Delegation on the NCLEX: RN vs LPN vs UAP
Who can do what, assessments, meds, teaching, sterile procedures. The scope rules the NCLEX tests and the traps that catch students.
Delegation is 5-10% of the NCLEX and one of the most missable categories. The rules are simple; the wording is the problem.
RN only
Initial assessments. Patient teaching. Care plan development. Discharge education. IV push meds. Blood transfusion initiation. Triage. First insulin dose for a new diagnosis. Anything that requires nursing judgment.
LPN/LVN can do
Reinforce teaching the RN started. Administer most oral, IM, SC meds (state-dependent on IV). Routine wound care on stable patients. Sterile dressing changes on stable patients. Tube feedings. Routine catheterizations. Stable patient assessments (with RN evaluating findings).
UAP/CNA can do
Vital signs on stable patients. ADLs. Ambulation. I&Os. Glucose checks (state-dependent). Linen changes. Stocking. Toileting. Bathing. UAPs cannot do anything requiring assessment or judgment.
The trap words
'Stable' vs 'unstable.' UAPs and LPNs work with stable patients only. If the question describes a patient with new abnormal findings, that patient stays with the RN regardless of whether the task is technically delegatable.
Five rights of delegation
Right task, right circumstance, right person, right direction/communication, right supervision/evaluation. Memorize the list, it shows up as a recognition question.
Frequently asked
Can an LPN do IV meds?
Varies by state. The NCLEX assumes the most restrictive interpretation, RN does IV push. LPN can sometimes do IV piggyback or maintenance fluids; check the stem context.
Can a UAP take vitals on an unstable patient?
No. Unstable = RN. The vital signs are part of an ongoing assessment that requires nursing judgment.
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