3.3 Assignment

Nursing team members working in inpatient or long-term care settings receive patient assignments at the start of their shift. Assignment refers to routine care, activities, and procedures that are within the legal scope of practice of registered nurses (RN), licensed practical/vocational nurses (LPN/VN), or assistive personnel (AP).[1] Scope of practice for RNs and LPNs is described in each state’s Nurse Practice Act. Care tasks for AP vary by state; regulations are typically listed on sites for the state’s Board of Nursing, Department of Health, Department of Aging, Department of Health Professions, Department of Commerce, or Office of Long-Term Care.[2]

See Table 3.3a for common tasks performed by members of the nursing team based on their scope of practice. These tasks are within the traditional role and training the team member has acquired through a basic educational program. They are also within the expectations of the health care agency during a shift of work. Agency policy can be more restrictive than federal or state regulations, but it cannot be less restrictive.

Patient assignments are typically made by the charge nurse (or nurse supervisor) from the previous shift. A charge nurse is an RN who provides leadership on a patient-care unit within a health care facility during their shift. Charge nurses perform many of the tasks that general nurses do, but also have some supervisory duties such as making assignments, delegating tasks, preparing schedules, monitoring admissions and discharges, and serving as a staff member resource.[3]

Table 3.3a Nursing Team Members’ Scope of Practice and Common Tasks[4]

Nursing Team Member Scope of Practice Common Tasks

 
RN
  • Create and implement individualized nursing care plans and revise as needed
  • Review prescribed medications for safety concerns, administer medications, and titrate medications based on protocols or standing orders
  • Plan and provide client education
  • Admit and discharge clients
  • Make referrals, such as to a caseworker, dietician, or chaplain, according to agency policy. (Many referrals to interprofessional team members require a provider order.)
  • Delegate appropriate tasks to LPN/VNs and APs

 
  • Assess clients
  • Initiate administration of blood products to a client
  • Administer high-risk medications, including heparin and chemotherapeutic agents
  • Establish intravenous (IV) access
  • Initiate IV fluids and IV medications
  • Administer IV push medications
  • Titrate medications per provider order
  • Perform any tasks that may be performed by a LPN/VN or AP
LPN/VN
  • Assist the RN by performing routine, basic nursing care with predictable outcomes
  • Assist the RN with collecting data and monitoring client findings on stable clients
  • Implement interventions outlined in the nursing care plan, as appropriate
  • Reinforce client education as outlined in the nursing care plan
  • Delegate tasks to AP
  • Provide basic nursing care
  • Assist with the collection of patient assessment data
  • Assist the RN with the development and revision of a nursing care plan
  • Reinforce teaching provided by an RN
  • Administer medications that are not high-risk
  • Administer enteral feeding
  • Perform routine dressing changes
  • Perform tracheostomy care on stable clients
  • Perform suctioning on stable or routine clients
  • Insert a urinary catheter
  • Perform any of the tasks that APs are permitted to perform

Tasks That Potentially Can Be Delegated According to the Five Rights of Delegation:

  • Monitor the administration of blood products after they have been initiated by an RN and report findings to the RN
  • Assist with the administration of IV fluids and medications after they have been initiated by an RN and under the supervision of an RN; cannot hang the first dose or change medications
AP
  • Assist clients with activities of daily living (ADLs), including:
    • Eating
    • Bathing
    • Toileting
    • Ambulating
  • Perform routine data collection that does not require clinical assessment or critical thinking, such as:
    • Measuring vital signs, weight, and height
    • Measuring intake and output (e.g., food and drink, urine, bowel movements)

 
  • Assist stable clients with eating (although clients with dysphagia or at an aspiration risk require qualified health care members with specific training in this area)
  • Assist with personal hygiene, grooming, bathing, positioning, transfers, range of motion exercises, toileting, and making beds
  • Obtain vital signs on stable clients
  • Transport clients
  • Collect and transport routine urine specimens
  • Restock supplies
  • Report to the RN if a change in client’s status is observed. Example, “Client is now complaining of pain at 9/10 when repositioned. Last time client was repositioned, no pain was reported.”

An example of a patient assignment is when an RN assigns an LPN/VN to care for a client with stable heart failure. The LPN/VN collects assessment data, monitors intake/output throughout the shift, and administers routine oral medication. The LPN/VN documents this information and reports information back to the RN. This is considered the LPN/VN’s “assignment” because the skills are taught within an LPN educational program and are consistent with the state’s Nurse Practice Act for LPN/VN scope of practice. They are also included in the unit’s job description for an LPN/VN. The RN may also assign some care for this client to AP. These tasks may include assistance with personal hygiene, toileting, and ambulation. The AP documents these tasks as they are completed and reports information back to the RN or LPN/VN. These tasks are considered the AP’s assignment because they are taught within a nursing aide’s educational program, are consistent with the AP’s scope of practice for that state, and are included in the job description for the nursing aide’s role in this unit. The RN continues to be accountable for the care provided to this client despite the assignments made to other nursing team members.

Special consideration is required for AP with additional training. With increased staffing needs, skills such as administering medications, inserting Foley catheters, or performing injections are included in specialized training programs for AP. Due to the impact these skills can have on the outcome and safety of the client, the National Council of State Board of Nursing (NCSBN) recommends these activities be considered delegated tasks by the RN or nurse leader. By delegating these advanced skills when appropriate, the nurse validates competency, provides supervision, and maintains accountability for client outcomes. Read more about delegation in the “Delegation” section of this chapter.

When making assignments to other nursing team members, it is essential for the RN to keep in mind specific tasks that cannot be delegated to other nursing team members based on federal and/or state regulations. These tasks include, but are not limited to, those tasks described in Table 3.3b.

Table 3.3b Examples of Tasks Outside the Scope of Practice of Nursing Assistive Personnel

Nursing Team Member Tasks That Cannot Be Delegated

 
LPN/VN
  • Cannot create nursing care plans, analyze patient assessment data, establish nursing diagnoses or expected outcomes, or evaluate the effectiveness of a nursing care plan. (However, LPN/VNs can collect data and contribute to the development and revision of a client’s nursing care plan in collaboration with the RN.)
  • Cannot administer high-risk medications (such as heparin and chemotherapeutic medications).
  • Cannot titrate medications. (Titrate refers to adjusting the dosage of medication until the desired effects are achieved.)
  • Cannot independently provide client education. (However, they can implement client education that has been planned by the RN.)
  • Cannot perform admission assessments or initial postoperative assessments.
  • Cannot discharge clients.
Assistive Personnel (AP)
  • Cannot complete tasks requiring clinical judgement and/or professional knowledge. For example, a nursing assessment of a client’s skin cannot be delegated to AP. However, AP are encouraged to report concerns about skin breakdown and other potential signs and symptoms to a licensed nurse.
  • Cannot delegate tasks.
  • Cannot provide client education, but can reinforce education previously provided. For example, an AP can encourage a patient to keep their nasal cannula in place while eating.
  • Cannot complete tasks that require clinical expertise unless advanced training has been received and written agency policy allows, such as:
    • Administering medications and injections
    • Inserting Foley catheters
    • Administering tube feedings
    • Performing wound care or dressing changes[5]

As always, refer to each state’s Nurse Practice Act and other state regulations for specific details about nursing team members’ scope of practice when providing care in that state.

Find and review Nurse Practice Acts by state at www.ncsbn.org/npa.

Read more about the Wisconsin’s Nurse Practice Act and the standards and scope of practice for RNs and LPNs Wisconsin’s Legislative Code Chapter N6.

Read more about scope of practice, skills, and practices of nurse aides in Wisconsin at DHS 129.07 Standards for Nurse Aide Training Programs.

  1. American Nurses Association and NCSBN. (2019). National guidelines for nursing delegation. https://www.ncsbn.org/NGND-PosPaper_06.pdf ↵
  2. McMullen, T. L., Resnick, B., Chin-Hansen, J., Geiger-Brown, J. M., Miller, N., & Rubenstein, R. (2015). Certified nurse aide scope of practice: State-by-state differences in allowable delegated activities. Journal of the American Medical Directors Association, 16(1), 20–24. https://doi.org/10.1016/j.jamda.2014.07.003 ↵
  3. RegisteredNursing.org. (2021, April 13). What is a charge nurse? https://www.registerednursing.org/specialty/charge-nurse/ ↵
  4. RegisteredNursing.org. (2021, January 27). Assignment, delegation and supervision: NCLEX-RN. https://www.registerednursing.org/nclex/assignment-delegation-supervision/ ↵
  5. State of Wisconsin Department of Health Services. (2018). Medication administration by unlicensed assistive personnel (UAP): Guidelines for registered nurses delegating medication administration to unlicensed assistive personnel. https://www.dhs.wisconsin.gov/publications/p01908.pdf ↵
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