(PrepU) Chapter 10: Leadership, Managing and Delegating

Which statement by a registered nurse (RN) represents appropriate delegation to a nursing assistant?

"Dispose of the disconnected IV set." Disposing of a disconnected IV set is a task that is within the scope of practice of a nursing assistant. Discontinuing an IV solution, inspecting an IV site for thrombophlebitis, and checking the IV infusion rate are not within the scope of practice of a nursing assistant and should be performed by the RN.

The new nurse is having difficulty managing the time required to care for a group of complex clients and is several hours behind in completing nursing interventions. Which intervention should the nurse complete first?

Administer a dose of digoxin that is two hours behind schedule. The first step in time management is to determine which tasks are priority. Digoxin is a critical client medication and therefore takes priority over the other options. Dressing changes, discharge orders, and completing facility forms can be delayed until critical tasks are complete.

The nurse is working to enhance time management skills and has to administer pain medications to several patients, obtain vital signs, and assist clients with bathing. What should the nurse do next?

Delegate bathing and vital signs tasks. Steps to enhancing time management include: establish goals, evaluate ability to meet goals and identify tasks that can be delegated, establish a timeline, evaluate success of the plan, and use the evaluation to make future plans. Goals were established in the stem of the question and therefore, the next step would be to delegate task.

The nurse has recently been promoted to nurse manager on a pediatric unit and has decided to accept input from staff regarding changes they would like to see on the unit. Which type of leadership style is the nurse embodying?

Democratic Democratic leadership style involves sharing the decision making process and activities with others who have an interest. Autocratic leadership style involves assuming control over the decisions and activities of the group. Laissez-faire leadership style involves the leader relinquishing power or control to the group. Quantum leadership style involves seeing an organization and members as interconnected and collaborative. This style involves change as continually unfolding, and frequently incorporates technology.

Which attributes should be characteristic of a nurse mentor? Select all that apply.

Is supportive Is resourceful Demonstrates leadership abilities Is an experienced, licensed professional Mentors should demonstrate characteristics that will help the less experienced person grow in the profession. Mentors should be supportive, resourceful, experienced, respectable, and trustworthy leaders. Mentors do not receive financial compensation for their effort as preceptors typically do. Mentors should not embrace conflict that is disruptive to tasks. Mentors should build and use health care networks, not deconstruct them.

A nurse on a telemetry unit is admitting a client and has an unlicensed assistive person (UAP) helping with the admission process. Which task can the nurse delegate to the UAP?

Obtaining an admission weight for the client utilizing the client's bed scale The nurse should delegate obtaining the initial weight to the UAP, as this is within the capability of the UAP. The task of obtaining a history, including home medications, is a responsibility of the nurse with documentation in the medical record. The nurse should also interpret the initial rhythm of the client. Although UAPs may be able to interpret the rhythm based on special training, there is no indication of this being true for the UAP in the scenario and the nurse should still verify the initial rhythm interpretation is correct.

The nurse manager is aware that nurses in the operating room are concerned about a proposed change in their working hours. Which is the nurse manager's best approach to addressing this problem and the nurses?

Relate the proposed change to the group's existing beliefs and values. Approaches to overcoming resistance to change include relating the proposed change to the group's existing beliefs and values; explaining the rationale for change in clear, concise language and allowing for opportunities of open discussion; and listing the advantages of this change both for individuals and the group. Discouraging dialogue, using email to address concerns, and ignoring staff concerns are ineffective managerial communication skills.

The case manager works in a facility that supports a participative leadership style. Which action should the nurse recognize as an example of democratic leadership style?

The interdisciplinary health care team collectively developing plans of care for clients Democratic or participative leadership style is characterized by a sense of equality among the leader and other participants. The interdisciplinary health care team collectively developing plans of care for clients is the only option that shows shared responsibility to achieve the same client outcome. The other answers are simply individual healthcare team members carrying out their assigned tasks.

The registered nurse (RN) wants to delegate measuring a client's urinary output to an unlicensed assistive personnel (UAP). Which factors should the nurse consider before delegating the task?

The stability of the patient's condition, potential for harm, and complexity of the activity RNs should consider the following when delegating tasks to UAPs: qualifications and capabilities of the UAP (not the age of the UAP or the RN's skill level), stability of the patient's condition (not the autonomy of the patient), complexity of the activity to be delegated (not the time required to complete the activity), potential for harm, predictability of the outcome (not the predictability of the UAP or the desired outcome), and overall context of other patient needs.

A nurse manager is educating the staff on new forms of charting. Within the education session, the manager sets a goal for complete use of the charting. Through goal setting, the manager is acting as:

a leader. Leadership is the ability to influence others to strive for a vision or goal or to change. Thus, goal setting is the act of a leader. Although educators may set educational goals, the primary focus of an educator is teaching. A guide provides advice but does not set goals. A clinical specialist develops expert skills and knowledge in one specific area of practice.

The nurse and unlicensed assistive personnel (UAP) are working together in the emergency room. Which task should the nurse avoid delegating to the UAP?

Assessing a rash on the arm When delegating, the RN must determine the skill level and education of the UAP, the client's condition and the complexity of the condition, and the potential for harm. Assessment of conditions should be reserved for the nurse. UAPs can be trained to empty indwelling catheter bags, perform EKGs, and place electrodes.

A nurse informs the client that the client has no choice and must take a bath in the morning. What type of leadership does this exemplify?

Directive leadership Directive (also known as autocratic or authoritarian) leadership describes a leader who makes all the decisions and tells followers what to do. Democratic, or participative, leadership style and shared governance involve sharing the decision-making process and activities with others who have an interest. Institutional governance is governance by the institution.

Which of these statements regarding a nurse manager role is accurate?

To effectively manage the nursing unit, the nurse manager should also be a leader. In order to be an effective nurse manager, the nurse manager must also be a leader. This is important with management of a healthy work environment, which is a responsibility of the nurse manager. This is done by helping ensure that interpersonal conflicts are resolved. The nurse manager is also accountable for client census, staffing, supplies, and budget, but is not responsible for setting financial targets for the budget; this is usually managed at the executive level.

In a nursing unit, the RN delegates nursing tasks to the nursing assistant. Keeping in mind the delegation guidelines, which statement denotes the right communication for the nursing assistant?

"Dispose of the disconnected IV set." The statement, "Dispose of the disconnected IV set" is in accordance with the delegation guidelines of right communication. The nurse should provide all the necessary information to carry out the assigned task. The other statements do not follow the delegation guideline of right communication. The tasks mentioned in the other instructions are not a nursing assistant's role.

A nurse manager informs the staff members during a meeting that unlicensed assistive personnel will no longer be allowed to check clients' blood glucose levels. The nurse manager informs the group that this is a new policy on the unit and that discussions will not change the enforcement of this policy. What type of leadership style is the nurse manager demonstrating?

Autocratic Autocratic leadership involves the leader assuming complete control of the decisions and activities of the group. An extremely autocratic leader might make all decisions for the workers or followers without considering their ideas or feelings. Democratic leadership is characterized by a sense of equality among the leader and the other participants. In laissez-faire leadership, the leader relinquishes power to the group. Transformational leadership can create a revolutionary change and may be directed by a charismatic leader who has a unique ability to inspire and motivate others.

A client is received into the emergency department after getting shot in the chest. The client is hemorrhaging profusely and is in hypovolemic shock. The nurse calls a code blue. What type of leadership style will be most effective during the management of the code?

Autocratic leadership Autocratic leadership will be most effective in this scenario. Autocratic leadership involves the leader assuming control over the decision and activities of the group. During code blue, a leader is needed to direct the actions needed and make quick decisions to positively affect the client. Laissez-faire leadership would ultimately lead to the demise of the client. Democratic leadership could possibly delay the client receiving life-sustaining measures and would be less effective than autocratic leadership. Transactional leadership would involve a reward system which would be unethical in this situation.

The nurse manager for the psychiatric unit sees that there are major conflicts between the day and night shift staff. The nurse manager suggests that each shift put aside their differences for a time and determine a common major goal. Which conflict resolution style does the nurse manager display?

Collaborating With the collaborating approach to conflict resolution, there is a joint effort to resolve the conflict with a win-win solution. All parties set aside previously determined goals, determine a priority common goal, and accept mutual responsibility for achieving this goal. With avoiding there is awareness of the conflict situation, but the parties involved decide to either ignore the conflict or avoid or postpone its resolution. Competing is an approach that results in a win for one party at the expense of the other. Smoothing is an effort to complement the other party and focus on agreement rather than disagreement, thus reducing the emotion in the conflict. The original conflict is rarely resolved with this technique.

Two staff nurses on a unit disagree with one another over certain key aspects of providing client care. The nurse manager of the unit arranges a meeting with the charge nurse and the two staff nurses at a mutually agreed-upon time to discuss this situation. This activity is most accurately described as what?

Conflict resolution Nurse managers frequently encounter conflict between employees and between themselves and employees. Unresolved conflict can lower morale and threaten quality care. Conflict resolution, also known as conflict management, is a process to work through conflicts in a way that minimizes negative effects and promotes positive consequences. In this scenario, the nurse manager is practicing conflict resolution by bringing the parties involved in the conflict together to discuss possible solutions. Problem solving consists of using generic or ad hoc methods in an orderly manner to find solutions to problems. In a way, conflict resolution is a type of problem solving, in which the problem to be solved is the relational conflict between two or more people. Delegation is the assignment of any responsibility or authority to another person to carry out specific activities. Client protection refers to preventing harm to the client, such as when the nurse keeps client data private.

A nurse leader on a unit allows the staff to make all decisions and direct themselves, including filling out the work schedule. The nurse leader is practicing which leadership style?

Laissez-faire In laissez-faire leadership, also called nondirective leadership, the leader relinquishes power to the group, such that an outsider could not identify the leader in the group. The democratic leadership style is characterized by a sense of equality among the leader and other participants. The autocratic leader assumes complete control over the decisions and activities of the group. Transformational leaders create intellectually stimulating practice environments and challenge themselves and others to grow personally, to grow professionally, and to learn.

The nurse manager calls a staff into a unit meeting to discuss patient satisfaction. During the meeting, several staff members assume control. The nurse manager does not intervene to regain control of the group. Which type of leadership style is the nurse embodying?

Laissez-faire Laissez-faire leadership style involves the leader relinquishing power or control to the group. Democratic leadership style involves sharing the decision making process and activities with others who have an interest. Autocratic leadership style involves assuming control over the decisions and activities of the group. Quantum leadership style involves seeing an organization and members as interconnected and collaborative. This style involves change as continually unfolding, and frequently incorporates technology.

A nurse manager best demonstrates effective leadership characteristic by which action?

Sharing a vision for the unit and enlisting support The nurse leader on a nursing unit should have a vision for the unit and be able to share this with the staff in order to enlist support and cooperation among the staff. The nurse leader should already be a role model, rather than just demonstrating interest. This would be related more to someone who was developing leadership qualities. The nurse leader should be flexible, not rigid, and does not have to know all information about the unit; rather, the nurse leader needs to know what resources are available among the staff and other leadership in helping reach expected goals and outcomes.

The registered nurse (RN) wants to delegate a task to an unlicensed assistive personnel (UAP) but is unsure if the task can be delegated. What is the best resource for the RN to use in determining if the task is appropriate?

The nurse practice act or facility's policy and procedures The RN should consult the nurse practice act or the facility's policy and procedures. The nurse mentor or preceptor and the more experienced nurse are good resources, but may mistakenly give inaccurate information. The medical practice act is designed to govern physician practice and may not contain information on the task that is to be delegated.

After a nurse manager implements a solution to the problem of delays in obtaining supplies, the first task for the manager is to:

assess whether the desired results have occurred. The nurse manager must evaluate the results of the efforts to determine whether the desired results have occurred. The nurse manager should solicit input from staff members about potential solutions before, not after, implementing a solution. Monitoring the supply cabinets would be more appropriate if the problem were suspected drug diversion by staff but would be unnecessary for evaluating for improvement in delays for obtaining supplies. Making an appointment with the chief nursing officer is not necessary and would not help the nurse manager evaluate the change in procedure related to obtaining supplies.

A nurse manager reviews an employee's contribution to the nursing division annually. This process is:

performance appraisal. Performance appraisal is typically conducted annually. Each organization determines a reward structure to define and to acknowledge success. Interpreting quality indicators pertains to evaluation of general client care, not of an individual nurse. An employee's job satisfaction survey is a tool that allows the employee to give feedback on the employee's satisfaction with work, not a review of the employee's contribution conducted by the nurse manager.

An inner-city hospital is seeing a declining client census. The nurse managers begin to strategically plan to determine ways to increase their client population. In the implementation of these strategies, they also evaluate their success and failure and renew their plan. This activity is:

problem solving. Management involves getting a job done or accomplishing a goal. The process they use is similar to the problem-solving process, which is based on the scientific or research method. The nurses are not making directive initiatives. Although this work is a continuing process, this description is too vague. Nurses cannot control patient outcomes; they can only hope to improve them by making changes that may or may not work.