Delegation and scope rules for the NCLEX

Before delegating, ask all five: right TASK (within delegee's scope), right CIRCUMSTANCES (stable, predictable client), right PERSON (license + competency), right DIRECTION (clear, specific instruction), right SUPERVISION (oversight + evaluation of outcome). Missing any one is a delegation error, no matter how nice the answer feels.

Unlicensed assistive personnel can collect data — vital signs, intake/output, glucose values, weights — but only the licensed nurse can ASSESS the meaning. 'Routine task' is for UAP; interpreting findings or changing the plan is for the RN.

Initial teaching — especially for high-risk content (insulin, anticoagulants, new diagnoses, discharge med list) — is RN-only. LPN/LVN can REINFORCE material previously taught by the RN. UAP cannot teach.

The first nursing assessment of a new admission requires nursing judgment and synthesis of new data into a care plan. UAP can collect vitals; LPN can collect specific information AFTER the RN's initial assessment — never in place of it.

Match the client to the license. LPN/LVN excels at stable, predictable, scheduled care (chronic IV antibiotics, routine post-op). Vasopressors, drip titration, new admissions, and unstable physiology stay with the RN. 'Experience' does not extend an LPN's scope.

When a UAP reports an abnormal vital sign or unexpected finding, the RN goes to the bedside — not to the chart. UAPs cannot interpret, cannot recheck-as-treatment, and cannot escalate care. Verifying and acting are the RN's job.

First post-op ambulation, first walk after a fall, first feed after dysphagia evaluation, first dose of a new high-risk med — the FIRST instance of any new task should be done by the RN to establish baseline tolerance. Once stable and predictable, it can be delegated.

Delegation is not 'hand it off and forget it.' The RN evaluates the outcome: was the task done correctly, was the result interpreted correctly, was the data meaningful? An abnormal finding that the delegee does not recognize is the RN's responsibility to catch.

When floated, accept tasks within your scope + competency; refuse specific tasks that require training you don't have (in writing, with reasons documented). Blanket refusal abandons patients; blanket acceptance risks license. Targeted refusal + documentation + supervisor notification is the safe middle path.

Match assignment to the new graduate's competency: independent for routine basics, side-by-side coaching for complex / high-risk tasks. Doing tasks FOR the new graduate prevents learning; making them solo on a high-risk task prematurely is unsafe. Accept charge nurse help to off-load patients so you have bandwidth to teach. Debrief every shift.

Scope of practice is set by state nurse practice act + institutional written policy — not unit culture. Before performing an unfamiliar procedure (arterial line, certain titrations, central line insertion), verify with state Board of Nursing + your policy. When in doubt, decline + document + escalate. License protection means knowing your scope.

Assign by competency, not equal count. Septic shock + pressors + IV titration = experienced RN. PCA + blood transfusion = requires check-off (often experienced or supervised practice). Stable post-CABG + discharge teaching = new grad in week 5 of orientation. Pair new grad with experienced for learning opportunities. Charge nurse remains available as resource.

Sort calls/notifications by clinical urgency: critical lab values + hemodynamic changes = minutes-critical (handle in parallel with colleagues). Medication clarifications = next 15-30 min. Family discussions = scheduled or deferred. Charge meetings + administrative = lowest unless explicitly required. Defer + delegate routine + administrative tasks during acute clinical events.