Licensed practical nurses, or LPNs, usually work under the supervision of a physician or registered nurse. Although the LPN is licensed, she is limited in the care she can provide. Each state regulates the practice of nursing and what an LPN can do in one state, she might not be able to do in another state. An LPN must know her scope of practice and should always speak up if someone tries to assign her a task she is not qualified or legally permitted to perform.
Appropriate delegation involves responsibility, accountability and authority, according to a May 2010 article in “The Online Journal of Issues in Nursing.” RNs have the authority to delegate as long as they assure that the person to whom they delegate is competent and the task is within the other person’s scope of practice. When you delegate a task to an LPN, she assumes the responsibility of performing that task. You, as the RN, retain responsibility for assuring the task is completed correctly and for intervening if a problem occurs. An RN is accountable to the patient, family and her organization for delegating appropriately.
The Rules of Delegation
Delegation is not a simple matter; it requires sophisticated clinical judgment and knowledge of an LPN’s qualifications, skills and scope of practice. In order to delegate a task to an LPN, it must be legal to do so in your state. The facility in which you work must also permit you to delegate the task. Prior to delegating a task, you must assess the patient and evaluate all current needs to prevent possible patient harm. Don’t delegate a task unless you feel the LPN is competent to perform the task. Delegating a task doesn’t relieve you of your responsibility to supervise or to intervene if you see a problem with what the LPN is doing.
Questions about delegation often arise when RNs and LPN perform similar tasks. For example, intravenous therapy is within the scope of practice for both RNs and LPNs in most states, according to “Advance for Nurses.” However, some states require the LPN to complete a course in IV therapy before she can administer IV solutions. Other states allow the LPN to add vitamins to an IV solution but not to give IV antibiotics. Hemodialysis, which is used for people with kidney failure, is a more complex therapy that uses different intravenous solutions and special machinery to remove wastes from a patient’s blood stream. In some states, dialysis therapy can be delegated to LPNs, while in others, it is prohibited.
Each state defines what nursing activities can be delegated to an LPN. In New York, for example, LPNS cannot perform patient assessments independently develop a nursing care plan, administer intravenous chemotherapy or give any medications by direct IV push, according to the New York State Nurses Association. In Nebraska, an LPN cannot perform triage, coordinate and manage care or perform activities that require independent nursing judgment. Nor can she insert a catheter for intravenous therapy or give intravenous fluids to pediatric patients, according to the Nebraska Center for Nursing. Consult the scope of practice regulations in your state to determine exactly what tasks can and cannot be delegated to an LPN.
- The Online Journal of Issue in Nursing: Developing Delegation Skills
- New York State Nurses Association: Guidelines Regarding Utilization of Licensed Nurses (RNs and LPNs) and Unlicensed Assistive Personnel (UAP) in the Delivery of Nursing Care
- Nebraska Center for Nursing: Delegation for the Newly Licensed Practical Nurse
- American Nurse Today: Delegating Without Doubts
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