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Prioritization and Delegation
Who to see first, five rights, scope, SBAR and escalation for NCLEX-RN and PN
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Who to see first
Use these filters together. ABC threats usually come first, then unstable or unexpected changes, then safety.
- ABCs; in cardiac arrest, compressions first (C-A-B); newborns: ventilate first
- Unstable or unexpected: new change, abnormal vital signs, falling LOC
- Safety: suicide plan, violence, fall risk, wrong drug or client
- Acute before chronic
- Actual before potential, unless harm is imminent
- Maslow for the rest: physiologic needs, then safety
| Pattern | See first | Can wait |
|---|---|---|
| Airway | New stridor or lip swelling after a drug | Stable trach, routine care due |
| Mental status | New restlessness or confusion | Confusion at baseline |
| Post-procedure | Just back; BP falling, HR rising | Day 3, pain controlled |
| Labs | Abnormal value with symptoms or ECG change | Stable value, routine follow-up |
Five rights of delegation (NCSBN/ANA 2019)
Delegation hands a specific task to a competent delegatee who accepts it. The nurse stays accountable for the client, the delegatee for the task. Nursing judgment is never delegated.
| Right | Ask yourself |
|---|---|
| Task | In the job description or written agency policy? |
| Circumstance | Is the client stable? A change means the nurse reassesses |
| Person | Trained, with validated competence? |
| Directions and communication | What, how, when to report; delegatee asks questions, changes nothing alone |
| Supervision and evaluation | Nurse follows up, evaluates, stays available |
- Assignment: routine care within a person's usual role
- Delegation: a task beyond the usual role, after extra training
- Not competent? Delegatee declines. Unsure it is safe? Nurse does it
- No re-delegation; delegatee reports back if unable to finish
- Whole-client transfer is a handoff; RNs can still delegate tasks to RNs
- Agency policy can be stricter than state law, never looser
The 2026 RN test plan lists all five rights. Management of Care (15–21% of items) is its largest subcategory.
Who does what
Exam-level scope; state law and facility policy set real scope.
| Role | Usually OK | Not this role |
|---|---|---|
| AP (UAP, CNA, tech) | ADLs, ambulation; VS, I&O, weight (stable); routine specimens | Assess, teach, judge; unstable clients; meds unless allowed |
| LPN/VN (LVN in some states) | Stable clients: data collection, routine meds, dressings, catheters, feedings | Admission/first post-op assessment, creating care plans, first teaching, evaluation, titration |
| RN | Admission/post-op assessment, care plan, teaching, evaluation, starting blood, unstable clients | Delegating assessment, initial teaching, evaluation or judgment |
NCLEX-PN: the LPN/VN lens
The 2026 NCLEX-PN calls this Coordinated Care (18–24% of items, its largest subcategory). The LPN/VN cares for clients with common problems and predictable outcomes.
- Collects data; the RN does the comprehensive assessment
- Contributes to the care plan; reinforces teaching
- Uses the five rights; assigns to AP or other LPN/VNs; monitors AP
- Tells the RN or supervisor when a status change means the assignment must change
- Delegates to AP only where state law allows
SBAR, handoff and chain of command
| Step | Say | Example |
|---|---|---|
| Situation | Who you are, which client, the problem now | 4 West RN; John J, 68: BP 84/50, was 126/78 |
| Background | Diagnosis, key history, treatment | Day 1 after bowel surgery, on heparin |
| Assessment | What you think is wrong | HR 124, pale; I think he is bleeding |
| Recommendation | What you need, by when; repeat back the reply | Please see him now; hold heparin? |
- Handoff: face to face when possible, structured (SBAR or I-PASS)
- Receiver asks questions and confirms understanding
- Read back verbal orders and critical results; sender confirms (check-back)
Escalating an unresolved safety concern:
- Tell the person directly (CUS: concerned, uncomfortable, safety issue)
- Restate if ignored (two-challenge rule)
- Charge nurse
- Nursing supervisor or manager
- Next medical or administrative level, per facility policy
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Related one-pagers
- Next Gen NCLEX: Clinical JudgmentThe six NCJMM steps, NGN item types and partial-credit scoring on the 2026 NCLEX-RN and NCLEX-PN
- NCLEX-PN: The LPN/VN RoleCoordinated Care, PN vs RN scope, what to report, working with UAP, and consent and client rights under the 2026 NCLEX-PN test plan
Sources
- American Heart Association. Part 7: Adult Basic Life Support. 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Link
- National Council of State Boards of Nursing and American Nurses Association. National Guidelines for Nursing Delegation. Effective April 29, 2019 (replaces the 2010 joint statement). Link
- National Council of State Boards of Nursing. 2026 NCLEX-RN Test Plan. Effective April 1, 2026 to March 31, 2029. Link
- National Council of State Boards of Nursing. 2026 NCLEX-PN Test Plan. Effective April 1, 2026 to March 31, 2029. Link
- National Council of State Boards of Nursing. NCLEX Test Plans (web page). Link
- Ernstmeyer K, Christman E, eds. Nursing Management and Professional Concepts, 2nd ed. Open RN / WisTech Open; 2024. Chapter 2.3, Tools for Prioritizing. Link
- Ernstmeyer K, Christman E, eds. Nursing Management and Professional Concepts, 2nd ed. Open RN / WisTech Open; 2024. Chapter 3.3, Assignment. Link
- Ernstmeyer K, Christman E, eds. Nursing Management and Professional Concepts, 2nd ed. Open RN / WisTech Open; 2024. Chapter 3.4, Delegation. Link
- Ernstmeyer K, Christman E, eds. Nursing Management and Professional Concepts, 2nd ed. Open RN / WisTech Open; 2024. Chapter 7.7, Conflict Resolution. Link
- Institute for Healthcare Improvement. SBAR Tool: Situation-Background-Assessment-Recommendation. Link
- Agency for Healthcare Research and Quality. TeamSTEPPS Curriculum Materials, Module 1: Communication. Tool: SBAR. Content last reviewed November 2019. Link
- Agency for Healthcare Research and Quality. TeamSTEPPS Curriculum Materials. Tool: Check-Back (or Repeat-Back). Content last reviewed July 2023. Link
- Agency for Healthcare Research and Quality. TeamSTEPPS Curriculum Materials. Tool: Handoff. Content last reviewed May 2023. Link
- Agency for Healthcare Research and Quality. TeamSTEPPS Curriculum Materials. Tool: I-PASS. Content last reviewed July 2023. Link
- Agency for Healthcare Research and Quality. TeamSTEPPS Curriculum Materials, Module 4: Mutual Support. Tool: CUS. Content last reviewed May 2023. Link
- Agency for Healthcare Research and Quality. TeamSTEPPS Curriculum Materials, Module 4: Mutual Support. Tool: Two-Challenge Rule. Content last reviewed May 2023. Link
- AHRQ Patient Safety Network. Handoffs (primer). Updated June 15, 2024. Link
- AHRQ Patient Safety Network. Rapid Response Systems (primer). Updated September 15, 2024. Link
- The Joint Commission. National Performance Goals, Effective January 2026 for the Hospital Program. Link