Delegation in US nursing: RN, LPN and UAP

The US nursing team

In a US hospital, the RN works with:

• Licensed nurses: advanced practice registered nurses (APRNs), RNs, and licensed practical or vocational nurses (LPN/VNs).
• Assistive personnel: for example nursing assistants, patient care technicians and medication aides. The 2019 national guidelines call them “assistive personnel” (AP). The NCLEX test plan also says AP. This lesson uses the older textbook name, unlicensed assistive personnel (UAP). Both mean the same.

An RN may delegate to an LPN/VN or to a UAP. Where state law allows it, an LPN/VN may also delegate to a UAP.

Delegation rules differ between states, and each nurse must know the rules where they work. A facility’s policy may be stricter than state law, never looser.

Passing a client’s care to another RN at shift change is a handoff, not delegation.

Assignment and delegation

The national guidelines use two different words:

• Assignment is routine care that a team member learned in basic training and that is part of their normal job. Example: an LPN/VN caring for a client with stable heart failure collects data, measures intake and output, gives routine oral medicines and reports back. A UAP helps the same client with hygiene and walking.
• Delegation means letting someone do a specific nursing task that is outside their usual job. They need extra training first, and their competence must be checked. Example: a UAP who has finished extra training gives medicines, where agency policy allows it.

Helping a client eat is normal UAP work, but not if the client has trouble swallowing after a stroke. Then the RN feeds the client, or gives the task only to a UAP with extra feeding training.

In both assignment and delegation, the RN stays accountable for the client. The person who accepts a delegated task is responsible for doing that task correctly.

A note on words: textbooks often use “delegate” for routine tasks too. Open RN, for example, says routine vital signs for stable clients can be delegated to a UAP. The 2026 NCLEX-RN test plan groups assignment, delegation and supervision as one topic. So the exact word matters less. Use the five rights either way, with the RN accountable.

The five rights of delegation

Check all five before you hand over a task:

1. Right task: the task is in the person’s job description or in the facility’s written policies and procedures.
2. Right circumstance: the client’s health is stable. If it changes, the UAP must tell the RN. The RN then reassesses the client and decides again whether delegation is still safe.
3. Right person: the person has the skills and knowledge for this task. The RN, the employer and the person all share this check.
4. Right directions and communication: the RN gives clear instructions for this client: what to measure or observe, how to do it, and when to report back. The UAP asks questions and must agree to take the task. The UAP may not change the way the task is done without asking the RN first.
5. Right supervision and evaluation: the RN monitors the work, checks in with the UAP when it is done, and evaluates how the client did. The RN stays available to step in.

What stays with the RN

The RN cannot hand over clinical reasoning, nursing judgment or critical decisions to anyone else. Open RN gives examples of RN-only work:

• the admission or initial assessment, including the first assessment after surgery
• creating the care plan and evaluating whether it is working
• client teaching, meaning planning and giving new education, such as teaching a new skill or a new medicine
• care of an unstable client: routine vital signs on a stable client may go to a UAP, but vital signs on an unstable client should not

Teaching and reinforcing are different. An LPN/VN cannot teach a client on their own. But an LPN/VN may reinforce teaching the RN has already given, as written in the care plan. A UAP cannot teach either, but can encourage a client to follow teaching already given, for example to keep oxygen tubing in place during meals.

Also from the guidelines:

• A UAP who does not feel able to do a task safely should not accept it.
• A UAP cannot pass the task to someone else. Only the licensed nurse decides who does it.
• If the RN is unsure that delegation is right, the RN does the task.

How to work through a delegation question

Ask these questions in order:

1. Is the client stable, with a predictable outcome? If not, the RN gives the care.
2. Does the task need assessment, judgment, planning, new teaching or evaluation? If yes, the RN keeps it. Reinforcing teaching already given can go to an LPN/VN.
3. Is it within this person’s role, training, state rules and facility policy?
4. Did the RN give clear instructions (what to report and when) and plan to follow up and evaluate?

The best answer usually keeps judgment with the RN and gives routine care for stable clients to others.

PH vs US: Job titles and the rules about who may do which task vary between countries, and even between US states. What was normal in your past workplace may not match US rules. On the NCLEX, do not answer from your past job. Use the five rights and the US guidelines in this lesson.

Something looks wrong