Chapter 20: Delegation
A nurse delegated some tasks to a nurse several hours ago. The manager has now learned that the nurse did not complete any of the delegated tasks. What is the manager's best initial action? a. Determine exactly why the nurse did not complete the delegated tasks. b. Assertively state the expectation that delegated tasks will be completed on time. c. Document the nurse's insubordination and arrange a private meeting. d. Take action to reestablish the authority power gap.
ANS: A Feedback: If an employee does not complete delegated tasks, the manager should assess the reasons for this before taking action. Addressing the problem before knowing the circumstances or the cause would be premature.
A nurse-manager is new to the unit and is worried about being perceived as incompetent or underqualified by subordinates. The manager should recognize that this creates a risk for what problem? a. Underdelegating b. Overdelegating c. Improper delegating d. Inappropriate delegating
ANS: A Feedback: Underdelegating occurs when a manager has a false assumption that delegation may be interpreted as a lack of ability on his or her part to do the job correctly or completely. This insecurity may make the manager highly reluctant to delegate.
The Omnibus Budget Reconciliation Act of 1987 established regulations for the education and training of which category of health-care worker? a. Certified nurse aide (CNA) b. Registered nurse (RN) c. Licensed practical nurse (LPN) d. Ward clerk
ANS: A Feedback: Although the Omnibus Budget Reconciliation Act of 1987 established regulations for the education and certification of "nurse's aides" (minimum of 75 hours of theory and practice and successful completion of an examination in both areas), no federal or community standards have been established for training the more broadly defined NAP. LPNs and ward clerks are not addressed by this act.
Which action on the part of a manager demonstrates the mark of a great leader? A. Acknowledging the accomplishment of staff members at the unit's staff meeting B. Providing onsite in-services on new equipment for the staff C. Including funds in the unit's budget of staff development D. Stressing the importance of patient safety to all new employees
ANS: A Feedback: The mark of a great leader is when he or she can recognize the excellent performance of someone else and allow others to shine for their accomplishments. Although the other options are appropriate, they are not identified as being the mark of a great leader but rather an efficient manager.
Which assessment should the RN prioritize when assigning tasks to nursing assistive personnel (NAP)? a. Determining the NAP's skills and knowledge level b. Assessing which tasks the NAP is motivated to perform c. Evaluating the NAP's ability to follow instructions d. Asking colleagues to appraise the NAP's strengths and weaknesses
ANS: A Feedback: The nurse or manager must be knowledgeable about the skills and knowledge of all members of the health-care team. These variables are more important than the NAP's motivation, ability to following instructions, or personal attributes because they are more closely associated with client safety and the avoidance of liability.
An RN is leading a care team on a busy hospital unit. What tasks is the RN justified in delegating to NAP? Select all that apply. a. Feeding a client who has unilateral weakness b. Repositioning an immobile client every 2 hours c. Assessing a client's surgical wound d. Weighing a client who has chronic heart failure e. Transporting a client to a diagnostic test
ANS: A, B, D, E Feedback: Assessment is beyond the scope of NAP. However, NAP can appropriately feed, reposition, transport, and weigh clients.
The nurse-manager is overseeing a culturally diverse group of staff. The manager should consider what variables when planning delegation? Select all that apply. a. Communication style b. Concepts of time c. Intelligence d. Biological variations e. Social organization
ANS: A, B, D, E Feedback: There are six cultural phenomena that must be considered when working with staff from a culturally diverse background: communication, space, social organization, time, environmental control, and biological variations. Intelligence is not a cultural phenomenon.
A manager's subordinate is having difficulty carrying out a delegated task. What is the manager's best initial action? a. Release the subordinate from the task so he or she will not become demoralized. b. Be available to the employee as a role model and resource for the task. c. Assign another more experienced employee to help with the task. d. Reassign the employee a different, less complex task.
ANS: B Feedback: A manager should be available to the employee to help identify solutions to problems encountered with a delegated task and should encourage the employee to persevere. Taking back a task that was originally delegated is an absolute last resort. Reassigning and coassigning the task are options that are not initially considered, but which may be necessary later.
A registered nurse has been leading teams of NAP for several years and will soon be leading licensed practical nurses for the first time. In preparation for delegating to these nurses, the RN should: a. delegate the same tasks to the LPNs that the RN normally delegated to NAPs. b. review the practical nurse scope of practice in the jurisdiction where they are working. c. ask each LPN what tasks he or she is comfortable performing. d. consult a decision tree for delegation to unlicensed assistive personnel.
ANS: B Feedback: Delegation to a LPN is different from delegation to a NAP. The parameters vary from state to state, and the RN should review the scope of practice. The LPN's comfort level is secondary to his or her knowledge, skills, and scope practice. A decision tree for delegation to unlicensed assistive personnel would guide delegation to NAPs, not LPNs.
A subordinate is reluctant to accept a task that the nurse-manager wants to delegate. The manager suspects that the subordinate's reluctance is due to a lack of self-confidence. What is the manager's best initial action? a. Teach the subordinate about the value of self-confidence. b. Try to empower the subordinate. c. Offer a reward to the subordinate in order to motivate. d. Restate the importance of the task to the subordinate.
ANS: B Feedback: Empowering the subordinate who lacks self-confidence is an appropriate initial action. If this is not possible, then reassigning the task may be necessary. Teaching about the need for self-confidence rarely instills self-confidence in those who lack it. Restating the importance of the task does not address the nurse's confidence level.
A health-care organization has laid off several RNs and hired numerous NAPs in their place. What effect is this change most likely to have on the remaining RNs? a. There will be a risk of the RNs underdelegating. b. The RNs' level of liability will increase. c. Cultural variables will become a larger consideration. d. The RNs' scope of practice will become expanded.
ANS: B Feedback: In general, increasing delegation to NAPs increases the scope of liability for the RN. There is no reason why this change in staffing would create a risk for underdelegating or make culture a more salient concern. The RNs' scope of practice is enacted in the jurisdiction's nurse practice act and is not affected by this change.
A manager needs to delegate some tasks. What consideration should the manager prioritize when identifying the appropriate person to whom to delegate a specific task? a. Whose turn it is to delegate a task b. The qualifications of the person regarding the task c. The fiscal cost of delegating the task d. Whether the person has experience with similar tasks
ANS: B Feedback: Managers should ask the individuals to whom they are delegating if they are capable of completing the delegated task. If the person lacks the appropriate qualifications, the fact that he or she has experience is irrelevant. The manager should not base delegation decisions primarily on whose turn it is or on cost
A nurse-manager has begun a new role in a community health center and will need to delegate tasks often to subordinates. What actions should the manager perform when delegating tasks? Select all that apply. a. Choose the most time-consuming tasks to delegate to subordinates. b. Evaluate the skills and education of subordinates before delegating. c. Ensure that subordinates know the goal of any delegated task. d. Avoid monitoring the subordinate unless there is evidence of a problem. e. Evaluate subordinates' performance after they have completed a task.
ANS: B, C, E Feedback: Safe and effective delegation involves evaluating the skills and education of staff, identifying goals clearly, and evaluating performance after completion. Tasks should not be selected for delegation on the sole basis of being time-consuming for the manager. Monitoring is appropriate and necessary and is not reserved just for problems or emergencies.
A nurse-manager has delegated some administrative tasks to an experienced RN. How does this act of delegation differ from the usual practice of assigning work to subordinates? Select all that apply. a. The nurse's task will be beyond his or her scope of practice. b. The manager transfers the authority for the task to the nurse. c. The nurse is practicing on the manager's license. d. The manager is released of the need to oversee the nurse. e. The manager remains accountable for the task.
ANS: B, E Feedback: In delegation, the individual transfers the authority to perform a specific activity from their own practice, to an individual qualified to perform that task, but retains accountability for the delegated task. Delegation does not involve going beyond the nurse's scope of practice, and there is still a need for oversight. The nurse does not perform on someone else's license when completing delegated tasks.
A performance appraisal states that the manager often underdelegates. What is potential cause of this delegation error? a. A high degree of trust in subordinates b. A democratic leadership style c. A need for perfectionism d. Sufficient time to accomplish unit goals alone
ANS: C Feedback: A manager with a need for perfectionism and control may believe that another person will not complete a task. Trust in subordinates and a democratic leadership style would support effective delegation. Delegating should not be based on the issue of time exclusively
An experienced RN has seen a significant increase in the need for delegation skills over the past several years. This change is most likely attributable to: a. increased numbers of uninsured clients. b. increased lengths of stay. c. increases in the use of NAP. d. decreases in nurse-client ratios.
ANS: C Feedback: With the increased use of NAP in patient care, the need for nurses to have highly developed delegation skills has never been greater. The impact of insurance, nurse-client ratios, and hospitalization stays does not have as great an impact on delegation as does the correct option. Hospital stays are shorter, not longer, than in the past.
Which action is considered a leadership role associated with delegation? A. Creating job descriptions for all personnel B. Providing formal recognition or reward for completion of delegated tasks C. Demonstrating sensitivity to how cultural phenomena affect trans-cultural delegation D. Reprimanding employees who demonstrate overt resistance to the tasks they are delegated.
ANS: C Feedback: Factors such as communication, space, social organization, timing, environmental control, and biological variations affect delegation to a culturally diverse staff and should be modeled as a leadership role. The other choices are all management functions
A nurse-manager delegates many tasks in the course of a day. Which practice should the manager reconsider or discontinue? a. The manager grants temporary authority to support completion of a delegated task. b. The manager confirms that the person to whom a task is delegated is adequately qualified. c. The manager provides employees with exact instructions for each step of completing the task. d. The manager asks for regular updates from the employee when tasks take a long time.
ANS: C Feedback: If an employee has the skills necessary to complete a task, that employee should be able to carry out the task with autonomy and be provided with the authority and resources necessary. There should be no need for the manager to give excessively detailed instructions. Depending on the complexity of the project, the manager should meet with the employee for updates. The manager must always confirm employees' qualifications.
The nurse-manager has asked an NAP for an update on delegated tasks, and the NAP has said, "I'm swamped right now." What is the manager's best response? a. "Don't be afraid to let me know if you feel the project is overwhelming you." b. "Time management is key to keeping on schedule with your tasks." c. "I can give you a few solutions to help manage this heavy workload." d. "Do you want more time to complete your work?"
ANS: C Feedback: If the worker is having difficulty carrying out the delegated task, the leader-manager should be available as a role model and resource in identifying alternative solutions. Leaders should encourage employees, however, to attempt to solve problems themselves first, although they should always be willing to answer questions about the task or to clarify desired outcomes as necessary. Suggesting solutions or removing the person from the task prematurely does not demonstrate an understanding of effective guidance. The NAP has already expressed feeling overwhelmed, so there is no need to give permission to do so.
A nurse has successfully completed a difficult and complex task that the manager delegated. What is the manager's best action? a. Document the fact that the nurse completed the task. b. Assign a slightly more difficult task the next time. c. Acknowledge the nurse's significant accomplishment. d. Ask the nurse to act as a role model for other staff members.
ANS: C Feedback: It is important to reward employees for accomplishment. This must precede "stretching" the nurse with even more difficult assignments or asking the nurse to act as a role model.
Which task would the director of a home health agency not delegate another staff RN? A. Assigning home health aides to specific patient care B. Serving on a diabetic study committee of community resources C. Meeting with the agency's administration regarding budget cuts D. Reviewing staff time cards for completion and accuracy
ANS: C Feedback: Management responsibilities associated with budgeting would not normally be delegated to another RN on the staff because this is a role that is not the responsibility of an RN. The other options could be appropriately delegated to another RN in most circumstances.
What must managers delegate to another RN in order to assure completion of a task? A. Time & space B. Leadership & creativity C. Authority & responsibility D. Personnel & Knowledge
ANS: C Feedback: Managers must delegate the authority and the responsibility necessary to complete the task. Qualities like leadership, knowledge, and creativity are not transferable. The remaining option choices are resources that are provided rather than delegated.
What principle should guide the nurse's delegation of tasks to unlicensed nursing assistive personnel (NAP)? a. It is safe to assume that the NAP has at least a high school diploma as a minimum hiring criterion. b. Like all members of the care team, NAP stands to lose their licensure in case of negligent practice. c. No federal or community standards have been established for training the broad classification of NAP. d. The nurse is protected from liability when allowing the NAP to perform only those tasks the employer includes in their job description.
ANS: C Feedback: No federal or community standards have been established for the training of the NAP. The hiring policies of institutions vary regarding the employment qualifications of the NAP, and many institutions do not have distinct job descriptions for NAP that define their scope of practice. NAPs do not have a license that they can lose.
Which statement is true regarding the general delegation liability of the RN? A. It is minimal because subordinates alone are held accountable for practicing within the accepted scope of practice for their job classification B. It is great because the RN is automatically held liable for the tasks delegated to all recognized subordinates C. It is reduced when the RN appropriately assesses what and to whom delegation is appropriate and supervises the completion of the tasks. D. It is avoided entirely by delegating tasks to other licensed personnel.
ANS: C Feedback: Proper delegation practices that include assessment and evaluation help protect the RN from liability. In general, accountability is shared and does not lie solely with the subordinate. Delegation to licensed personnel does not completely release a nurse from liability
What is an inappropriate reason for delegation? A. To empower subordinates by stretching them in their work assignment B. To free the manager to address more complex, high level unit needs C. When the task is not a challenge for the manager D. Because someone else is better qualified to do the task that needs to be done
ANS: C Feedback: That the manager is not challenged by a task is not a valid reason for delegating that task to another. The other options are all appropriate reasons to delegate tasks to qualified staff.
Periodically during the day the RN checked with the team members to determine whether they are having difficulty completing their assigned tasks. This describes which manager role? A. Skills eval B. Patient safety C. Effective delegation D. Micromanagement
ANS: C Feedback: This manager provided the team with the autonomy to complete the work and was available should any need arise. This describes effective delegation. This action does not constitute micromanagement, provided it is not excessive. This promotes client safety but is not synonymous with it. This practice is not a form of skills evaluation.
What action should the nurse-manager perform when supporting the delegation of a task to a subordinate? a. Holding the subordinate's professional development as the highest priority b. Frequently reassuring the employee that if they are incapable of completing a delegated task, it will be reassigned c. Drafting a preliminary plan of how the task will be redone if the outcome does not meet stated expectations d. Occasionally providing learning or "stretching" opportunities for employees
ANS: D Feedback: "Stretching" provides growth opportunities for employees, builds employee self-esteem, and helps prevent boredom and demotivation. Client safety is prioritized over professional development. The manager should avoid excessive reassurance and threats of reassignment. The nurse should not presume that the task will need to be redone before the subordinate has attempted it.
An RN needs to confirm the specific delegation parameters for RNs. The RN should refer to guidelines from what organization? a. The Joint Commission b. U.S. Department of Health and Human Services c. National League for Nursing (NLN) d. The state board of nursing
ANS: D Feedback: State boards of nursing are responsible for clarifying the delegation parameters for RNs. None of the other options are involved in this process.
A member of the team has been delegated some tasks and reports, "I've been given too much to do and I'm not going to be able to complete the work on time." What is the RN's best initial action? a. Assign the work to another team member. b. Take on the responsibility of the tasks. c. Have the team member perform only the most necessary tasks. d. Examine the workload and assist the individual in reprioritizing.
ANS: D Feedback: The manager should help the overwhelmed employee reprioritize the workload with the goal of making it manageable for that employee. This strategy should be tried before assigning work to another team member or having the employee abandon some of the tasks. In most cases, it is ineffective if the RN takes on the tasks that the employee was supposed to complete.
A registered nurse (RN) was working with a nursing assistive personnel (NAP) and delegated some tasks to the NAP. The NAP exceeded his scope of practice and caused injury to a client. Ultimate responsibility for this adverse event lies with whom? a. The NAP b. The facility's director of nursing c. The unit's nursing manager d. The RN
ANS: D Feedback: The team's RN always bears the ultimate responsibility for ensuring that the nursing care provided by his or her team members meets or exceeds minimum safety standards. This is not the ultimate role of any of the other positions mentioned.
Which restraining force occurs when a subordinate tests the water to determine what the consequences are of not completing a delegating task? A. Failure of delegator to see subordinate perspective B. Subordinate incapable of completing the task C. Subordinate inherent resistance to authority D. OVerdelegationg of specificity of the task
C