3.3 Assignment

Nursing team members receive assignments at the start of their shift. Assignment refers to routine care, activities, and procedures that are within the authorized scope of practice of the RN or LPN/VN or routine functions of the assistive personnel.[1] Assistive personnel (AP) are defined as certified nursing assistants (CNA), client care technicians (PCT), certified medical assistants (CMA), certified medication aides, and home health aides.[2] See Table 3.3a for a description of the typical scope of practice and common tasks performed by members of the nursing team. These tasks are within the traditional role that the team member has acquired through a basic educational program and are the expectation of the hiring agency during a shift of work. Keep in mind that scope of practice is defined by each state’s Nurse Practice Act. Agency policy can be more restrictive than the Nurse Practice Act but cannot be less restrictive.

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 hospital 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

(Note: Defined by each state’s Nurse Practice Act)
RN
  • Create individualized nursing care plans and revise as needed
  • Initiate, administer, and titrate medications
  • 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

 
  • 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 APs
  • 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
Assistive Personnel (AP)
  • Assist clients with activities of daily living (ADLs), including:
    • Eating
    • Bathing
    • Toileting
    • Ambulating
  • Perform routine procedures that do 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)

 
  • Assist stable clients with eating (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 to care for a client with stable heart failure. The LPN collects assessment data, monitors intake/output throughout the shift, and administers routine oral medication. The LPN documents this information and reports information back to the RN. This is considered the LPN’s “assignment” because the skills are taught within an LPN educational program and are consistent with the state’s Nursing Practice Act for LPN scope of practice. They are also included in the unit’s job description for an LPN. The RN may also assign this client to a CNA to help provide assistance with tasks that are allowed within the CNA scope. These tasks may include assistance with personal hygiene, toileting, and ambulation. The CNA documents these tasks as they are completed and reports information back to the RN. These tasks are considered the CNA’s assignment because they are taught within a nursing assistant educational program, are consistent with the nursing assistant scope of practice, and are included in the job description for this unit’s nursing assistant role.

Special consideration is required for advanced assistive personnel roles. With increased staffing needs, skills such as administering medications, inserting Foley catheters, or performing injections are included in specialized training programs for assistant personnel. 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” subsection 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. 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/LVN
  • Cannot create nursing care plans, analyze client assessment data, establish nursing diagnoses or expected outcomes, or evaluate the effectiveness of a nursing care plan. (However, LPNs 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 administer IV push 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, such as assessing a client’s skin at bath time
  • Cannot delegate tasks
  • Cannot provide client education
  • 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 the state’s Nurse Practice Act for specific details about nursing team members’ scope of practice. See the following box for an example of the scope of practice for RNs and LPNs according to Wisconsin’s Nurse Practice Act.

Read more information about scope and standards of practice for RNs and LPNs in Wisconsin’s Nurse Practice Act, Chapter N6 PDF.

  1. American Nurses Association and NCSBN. (2019). National guidelines for nursing delegation. https://www.ncsbn.org/NGND-PosPaper_06.pdf ↵
  2. American Nurses Association and NCSBN. (2019). National guidelines for nursing delegation. https://www.ncsbn.org/NGND-PosPaper_06.pdf ↵
  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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Leadership and Management of Nursing Care Copyright © 2022 by Kim Belcik and Open Resources for Nursing is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

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