Deck 26: Delegation: An Art of Professional Practice

Question 1

A key advantage that a nurse manager has in terms of delegating is that:

A) Clients receive less attention because too many staff make it difficult to coordinate care.
B) Nurses report less pressure to perform necessary tasks themselves.
C) Administration can predict overtime more accurately.
D) Team skills can be used more effectively.

Answer 1

Team skills can be used more effectively.

Question 2

Which of the following indicates safe delegation?

A) The nurse supervisor for a large urban acute care department asks the unit manager to accept two new acutely ill patients, which the manager does. The unit is short two staff, and the replacement is inexperienced.
B) A unit manager agrees to release a staff from her unit to Unit B. The staff member she agrees to release is experienced on Unit B and is agreeable to the change. The unit manager's unit is fully staffed and patients are stable.
C) The nurse supervisor asks the head nurse for Unit A to make do without a replacement for an ill staff member because Unit A was originally overstaffed anyway. Patient acuity levels are very high on Unit A and two staff are orientating.
D) The nurse supervisor asks the charge nurse on Unit B to cover Unit F, which is two floors up, because the charge nurse for Unit F is ill. The charge nurse for Unit B is an experienced manager but has no experience with the nursing care required on Unit F.

Answer 2

A unit manager agrees to release a staff from her unit to Unit B. The staff member she agrees to release is experienced on Unit B and is agreeable to the change. The unit manager's unit is fully staffed and patients are stable.

Question 3

The nurse manager is setting up the room assignments for the unit.She has one critical patient on the unit,who is going to require more care than the others.Before delegating a task,a nurse manager should:

A) Delegate the admission assessment to the LPN.
B) Review the employee's performance assessment for the most recent period.
C) Assess the amount of guidance and support needed in a particular situation.
D) Create a task analysis of critical behaviors for the individual.

Answer 3

Assess the amount of guidance and support needed in a particular situation.

Question 4

In delegating to a UNP in a home health setting,which of the following represents the most appropriate delegation communication?

A) "You will be taking care of Mrs. S. Mrs. S. needs assistance with her bath."
B) "You will need to help Mrs. S. get into and out of her shower. Ensure that you check the condition of her feet, and let me know if you have any concerns when you check in."
C) "I am not sure that you know how to do this, but I am giving you Mrs. S. She is quite obese and needs skin care."
D) "Mrs. S. needs help to get into and out of her bathtub. Her bath will need to be completed by 10:00. When you are helping her to dry, please check between her toes and toenails, and phone me by 10:30 if you notice nail discoloration or redness."

Question 5

Which of the following would be most in line with Hersey and Blanchard's concepts?

A) The team of caregivers on day shift is familiar with their roles and with the patients. The nurse manager decides to work on the unit budget in her office.
B) After a year of working on the unit, Shari, an LPN, is still hesitant about many policies and procedures. The charge nurse decides to challenge Shari with more difficult patients.
C) The nursing supervisor asks one of her charge nurses to lead a technology integration project. The supervisor continuously demands involvement in decisions that the charge nurse is making in the project.
D) Team members complain that Alysha, an RN, is unmotivated, and that she refuses assignments that are complex or difficult. The charge nurse suggests that Alysha is relatively new and that she needs time to adjust.

Question 6

You ask Evelyn,a new UNP,to check what is left in Mrs.N.'s inhaler when Evelyn makes visits to Mrs.N.,and also to check whether Mrs.N.is receiving any positive effect from the medication.Evelyn reports for 3 weeks that Mrs.N.is using the inhaler,and that there is enough medication left in the device.The day of her last visit to Mrs.N.,Mrs.N.is admitted to the hospital in severe respiratory distress.When she is admitted,she tells the physician that she has not been using the inhaler for 4 weeks.This incident is an example of:

A) Incompetence of the UNP.
B) Failure to follow through.
C) Skills but no motivation.
D) Lack of accountability.

Question 7

You are working in a home health service and have three unlicensed nursing personnel (UNPs)assigned to your team.You have worked with two of them for 2 years; the third is new.The two experienced UNPs have patients with complex illnesses for whom they provide basic care.The third member of the team has been assigned to patients with less complex illnesses.Your best approach to supervising their care is to:

A) Remain in the office and ask each UNP to check in with you upon arrival at their first patient care site.
B) Ask another RN to supervise the two experienced assistants so you can be with the new person full time.
C) Meet the new staff member at the first patient care site and ask the others to call if anything is unusual.
D) Meet the new staff member at the first patient care site and call the others with questions to determine whether anything is unusual.

Question 8

Sally is an experienced nurse on the unit and is very experienced with ICP monitoring.She is assigned David,a patient who has been admitted with a severe head injury.In communicating with Sally,you would:

A) Provide a detailed explanation of what she needs to do with ICP monitoring.
B) Tell her when she needs to provide an update about David's status.
C) Ask her to tell you what she knows about ICP monitoring and share expectations about reporting.
D) Advise her that you are available if she needs you.

Question 9

Determination of Evelyn's educational preparation and certification (Question 18)is related to the concept of:

A) Accountability.
B) Authority.
C) Role performance.
D) Assignment.

Question 10

An RN colleague,who is a long-standing and collaborative member of your team,is performing a complex and novel dressing for the first time for the patient to whom she has been assigned.Which of the following would be the most appropriate communication with her?

A) "How do you usually do this kind of dressing?"
B) "The dressing needs to be done today and tomorrow with the supplies on this cart."
C) "Here is what you need for the dressing, and I will show you what needs to be done."
D) "I know you know what you are doing. Let me know if you have any problems."

Question 11

During staff development programs,staff nurses verbalize their frustration about their workloads and having to delegate so many tasks to others.One of the main reasons that delegation has emerged as an issue is because of:

A) The amount of paperwork required to complete care.
B) The complexity of client care.
C) Earlier discharge practices.
D) The numbers of other disciplines present on a given unit.

Question 12

The unit manager is working in a large metropolitan facility and is told that two UNPs are to be assigned to work with her.Delegation begins with:

A) Acknowledging the arrival of the second UNP on the unit.
B) Providing clear directions to both UNPs.
C) Matching tasks with qualified persons.
D) Receiving reports from the prior shift.

Question 13

During a fire drill,the nurse manager becomes very assertive and directive in her communications with staff.This type of situational leadership depends on:

A) Supportive behavior by the leader and immature followers.
B) The development level of the followers and the type of behavior of the leader.
C) Well-developed followers combined with a strong leader who acts quickly.
D) The leader's ability to evaluate personnel and communicate that evaluation.

Question 14

You are a member of a team assigned to care for 15 general medical/surgical clients.You have all worked well together in the past in this same type of care.If you are assigned to coordinate this team's work,your best strategy,based on the Hersey and Blanchard model,would be to:

A) Have a list of tasks to be accomplished and tell each member of the team what he or she must do.
B) Encourage people to discuss their frustrations in providing this care.
C) Ignore them-they've done it before.
D) Provide minimal direction and let them come to you with questions.

Question 15

The night nurse understands that certain factors need to be considered before delegating tasks to others.These factors include the:

A) Complexity of the task and the age of the delegate.
B) Potential for benefit and the complexity of the task.
C) Potential for benefit and the number of staff.
D) Complexity of the task and the potential for harm.

Question 16

Which of the following exemplifies accountability? Karen,the nurse manager on 5E:

A) Consistently submits her budgets on time.
B) Consistently performs the responsibilities outlined for nurse managers at her institution.
C) Outlines her rationale for reduction of RN coverage on nights to the Nursing Practice Committee after serious patient injury.
D) Actively solicits ideas regarding scheduling from her staff.

Question 17

The nurse on the 11-7 shift is assigning a component of care to an unlicensed nursing personnel (UNP)employee.The night nurse should remain:

A) Accountable and responsible.
B) Accountable and liable.
C) Authoritative and liable.
D) Responsible and task-oriented.

Question 18

The day shift nurse asks an LPN/LVN to complete a component of care for a client.The day shift nurse is _____ care.

A) Delegating
B) Assigning
C) Sharing
D) Authorizing

Question 19

With delegation,responsibility and accountability remain with the:

A) Physician.
B) Professional who delegates.
C) Individual who receives the delegation.
D) Individual who previously performed the task.

Question 20

In Question 18,before assigning Evelyn to Mrs.N.'s care,the most appropriate action of the care coordinator would have been to:

A) Determine Evelyn's educational background and preparation for this role.
B) Ask Evelyn if she has worked with inhalers before and to describe what she knows about them.
C) Advise that if Evelyn has any questions about what to do with the inhaler, she should come to the coordinator.
D) Advise Evelyn that working the inhaler is not really complicated and that she should ask the patient how to check medication levels in the inhaler.

Question 21

Functions such as "delegates tasks to assistive personnel" that are outlined in a position description for an RN Team Leader would be considered:

A) Active delegation.
B) Passive delegation.
C) Passive accountability.
D) Active responsibility.

Question 22

County Hospital has position descriptions for all staff,including RN Team Leaders.Sarah,a team leader on the rehab unit,assesses the needs of the patients in her area,assesses the skills and backgrounds of each of the individuals on her team,and then assigns and delegates the appropriate care provider to each patient and task.Sarah's activity in the example described is termed:

A) Passive delegation.
B) Passive accountability.
C) Active delegation.
D) Active responsibility.

Question 23

Ali,an RN on your unit,is consistently late to work and makes remarks such as "Do you really want me to do that?" when patients and care are assigned to her.You have spoken with her frequently about her:

A) Ability.
B) Skills.
C) Attitude.
D) Personal issues.

Question 24

Sarah (Question 21)provides Colleen,her RN colleague with details regarding the patients to whom Colleen has been assigned on the day shift.This is an example of:

A) Accountability.
B) Responsibility.
C) Assignment.
D) Delegation.

Question 25

An example of a care activity that would likely not be delegated by an RN to a UNP is

A) Teaching self-catheterization to a patient with paraplegia who has limited English.
B) Basic care for a patient with a head injury who is rapidly deteriorating.
C) One-to-one observation with a suicidal patient.
D) Assessment of patients being admitted through the Emergency Department.
E) Basic hygienic care for a patient who is post MI and stable.

Question 26

Leslie,a UNP,transfers a patient while using improper technique.The patient is injured,and as a result,a suit is launched in which both Sarah,the delegator,and Leslie,the delegatee,are named.Sarah is named in the suit because she:

A) Retains responsibility for the care of the patient.
B) Worked the same shift as Leslie.
C) Has passive accountability for delegation.
D) Retains accountability for the outcomes of care for the patient.