NCLEX-RN: Delegation

roser13, ASN, RN · Jan 26, 2013

1. Your list cannot be viewed (at least on my iPad).

2. Scopes of practice are state-specific, for the most part.

3. "I know that RNs floating from another unit are treated like LPNs."

I don't know how you "know" this, but if it's true, it's definitely specific to your facility.

BrandonLPN, LPN · Jan 26, 2013

I think she means that in NCLEX world float nurses are given the less acute/unstable patients. Also, in NCLEX world nurses have time to do everything perfectly by the book. And magical flying unicorns poop perfumed diamonds. It's a nicer place than the real world.

roser13, ASN, RN · Jan 26, 2013

BrandonLPN, I thought I knew everything there was to know about unicorns. And now I find that their poop is really perfumed diamonds?? Whoa!!(Sorry, OP)

BrandonLPN, LPN · Jan 26, 2013

Delegation questions in the NCLEX usually follow a predictable pattern. You'll have a nursing team that consists of a RN, a LPN and a UAP. You'll be given a list of four pts and asked who should be assigned to which pt.

For example:

pt A is a fresh post op who needs to be monitored closely for s/s of infection, bleeding, etc.

Pt B is a stable diabetic pt who needs numerous dressing changes for stasis ulcers on his legs.

Pt C is being discharged and has discharge instructions.

Pt D is a day 5 post op who needs help ambulating to the BR.

Who should be assigned to what

task?

Well, only the RN can be assigned to pts A and C because pt A needs a RN's assessment skills and pt C needs teaching. The LPN should be assigned pt B, because (in the NCLEX world) LPNs are utilized for tasks that require a nursing *skill* but not nursing assessment. A routine, scheduled dressing change on a stable pt falls into that category. The UAP should be assigned pt D because all this task is just custodial care. To assign the RN or LPN this task wouldn't be an efficient use of the nursing team.

Basically, only RNs can perform assessments, teaching or care for unstable pts.

UAP are used for hands-on care tasks that it would be a "waste" to assign to a licensed nurse. (Remember, NCLEX world)

LPNs are sort of stuck in the middle. They do tasks that ten UAP cannot, sterile dressing changes seems to be the NCLEX's favorite LPN duty. In NCLEX world LPNs care for stable pts with predictable outcomes and perform tasks that, while outside of the UAP's scope, are routine and unchanging and not requiring too much "nursing judgement".

itsdebraanne, ASN, RN · Jan 26, 2013

Delegation questions in the NCLEX usually follow a predictable pattern. You'll have a nursing team that consists of a RN, a LPN and a UAP. You'll be given a list of four pts and asked who should be assigned to which pt.
For example:
pt A is a fresh post op who needs to be monitored closely for s/s of infection, bleeding, etc.
Pt B is a stable diabetic pt who needs numerous dressing changes for stasis ulcers on his legs.
Pt C is being discharged and has discharge instructions.
Pt D is a day 5 post op who needs help ambulating to the BR.
Who should be assigned to what
task?
Well, only the RN can be assigned to pts A and C because pt A needs a RN's assessment skills and pt C needs teaching. The LPN should be assigned pt B, because (in the NCLEX world) LPNs are utilized for tasks that require a nursing *skill* but not nursing assessment. A routine, scheduled dressing change on a stable pt falls into that category. The UAP should be assigned pt D because all this task is just custodial care. To assign the RN or LPN this task wouldn't be an efficient use of the nursing team.
Basically, only RNs can perform assessments, teaching or care for unstable pts.
UAP are used for hands-on care tasks that it would be a "waste" to assign to a licensed nurse. (Remember, NCLEX world)
LPNs are sort of stuck in the middle. They do tasks that ten UAP cannot, sterile dressing changes seems to be the NCLEX's favorite LPN duty. In NCLEX world LPNs care for stable pts with predictable outcomes and perform tasks that, while outside of the UAP's scope, are routine and unchanging and not requiring too much "nursing judgement".

THIS IS HOW I LEARN WHEN PPL EXPLAIN THINGS LIKE YOU DO!! thank you soooo much

TxTnfan3 · Jul 12, 2013

I am taking the NCLEX-RN next week. I am going over my practice Kaplan Online Review exams. I am so confused. In one of their questions they say a Nursing Assistant can feed an alzheimer's pt. in another it says that requires the Assessment skills of an RN. Neither patient are new admits or have anything else going on. So can the N. A. be assigned to feeding the Alzheimer pt.? Also, I really thought a N.A. cannot give an enema. But one of the Kaplan questions says that because the RN gave specific directions of "come back and notify me of the description of the stool" that it was ok. I think Kaplan may be confusing me more…..

BrandonLPN, LPN · Jul 12, 2013

I am taking the NCLEX-RN next week. I am going over my practice Kaplan Online Review exams. I am so confused. In one of their questions they say a Nursing Assistant can feed an alzheimer's pt. in another it says that requires the Assessment skills of an RN. Neither patient are new admits or have anything else going on. So can the N. A. be assigned to feeding the Alzheimer pt.? Also, I really thought a N.A. cannot give an enema. But one of the Kaplan questions says that because the RN gave specific directions of "come back and notify me of the description of the stool" that it was ok. I think Kaplan may be confusing me more…..

Are you sure the book didn't say that patients with dysphagia should be fed by a licensed nurse, so that he/she can assess for swallowing difficulty? I can't imagine why it would need to be a nurse if the only problem noted was alzheimers.

Also, in most facilities, aides can give non-medicated enemas. It surprises me a little that the NCLEX says they can, though, considering it's an invasive procedure. But I remember the review saying they can as well....

classicdame, MSN, EdD · Jul 12, 2013

unlicensed people do not have a scope of practice. They can only do what is delegated to them and what they are able to do per education, training and competency (so charge nurse needs to know these three things). Texas has an algorithim for delegation that fits their NPA. Maybe it will help you. www.bon.state.tx.us. Just put delegation in the search window.

TxTnfan3 · Jul 12, 2013

I will look up the Alzheimer questions again in a few hours. I'm pretty sure I read them back & forth. But I occasionally do miss strategic words. The enema question was in the review of questions online by the Kaplan head of nursing. I looked in my 2013 Leadership & Management book. Sure enough, it did say N.A. can be delegated to give a "cleansing enema" of course w/ all the other qualifications having been met. That surprises me.

nurseprnRN, BSN, RN · Jul 12, 2013

I am taking the NCLEX-RN next week. I am going over my practice Kaplan Online Review exams. I am so confused. In one of their questions they say a Nursing Assistant can feed an alzheimer's pt. in another it says that requires the Assessment skills of an RN. Neither patient are new admits or have anything else going on. So can the N. A. be assigned to feeding the Alzheimer pt.? Also, I really thought a N.A. cannot give an enema. But one of the Kaplan questions says that because the RN gave specific directions of "come back and notify me of the description of the stool" that it was ok. I think Kaplan may be confusing me more…..

I gave plenty of enemas when I was a nursing aide. :)

jayaay · Jul 12, 2013

The best advice is to NEVER ever connect what you do clinically to a standardized test like the NCLEX. The nclex is looking for textbook answers bc the nclex world is a textbook world. So it doesn't matter what you did at work bc all that matters is what the text says. Try to keep personal experience out of the exam bc next to anxiety, personal experience is another reason why people fail the first time. They let memories of what they did as a nurses aide or what they saw a nurse do seem like it's textbook when in fact it's not. So stay textbook based and you'll be fine.

Good luck.