Nursing care
Delegating to LPN: the method, the errors, and the exam
Written and reviewed by Dana Whitfield, RN, MSN · 5 min read · Updated September 2026
Short answer
An RN delegates to an LPN or LVN tasks involving stable patients and already-established plans of care, such as administering most oral and IM medications, reinforcing teaching, and performing routine assessments beyond baseline. Delegation excludes initial assessment, initiating patient teaching, care of unstable patients, and IV push medication in most states.
What the skill is for
Delegation exists because an RN cannot personally perform every task on a full patient assignment, and safe care depends on matching each task to the scope of the person best suited to do it without compromising oversight. An LPN or LVN has a defined scope narrower than an RN's, built around a completed plan of care and a stable patient rather than the open-ended clinical judgement an RN's licence covers.
The distinction that matters is between tasks that require independent nursing judgement, which stay with the RN, and tasks that follow an established plan, which can go to an LPN. Delegation is tested because it sits at the centre of scope of practice, and getting it wrong exposes patients to risk while also exposing the RN to accountability for a task delegated outside another provider's licence.
The method, step by step
Start with the patient's stability. An LPN can be assigned a patient whose condition is stable and predictable, with a plan of care already established by the RN; an unstable or newly admitted patient stays with the RN. Confirm that the task itself falls within LPN scope: administering most oral, subcutaneous, and intramuscular medications, reinforcing education the RN has already begun, performing routine and follow-up assessments, and carrying out treatments specified in the care plan.
Exclude from delegation anything that requires independent clinical judgement at the point of care: the initial admission assessment, initiating patient or family teaching from scratch, and IV push medications, which remain outside LPN scope in most states. After assigning a task, the RN retains responsibility for supervising the outcome and must be available to reassess if the patient's condition changes, since delegation transfers the task, not the accountability.
Where it goes wrong
The most frequent error is delegating the initial assessment of a newly admitted or unstable patient, on the assumption that any assessment is fair game once a patient is on the unit. Initial assessment sets the baseline the entire plan of care depends on, and it requires the clinical judgement that belongs to the RN's scope, not the LPN's.
A second error is assuming state scope of practice is uniform. IV push medication is excluded from LPN scope in most states, but scope of practice is set at the state level, and a small number of states or facility policies permit it under specific certification. Assuming a blanket rule without confirming local scope is a real risk in practice, though NCLEX questions default to the majority position unless the stem specifies otherwise. A third error is delegating teaching that the RN has not yet started, since an LPN can reinforce established teaching but should not be the one introducing new information to a patient.
Practising it deliberately
Build a short mental checklist and run it against every delegation scenario: is the patient stable, is the plan of care already established, does the task require independent judgement or does it follow a set plan. If any answer points toward instability or judgement, the task stays with the RN.
Practise sorting a mixed list of tasks, some appropriate for LPN delegation and some not, and explain out loud why each one belongs where it does. Pay particular attention to tasks that look similar on the surface but differ in scope, such as reinforcing teaching versus initiating teaching, or performing a routine reassessment versus completing the initial assessment. The words used in a scenario, first assessment versus follow-up assessment, are usually the signal.
Applying it on the exam
NCLEX delegation questions usually list several tasks and ask which one is appropriate to delegate to an LPN, or which one the RN should retain. The correct answer is the task involving the most stable patient and the least independent judgement; the wrong answers usually bundle in an unstable patient, a new admission, or a teaching task framed as starting from nothing.
Watch for questions that test IV push specifically, since it is a frequently tested exclusion. Also watch for scenarios where a patient who was initially stable begins to show a new symptom, such as new-onset chest pain or a change in level of consciousness, mid-shift; the correct response is that the RN reassesses and resumes responsibility for that patient's care, not that the LPN continues managing it under the original plan.
A worked example
An RN has four patients: a newly admitted patient awaiting an initial assessment, a post-operative patient two days out with a stable and established plan of care needing routine wound care and oral pain medication, a patient requiring IV push antibiotics, and a patient who needs discharge teaching started for a new diagnosis. The RN must decide which of these can go to an LPN.
The post-operative patient's routine wound care and oral medication administration are appropriate to delegate, since the patient is stable and the plan of care is already established. The new admission's initial assessment stays with the RN, as does the IV push antibiotic in most states, and the RN should personally initiate the discharge teaching, though the LPN could later reinforce it once the RN has introduced the content.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our prioritization and delegation practice questions are the closest set to what this page covers.
Common questions
Can an LPN give IV push medications?
In most states, no. IV push is generally outside LPN or LVN scope of practice, though a small number of states and facilities permit it with additional certification, so the RN should confirm local scope rather than assume.
Can an LPN perform patient assessments?
An LPN can perform routine and follow-up assessments once a baseline is established, but the initial admission assessment requires the independent clinical judgement that belongs to the RN's scope.
Can an LPN do patient teaching?
An LPN can reinforce teaching that the RN has already introduced, but initiating new patient or family teaching, such as discharge instructions for a new diagnosis, stays with the RN.
What patient type is safe to delegate to an LPN?
A stable patient with an already-established plan of care is appropriate for LPN assignment. An unstable, newly admitted, or unpredictable patient should remain with the RN.
More on prioritization and delegation