What are the Five Rights of Delegation?
Answer: Right task, right circumstance, right person, right directions/communication, right supervision/evaluation.
Explanation
Framework from the NCSBN used to determine safe, appropriate delegation.
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NCLEX-RN: Management of Care, Delegation and Prioritization (University)
Five Rights of DelegationDelegation PrinciplesDelegation to LPN/LVNDelegation to UAPPrioritization FrameworksTriageInformed ConsentAdvance DirectivesConfidentiality (HIPAA)Incident ReportsContinuity of CareEthical Principles
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Five Rights of Delegation
'Right Task' in delegation means what?
Answer: The task is one that can legally and appropriately be delegated to that level of caregiver (within their scope of practice).
'Right Circumstance' in delegation means what?
Answer: The patient's condition is stable and appropriate for delegation; an unstable or complex patient should not have care delegated.
'Right Person' in delegation means what?
Answer: The right task is delegated to the right person based on their training, competency, and job description.
'Right Direction/Communication' in delegation means what?
Answer: The RN gives clear, concise instructions including expected outcomes, limits, and what to report back.
'Right Supervision/Evaluation' in delegation means what?
Answer: The RN monitors performance, intervenes if needed, and evaluates the patient outcome and the delegatee's performance.
Delegation Principles
Can the RN delegate accountability for a task?
Answer: No. The RN can delegate the task/activity but always retains accountability and responsibility for the overall patient outcome.
Explanation
This is a frequently tested distinction: responsibility can be shared, accountability cannot.
General rule: what type of patient should never be assigned/delegated to LPN or UAP?
Answer: Unstable, unpredictable, newly admitted, or complex patients — these require the RN.
Delegation to LPN/LVN
What tasks can be delegated to an LPN/LVN?
Answer: Medication administration (most routes, not IV push in most states), reinforcing teaching, wound care, suctioning, checking NG tube placement, monitoring stable chronic patients.
Explanation
LPN/LVN scope varies by state; generally cannot do initial assessments, IV push meds, or manage unstable patients.
Can an LPN/LVN administer IV push medications?
Answer: Generally no — in most states this is outside LPN/LVN scope and restricted to RNs (with some state/facility exceptions).
Can an LPN/LVN perform the initial nursing assessment?
Answer: No. Initial/admission assessments and evaluation of care require RN-level judgment.
Explanation
LPN/LVNs can collect data and reinforce an existing plan but cannot independently interpret findings to form a nursing diagnosis.
Can an LPN/LVN hang a blood transfusion?
Answer: No — typically only the RN can initiate, monitor, and manage blood product administration.
Can an LPN/LVN care for a patient receiving a first-time medication or unstable patient?
Answer: No — unstable patients and first-dose/unpredictable-response situations require RN assessment and judgment.
Delegation to UAP
What tasks can be delegated to a UAP/nursing assistant?
Answer: ADLs (bathing, feeding, ambulating), vital signs on stable patients, I&O, repositioning, specimen collection, routine glucose checks (per facility policy).
Explanation
UAPs perform tasks that do not require nursing judgment.
What can a UAP NEVER do?
Answer: Assess, teach, administer medications, perform sterile procedures, evaluate care, or make clinical judgments.
Explanation
Mnemonic: UAPs do NOT assess, diagnose, plan, teach, or evaluate — that's RN/LPN territory.
Scenario: Which patient is safe to assign to a UAP — a stable post-op day 3 patient or a new admission with chest pain?
Answer: The stable post-op day 3 patient; the new/unstable patient needs RN assessment first.
Can a UAP document a patient's response to pain medication?
Answer: No — evaluating response to an intervention requires nursing judgment and must be done by the RN (or LPN reporting to RN).
Explanation
A UAP can report a vital sign reading, but interpreting it is a nursing function.
Prioritization Frameworks
Prioritization framework: ABCs stands for what, and in what order?
Answer: Airway, Breathing, Circulation — addressed in that order first in any emergency.
Using Maslow's hierarchy, which need is prioritized first: physiological or safety?
Answer: Physiological needs (oxygen, food, fluids) are prioritized before safety and psychosocial needs.
Explanation
Order: physiological > safety/security > love/belonging > self-esteem > self-actualization.
Acute vs. chronic condition: which gets priority?
Answer: Acute (sudden onset) conditions typically take priority over chronic (long-standing, stable) conditions.
Stable vs. unstable patient: which gets priority for RN attention?
Answer: The unstable patient always takes priority, regardless of acuity level of other tasks.
Using the nursing process to prioritize, which step comes first: assessment or planning?
Answer: Assessment — you must assess before diagnosing, planning, implementing, and evaluating (ADPIE).
Scenario: You have a patient with new-onset confusion and one with a scheduled dressing change. Who do you see first?
Answer: The patient with new-onset confusion — an acute, unexpected change always takes priority over a routine scheduled task.
Triage
What is triage?
Answer: The process of sorting patients by urgency/severity of condition to determine order of treatment, especially in ED or mass casualty settings.
In mass casualty triage, what does a 'black tag' mean?
Answer: Expectant/deceased — the patient is not expected to survive given available resources and is given lowest priority for treatment.
Explanation
Color system: Red=immediate, Yellow=delayed, Green=minor, Black=expectant/deceased.
In mass casualty triage, what does a 'red tag' indicate?
Answer: Immediate — life-threatening but survivable injury requiring treatment right away (e.g., airway compromise, severe bleeding).
Informed Consent
What is required for informed consent to be valid?
Answer: Patient must be competent, consent must be voluntary, and the provider must disclose risks, benefits, alternatives, and purpose of the procedure.
Explanation
The physician/provider performing the procedure is responsible for obtaining consent; the nurse witnesses the signature.
What is the nurse's role in informed consent?
Answer: To witness the patient's signature and confirm the patient understands — not to explain the procedure's risks/benefits (that's the provider's job).
Explanation
If the patient has questions or doesn't understand, the nurse should notify the provider before proceeding.
Scenario: A sedated patient is asked to sign a surgical consent. Is this valid?
Answer: No — the patient must be alert, oriented, and not under the influence of sedating medications to give valid informed consent.
Advance Directives
What is an advance directive?
Answer: A legal document stating a person's wishes for future medical care if they become unable to make decisions themselves (e.g., living will, durable power of attorney for healthcare).
What is a DNR (Do Not Resuscitate) order?
Answer: A physician's order indicating that CPR/resuscitation should not be performed if the patient's heart or breathing stops.
Explanation
Does not mean 'do not treat' — other care continues as appropriate.
Who makes decisions if a patient has no advance directive and becomes incapacitated?
Answer: A designated healthcare proxy/durable power of attorney, or if none, the next of kin per state law/facility policy.
Confidentiality (HIPAA)
What does HIPAA protect?
Answer: Patient privacy and confidentiality of protected health information (PHI).
Explanation
Health Insurance Portability and Accountability Act.
Scenario: A patient's family member calls asking about test results. What should the nurse do?
Answer: Do not disclose information without patient consent — verify if the caller is authorized, otherwise decline to share details.
Explanation
Even confirming a patient is admitted can violate HIPAA without authorization.
Is it a HIPAA violation to discuss a patient's case in a public hallway or elevator?
Answer: Yes — any disclosure of PHI where it can be overheard by unauthorized persons violates confidentiality.
Incident Reports
What is an incident report used for?
Answer: To document unusual occurrences (falls, med errors, injuries) for quality improvement and risk management — it is NOT part of the patient's medical record.
Explanation
Should never be mentioned/referenced in the chart; chart only the factual clinical details of what happened.
Scenario: A patient falls out of bed. What should the nurse document in the medical record vs. the incident report?
Answer: Medical record: objective facts, assessment, interventions, and patient response. Incident report: details of the event itself for risk management, kept separate from the chart.
Continuity of Care
What is continuity of care?
Answer: Coordinated, consistent care across settings and providers over time, often supported by handoff/report (e.g., SBAR) between shifts or facilities.
Explanation
SBAR = Situation, Background, Assessment, Recommendation.
What is SBAR used for?
Answer: A standardized communication tool for handoff reports: Situation, Background, Assessment, Recommendation.
Explanation
Improves continuity of care and reduces communication errors during transfers/shift changes.
Ethical Principles
Define the ethical principle of autonomy.
Answer: The patient's right to make their own healthcare decisions.
Explanation
Basis for informed consent and the right to refuse treatment.
Define the ethical principle of beneficence.
Answer: Acting in the best interest of the patient; doing good.
Define the ethical principle of nonmaleficence.
Answer: The duty to do no harm to the patient.
Define the ethical principle of justice.
Answer: Fair and equal distribution of healthcare resources and treatment among patients.
Define the ethical principle of fidelity.
Answer: Keeping promises and being loyal/faithful to commitments made to patients.
Define the ethical principle of veracity.
Answer: The duty to tell the truth to patients.
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