Ch. 39 Managing Care/UAP
In a team approach to nursing care, which function or task would most likely be delegated to unlicensed assistive personnel (UAP)? (Select all that apply.) A. Collecting specimens B. Assisting with feeding C. Client bathing D. Client assessment E. Identification of health problems
A. Collecting specimens B. Assisting with feeding C. Client bathing Rationale: In a team nursing approach, delivery of care to clients is done by a team that is led by the professional nurse. UAPs assume delegated aspects of care, including bathing, collecting specimens, and assisting with feeding. Registered nurses are responsible for client assessment and identification of health problems.
The nurse manager for an oncology unit is concerned that a staff nurse is overdelegating tasks to an unlicensed assistive personnel (UAP). Which is the most appropriate action for the nurse manager at this time? A. Discussing the delegated tasks with the nurse B. Telling the UAP to stop performing the tasks C. Reassigning the UAP to complete other tasks D. Directing all nurses to complete individual tasks
A. Discussing the delegated tasks with the nurse Rationale: The nurse manager should discuss with the nurse the appropriateness of the tasks in question in order to support the activity of delegation. Telling the UAP to stop performing the task interferes with the delegation process between the nurse and the UAP, as does reassigning the UAP to complete other tasks. Directing all nurses to complete individual tasks is an example of a nonsupportive environment, which can lead to poor job satisfaction, mistrust, and poor tolerance for mistakes.
The new nurse asks to speak to the nurse preceptor regarding fears and concerns related to the process of delegation. Which reason common to new nurses may be interfering with the nurse's ability to delegate tasks to other members of the healthcare team? (Select all that apply.) A. Fear of competition and criticism B. Fear of overburdening others C. Fear of loss of control D. Fear of liability or being blamed for the delegate's mistakes E. Fear of making mistakes
A. Fear of competition and criticism B. Fear of overburdening others C. Fear of loss of control D. Fear of liability or being blamed for the delegate's mistakes Rationale: Reasons that delegators do not delegate include the fear of competition and criticism, the fear of liability or being blamed for the delegate's mistakes, the fear of overburdening others, and the fear of losing control. The fear of making a mistake is a reason a delegate may be unwilling to accept a delegated task, not a reason the nurse hesitates to delegate.
The nurse is preparing a presentation related to sources of payment for healthcare services. The nurse wants to highlight differences between the values of the United States versus other countries. Which statement by the nurse is appropriate to include in the presentation? A. "The United States values individual accountability for retaining and paying for healthcare." B. "The United States values universality in providing healthcare to citizens, which lowers costs." C. "The United States has global budgets to pay for the healthcare of citizens." D. "The United States rations care in order to control costs."
A. "The United States values individual accountability for retaining and paying for healthcare." Rationale: The United States values individual accountability for retaining and paying for healthcare. This has led to citizens being underinsured or uninsured, which increases healthcare costs. The United States values pluralism and choice, not universality. The United States also values volunteerism and communitarianism, not global budgets. At this time, there is no nationwide rationing to control costs.
After shift report, the registered nurse directs an unlicensed assistive personnel (UAP) to provide morning care to four clients. Which behavior did the nurse demonstrate with the UAP? A. Collaborating B. Assigning C. Delegating D. Dumping
Assigning Rationale: Delegation is not the same as assignment. An assignment is a direction to an individual to complete work based on position descriptions or other organizational goals or functions. The nurse assigned the UAP to complete morning care on four clients without following all the steps of delegation, including providing any information and resources that the UAP might need. The nurse did not "dump" the morning care of four clients on the UAP. Dumping is pushing undesirable tasks onto someone else to complete; morning care of four clients is a reasonable task for delegation. The nurse did not collaborate with the UAP on the care of the clients because the nurse did not work with the UAP to complete the task.
Which client should the nurse refer to the case manager for ongoing care? A. A client who is being discharged after a total hip replacement B. A client with exacerbation of multiple sclerosis C. A client with hepatitis B D. A client who is being treated for deep vein thrombosis
B. A client with exacerbation of multiple sclerosis Rationale: To maximize effectiveness, clients who benefit the most from case management are those with chronic health problems, such as chronic alterations in lung, heart, or neurological health. The client with an exacerbation of multiple sclerosis would benefit the most from case management. Hepatitis B, deep vein thrombosis, and total hip replacement are all acute problems with minimal risk for developing into a chronic disorder.
The nurse manager for a long-term care unit wants to share the management function of controlling with the staff nurses. Which action should the manager take to share this function? A. Explaining the contingency plan to the staff nurses B. Assigning staff to peer-review groups C. Dividing client care assignments among the staff D. Coaching the staff on ways to achieve the organization's objectives
B. Assigning staff to peer-review groups Rationale: The management function of controlling may be shared with staff through the use of peer review. Coaching the staff on ways to achieve the organization's objectives is an action within the management function of directing. Dividing the work, such as client care assignments, among the staff is an action within the management function of organizing. Contingency planning is a part of the management function of planning.
The nurse is interviewing for a leadership position in an acute care facility. When asked to describe the nurse's approach to leadership, the nurse explains an overall belief that people, especially nurses, are externally motivated and often have difficulty making independent decisions. Which leadership style would the interviewer most likely expect this nurse to practice? A. Bureaucratic B. Laissez-faire C. Autocratic D. Democratic
C. Autocratic Rationale: Autocratic leaders believe that individuals are externally motivated and incapable of independent decision making; thus, the interviewer would suspect that this nurse would be an autocratic leader. A laissez-faire leader recognizes the group's need for autonomy and self-regulation, taking a hands-off approach. A democratic leader encourages group discussion and decision making. A bureaucratic leader relies on the organization's rules, policies, and procedures to direct the group's work efforts.
Which activity completed by the nurse manager characterizes the management function of controlling? A. Creating unit-level goals to achieve the best possible client outcomes B. Determining the chain of command for nurses and other healthcare team members to use when issues occur C. Developing performance standards for a newly created nursing position D. Developing a plan to respond to unanticipated mass-casualty events
C. Developing performance standards for a newly created nursing position Rationale: Developing performance standards for a newly created nursing position best reflects the function of controlling. Developing a plan to respond to unanticipated mass-casualty events and creating unit-level goals to achieve the best possible client outcomes reflect the management function of planning. Determining the chain of command for nurses and other healthcare team members to use when issues occur reflects the management function of organizing.
Two veteran staff nurses on a care area have resigned their positions to begin employment elsewhere. Which action should the nurse manager take to best address the vacancies created by their resignations? A. Holding a staff meeting to announce the resignations of the staff nurses B. Encouraging the nurses to reconsider their decision to leave C. Posting the open positions within the organization D. Meeting with human resources to discuss nursing retention strategies
D. Meeting with human resources to discuss nursing retention strategies
The registered nurse team leader is performing gastric lavage for a client who is experiencing an acute gastrointestinal bleed. Which function will the nurse most likely have difficulty completing when the team nursing approach is used? A. Client teaching B. Delegation C. Decision making D. Identifying nursing diagnoses
Delegation Rationale: Team nursing is not as effective when caring for clients who are acutely ill because the nurse is needed for direct care and little time is allowed for delegation of many tasks. Teaching, identifying nursing diagnoses, and decision making are skills that are used in primary nursing and would be required when caring for this client.
The nurse chief executive officer (CEO) of a large nonprofit hospital is motivated more by a desire to serve rather than to lead. The nurse CEO notes that this has been a very effective leadership style because it helps others to grow and become empowered in their roles. Which type of leader is this nurse CEO? A. Transactional B. Transformational C. Servant D. Charismatic
Servant Servant leaders are motivated primarily by a desire to serve rather than a desire to lead, placing others' needs before their own. They inspire their followers to grow and become more self-directed. A charismatic leader is characterized by the ability to cultivate an emotional relationship with group members. A transactional leader has a relationship with group members based on an exchange for some resource valued by the members. A transformational leader fosters creativity, risk taking, commitment, and collaboration by empowering the group to share in the organization's vision.
The nurse works in a facility where the focus is on the jobs necessary to provide client care, using different members of the healthcare team to perform baths, vital signs, and so on. Which care delivery model is being used in this facility? A. Functional B. Case C. Primary D. Team
Functional Rationale: The functional method uses a task-oriented approach, focusing on the jobs to be completed as part of client care. In the case method, one nurse is assigned to and responsible for the care of a group of clients over the course of a shift. In the team method, the registered nurse (RN) has the responsibility and authority for client care but delegates tasks to other team members as appropriate. In primary nursing, one nurse is responsible for overseeing the total care for a number of clients 24 hours a day, 7 days a week.
The nurse is delegating a task to an unlicensed assistive personnel (UAP). After the nurse has explained the task, which activity is required of the delegate who accepts the task? (Select all that apply.) A. Clarifying how to report completion of the task B. Defining the task C. Reporting concerns D. Clarifying the time frame to complete the task E. Keeping the delegator informed of progress
A. Clarifying how to report completion of the task C. Reporting concerns D. Clarifying the time frame to complete the task E. Keeping the delegator informed of progress Rationale: The nurse is responsible for defining the task, which helps determine if the task can be delegated. The delegate is responsible for clarifying the time frame to complete the task, reporting progress toward completion, reporting any concerns about the task, and clarifying how to report completion of the task, including what information the nurse wants reported.
The primary nurse is coordinating care for a newly admitted client. Which nursing action is appropriate when planning this client's care? (Select all that apply.) A. Identifying applicable evidence-based practice guidelines for the client's care B. Obtaining orders for referrals and consultations from the healthcare provider C. Selecting appropriate critical pathways for the client D. Suggesting appropriate referrals for the client's care E. Initiating consultations with other healthcare providers
A. Identifying applicable evidence-based practice guidelines for the client's care C. Selecting appropriate critical pathways for the client Rationale: In the planning phase of care coordination, the nurse should utilize standard protocols, critical pathways, and evidence-based guidelines; prepare the care plan in consultation with the client; and make the care plan the framework for care coordination. Initiating consultations, suggesting referrals, and obtaining orders for consultations and referrals from the healthcare provider are actions that occur during the implementation phase of care coordination.
The nurse manager is performing actions associated with a delicate client care situation. Which action indicates a responsibility appropriate for the nurse manager? (Select all that apply.) A. Notifying central storage of stock items that are no longer needed for the client care area B. Referring to the nurse practice act before delegating a task to a nurse C. Meeting with staff about the need to maintain client confidentiality D. Ensuring that paperwork is completed and submitted to the security department as required E. Directing nursing staff to check expiration dates before using intravenous fluids
A. Notifying central storage of stock items that are no longer needed for the client care area C. Meeting with staff about the need to maintain client confidentiality D. Ensuring that paperwork is completed and submitted to the security department as required Rationale: Responsibility is an obligation to meet objectives and perform tasks. The focus is on the use of resources, communication to subordinates, and implementation of organizational goals and objectives. Directing others' actions is a characteristic of authority. Referring to the nurse practice act is an action within accountability.
The charge nurse observes a registered nurse delegate tasks to an unlicensed assistive personnel (UAP). Which observation by the charge nurse indicates that follow-up is required? (Select all that apply.) A. The UAP asked another nurse to assist with the delegated task. B. The UAP and nurse discussed completion of delegated tasks. C. The UAP was unable to recognize a change in a client's condition. D. The nurse provided direction and feedback on task progress and completion. E. The nurse did not have complete information about the status of delegated tasks at the change-of-shift report.
A. The UAP asked another nurse to assist with the delegated task. C. The UAP was unable to recognize a change in a client's condition. E. The nurse did not have complete information about the status of delegated tasks at the change-of-shift report. Rationale: If the UAP was unable to recognize a change in the client's condition, it is possible that the nurse did not provide sufficient information when delegating the task or that the nurse selected the wrong delegate for the task. If the nurse is not prepared for report because tasks were not completed, the nurse did not adequately follow up with the UAP regarding task completion. If the UAP asked another nurse for assistance in completing a task, the task might have been too complicated, or the UAP did not possess the required skills to complete the task. Discussing the completion of tasks and providing direction and feedback on task progress are expected actions when delegating.
The nurse manager plans to inform the staff that the organization is going to provide a group self-insurance health plan for all employees. Which information should the manager include when explaining this health plan? (Select all that apply.) A. The group will assume all or part of the costs of healthcare for the employees. B. A predetermined amount of money will be paid to the hospital based on a diagnosis. C. It is a prospective payment system that determines costs before care is provided. D. Rates for care are set in advance of the year in which they apply. E. Coverage will cost the organization less because of lower fees and tax exemptions.
A. The group will assume all or part of the costs of healthcare for the employees. E. Coverage will cost the organization less because of lower fees and tax exemptions. Rationale: With a group self-insurance health plan, the group assumes all or part of the costs of health care for the members, and coverage is provided at rates lower than health insurance plans because of lower fees and tax exemptions. A predetermined amount of money that is paid to the hospital based on a diagnosis describes diagnosis-related groups. Setting the rates for care in advance of the year in which they apply also is a characteristic of diagnosis-related groups. Diagnosis-related groups typically use a prospective payment system that determines costs before care is provided.
The nurse who is working on a unit that uses a primary nursing care delivery model is assigned a client with newly diagnosed type 2 diabetes mellitus. Which nursing action is most appropriate when caring for this client? A. Participating on a task force to identify glucometers for use during care B. Instructing the client on the role of medications to control the disease process C. Providing direct care to the client during the scheduled shift D. Directing nursing assistants to complete morning care on a group of clients
B. Instructing the client on the role of medications to control the disease process Rationale: Client teaching is a role of the nurse in the primary nursing delivery model. Participation in a task force is an activity within shared governance. Delegating tasks related to a group of clients is not the same as providing direct client care. In this scenario, the nurse is working within the primary nursing method; providing direct care during a scheduled shift is a characteristic of the case method.
The nurse preceptor is discussing the aspects of a prospective payment system with a newly hired home care nurse. Which statement most accurately describes this system? A. Prospective payment limits the reimbursement paid to healthcare providers for services provided for Medicaid and Medicare clients. B. Under prospective payment, billing is determined before the client is admitted based on diagnosis. C. In a prospective payment system, billing is based on clients' progression during their care, allowing for extra costs due to complications. D. Prospective payment provides general ranges of payment allowed for specific diagnoses depending on client comorbidities.
B. Under prospective payment, billing is determined before the client is admitted based on diagnosis. Rationale: With a prospective payment system (PPS), billing is determined before the client is ever admitted to the hospital. It sets a specific amount, not a range. It does not limit reimbursement to healthcare providers, nor does it determine payment as clients progress through their illness.