachingtheRN , ,
(LPN/LVN)	hasprovided allunderRNsupervision ,
Registerednurseonly	Initialandadmissionassessments nursingdiagnoses careplandevelopment initialclientteachingthat , , ,
	requiresprofessionaljudgment evaluationofclientresponses IVmedicationadministration initiating , , ,
	bloodtransfusions andacceptingtelephoneorders ,

Supervision Levels

Direct supervision requires the RN to be physically present while the task is performed. Indirect supervision means the RN is available but not immediately present. The level depends on task complexity, client stability, and the delegate's competency. Effective supervision includes clear instructions, expected time frames, defined parameters for reporting findings, and follow-up evaluation, and documentation reflects both the delegation decision and the supervision provided.

Assignment Considerations

Assignments consider client acuity, staff competencies, and continuity of care. Complex clients who need frequent assessment belong with experienced staff; stable clients with predictable outcomes may be assigned to less experienced nurses with adequate supervision. Grouping clients geographically saves travel time, balanced workloads prevent burnout and errors, and client preference and cultural considerations are honored when feasible.

If a task involves assessing, teaching, or evaluating, or the client is unstable or unpredictable, it stays with the RN. UAPs handle routine, standard, unchanging tasks; LPNs handle stable clients with predictable outcomes.

Ethical Principles

Principle	MeaninginPractice
Autonomy	Respectingtheclient'srighttomakeinformeddecisionsaboutcare includingchoicesthenurse ,
	disagreeswith;thenursesupportsthisbyprovidingcompleteinformation
Beneficence	Acting in the client's best interest; guides interventions that promote well -being and positive outcomes
Nonmaleficence	Avoidingharmthroughactionsoromissions
Justice	Fairdistributionofresourcesandequitabletreatmentregardlessofpersonalcharacteristics;advocating
	forequalaccessandchallengingdiscriminatorypractices
Veracity	Truthfulnessinallcommunicationwithclientsandcolleagues
Fidelity	Faithfulnesstocommitmentsandpromises;maintainingtrustrelationships
Confidentiality	Protectingclientinformationfromunauthorizeddisclosure

Legal Frameworks

Nurse practice acts are state laws that define the scope of nursing practice, set licensure requirements, establish professional boundaries, and outline disciplinary procedures. Standards of care describe the care a reasonably prudent nurse would provide under similar circumstances; they come from professional organizations, institutional policies, and established practice, and deviation from them may constitute negligence.

Malpractice occurs when a nurse breaches the duty of care owed to a client and causes harm. Its four elements are duty, breach, causation, and damages. Documentation provides evidence of the care given and supports a legal defense.

➜

➜

➜

A nurse–client relationship exists

Care falls below the standard

The breach caused the injury

Actual harm resulted

Informed Consent

Valid informed consent requires disclosure of relevant information, client comprehension, a voluntary decision, and decision-making capacity. The provider performing the procedure explains its risks, benefits, and alternatives. The nurse witnesses the signature, verifies understanding, and advocates for clients who appear confused or coerced. Emergencies may permit treatment without consent when delay would cause serious harm. Minors generally cannot consent except emancipated minors or for specific services such as reproductive health care; clients who lack capacity need a surrogate decision-maker; and advance directives guide care when clients cannot communicate their wishes. (Consent is covered in more depth in Section 7.3.)

Mandatory Reporting

Suspected abuse of children, older

Communicable diseases reported to

Colleagues whose practice endangers

adults, and vulnerable adults, including

public health authorities for

clients because of substance use,

physical abuse, neglect, emotional

surveillance and outbreak control (lists

impairment, or practice deficiencies are

abuse, and exploitation. Good-faith

vary by jurisdiction), and certain

reported to the licensing board through

reporters are protected from liability.

injuries, such as gunshot wounds,

the chain of command.

reported to law enforcement.

Client Advocacy