Which of the following tasks would you be willing to delegate to a nursing assistive personnel or licensed practical nurse/licensed vocational nurse? Use your state’s Nurse Practice Act or a decision tree created by the National Council of State Boards of Nursing or a State Board of Nursing as a reference for this case.
Uncomplicated wet-to-dry dressing change on a patient 3 days post-hip replacement
Every 2 hours checks on a patient with soft wrist restraints to assess circulation, movement, and comfort
Cooling measures for a patient with a temperature of 104°F
Calculation of intravenous (IV) credits, clearing IV pumps, and completing shift intake/output totals
Completing phlebotomy for daily drawing of blood
Holding pressure on the insertion site of a femoral line that has just been removed
Educating a patient about components of a soft diet
Conducting guaiac stool tests for occult blood
Performing electrocardiographic testing
Feeding a patient with swallowing precautions (high risk of choking post-cardiovascular accident [CVA])
Oral suctioning
Tracheostomy care
Ostomy care
Instructions:
By utilizing the Florida State Board of Nursing standards decide which of the following tasks could be delegated to an UAP or a LPN/LVN.
Florida Nurse Practice Act Delegation Principles
The overarching principle in Florida (and most states) is that the RN retains accountability for the decision to delegate and the assessment of the patient. The task must meet the "five rights of delegation":
Right Task: Does the task fit the scope of practice and state law?
Right Circumstance: Is the patient stable, and is the setting appropriate?
Right Person: Does the delegatee have the knowledge and skill?
Right Direction/Communication: Is the instruction clear, specific, and detailed?
Right Supervision/Evaluation: Will the RN monitor, evaluate, and follow up?
In Florida, an LPN's practice is considered dependent, requiring supervision by an RN or physician, and does not include the initial assessment, the development of the plan of care, complex patient teaching, or IV push medications. An NAP's role is limited to tasks that are considered routine, repetitive, pose minimal risk, and do not require independent nursing judgment.
Sample Answer
The decision to delegate a task from a Registered Nurse (RN) to a Nursing Assistive Personnel (NAP) or a Licensed Practical Nurse/Licensed Vocational Nurse (LPN/LVN) is governed by the scope of practice for each role, as defined by the Florida Nurse Practice Act (NPA), specifically Chapter 464.
Based on Florida standards, here is the breakdown of which tasks can be delegated to an NAP and which can be delegated to an LPN/LVN, and which tasks must be retained by the RN.