EAQ Leadership/Management/Delegation
Which nursing professional has the maximum span of control? 1. Nurse manager 2. Registered nurse 3. Patient care associate 4. Licensed vocational nurse
Correct Answer 1. Nurse manager Span of control, the number of people for whom one is ultimately responsible, increases with the number of individuals under a person's control. The nurse manager is the person responsible for the tasks performed by registered nurses, patient care associates, licensed vocational nurses/licensed practical nurses, and other nursing professionals, and, therefore, has the maximum span of control.
The registered nurse (RN) is caring for a client who underwent knee surgery. Which activity delegated to the novice unlicensed assistive personnel (UAP) in the immediate postoperative period would be most appropriate to achieve an effective care outcome? 1. Feeding the client with fluids 2. Dressing the client's surgical site 3. Monitoring temperature of the client 4. Administering oral medication to the client
Correct Answer 1. Feeding the client with fluids The unlicensed assistive personnel (UAP) can feed the client with fluids. Dressing the client's surgical site should be done by an experienced UAP. Monitoring the vital signs should be done only by the licensed practical nurse (LPN) in the immediate postoperative period. Administering oral medication should not be delegated to the UAP; it is the responsibility of the LPN.
The registered nurse is delegating tasks for nursing assistants caring for a client who requires more attention. Which element should be considered when selecting the suitable nursing assistant for delegation of a task? 1. Time 2. Safety 3. Stability 4. Critical thinking
Correct Answer 4. Critical thinking Critical thinking is of utmost importance for selecting a suitable nursing assistant for delegation of a task in a situation where a client requires more attention, as the delegatee should be able to perform the task effectively. Time, safety, and stability are also the elements for effective delegation, but these are suitable depending on the situation for assigning a task and delegation.
The charge nurse delegates the task to the healthcare team to provide an IV medication to a group of people who were diagnosed with gastroenteritis due to food poisoning. Which healthcare team member is suitable to provide medication in this situation? 1. Registered nurse 2. Healthcare provider 3. Licensed practical nurse 4. Unlicensed assistive personnel
Correct Answer 1. Registered nurse Intravenous medications are provided in case of gastroenteritis due to food poisoning for immediate relief in the clients. The registered nurse is eligible to provide intravenous medications to clients. The healthcare provider prescribes the medication for the clients. Licensed practical nurses are not eligible to provide intravenous medications; they can provide oral and intramuscular medications. Unlicensed assistive personnel are eligible to provide assistance and monitoring.
The registered nurse orders unlicensed nursing personnel (UNP) to check blood oxygen saturation levels every 6 hours and to report the results regularly. Which activity is the registered nurse performing in this situation? 1. Active delegation 2. Passive delegation 3. Individual accountability 4. Organizational accountability
Correct Answer 1. Active delegation Active delegation by the registered nurse helps him or her assess the situation and determine what is appropriate for client care. The registered nurse must direct the UNP to check the oxygen saturation and record it and to hold the UNP accountable. Functions that are normally performed by a licensed individual are called passive delegations. Individual accountability is a component of delegation that refers to individuals' ability to explain their actions and results. Making appropriate decisions depends on how well the organization provides adequate resources and is called organizational accountability.
The registered nurse assists other registered nurses when there are no safety issues. While assisting, the registered nurse uses the strategy of asking. What is the benefit of this strategy? Select all that apply. 1. Allows the registered nurse to reassess 2. Allows the delegator to examine the situation differently 3. Demonstrates a specific task or behavior to improve client care 4. Opens lines of communication between delegator and the delegatee 5. Helps to make a suggestion to facilitate the achievement of a desirable client care outcome
Correct Answer 1. Allows the registered nurse to reassess 2. Allows the delegator to examine the situation differently 4. Opens lines of communication between delegator and the delegatee When there are no safety issues, the registered nurse can assist other nurses by using different strategies. The strategy of asking begins with questions related to the problem or issue regarding client care and it allows the nurse to reassess and examine the situation differently. Asking provides an opportunity to open lines of communication between the delegator and delegatee. The strategy of doing helps in demonstrating a specific task or behavior to improve client care. The strategy of offering helps in making a suggestion to facilitate the achievement of a desirable client care outcome.
Which of the nurse's statements are true regarding delegation? Select all that apply. 1. Delegation is a complex process. 2. Delegation involves a single individual to achieve the goals. 3. Delegation involves transfer of responsibility and accountability. 4. Delegation improves client care outcomes when used effectively. 5. Delegation includes delegatees who allocate a portion of work to others.
Correct Answer 1. Delegation is a complex process. 4. Delegation improves client care outcomes when used effectively. Delegation is a complex decision-making strategy implemented to the work-related performance of the staff employed in healthcare organizations. Therefore, when used effectively, delegation improves client care outcomes. Delegation always involves at least two individuals such as the delegator and the delegatee, who engage in open communication to achieve a goal. Delegation involves the transfer of responsibility for the performance of a task from one individual to another while retaining the accountability for the outcome. Delegation includes delegators who allocate a portion of work to others.
How can registered nurses develop delegation and supervisory strategies to adapt to their changing roles? Select all that apply. 1. Engage a nurse mentor for guidance. 2. Practice the nursing care process in various clinical settings. 3. Reinforce delegation knowledge through continuing education. 4. Become familiar with the hierarchy of authority in the health care organization. 5. Seek high-quality clinical delegation experience early in their career.
Correct Answer 1. Engage a nurse mentor for guidance. 3. Reinforce delegation knowledge through continuing education. 5. Seek high-quality clinical delegation experience early in their career. Engaging a nurse mentor helps provide guidance and facilitate problem-solving related to delegation and supervision. Reinforcing delegation knowledge through continuing education helps nurses become familiar with the changing trends in health care delivery in context of delegation. Seeking high-quality clinical delegation experience early in a nurse's career helps nurses gain confidence in delegation skills. Practicing the nursing care process in various clinical settings helps the nurses to improve client outcomes, but would not specifically help develop delegation and supervisory strategies. Becoming familiar with the hierarchy of authority in the health care organization may help nurses understand management-related issues. However, this knowledge would not directly help nurses develop delegation and supervisory strategies.
Which questions should the nurse consider to assess and ensure delegation to the right person? Select all that apply. 1. Is the prospective delegatee a willing and able employee? 2. Does the delegatee understand the directions and expected results of the task? 3. Does the delegatee understand how, what, and when to report to the delegator? 4. Is it clear that the delegatee will provide feedback related to the task when appropriate? 5. Does the delegatee have the knowledge and experience to perform the specific task safely?
Correct Answer 1. Is the prospective delegatee a willing and able employee? 5. Does the delegatee have the knowledge and experience to perform the specific task safely? The right delegatee is chosen on the basis of the person's willingness and ability. The nurse should assess the knowledge and experience of the prospective delegatee to perform the specific task safely and fulfill the expected outcomes. Right direction and documentation are assessed by the delegatee's ability to understand the directions and expected results of the task. It can also be assessed on the basis of the delegatee's understanding of how, what, and when to report to the delegator. The right supervision is providing feedback to the delegatee, related to the task, when appropriate.
A client with dehydration is prescribed an intravenous (IV) fluid infusion. Which healthcare professional would the nurse expect to be delegated this task? 1. Registered nurse (RN) 2. Licensed practical nurse (LPN) 3. Licensed vocational nurse (LVN) 4. Unlicensed assistive personnel (UAP)
Correct Answer 1. Registered nurse (RN) While treating clients, tasks such as IV administration of fluids should be carried out by the RN because they are associated with risks. The LPN and LVN may provide oral medications and treatments under the supervision of an RN. The UAP is eligible to carry out all hygiene tasks and record vital signs under the strict supervision of an RN.
What does Hersey's situational leadership model describe about ability and willingness? Select all that apply. 1. Willingness relates to knowledge and skills in a specific situation. 2. An individual's ability does not change from one moment to the next. 3. An individual's willingness can fluctuate from one moment to another. 4. Ability relates to the individual's attitude and commitment towards a specific situation. 5. Ability and willingness need to be assessed to determine the level of the follower's readiness.
Correct Answer 2. An individual's ability does not change from one moment to the next. 3. An individual's willingness can fluctuate from one moment to another. 5. Ability and willingness need to be assessed to determine the level of the follower's readiness. According to Hersey's situational leadership model, an individual's ability does not change from one moment to the next because it relates to the knowledge of an individual. An individual's willingness can fluctuate from one moment to another since it relates to an individual's attitude, which can fluctuate. Ability and willingness are two factors that need to be assessed, according to Hersey's situational leadership model, to determine the level of the follower's readiness. According to Hersey's situational leadership model, ability relates to knowledge and skills in a specific situation. Willingness relates to the individual's attitude and commitment towards a specific situation.
The registered nurse delegates care of a client with hyperpyrexia to a licensed practical nurse. How would the registered nurse achieve workable unity for an effective outcome? 1. Assisting the staff with planning 2. Assisting the staff to achieve optimal functioning 3. Assisting the staff in interpreting organizational value 4. Assisting other organizational leaders in the expression of community
Correct Answer 2. Assisting the staff to achieve optimal functioning Assisting the staff to achieve optimal functioning to benefit transition to enhanced organizational functions is related to achieving workable unity for the effective outcome. The staff assists the clients and their families to achieve optimal functioning to benefit the transition to enhance health functions. Assisting the staff with planning is related to management positions and ensuring that systems work to enhance the staff's ability to meet client's care needs. Assisting the staff in interpreting organizational value and assisting other organizational leaders in the expression of community are related to affirming values assists the client to sort out and articulate personal values in relation to health problems and the effect of these problems on lifestyle adjustment.
What is a high-level cognitive process that the nurse recognizes can be improved with practice in delegation? 1. Creativity 2. Critical thinking 3. Problem solving 4. Decision making
Correct Answer 2. Critical thinking Critical thinking is a high-level cognitive process that can be improved by practice. Creativity is essential for the generation of options or solutions. Problem solving mainly focuses on resolving an issue. Decision making is a purposeful and goal-directed effort that uses a systematic process to choose among options.
The registered nurse in a hospice is working with a new assistant who has prior experience working in a physician's office. Which action made by the registered nurse will promote a healthy working environment? 1. Encouraging the assistant to perform the registered nurse functions 2. Encouraging the assistant to adopt the philosophy of the organization 3. Asking open-ended questions and supervising the work by the assistant 4. Allowing the assistant to tackle various procedures and take accountability for the task performed
Correct Answer 2. Encouraging the assistant to adopt the philosophy of the organization The nursing assistant should concur with the philosophy of the organization, as the goals of hospice care are to overcome negative influence on the clients. Encouraging the assistant to perform the registered nurse functions is not within the assistant's scope of practice. The nursing assistant may have negative feelings about being supervised when the registered nurse asks open-ended questions and supervises the work without proper communication. The registered nurse as a delegator always has final responsibility and accountability.
Who is the designated delegator? 1. Unit secretary 2. Nurse manager 3. Registered nurse 4. Licensed practical nurse
Correct Answer 2. Nurse manager The nurse manager is the designated delegator. The unit secretary has no formal preparation or legal recognition. The registered nurse is answerable to the delegator. The licensed practical nurse has a dependent status, functioning under the direction of a registered nurse.
A healthcare team is caring for a client who underwent kidney transplantation. Which task is most suitable to be delegated to a licensed practical nurse (LPN) to provide effective client care? Select all that apply. 1. Emptying urinary drainage bag 2. Recording vital signs 3. Assessing of urine output 4. Placing the urinary catheter 5. Administering intravenous fluids
Correct Answer 2. Recording vital signs 4. Placing the urinary catheter The licensed practical nurse (LPN) is eligible to record the vital signs of a client. The LPN is eligible and can place a urinary catheter for a client who underwent kidney transplantation. Emptying the drainage is performed by an unlicensed nursing professional. The LPN cannot assess urine output of the client; this is performed by a registered nurse. Administering intravenous fluids is performed by registered nurses.
An emergency department consists of five nurses who take care of 30 clients. Which responsibility of the registered nurse is most helpful in overcoming this overwhelming situation? 1. Task behavior 2. Span of control 3. Sharing activities 4. Situational leadership
Correct Answer 2. Span of control The registered nurse has to handle five nurses who take care of 30 clients, meaning that each nurse will be caring for six clients. Managing 30 clients in stable condition is easy; whereas, managing clients in critical condition requires span of control to make the overwhelming situation less challenging. The nursing staff should render a portion of the care to reduce the client care workload. Task behavior is the amount of guidance given to an individual in a specific situation. The delegator shares activities among the individuals to ensure quality client care outcomes. Situational leadership is the ability to diagnose the performance, competence, and commitment of others to be flexible and efficient in performing an activity.
In a long-term care facility, the care tasks for a client who is suffering with liver disease are being delegated. Which statement made by the delegator indicates the responsibility for the tasks is with the registered nurse? Select all that apply. 1. "You will be responsible for the whole nursing unit." 2. "You will provide the treatment that is prescribed." 3. "You will assess alleviation of the client's symptoms." 4. "You will be monitoring the client care on an hourly basis." 5. "You will admit the client to the intensive care unit (ICU) if her condition deteriorates."
Correct Answer 3. "You will assess alleviation of the client's symptoms." 4. "You will be monitoring the client care on an hourly basis." 5. "You will admit the client to the intensive care unit (ICU) if her condition deteriorates." In a long-term care facility, the registered nurse will be responsible for supervising the licensed nursing professionals who will be the performing the delegated tasks. The registered nurse takes the responsibility of assessing alleviation of symptoms and monitoring the client on an hourly basis. Admission of the client to the ICU is the responsibility of the registered nurse. The licensed practical nurse (LPN) or the licensed vocational nurse (LVN) is responsible for taking the responsibility for the whole nursing unit. The LPN or LVN will be delegated the task of providing the treatments that are prescribed by the primary healthcare provider.
Which questions related to decision making for delegation are appropriate according to the delegation right of "right circumstance"? Select all that apply. 1. Is the task legally appropriate to delegate? 2. Is the prospective delegatee a willing and able employee? 3. Are the equipment and resources available to complete the task? 4. Does the delegatee have appropriate supervision to complete the task? 5. Is the task appropriate to delegate based on the institutional policies and procedures?
Correct Answer 3. Are the equipment and resources available to complete the task? 4. Does the delegatee have appropriate supervision to complete the task? There are Five Rights of Delegation. Questions related to the equipment and resources available for carrying out the task allotted are appropriate for the delegation right "right circumstance." Asking about the required supervision needed for the delegatee to complete the task is appropriate for the delegation right "right circumstance." Questioning whether the task allotted is legal is appropriate for delegation right "right task." Checking whether the delegatee is an able person to perform the task would come under delegation right "right person." Checking whether the task is based on the policies and procedures of the institution comes under the delegation right "right task."
The registered nurse (RN) delegates obtaining and recording a client's pulse every 30 minutes. During the last hour, the licensed practical nurse (LPN) fails to report the client's elevated heart rate to the RN. Which factor best explains the situation? 1. Limited delegation 2. Information salience 3. Decayed information 4. Ineffective supervision
Correct Answer 3. Decayed information Information decay is the characteristic feature of communication that occurs when the client's health status changes rapidly; this might include a change in the client's vital signs such as the heartbeat. Nursing when performed with limited delegation leads to misusing valuable resources. Information salience is a characteristic feature of communication in which the information provided by the delegator is monitored and evaluated. Supervision is mainly provided to the new delegatees.
Which action in the delegation process represents accountability? 1. Providing open and honest feedback to the delegatee 2. Assisting other registered nurses with delegation decisions 3. Monitoring the client care given and determining outcomes 4. Assessing the ability of the delegatee and educating him or her about the task
Correct Answer 3. Monitoring the client care given and determining outcomes Monitoring client care and determining outcomes represents accountability of the task in case of conflicts. Providing open and honest feedback to the delegatee improves work performance and client care outcomes. The nurse can assist other registered nurses with delegation decisions when there are safety issues, an urgent need to intervene, or potential negative client outcomes. Assessing the ability of the delegatee and educating him or her about the task indicates responsibility.
Which two factors would the nurse state influence the effectiveness of the leader? Select all that apply. 1. Ability 2. Attitude 3. Readiness 4. Willingness 5. Assessment
Correct Answer 3. Readiness 5. Assessment Readiness and assessment are two of the factors that influence the effectiveness of the leader. Ability and willingness are the two factors that need to be assessed to determine the level of the leader's readiness. The attitude is related to the individual's willingness.
After assessing the delegatee's inability to perform an assigned task, the delegator explains the procedure and demonstrates the task to the delegatee. What can be inferred about the delegatee? 1 The delegatee may have limited knowledge and ability to perform the task. 2 The delegatee has an established relationship with the delegator and expertise. 3 The delegatee has the willingness and ability, but the relationship with the delegator is new. 4 The delegatee may have an ongoing relationship with the delegator, but a new task is assigned.
Correct Answer 4 The delegatee may have an ongoing relationship with the delegator, but a new task is assigned. When the delegatee has an ongoing relationship with the delegator, but a new task is assigned, the delegator should explain and demonstrate the procedure. When the delegatee has limited knowledge and ability to perform the task, the delegator should provide more guidance. When the delegatee has an established relationship with the delegator and the expertise, little guidance is needed from the delegator to perform the task. When the delegatee has the willingness and ability to perform a task, but the relationship is new, it requires both individuals to create mutual expectations and the conditions for performance.
The charge nurse is teaching the newly-hired registered nurse (RN) about delegating tasks to unlicensed nursing personnel (UNPs). Which statement made by the newly hired RN indicates the need for further teaching? 1. "I should assist the staff in interpreting." 2. "I should assist the staff in decision-making." 3. "I should assist the staff in achieving optimal functioning." 4. "I should assist the staff in sorting out and articulating values."
Correct Answer 4. "I should assist the staff in sorting out and articulating values." The RN does not assist the staff in sorting out and articulating the values, the healthcare provider or the physicians do. The RN should assist the staff in interpreting to achieve better outcomes. As a delegator, it is the duty of the RN to help the staff in decision-making. The RN should assist the staff in achieving optimal functioning because the allotted task can have a better outcome only under the supervision of the RN.
A client with pulmonary edema is provided care according to the functional model of nursing. The registered nurse (RN) who is in charge of providing intravenous medication every hour went on a break. Which activity performed by the RN would be most appropriate in this situation? 1. Delegating the work to the nursing manager 2. Informing the associate nurse before taking a break 3. Delegating the work to the licensed practical nurse (LPN) 4. Reporting the client's condition to a charge nurse before taking a break
Correct Answer 4. Reporting the client's condition to a charge nurse before taking a break The charge nurse takes responsibility for all activities in the absence of the registered nurse (RN). Therefore the RN should inform the charge nurse and report the client's condition prior to leaving for a break. The RN does not have any right to delegate work to the nursing manager because the nursing manager is more experienced and educated than the RN. There is no associate nurse in functional nursing; associate nurses are involved in primary nursing. The administration of intravenous medication cannot be done by a licensed practical nurse (LPN); only oral medication can be given by an LPN.
A registered nurse is caring for a client according to the total client care model of nursing. Which activity performed by the nurse manager would be appropriate in this situation? Select all that apply. 1. Providing care to group of clients 2. Providing care to clients in ambulatory clinics 3. Delegating tasks to licensed practical nurse (LPN) 4. Weighing the expenses of a registered nurse (RN) vs. LPNs 5. Deciding the type of care provided by nursing assistive personnel
Correct Answer 4. Weighing the expenses of a registered nurse (RN) vs. LPNs 5. Deciding the type of care provided by nursing assistive personnel. Weighing the expenses of RNs versus LPNs and unlicensed assistive personnel (UNP) are performed by the nurse manager in the total client care model of nursing. Providing care to the group of clients is the responsibility of a direct care nurse in the functional nursing model. Providing care to a client in an ambulatory clinic is the responsibility of the nurse manger in the functional nursing model. Delegating a task to an LPN is not the responsibility of the nurse manager; it is the responsibility of the RN.
What order should the nurse follow during the delegation decision-making process when delegating client care? Correct - 1. Assessing the health needs exhibited by the client Correct - 2. Assessing the abilities demonstrated by unlicensed personnel Incorrect - 3. Seeking client care issues Incorrect - 4. Ensuring the stability of the client Incorrect - 5. Monitoring the task Correct - 6. Providing feedback to unlicensed personnel
The delegation process starts with assessing the health needs of the client and the skills of unlicensed personnel (UNP). The key component of delegation decision-making is assessing the UNP's ability to perform the work, including, safety, critical thinking, stability, and time. It is also vital to make client care decisions at the same time. The nurse has to make sure that the client is stable and steady to ensure the best care. The greater the stability of a client, the more likely the UNP can provide safe client care. The nurse should then monitor the task being performed by the UNP. The nurse should also maintain an open line of communication with the UNP to seek client care updates and limitations. The nurse should always provide direct feedback to the UNP for professional growth and development to improve client care outcomes.
Which aspects of organizations does the nurse consider during the decision-making process? Select all that apply. 1. Laws 2. Policies 3. Standards 4. Environment 5. Relationships
Correct Answer 1. Laws 2. Policies 3. Standards The decision-making process occurs in view of the organizational laws, policies, and standards. These views are important for the delegator to know when delegating tasks. Environmental considerations may not come under the organizational views. Relationships should be known and considered while delegating tasks to the delegatee.
Which task can be delegated to the licensed vocational nurse (LVN)? Select all that apply. 1. Analyzing vital signs 2. Maintaining oral hygiene 3. Administering intravenous drugs 4. Administering oral hypoglycemic agents 5. Administering intramuscular medications
Correct Answer 4. Administering oral hypoglycemic agents 5. Administering intramuscular medications Licensed vocational nurses and licensed practical nurses are authorized to administer drugs through oral and intramuscular routes. Analyzing vital signs should be performed by the registered nurse. Hygiene maintenance can be delegated to unlicensed nursing practitioners (UNP). Administering intravenous drugs should be done by the registered nurse.
