Chapter 10: Leadership, Managing and Delegating
The nurse is caring for an older adult client who states the need to use the restroom. Which safety intervention must the nurse perform first?
Assess the need for assistance with ambulation. Explanation: The diverse physiologic and psychologic capabilities of people and encounters with various safety hazards across the lifespan put various age groups at risk for different safety concerns and potential injuries. Older adult clients are at a higher risk for falling. Thus, the nurse should assess the client's ability to ambulate independently before allowing the client to go to the restroom and to provide assistance, if needed. The nurse would lower, not raise, the bedside rails before having the client exit the bed. The nurse would put nonskid footwear like slippers, not socks, on the client to help prevent falls. Furniture should be arranged so that the client has a clear and easy path to the restroom.
The nurse is working to enhance time management skills and has to administer pain medications to several clients, obtain vital signs, and assist clients with bathing. What should the nurse do next?
Delegate bathing and vital signs tasks. Explanation: 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.
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 Explanation: 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.
A nursing facility has recently implemented new policies regarding nurse-to-client ratios. The nursing staff seems very resistant to the change. How can the nurse manager help the staff accept the change?
Hold a unit meeting to discuss how the changes will benefit staff. Explanation: Holding meetings allows open communication and opportunities for feedback. Listing the benefits of change to the individual and group also helps with buy-in. Laissez-faire leadership styles tend to increase conflicts and anxiety during times of change. Challenging staff beliefs will increase anxiety and create unpleasant work environments. Change should be instituted gradually, if possible.
The registered nurse (RN) and unlicensed assistive personnel (UAP) are working together to admit a pediatric client to a nursing unit. Which task would be inappropriate for the RN to delegate to the UAP?
Initiating intravenous therapy Explanation: When delegating, the RN must determine the skill level and education of the UAP, the client's condition and the complexity of that condition, and the potential for harm. Initiating intravenous therapy is reserved for the RN due to the potential for harm and the scope of the UAP. The UAP can assist the nurse by obtaining equipment, securing the client, and soothing the client.
Which is a task that the nurse can delegate to the unlicensed assistive personnel (UAP)?
Obtaining intake and output on a client with a foley catheter Explanation: The nurse should delegate tasks to the UAP that consider the scope of practice of the UAP, as well as the client's stability and the complexity of the task. The client with a foley catheter who needs intake and output involves a routine process on a medical-surgical unit and would be within the scope of practice of the UAP. A client who is actively bleeding or has orthostatic hypotension is unstable, and these tasks should not be delegated to the UAP. Teaching a client about injection of insulin should not be delegated because it is a complex task that is outside the scope of practice for a UAP.
A nurse manager has asked the staff to create a plan to improve client outcomes. In the past, the staff have not met deadlines. How can the nurse manager use transactional leadership style to ensure that the deadline is met?
Offer 2 days of paid vacation. Explanation: The transactional leadership style involves a task and reward system. Paid vacation is a reward for meeting the deadline. Asking politely, demanding efficiency, and giving extensions are not rewarding behaviors.
The registered nurse (RN) notices that client assignments are not being made fairly. The charge nurse is responsible for making the client assignments and has a reputation for being argumentative. Who should the RN consult regarding the unfair client assignments?
The charge nurse Explanation: The RN should follow the proper channels for communication and consult the charge nurse. If conflict arises, the RN should then contact the nursing supervisor, director of nursing, and the medical director, respectively.
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 Explanation: 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 health care provider practice and may not contain information on the task that is to be delegated.
A nurse manager best demonstrates effective leadership characteristic by which action?
Sharing a vision for the unit and enlisting support Explanation: 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.
Which of these statements reflects the expected functioning at a hospital that has achieved Magnet status?
Staff nurses are developing innovative solutions to problems. Explanation: A hospital that has achieved Magnet status has recognition of quality client care that is provided by nursing staff who are professional and well-qualified. The staff nurses participate in self-governance and, therefore, work toward innovative solutions to problems. Having an increased turnover among staff nurses and a lack of quality client outcomes would not be characteristics of a Magnet hospital.
Which statement by a registered nurse (RN) represents appropriate delegation to a nursing assistant?
"Dispose of the disconnected IV set." Explanation: 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 nurse has recently been promoted to nurse manager on an oncology unit and has decided to be the sole decision maker regarding issues that concern the unit. Which type of leadership style is the nurse embodying?
Autocratic Explanation: Autocratic leadership style involves assuming control over the decisions and activities of the group. Democratic leadership style involves sharing the decision making process and activities with others who have an interest. 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.
How might one define leadership?
Leadership is the process of guiding, educating, motivating, and directing others. Explanation: Leadership may be viewed as the process of guiding, educating, motivating, and directing the activities of others toward attaining goals. Management includes planning, organizing, directing and controlling activities. Empowerment is the process by which the leader shares power with others. It is the manager who interviews, hires, and fires.
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." Explanation: 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 staff nurse is talking with a clinical nurse leader and asks, "What exactly do you do?" Which statement by the clinical nurse leader would be appropriate?
"I collaborate with health care teams to promote client care." Explanation: A clinical nurse leader is a master's-prepared nurse who has earned the certified CNL credential and works collaboratively with the health care team to facilitate, coordinate, and oversee care provided to clients. This role is not considered an administrative or management role, but rather one of leadership in all health care settings. Clinical nurse specialists are advanced practice nurses with specialist education in a defined area of practice.
A nurse is planning to delegate client care to an unlicensed assistive personnel (UAP). The UAP is experienced but has limited exposure to the type of clients who are on the nursing unit. Which client should the nurse recognize as being appropriate to delegate to the UAP?
A client who is admitted for hypovolemic shock one day prior and needs to have urinary output measured Explanation: The stem of the question indicates that the UAP is not familiar with the client population but is an experienced health care professional. The UAP's qualifications and capabilities should be considered before delegating tasks. The client requiring urinary output measure is the most appropriate client for the UAP because no additional training would be required to complete the task. Clients who have recently undergone hypovolemic shock have an indwelling catheter, and UAPs can easily measure the amount of urine contained in the drainage system. Clients who have experienced stroke may have difficulty swallowing and require professionals trained in assisting them to swallow and who can respond to accidental choking. Clients who have had scoliosis surgery must be logrolled during the first postoperative day and require professionals experienced in logrolling. Education is outside of the scope of practice for a UAP and should be performed by an RN.
Which nurse leader most clearly exemplifies transformational leadership?
A leader who is dynamic and inspiring and promotes change by the power of the leader's convictions Explanation: Transformational leaders can create revolutionary change. They are often described as charismatic, and they are unique in their ability to inspire and motivate others. A careful examination of contextual factors is associated with situational leadership. Delegation to group members and an emphasis on equality are typical of laissez-faire and democratic leadership styles, respectively.
Two nurse managers working on different units in a hospital are planning for a major change to occur on both units. One nurse manager reports to the other having identified a key power player on the unit. Which description most applies to a key power player in this context?
A regular employee who is a natural leader Explanation: People who are "natural leaders" because of their demonstrated ability to influence others are "key power players," whose support is essential to effecting change. The other choices do not describe persons who necessarily have power.
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 Explanation: 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.
A staff nurse works on a medical unit where staff retention is very high. There is a sense of equality between the leader and the staff nurses. The unit decisions and activities are shared between the leader and the group. The designated nurse leader practices which leadership style?
Democratic Explanation: The democratic leadership style is characterized by a sense of equality among the leader and other participants and shared decision making. 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. 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.
How should a nurse leader best address nurses' resistance to a change in the shift-scheduling protocol on their hospital unit?
Explain the benefits of the change and elicit honest feedback. Explanation: Strategies for overcoming resistance to change include explaining the benefits of the change to those who are affected and encouraging feedback. Emphasizing the benefits of the change to the institution is not likely to overcome resistance. Allowing skeptics to opt out or putting the matter to a vote are likely impractical and unrealistic and may lead to further conflict and resistance.
A registered nurse is delegating activities to unlicensed assistive personnel (UAP) on a hospital unit. Which activities could this nurse normally delegate? Select all that apply.
Giving a bed bath to a client Taking routine vital signs Transferring a client to another floor Explanation: The nurse should be familiar with guidelines for delegating nursing care. The nurse could delegate the following tasks to UAP: giving a bed bath to a client, taking routine vital signs, and transferring a client to another floor. The nurse could not delegate the administering of medications, planning client education for a client with a colostomy, or the determination of a nursing diagnosis.
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 Explanation: 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.
A nurse is caring for a client with pneumonia. Which task is most appropriate for the nurse to delegate to an experienced unlicensed assistive personnel (UAP)?
Obtaining vital signs every 4 hours Explanation: Having the UAP obtain vital signs every 4 hours is most appropriate, as it is within the UAP's scope of practice to perform this task. Assessment, teaching, and administration of medication are not in the current scope of practice for UAPs.
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 Explanation: 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.
A nurse manager of a health care provider's office uses the laissez-faire style of leadership with the staff. Which nursing actions reflect this management style? Select all that apply.
The nurse manager allows self-scheduling. The nurse manager allows dominant staff members to direct the group activities. Manager and staff work independently, making task accomplishment difficult. Explanation: 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 nurse manager would allow staff members to choose their own schedules. The nurse manager could allow dominant staff members to direct the group activities. The nurse manager and staff work independently, making task accomplishment difficult. In autocratic leadership the leader is always the authority on all issues. In democratic leadership the nurse manager views staff as equal partners. In transformational leadership the nurse manager inspires and motivates staff to provide excellent client care.
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 client's condition, potential for harm, and complexity of the activity Explanation: 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 client's condition (not the autonomy of the client), 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 client needs.
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. Explanation: 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.
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. Explanation: 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.
The nurse manager who asks staff members to give suggestions on how to improve collaboration between nurses and health care providers is exhibiting what style of leadership?
Democratic Explanation: The nurse manager who involves staff members in decision-making by asking for suggestions is exhibiting a democratic style of leadership. Autocratic leadership style would be exhibited by a leader who gave staff little opportunity to give feedback or suggestions. Transactional leadership also involves little input by staff into decision-making and is instead focused on providing rewards when tasks are completed. A leader with a laissez-faire style would give all control to staff members to determine how to improve collaboration.
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 Explanation: 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.
The registered nurse on a busy telemetry floor is delegating tasks to an unlicensed assistive person (UAP). Which task is appropriate for the UAP to complete?
Bathing a combative client Explanation: Bathing a client, whether combative or not, is within the scope of practice of a UAP. Skills such as inserting an indwelling catheter, taking a health care provider order, and assessment must be completed by licensed nurses, however.
The nurse is working at a facility that is applying for Magnet® Recognition. The nurse knows that compared with other hospitals, Magnet® hospitals have which direct effect on client care?
Better client outcomes Explanation: Magnet® hospitals have better client outcomes than facilities without the recognition. Magnet® hospitals have higher nurse retention and job satisfaction scores, but these do not have a direct effect on client care. Magnet® hospitals have shorter, not longer, client stays.
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 Explanation: 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 Explanation: 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.
The nurse manager is concerned about the large number of adolescent mothers being seen in the obstetrics clinic. How can the nurse manager use the transformational leadership style to address the concern?
Enlist volunteers to help develop a community outreach project that will educate adolescents on methods to prevent pregnancy. Explanation: Transformational leaders create revolutionary change and inspire others to become involved with their cause or concern. Enlisting others to make a change in the community is an example of transformational leadership. Creating new policies to distract attention from the problem and talking individually to each adolescent does not inspire others to become involved in the change. Conducting research may be a step taken when developing the community outreach project; however, conducting research does not involve others getting inspired to be a part of the change.
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 Explanation: 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.
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 Explanation: 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 registered nurse checks the American Nurses Association (ANA) regulations prior to delegating tasks to unlicensed assistive personnel (UAP) on a burn unit. Which principles regarding the regulation, education, and use of UAP are recommended by the ANA? Select all that apply.
It is the purpose of assistive personnel to work in a supportive role to the registered nurse. It is the role of the assistive personnel to carry out tasks to enable the professional nurse to concentrate on nursing care for the client. It is the registered nurse who is responsible and accountable for nursing practice. Explanation: The nurse must be familiar with the delegation guidelines when working as a registered nurse. The purpose of assistive personnel is to work in a supportive role to the registered nurse. It is the role of the assistive personnel to carry out tasks to enable the professional nurse to concentrate on nursing care for the client. It is the registered nurse who is responsible and accountable for nursing practice. It is the nursing practice act of each state, not the health care institution, that determines the scope of nursing practice within a given state. The LPN does not supervise the assistant, the RN does. It is not the role of the LPN, rather the RN, to assign nursing duties.
A charge nurse on a medical-surgical unit is asked by the nurse manager to serve as a mentor to another staff nurse who is less experienced. Which of these would best describe this role?
The charge nurse is providing support for the staff nurse in new responsibilities. Explanation: A mentor is not a paid position, but, instead, is a person who provides support and encouragement to a less experienced nurse who is learning new responsibilities for a current role or an expanded one. Preceptorship typically is a paid position, and is provided for a new or experienced nurse who is training for a new position on a unit. The preceptor would teach the new nurse about hospital policies and procedures, as well as supervise the nurse in daily assignments.
A nurse is successful in promoting change on the nursing division. This nurse would be considered a:
leader. Explanation: The role of a leader is to direct or motivate a person or group to achieve set goals. The role of a manager is to plan, organize, direct, and control available human, material, and financial resources to deliver quality care to clients and families. A guide can show the way to a desired result but cannot effect change in the way that a leader can. A specialist is one who has expert skills and knowledge in a specific area of practice.
A nurse manager reviews an employee's contribution to the nursing division annually. This process is:
performance appraisal. Explanation: 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. Explanation: 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 client outcomes; they can only hope to improve them by making changes that may or may not work.