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Difficulty: HardAssignment, Delegation and Supervision

An experienced registered nurse (RN) and a licensed practical nurse (LPN/VN) are partnered to provide care on an inpatient oncology floor. The RN is reviewing the morning task list. Which of the following interventions are appropriate for the RN to delegate to the LPN/VN? Select all that apply.

  1. Administering a scheduled intramuscular antiemetic to a client experiencing chemotherapy-induced nauseaAnswer
  2. B
    Completing the admission physical assessment for a client transferred from the emergency department with neutropenic fever
  3. C
    Titrating a continuous intravenous infusion of morphine based on prescribed parameters for a client receiving palliative care
  4. Reinforcing prior education about infection prevention measures for a client with severe neutropenia preparing for dischargeAnswer
  5. E
    Evaluating a client's physiological response to a newly prescribed breakthrough oral analgesic
  6. Inserting an indwelling urinary catheter for a client experiencing acute urinary retention secondary to a pelvic tumorAnswer

Answer

The RN can safely delegate administering the intramuscular antiemetic, reinforcing prior education about infection prevention, and inserting the indwelling urinary catheter.
The RN safely delegates tasks that have predictable outcomes and do not require independent nursing judgment. The LPN/VN scope of practice legally includes administering standard oral, intramuscular, and subcutaneous medications; performing routine sterile procedures such as urinary catheterization; and reinforcing education that was initially provided and documented by the RN. Therefore, delegating the administration of the antiemetic, the insertion of the Foley catheter, and the reinforcement of infection prevention education is appropriate.

Step-by-Step Solution

1
Identify the legal and professional scope of practice for a Licensed Practical Nurse (LPN/VN).
The LPN/VN scope includes performing predictable, routine tasks, administering standard medications (excluding high-risk IV push or continuous titrations), performing sterile procedures, and reinforcing established teaching.
Understanding scope of practice limits is the foundation of safe delegation.
2
Determine which tasks require the RN's specific, non-delegable competencies.
The RN cannot delegate the core nursing process elements: Evaluation, Assessment, and primary Teaching (often remembered by the acronym EAT).
These tasks demand advanced, independent nursing judgment and critical thinking.
3
Analyze each proposed task to ensure it does not cross into the RN's exclusive scope.
Initial admission assessments, titrating high-alert continuous IV drips, and evaluating the clinical effectiveness of a newly prescribed treatment are strictly RN responsibilities. The remaining tasks align with LPN/VN competencies.
Applying specific delegation rules to the clinical scenario ensures safe client care and regulatory compliance.

Key Concept

Delegation to the Licensed Practical Nurse (LPN/VN) requires adherence to scope of practice guidelines; LPN/VNs can manage routine care, standard medication administration, sterile procedures, and teaching reinforcement, but cannot perform initial assessments, evaluate clinical responses, provide primary education, or manage unstable IV therapies.
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Assignment, Delegation and Supervision

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