Delegation & Prioritization

The 5 Rights of Delegation

Right	Description	Key Questions
Right Task	The task is appropriate to delegate for this patient	Is it within the delegate's scope? Is it routine and predictable?
Right Circumstance	The patient is stable and the setting is appropriate	Is the patient condition stable? Are resources available?
Right Person	The right person is delegating to the right person	Is the delegatee competent to perform this task?
Right Direction/Communication	Clear, concise description of the task with expectations	Did I include what, when, and any specific instructions or limits?
Right Supervision/Evaluation	Appropriate monitoring and follow-up	Did I check outcomes? Did I provide feedback?

Scope of Practice Comparison

Task	RN	LPN/LVN	UAP/CNA
Assessment (initial and ongoing)	Yes	Collect data only (no interpretation)	No (report observations)
Nursing Diagnosis	Yes	No	No
Care Plan Development	Yes	Contribute	No
Patient Teaching (initial/complex)	Yes	Reinforce only	No
IV Medications	Yes	Varies by state (some can maintain IV)	No
PO Medications	Yes	Yes	No
Blood Products	Yes	No	No
Wound Assessment	Yes	Perform sterile dressing changes	No
Vital Signs	Yes	Yes	Yes (stable patients)
Ambulation/ADLs	Yes	Yes	Yes
Hygiene/Bathing	Yes	Yes	Yes
I&O Measurement	Yes	Yes	Yes
Feeding (non-complex)	Yes	Yes	Yes
Trach Suctioning	Yes	Yes (in some states)	No

What Can NEVER Be Delegated by the RN

• Initial assessment and reassessment
• Nursing diagnosis and care planning
• Patient/family teaching of new content
• Evaluation of patient outcomes
• Unstable or complex patient care decisions
• Administration of blood products
• Any task requiring nursing judgment

Priority Frameworks

ABCs (Airway, Breathing, Circulation)

1. Airway — Always first. Obstruction, stridor, absent breath sounds, anaphylaxis
2. Breathing — Respiratory distress, hypoxia, abnormal breathing patterns
3. Circulation — Hemorrhage, shock, chest pain, dysrhythmias, absent pulses

Exception: In cardiac arrest, CAB (Compressions, Airway, Breathing) per AHA guidelines.

Maslow's Hierarchy of Needs

1. Physiological — Oxygen, food, water, elimination, pain management (address first)
2. Safety & Security — Fall prevention, infection control, side rails, medication safety
3. Love & Belonging — Family involvement, support groups, therapeutic communication
4. Self-Esteem — Patient independence, dignity, privacy
5. Self-Actualization — Patient education, health promotion (address last)

Acute vs. Chronic

• New-onset or acute problems take priority over chronic/stable conditions
• Unexpected findings take priority over expected findings
• Actual problems take priority over potential/risk problems

NCLEX Prioritization Tips

• See the most unstable patient first — the one whose condition is changing or unexpected
• Least-experienced staff gets the most stable patients
• New admissions, new post-ops, and transfers need RN assessment first
• If two patients are equally unstable, choose the one whose situation you can actually change
• When asked "who to see first," eliminate stable/expected findings
• Assessment before intervention unless an emergency (e.g., anaphylaxis → epinephrine immediately)