CH. 9: Delegation in Nursing Review Questions
Chief nursing officers (CNOs) are accountable for establishing systems to assess, monitor, verify, and communicate ongoing competence requirements related to delegation, for both RNs and delegates. Which statements are correct? SATA A. A key element in delegation is to assess the competency level of the staff. B. When an RN delegates a task, he or she is responsible for supervision but is not accountable for the outcome. C. A state's nurse practice act consists of rules that govern how RNs delegate to competent staff. D. The National Council of State Boards of Nursing is opposed to delegation to unlicensed assistive personnel (UAP). E. Any traveling nurse unaware of the organizational systems in place to establish competency requirements for the unlicensed assistive persons.
A. A key element in delegation is to assess the competency level of the staff. The correct statements for the CNO are that a key element in delegation is to assess the competency level of the staff, and the state's nurse practice act consists of rules that govern how RNs delegate to competent staff. The CNO would also need to ensure any traveling nurse who comes into the organization is made aware of the organizational systems in place to establish competency requirements for the unlicensed assistive persons or what the state practice acts legally allow the UAP to perform. The second statement is incorrect because when an RN delegates a task, he or she is responsible for supervision and is accountable for the outcome. The National Council of State Boards of Nursing is not opposed to delegation to UAP.
The critical care nurses' specialty organization identified five factors that should be considered to make the best decisions. Which of the following identifies all five factors? A. Care is complex and requires attention, adaptation, or innovation in approach, with some risk that the activity may cause potential harm, and the level of patient interaction and the patient's response to the activity are unpredictable. B. The complexity of the intervention or task, the skill of the registered nurse's (RN's) delegation, the competencies of unskilled assistive caregivers, the risk of harm to patients, and the criticality of the outcome. C. The care requires special attention, adaptation, or an innovative approach, the skill of the RN's delegation, and the competencies of unskilled assistive caregivers. D. A patient's risk for potential harm, the skill of the RN's delegation, the competencies of assistive caregivers, the difficulty of the intervention, and the fact that a patient's response to the activity is unknown or unpredictable.
A. Care is complex and requires attention, adaptation, or innovation in approach, with some risk that the activity may cause potential harm, and the level of patient interaction and the patient's response to the activity are unpredictable. The first answer is the best because it covers the five factors of when not to delegate: (1) When the potential for harm or risks for the activity are high for an individual patient; (2) when the complexity of the task makes it less desirable to delegate; (3) when the amount of problem solving and innovation requires special attention, adaptation, or an innovative approach for a particular patient; (4) when the outcome is unpredictable, which depends on how stable the patient is; and (5) when the level of patient interaction with delegated activity increases or decreases the amount of time the RN can spend with the patient and patient's family. Every time a nursing activity is delegated or one or more additional caregivers become involved, a patient's stress level may increase, and the nurse's opportunity to develop a trusting relationship is diminished. The other three answers provide one or more of the above five factors, but not all five are included in them.
Effective delegation skills are important for leaders and managers whose function is to get work done through the efforts of others. The individual who accepts this work is called the: A. delegate. B. adaptor. C. supervisor. D. delegator.
A. delegate. Delegates accept the service, work, activities, or projects that need to get done. In nursing, a team of delegates from an organization may gather together to do service projects locally in communities or in third world countries. An adaptor is an individual who generates new solutions to problems. A supervisor is an individual who guides others to accomplish a specific task or activity. A delegator is an individual who assigns a task to another.
The determinant for the decision to delegate is the legal scope of delegation rules described within: A. an institutional policy. B. a nurse practice act. C. the American Nurses Association (ANA) Code of Ethics. D. The Joint Commission (TJC) Patient Care Standards.
B. a nurse practice act. The state's nurse practice act contains language that allows registered nurses to delegate. Some state nurse practice acts clearly define scope of practice concerning delegable activities, and others are more unclear. Some nurse practice acts have not been updated to account for the current prevalence of home and community-based health care delivery, which can cause role blurring and confusion of delegable tasks (Wilt & Foley, 2016). Certain discrete tasks may be delegated in any health care setting, the nursing process consisting of assessment, clinical judgment, and evaluation of outcomes may not be delegated (NCSBN, 2005b, 2016). This foundational fact should direct the nurse's response concerning delegation no matter whether it is a scope-of-practice or organizational issue. Institutional policies do not set rules but rather provide further interpretation of the procedural steps to guide nurses in the intervention of delegation. The ANA Code of Ethics is incorrect because the code guides the conduct of the profession but is not a set of rules. TJC is a standards-setting organization for institutional settings and defers to the state practice acts and local policies to evaluate the quality and safety of care within the organization.
Criteria can be used to assess co-workers competency for delegation. Which of the following methods can be used to assess the competency of nursing assistive personnel? SATA A. Micro-managing and being able to step in and take over tasks B. Educating and training for the required role function C. Supervising with periodic review and performance feedback D. Orienting to the job description and evaluating tasks within a designated time frame E. Checking with unlicensed assistant when completing the task to obtain feedback about the patient
C. Supervising with periodic review and performance feedback D. Orienting to the job description and evaluating tasks within a designated time frame E. Checking with unlicensed assistant when completing the task to obtain feedback about the patient The criteria to assess competency accomplished through three answers to supervise with periodic review and performance feedback, to orient to job description and evaluate tasks within a designated time frame, and to check with unlicensed assistant after task is completed to obtain feedback about a patient. The immediate feedback from UAP ensures supervision and validates the competency by asking questions. Micro-managing and being able to step in and take over tasks are incorrect because these will result in mistrust within the delegator-delegate relationship. Educating and training for the required role function is not an assessment process.
