Looking for some help with delegation.

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I'm in my last semester, and delegation is giving me the most trouble I've had in nursing school. You know, the questions like "You have patient A, B, C, and D, who do you assign the LPN too?" While the only thing they really tell us is, LPNs cannot push meds, they can't teach, can't do shift assessments, and can't discharge. Those are what I know for fact, but does anyone know of any websites who might give me some insight on delegating? Its kinda hard to know what an RN can delegate for sure or not, because in clinical you see LPNs doing shift assessments, teaching, I've even seen them do pushes. I'm afraid when I take a test I'm gonna look at answers and think "I've seen an LPN do that" and get the question wrong. Anyone have any helpful websites that have lits of things an RN definitely cannot delegate to an LPN?

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Specializes in med/surg, telemetry, IV therapy, mgmt.

the general guidelines of delegation are:

  • primary concern is to make sure that the patient is safe
  • you must know the job descriptions and abilities of the healthcare personnel and subordinates who you supervise
  • you must know facility policies and procedures
  • you must know your nurse practice act
  • you must delegate tasks to those who you know are capable of performing what you are assigning them to do
  • you base tasks that you delegate to others on your knowledge of the state nurse practice act, facility policies and facility job descriptions.
  • give directions for the task that are clear in order to avoid misunderstandings
  • give a deadline when you expect the task to be completed
  • ask the person to repeat back instructions to verify they have the directions correct if you suspect they do not understand what you are asking them to do
  • follow-up to make sure the task was completed correctly and by the deadline in order to evaluate the performance of the task (this is your supervision function)
  • provide praise when tasks are done well and within deadlines; provide feedback and criticism when necessary
  • assign same tasks to the same individuals if possible

you need to clarify with your instructors if your school tests are going to incorporate aspects of the state nursing law that pertains to what lpns in your state can and can't do. if they say "yes". have them delineate what those specifically are. the nclex is going to be very general because is it given in all 50 states and some states still don't allow their lpns to touch ivs or iv meds so the nclex can't fairly include that as an answer choice.

these questions of delegation involve critical, rational thinking. i listed the guidelines of delegation above, but there is one very important element that isn't there that i told every one of the new grads that i ever precepted: there are certain things that only you can do (these are dictated by state and federal law as well as facility policy) and certain things that only you are going to want to do for your own reasons. everything else can be delegated. you generally assign lpns patients that are more difficult than you would give to a cna. lpns can do most nursing procedures, so you assign patients needing nursing procedures to lpns. who said lpns can't teach? the rn develops the teaching plan, but the lpn can reinforce the teaching, follow up on it and have the patient do return demonstrations. they can also assess. you either do an initial exam and instruct them to report any change or abnormality that they find immediately and have them assess and then follow up and verify their findings. i worked for many years with lpns because the hospitals did not even consider hiring cnas or nursing assistants. they passed meds and did assessments for us. it was up to us to also get in and verify their assessment findings. our lpns also gave meds and did treatments. you know what their gripes were? they often complained that they felt like they were doing the rns job and not getting paid for it! the rns who did follow up on what the lpns were doing for them were accused of being tyrants and not trusting their lpns. go figure. most lpns are taught how to do basic assessment and how to teach many different nursing procedures. now why do you suppose that is?

anyone have any helpful websites that have lists of things an rn definitely cannot delegate to an lpn?

for your state, specifically, go to your state nursing law, or there might be a position paper or a faq question on their website that will answer this for you. in general, and according to federal law, lpns cannot plan care. that means the writing and determination of the nursing care plan. they can, however, contribute to it and many lpns learn how to write a care plan. it is within their scope of practice to know how to carry the plan out. rns are the managers of patient care. and, like in any business, you are going to see good and bad management in your clinical experiences.

these are the websites i have on delegation:

these are books on delegation and prioritizing i don't know which specifically have any delegation stuff in them except for the last one listed:

  • critical thinking in nursing: a cognitive skills workbook
    by saundra k. lipe and sharon beasley. runs about $36.

  • strategies, techniques, and approaches to thinking: critical thinking cases in nursing
    by sandra luz martine de castillo. runs about $35.

  • winningham and preusser's critical thinking in medical-surgical settings: a case study approach
    by barbara a. preusser. runs about $34.

  • prioritization, delegation and assignment
    by linda lacharity

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