Coordinated Care: Assignments, Delegation, and the Care Plan
What you must understand
Coordinated care questions test whether you can organize care for a group of clients and work legally within the LPN scope. Know the five rights of delegation (right task, circumstance, person, direction/communication, supervision), the difference between delegation and assignment, and which tasks may go to unlicensed assistive personnel (UAP). Know the chain of command, informed consent basics (the provider obtains consent; the nurse witnesses and clarifies), advance directives, and the role of the case manager.
Traps to watch
- Delegation vs. teaching. UAP may reinforce teaching already done by a licensed nurse but may not perform initial client education, triage, or evaluation.
- Unstable beats stable. The most acute or unpredictable client belongs to the RN; a stable client with routine needs may be assigned to an LPN or UAP.
- Never delegate judgment. Assessment, care planning, and evaluation stay with the licensed nurse.
- "Ask the charge nurse" is not always correct. If the scenario describes a clear scope violation, the answer is to refuse the task and report it.
Rule of thumb
Assign by acuity and predictability first, then by skill match. If a task requires interpreting a change in condition, it cannot be delegated.
Worked example
An LPN is given four clients: (A) new admission with chest pain 30 minutes ago, (B) postoperative day 3 requesting a dressing change, (C) client with dementia who is wandering, (D) client awaiting discharge instructions. The LPN should see A first because the complaint is potentially life-threatening and unstable, then C for safety, then B, then D. Delegate only the stable, predictable tasks (vital signs on B) to UAP.