Delegation 101: Can the CNA do this?
When you inevitably encounter your first delegation questions, your instinct is going to be to recall some scope-of-practice table from your med-surg or nursing fundamentals textbook. Memorizing that table is a fantastic way to get these questions wrong on your first med-surg exam đ. I say that with love.
Here is the problem: the exam is not asking what is on the chart. It is asking whether you can look at a patient, look at a task, and make a judgment call. A table cannot teach you that. So today, I am walking you straight into the world of delegation.
Quick note: if you are a current CNA or tech... forget everything you know.
I mean it. Do NOT walk into that exam and say "but I have taught crutch-walking a hundred times!" On the floor, sure, maybe. On the NCLEX, teaching belongs to the RN, and leaning on your real-world shortcuts will cost you points. We start fresh.
First, the vocabulary
Let's start by defining the words that you will encounter in your exam and in the clinical setting.
UAP means unlicensed assistive personnel. It is the umbrella term.
A CNA (certified nursing assistant) is the most common type of UAP, but the category also includes patient care techs and nurse aides. Unlicensed is the key word: no nursing license = no nursing judgment = no ADPIE.
On the exam you will usually see "UAP." On the floor you will hear "CNA" or "tech."
Then you have the LPN/LVN (licensed practical or vocational nurse), who is licensed but works under a narrower scope than you do.
And then there is you, the RN.
The UAP (and the CNA)
The UAP gets stable, predictable patients and standard, predictable tasks.
Think about what that looks like: vital signs on a stable patient, bathing, feeding, toileting, dressing, ambulating, turning and positioning, intake and output, routine specimen collection, weights. These tasks do not change much from patient to patient.
What the UAP cannot do is anything that requires a license or a judgment call.
No assessing.
No teaching.
No evaluating.
No medications (with narrow exceptions that vary, so treat this as a no for the exam).
And nothing on an unstable patient.
The LPN/LVN
This is where most of my students get confused. They either underestimate or overestimate the scope of practice of LPN/LVNs.
The LPN/LVN can do a lot of hands-on care: give most medications (oral, IM, subcutaneous), perform sterile and non-sterile dressing changes, do tracheostomy care and suctioning on established airways, run tube feedings, insert a Foley, provide ostomy care, and reinforce teaching that you already started (*Notice that last one. Reinforce, not initiate).
The LPN/LVN does not do the initial assessment, does not create the care plan, does not do the first patient teaching, and does not evaluate whether the plan is working.
Essentially, they cannot do ADPIE. And in most states, no IV push medications and no blood products.
So... the RN assesses, the LPN collects data. You perform the assessment and make the clinical judgment. The LPN monitors the patient and reports findings back to you. If an answer choice hands the LPN a true assessment, it is usually wrong.
The RN (that's you!)
You keep the nursing process: the initial assessment, the plan, the first teaching, and the evaluation. You keep the unstable patient. You keep the IV push and the blood. And you keep the first time of anything (the first dose, the first ambulation after surgery, the first time a patient tries something new).
The traps you need to see coming
Watch what happens with a single task: Can a UAP take a blood pressure. Absolutely!
But can the UAP take the blood pressure on the patient who started an IV antihypertensive twenty minutes ago? No. Same task. Different patient. Different answer.
The task did not change. The patient did.
Another "trick" is to find the assessment that is disguised as a task. "Go check on Mr. Lopez" is not a task, it is an assessment, and it is vague on top of that. "Take Mr. Lopez's noon vitals and report them to me" is a task. If the delegation is fuzzy or open-ended, that is a clue the answer is wrong.
Remember: UAP and LPNs can reinforce teaching. Only you do the first teaching. If the word "initial" or "new" is anywhere near the teaching, it is yours. Same with evaluating: "Find out if her pain is better after the medication" sounds like a simple errand. It is evaluation. That is the RN's responsibility.
Let's practice!
The nurse is delegating to the UAP. Which instruction is worded appropriately?
"Check on Mrs. Smith and let me know how she's doing"
"Assess Mrs. Smith's incision for signs of infection"
"Take Mrs. Smith's noon vital signs and report them to me"
"Find out whether Mrs. Smith's pain improved after her medication"
Correct answer: C
Were you stuck between C and D? Remember: A good delegation is a specific, measurable task with clear direction. C is exactly that. A is vague and open-ended (and really an assessment). B is an assessment outright. D is evaluation.
I hope this helps!
-Fernanda
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