What can RN's delegate to LPN/NA's?

[Mrs. SnowStormRN, RN]

I just want to say that as an LPN and military, I've never been in a state where we could do IV pushes. Hang IV bags, but NO PUSHES - so I think that LPN was violating the rules of the Nurse Practice Act. I think you should look into LaCharity Prioritization, Delegation and Assessment book for practice on these type of questions. Because what you see happening in hospital may not be text book correct. LPNs are trained to handle stable patients, they can insert foley caths, NG tubes and discontinue them as well. They can also pass medications. You can not delegate assessments and discharges or patient teaching, and always give the critical patient to the RN. Delegating to the UAP will be easier than delegating to the LPN because the LPN is trained and qualified on a higher level than the UAP. Good Luck, took my test (NCLEX-RN) yesterday and I think that you finding this info now is great because you will need it. GOOD LUCK AGAIN!

[smk1, LPN]

As a general rule LPN education is designed to handle stable patients with predictable outcomes. The IV thing will vary from state to state so as NCLEX is a national test probably your questions won't deal with a state specific issue. Look at your patients in a given scenario and think about who is stable and predictable. (routine wound care, routine med passes that sort of thing). NA can do ADL's and routine vital signs.

[shoegalRN, RN]

This is what I'm getting from Kaplan:

LPN/LVN's can do dressing changes, and can be assigned the most stable patient with the most predictable outcome. They can not do any assessment or patient teaching. So if a pt is being discharged, you can not delegate that pt to a LPN/LVN because discharge needs patient teaching.

They can also pass PO meds. I think I remembered in nursing school they can do suctioning as well, as long as it's a stable pt.

UAP (unlicensed assisted personnel) can do ADL's, ambulating, bathing, feeding (as long as it's a stable pt), turning, collection urine, input and output.

Hope this helps!

[MaroonTX]

I posted this a couple of days ago but i'll repost it here just in case:

It's basically a list of keywords that will lead you in the right direction on delegation questions (NOTE: These aren't 100% accurate ALL of the time, but combining these loose "rules" with some critical thinking has really improved my delegation results)

Nursing Assistant

• ADLs/Noninvasive
• Assist
• Remind/Reinforce: usually reminds pt. TO do something rather than HOW to do it (skills previously taught by other health care professional or precaution measures)***
  ** Usually in regards to ADLs (hygiene, nutrition, ambulating, skin care), turning, repositioning, cough deep breathe ROM **
• Special positioning-- requires initial education by RN -- assistant will assist not teach
• I/O , VS, Weight
• They can detach suction and remove a foley but not connect or insert
• Gather (equipment)

LVN/LPN

• Auscultate/Listen
• Check(s)
• Reinforce/remind
• Administer (PO,SubQ,IM -- NO high alert meds, plasma, blood products-- these and IV are done by RN)
• Observe
• Collect (data, specimens)
• Monitor
• Set up (basic equipment)
• Review/Teach-- Usually standard practices (hand washing/hygiene) or med administration (ie. eye drops) -- RN mostly teaches/educated and LPNs Reinforce
• Routine/Standard
• Wound care/Suction/Urinary Cath/Blood glucose readings

** Don't assign LVN/LPN to do a task an nurse assistant can complete**

RN

• Assess
• Plan
• Evaluate
• Consult
• Teach/Educate
• Encourage
• Develop
• Review
• Update
• Counsel
• Suggest
• Initial/Comprehensive/Baseline (assessments)
• Frequent/Ongoing assessments (unstable pts)

Physician

• Informed Consent
• Medical diagnosis
• Prescriptions
• Order procedures

Avoid These Assignments for New/Float/LVN/LPN/Traveling

• New onset/sudden/acute
• New admission
• Transfer
• Newly diagnosed
• Discharge
• Require education/teaching (beyond basic skills -- tend to be complex and specific to patients on that particular unit)
• Unstable (ie. High risk of sudden respiratory failure, or requires frequent assessments and changes in therapy(like electrolyte imbalances)

Give

• Chronic
• Routine meds/procedures
• Stable

ALL HEALTHCARE WORKERS

Responsible for knowing about and implementing standard precautions + airborne/droplet/contact --> therefore all can teach about it or prepare a room for it

[turnforthenurse, MSN, NP]

Here is what I got from an NCLEX review course that I just completed:

LPN

• Get CHRONIC, STABLE pts with predictable outcomes (a popular one is COPD!)
• Pts who are 24hr post-op
• NO: d/c planning, admission assessments (including admission VS) and IVs.
• YES: can give narcs, have patients 72hr after MI, have patients with CVA, SCI, on vents or with low coma scale AFTER ONE WEEK.
• Can do sterile procedures
• Give meds (but nothing IV)
• Nursing process under the direction of the RN
• Can work with contagious patients (think of patient assignments! these can all be delegated to the LPN)
• Can reinforce teaching, but the RN has to do the initial teaching.

NA

• Work with STABLE patients
• Beds/H2O/enemas/stool spec./I&O
• Transport pts
• Feed = CHRONIC parkinson's, CHRONIC CVA (do not let an NA feed anyone who is an aspiration risk)
• VS on STABLE patients, can do vitals 1/2 hr AFTER blood has started
• NO: admission vitals, sterile procedures, drugs (even OTC topicals!), teaching, working with PTs with art lines, trachs, ETTs, vents, contagious diseases
• STAY AWAY FROM options asking to show, explain, monitor, teach, check, assess & demonstrate - all outside the scope of the NA!

Just think of the RN as TIA: Teach, IVs and Assessments.

We know what happens in real life, but as my instructor said, the NCLEX isn't real-life...

[lizzyberry]

Any other responses, I'm also having trouble with this.

[Nursemarymary LPN]

Wow! Some of this material has helped me out a lot hopefully it will when I take the NCLEX-RN!