3.3 Assignment – Nursing Management and Professional Concepts (2024)

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.”

Nursing Team Member

Scope of Practice

Common Tasks

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

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.

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]

FAQs

What are the concepts of nursing management? ›

This involves several key concepts, including organizing, delegation, motivation, supervision, coordination, and conflict management.

What are the concepts of professional nursing? ›

Yoder defined nursing professionalism based on six components: acting in the patients' interests; showing humanism; practising social responsibility; demonstrating sensitivity to people's cultures and beliefs; having high standards of competence and knowledge; and demonstrating high ethical standards [9].

What is your own concept of nursing? ›

Nursing integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence.

3.3 Assignment – Nursing Management and Professional Concepts (2024)

FAQs

What are the concepts of nursing management? ›

What is your own concept of nursing? ›

References