NR 103 Week 3 RN Role and Delegation Paper Example

The Registered Nurse on a Subacute Rehabilitation Unit: Where the Role Overlaps With the Practical Nurse, and Where Delegation Draws the Line

Student Name

College of Nursing, Chamberlain University

NR 103: Transition to the Nursing Profession

Instructor Name

Month Day, Year

The Registered Nurse on a Subacute Rehabilitation Unit: Where the Role Overlaps With the Practical Nurse, and Where Delegation Draws the Line

One Setting, Fixed Early

This paper describes the role of the registered nurse (RN) on a single kind of unit: a 32-bed subacute unit in a nursing and rehabilitation center, where patients stay two to four weeks after a hospital admission for a hip replacement, a stroke, pneumonia or heart failure before going home. I worked on such a unit as a nursing assistant for a year. On a typical day shift, it is staffed by two RNs, three licensed practical nurses (LPNs) and five nursing assistants, with a physical therapist, an occupational therapist and a nurse practitioner who visits each morning.

I chose one setting because the role of the RN differs sharply between settings. On an intensive care unit the RN does almost everything at the bedside; on a subacute unit, most hands-on care is done by others, and the RN's work is harder to see. That makes this setting a useful test of what the RN's role actually is.

The Definition, Taken From the Regulator

The legal definition of nursing comes from each state's nurse practice act, and the details differ from state to state. The common structure, reflected in the national delegation guidelines published by the National Council of State Boards of Nursing, the organization of the state boards that license nurses, is that the RN is responsible for the full nursing process: the comprehensive assessment of a patient, the nursing diagnosis, the plan of care, and the evaluation of whether the plan is working (National Council of State Boards of Nursing [NCSBN], 2016). The LPN, under the direction of an RN or another authorized provider, contributes to that process by collecting focused data, carrying out established parts of the plan, and reporting changes. The guidelines also distinguish two ways in which work passes between people: assignment, meaning routine care that falls within a person's authorized scope, and delegation, meaning a specific task that falls outside a person's usual role and is handed over by a licensed nurse who keeps accountability for it.

Taken from the regulator rather than from a textbook, the RN's role on this unit is not defined by kindness or dedication, which the LPN and the nursing assistant share, but by responsibility for judgment: deciding what the patient's condition means, what the plan should be, and who is permitted to carry out each part of it.

Two Roles, Honestly Overlapped

On this unit, the RN and LPN roles overlap more than the legal definitions suggest. Both give oral and injected medications, change dressings, check blood glucose, take vital signs and talk with families. On a busy morning, a visitor could not tell them apart. An LPN with fifteen years on the unit may know the patients and their routines better than a newly hired RN, and may be the first to notice that a patient is not himself.

The difference appears when something changes. When an LPN notices that a patient recovering from pneumonia has a new cough and a temperature of 38.1 C, the LPN reports it. The RN performs the assessment that decides what it means: listening to the lungs, reviewing the trend in vital signs and oxygen levels, considering the patient's history, and deciding whether to call the nurse practitioner now, update the care plan, or watch and recheck. The LPN's observation starts the process; the RN's assessment and judgment carry it forward. On this unit, the RN also writes and updates the care plans for all 32 patients, completes the admission assessments, and signs off the federally required resident assessment for each patient, none of which can be done by the LPN.

Nobody on the unit needs this overlap removed, because the unit runs on it every single day. An RN who treated every LPN report as unreliable until personally confirmed would be overwhelmed within an hour. An LPN who waited for the RN before acting on anything would leave patients waiting. The unit depends on each role doing its own part fully and trusting the other to do the same, which is why the line between assessment and data collection matters: it tells each nurse where the handoff happens and who owns the decision once it does.

Delegation as the Visible Edge

Delegation is where the RN's role becomes visible. When the RN asks a nursing assistant to walk a patient after a hip replacement with a walker twice before lunch, the RN has decided that the patient is stable enough, that the assistant is competent to do it, and what the assistant should report back, such as pain above 6, dizziness, or the patient refusing. If the patient falls, the RN remains accountable for the decision to delegate, even though the RN never touched the patient. The guidelines make this explicit: the licensed nurse who delegates keeps responsibility for the delegation and for evaluating its outcome (NCSBN, 2016).

This is the part of the role I did not understand as a nursing assistant. I thought the RN on my unit spent too much time at the computer and too little at the bedside. I now see that much of her time went to deciding who would do what for whom, checking that it had been done, and adjusting the plan when it had not worked. The work was real; it was simply done through other people.

The Limit, Stated at the End

The limit of this paper is that it describes one kind of unit, in general terms, and my understanding comes partly from a nursing assistant's view. The specific tasks an LPN may perform differ by state, and some states allow LPNs to do things on this list that others do not, such as parts of the admission assessment or certain intravenous care. What does not change across states, as far as the national guidelines describe, is that the RN holds responsibility for comprehensive assessment, for the plan of care, and for decisions about delegation. On a subacute unit, that responsibility is most of the RN's job, and it is the part I will need to learn to do when I am no longer the one being delegated to.

Before I start work as an RN, I will read the practice act of the state where I am licensed rather than rely on this general picture.

References

National Council of State Boards of Nursing. (2016). National guidelines for nursing delegation. Journal of Nursing Regulation, 7(1), 5-14. https://doi.org/10.1016/S2155-8256(16)31035-3