Delegation and Supervision for LPN Practice

Five rights of delegation

Safe delegation requires the right task, circumstance, person, direction, and supervision. AHRQ patient safety literature ties communication failures during handoffs and task assignment to adverse events.¹ RNs delegate stable, predictable tasks with clear instructions; they retain unstable patients, new admissions with incomplete data, and tasks requiring nursing judgment beyond the delegatee’s scope.

UAP may obtain vital signs, assist with ambulation, bathe, and feed when policies allow. LPNs administer medications, provide wound care per competency, and reinforce teaching—but initial comprehensive assessment and new care plan development typically remain RN responsibilities in acute care. State nurse practice acts vary; exam items reflect general national patterns.

Tasks that cannot be delegated

Never delegate sterile technique procedures to UAP unless facility policy explicitly permits and competency is verified. IV push medications, initial patient education on new diagnoses, triage decisions, and evaluation of unstable postoperative patients stay with licensed nurses at appropriate level.

The delegating RN remains accountable for patient outcomes—the delegate performs the task, but supervision must match risk.² After delegation, verify completion and assess the patient when results could signal deterioration: post-ambulation blood pressure after UAP walk, intake and output totals before diuretic timing. Document who was assigned what and follow-up findings.