Leadership: Delegation

A postoperative client is transferred to the medical-surgical unit from the intensive care unit (ICU). The client asks the assigned nurse why unlicensed assistive personnel (UAP) help with range-of-motion exercises. Which is the best response by the nurse? A) "Your condition has improved, so I delegated that part of your care to the UAP." B) "You do not need me to ambulate you." C) "The charge nurse made the decision to have the UAP assist you when walking." D) "I assigned all of your care to the UAP."

Answer: A Explanation: A) An assignment of care is made to a qualified individual (the RN), who then may delegate parts of that care to a UAP. The nurse would not assign care to the UAP, but rather, delegate certain tasks to the UAP. Saying that the client does not need the nurse is not the best approach; it is better to explain that the client has improved to the point where the UAP can assist with certain tasks. The UAP may be delegated tasks by a nurse assigned to care for the client. The charge nurse does not make the assessment to delegate to the UAP; the RN assigned to the care of the client is the decision maker.

The nurse delegated to an unlicensed assistive personnel (UAP) the task of assisting a client with a simple dressing change. The client was formerly able to do the procedure, but because of painful arthritis is now unable to perform the redressing. The UAP has done this procedure before. Which must the nurse emphasize to the UAP? A) Report to the nurse immediately anything unusual, such as bleeding or infection. B) The nurse should demonstrate the steps of the procedure. C) Make the client do most of the procedure and report the expected output. D) The UAP should do health teaching while performing the procedure.

Answer: A Explanation: A) The nurse delegated a specific legal task to the UAP, which is within the scope of the UAP's ability. The nurse established the particular parameters outside of which immediate notification is requested. If in pain, the client should not have to do any of the procedure. If the UAP has done the procedure before, the nurse should not need to demonstrate it. Health teaching is outside of the scope of practice for the UAP.

The nurse is working on a medical-surgical unit that is short staffed due to a callout. The manager of the unit was unable to replace the nurse, so the extra clients were assigned to the remaining nurses. The manager was able to get the help of unlicensed assistive personnel (UAP) from the house pool to help on the unit. Which action by the nurses would ensure effective care for the client? A) Delegate vital signs and weights to the UAP. B) Explain to the manager that care may be compromised if another nurse does not work the shift. C) Tell the clients their care will be sparse. D) Assign care of invasive lines to the UAP.

Answer: A Explanation: A) The nurses would delegate to the UAP tasks such as taking and recording vital signs and weights to ensure that all clients receive appropriate care. UAPs are not assigned care, they are delegated tasks, and nurses should never delegate the task of care of invasive lines to the UAP. The goal for the unit is to meet the needs of the clients; complaining to the manager will not accomplish this. Telling the clients their care will be sparse is inappropriate.

A nurse-supervisor is encouraging nurses to delegate responsibilities whenever possible. Which criteria are used to determine tasks that can be delegated? Select all that apply A) Does the delegate have the appropriate skills to perform the task safely? B) How busy are you? C) Is the client frequently complaining? D) Does the task require client education? E) Is the task unpleasant?

Answer: A, D Explanation: A) Only tasks that are within the delegate's scope of practice and that the delegate has the skills to perform safely should be delegated. Tasks that require client education should never be delegated. The nurse's busyness may point out the need for delegation but it does not define which tasks may be delegated. The behavior of the client and the unpleasant nature of the task are not criteria for delegation.

An experienced delegator is mentoring a newly appointed nurse in the hospital. The new nurse states, "I am hesitant to delegate tasks to unlicensed assistive personnel (UAP) because I am afraid they will not be done correctly." Which response by the experienced delegator is appropriate? A) Tell her not to delegate any tasks unless she is completely confident. B) Tell her to clearly identify the task and expectations and then to monitor the delegate's progress. C) Tell her that delegation often results in a decrease in job satisfaction. D) Tell her that her job responsibility requires that she do everything herself.

Answer: B Explanation: A) Although this is a typical concern of inexperienced and insecure delegators, following the delegation guidelines can increase her confidence in the process. The key to retaining control is to clearly identify the task and expectations and then to monitor the delegate's progress and provide feedback. If one is able to delegate some routine tasks to others, then job satisfaction should increase because of increased opportunities. An appropriate environment supports delegation.

A staff nurse at a hospital calls a long-term care facility that has just received transfer of care for a client. The hospital nurse reports the physician's medication orders to a nurse at the receiving facility. The hospital nurse does not have prescribing privileges. What is the responsibility of the nurse at the receiving facility in order to reduce the fear of liability? A) Withhold medications until the facility's physician can assess the new client B) Administer medications to the client immediately C) Verify the order with the prescribing physician D) Submit the medication order to the on-site pharmacy as soon as possible

Answer: C Explanation: A) If the nurse calling the long-term care facility does not have prescribing privileges, then the nurse at the receiving facility must verify the order with the prescribing physician. Administering medications immediately or submitting the order to the pharmacy without verification would not reduce liability. Withholding medications until the facility's physician can assess the new client would also not reduce liability.

The nurse is working on a unit with unlicensed assistive personnel (UAP). One nurse refuses to use the UAP and is consistently leaving nursing tasks for the next shift that have yet to be completed. Which is the most likely reason the nurse is not using the UAP to assist with client care? A) Avoidance of responsibility B) Overdependence on others C) The belief that no one else can perform a task as well as the nurse can D) The state nurse practice act

Answer: C Explanation: A) One barrier to delegation is the belief that nobody else is capable of getting the job done for the client. The state nurse practice act would be considered an environmental barrier. The nurse who refuses to delegate care is not being overly dependent. The nurse is accepting too much responsibility rather than too little.

The nurse is caring for several medical-surgical clients. The nurse has delegated skin care of an incontinent client to new unlicensed assistive personnel (UAP) on the unit. Which action by the nurse will improve effectiveness of the client care provided? A) Ask the client if the care was appropriate. B) Ask the UAP if the care was given. C) Demonstrate the appropriate care needed and have the UAP give a return demonstration. D) Closely observe the UAP each time the care is given.

Answer: C Explanation: A) The nurse would show the UAP the exact procedure the first time to avoid any confusion and then have the UAP give a return demonstration to ensure the UAP knows how to properly perform the procedure. The nurse would reassess the client's skin later rather than asking the UAP if the task was done. The nurse could possibly alarm the client by asking the client if care was appropriate. Closely observing the UAP each time defeats the purpose of delegation.

The nurse delegates vital signs and daily weights of assigned clients to the unlicensed assistive personnel (UAP) on duty. Which is the reason for the nurse to assess each client throughout the shift? A) The UAP cannot report to the next shift. B) The UAP is not trustworthy. C) The nurse maintains the authority to care for the clients. D) The nurse remains accountable for the clients' care.

Answer: D Explanation: A) The nurse remains accountable for the care of clients during delegation to the UAP. The UAP may be untrustworthy, but the reason the nurse checks on the clients is because the accountability belongs to the nurse. The nurse could take a report from the UAP and report that to the next shift. The nurse transfers the authority for the delegated care to the UAP.