RN vs. LPN vs. UAP: The Scope Lines That Get Tested

The registered nurse owns assessment, teaching, evaluation, care planning, and any unstable or unpredictable client. The LPN/LVN may reinforce teaching the RN already started, monitor stable clients with predictable outcomes, give most oral and many IM/SubQ medications, perform sterile dressing changes, insert Foley catheters, and manage tube feedings — but not initial assessment, IV push medications in most states, blood administration, or care planning. The UAP works with data collection and activities of daily living: vital signs on stable clients, bathing, feeding clients without swallowing risk, ambulating, positioning, intake and output, and specimen collection. When a stem uses the words 'assess,' 'teach,' 'evaluate,' 'plan,' or describes anything new, unstable, or changing, the answer belongs to the RN.

The Five Filters for 'Which Client Do You See FIRST?'

Work these filters in order. (1) Airway, breathing, circulation — a compromised airway or active hemorrhage beats everything. (2) Acute over chronic — new-onset confusion outranks long-standing dementia. (3) Unstable over stable — trending vital signs matter more than a single abnormal number. (4) Actual over potential — a client who is bleeding outranks a client at risk for bleeding. (5) Unexpected over expected — post-op pain at 6/10 on day one is expected; sudden calf pain with dyspnea is not. If two clients both look unstable, choose the one whose problem will kill faster. Maslow is the tiebreaker only after physiologic threats are ruled out.

Five Rights of Delegation

Every delegation answer can be checked against the five rights: right task (routine, repetitive, predictable), right circumstance (client is stable with a known outcome), right person (within the delegatee's scope, training, and demonstrated competence), right direction and communication (specific, measurable instructions with what to report back and when), and right supervision and evaluation (the RN follows up and remains accountable). The most commonly missed of the five is right circumstance — a task that is normally fine for a UAP, such as taking vital signs, becomes an RN task the moment the client is unstable. Accountability never transfers; the RN who delegates still owns the outcome.

Assignment Traps and How to Beat Them

Distractor answers usually break one of four rules. They delegate an assessment ('have the UAP check whether the client is short of breath'). They delegate teaching ('have the LPN teach new insulin administration'). They assign an unstable client to a less-qualified caregiver. Or they float a nurse to a unit and hand her the sickest client — a floated nurse should receive the most stable clients in her area of competence. Also watch infection-control assignments: never place an immunocompromised client with an infectious roommate, and never assign a pregnant staff member to a client receiving internal radiation therapy.