3.4 Coordination of Care & Delegation

Care Planning and the Nursing Process

The practical nurse (PN) — called a licensed practical nurse (LPN) in most provinces and a registered practical nurse (RPN) in Ontario — coordinates client care using the nursing process, remembered as ADPIE: Assessment, Diagnosis (analysis), Planning, Implementation, and Evaluation. The care plan converts assessment data into measurable, client-centred goals with specific interventions and target dates. The PN gathers ongoing data, carries out interventions, documents the client's response, and revises the plan when goals are met or the client's status changes.

On the CPNRE and REx-PN, care coordination lives in the Safe and Effective Care Environment domain (28-40% of the exam). Within that domain, Management/Coordination of Care is 18-24% — the single largest sub-category outside Physiological Integrity — so mastering assignment, delegation, priority setting, and continuity of care is high-yield. Expect scenario items that ask what the PN should do first, next, or delegate.

The Interprofessional Team

Collaborative practice means the PN contributes nursing knowledge and observations while respecting each member's distinct scope. The PN does not simply take orders from physicians, nor does the PN supervise every team member. Instead, the PN communicates client information, flags changes, and refers to the right discipline. A frequent trap answer is "work independently without consulting other disciplines" — always wrong.

Match the client need to the correct referral:

Remember the LPN/RPN versus RN distinction: the PN generally cares for clients whose conditions are stable and predictable, while the RN takes the complex, unstable, or unpredictable client. When acuity rises unexpectedly, the PN collaborates with or transfers care to the RN.

Assignment versus Delegation

These two words are tested constantly and are not interchangeable.

• Assignment distributes work to a regulated provider who already has the authority and competence within their own scope. Each provider is individually accountable for the assigned care. Matching clients to providers is done by acuity — higher-acuity clients require regulated providers with the needed competence, not by seniority, staff preference, or simply equal client numbers.
• Delegation transfers authority to perform a specific task to another person (commonly an unregulated care provider, UCP, also called a personal support worker, PSW) for whom the task is normally outside scope. The delegating nurse remains accountable for the decision to delegate and for supervision.

Supervising Unregulated Care Providers

A UCP/PSW may be delegated stable, routine, predictable tasks: assisting a stable client with bathing, oral hygiene, feeding, ambulating, and recording routine vital signs on stable clients. A UCP may never perform the nurse-only activities that require clinical judgment:

• Assessment (including the initial admission assessment)
• Medication administration
• Client teaching
• Evaluation of a client's response to therapy

Use the Five Rights of Delegation as your checklist: Right Task, Right Circumstance, Right Person, Right Direction/Communication, and Right Supervision. If any right is missing — for example, an unstable client (wrong circumstance) or a task requiring judgment (wrong task) — do not delegate.

Continuity of Care and Handover — SBAR

Continuity depends on structured communication. The standard tool is SBAR:

• S — Situation: the current problem ("Mr. L is post-op day 1 and rates pain 8/10").
• B — Background: relevant history and context.
• A — Assessment: your findings and interpretation.
• R — Recommendation: what you need or suggest.

At handover/shift report, prioritize time-sensitive clinical information — for example, that a client received analgesia 30 minutes ago yet still reports pain — over comfort or social details like visitor times or curtain preferences. Verbal and telephone orders are avoided except in genuine emergencies; once the situation stabilizes, the order must be documented and then verified and signed by the prescriber per facility policy.

Discharge Planning and Referrals

Discharge planning begins at admission, not on the day of departure. Effective discharge coordination includes medication reconciliation, teach-back to confirm understanding, arranging follow-up appointments, and making referrals — such as OT for a home-safety assessment before a client with new mobility limits goes home, home care for ongoing wound care, or community services for support. Coordinating these transitions prevents readmission and keeps care safe, continuous, and client-centred.

A Worked Coordination Scenario

Consider a busy medical unit where the PN is responsible for six clients with the help of one UCP. Client A is a stable long-term resident who needs a bed bath and breakfast set-up; client B is one day post-op and reports pain; client C is medically stable but needs teaching on a new inhaler; client D is being discharged home with new mobility limits. The PN delegates the bath and meal set-up for the stable client (A) to the UCP — a right task, right person, right circumstance — while keeping the post-op pain assessment (B), the inhaler teaching (C), and the discharge coordination (D) because each requires nursing judgment. For client D, the PN initiates an OT referral for a home-safety assessment and completes medication reconciliation and teach-back before discharge. This distribution keeps every task with a provider whose scope and competence match the need, which is exactly what the exam rewards.

Common Coordination and Delegation Traps

• Never delegate assessment, evaluation, teaching, or medication administration to a UCP, even when the unit is short-staffed.
• Match by acuity, not by seniority, staff preference, or equal client numbers — a higher-acuity client needs a provider with the right competence.
• Accountability stays with the delegating nurse; delegating a task does not transfer responsibility for the outcome.
• Address a colleague's unsafe or falsified documentation directly and through the chain of command first, before escalating to the regulatory college.
• Escalate to the RN when a client who was stable becomes complex or unpredictable — the PN's typical scope is stable, predictable clients.