Leadership and Management Concepts
A nurse needs help with moving clients quickly in a fire drill. Which client will the nurse ask the nursing assistant to help first? A. A client who is ambulatory but does not hear well. B. A client who uses a wheelchair for mobility C. A client who had surgery today. D. A client with confusion.
Correct Answer: D. A client with confusion. The confused client will need someone with him at all times, so he does not become lost in the drill. Incorrect Answers: A. An ambulatory client will not require assistance. B. This client can evacuate in a wheelchair. C. This client will require more assessment and assistance from the nurse due to multiple drains or intravenous lines. Vital Concept: Clients who are the most unstable should be assisted by the nurse to allow monitoring. Other clients should be delegated to the nursing assistant.
Which tasks should the nurse delegate to an unlicensed assistive personnel (UAP)? select all that apply a. Turn patient every 2 hrs b. Evaluate patient's skin during bathing. c. Feed patient breakfast and lunch. d. Assist patient with morning care. e. Teake and record patient's vital signs f. Discontinue IV infusion
A C D E
A charge nurse notes that a staff nurse delegates an unfair share of tasks to the unlicensed assistive personnel (UAP). The nurses on the next shift report the same staff nurse frequently leaves tasks uncompleted. Which of the following statements should the charge nurse make to the nurse to resolve conflict. A. I need to talk to you about delegating and completing tasks' B. "Several staff members are complaining that you don't do your fair share of work* C. If you don't do your share of the unit work | will have to inform the nurse manager: D. This unit may not be the right fit for your delegation style
Answer: A
A nurse is discussing malpractice issues at an in-service class which situation is an example of malpractice? A. Nurse take a client narcotics resulting in pt not experiencing pain relief and crying B. the nurse signs out med to give to her client for HTN and forgets to give pt the med C. The nurse fails to report a neighbor who is abusing his 2 children and one ends up in hospital D. The nurse does not intervene while caring for a pt whose BP is dropping and the pt goes into shock and subsequently dies
Answer: C
When using the Situation, Background, Assessment, Recommendation (SBAR) method of communication, the nurse would include which information in the B section? a. Recommend fingerstick glucose monitoring b. Patient states he feels dizzy and lightheaded. c. Admission diagnosis new-onset type 2 diabetes d. Blood pressure is 130/90 mm hg; heart rate is 89 beats per minute
C
When implementing a team nursing approach in a healthcare facility, planning care delivery in this nursing practice model is based on which of the following characteristics? A. Use of managed care concepts and tools B. A registered nurse leading other nursing personnel in providing care to a group of clients C. Providing client care using a task approach method D. A registered nurse taking responsibility for providing care to a defined group of clients.
Correct Answer: B. A registered nurse leading other nursing personnel in providing care to a group of clients A team nursing approach is characterized by the leadership of a registered nurse in collaboration with other personnel to provide coordinated client care to a group of clients. Other personnel on the nursing team include licensed practical nurses (LPN) and unlicensed assistive personnel (UAP). The registered nurse delegates tasks to members of the team while retaining ultimate responsibility for client care. Incorrect Answers: A. Use of managed care concepts is a component of case management. C. A task approach method is a functional approach to nursing care. D. This option describes a relationship-based practice of nursing. Vital Concept: Team nursing refers to a team approach to provide individualized client care. The nursing team consists of registered nurses, LPNs, and UAPs. The RN is ultimately accountable for the process of delegation, including appropriate delegation and followup, and for the outcome of care. The team member to which the task is delegated accepts responsibility, authority, and accountability for the assigned work.
A registered nurse delegates a routine task to the UAP. Which of the following best describes the legal consequences for the nurse if there is negligence by the UAP? A. The nurse is automatically held liable for negligence on the part of personnel they supervise. B. The nurse is only liable for negligence if the task delegated was outside the scope of practice of the UAP. C. The RN may be liable if negligent in supervising the UAP. D. The RN is only liable if the task was not within the job description of the UAP.
Correct Answer: C. The RN may be liable if negligent in supervising the UAP. The scope of liability is increased when an RN acts as a delegator or supervisor to a UAP. This liability is not automatic in acts of negligence by those supervised by the RN, but the RN is responsible for determining whether the subordinate is able to perform a task safely without supervision. The RN may be found liable for negligent acts by a subordinate if the RN is negligent in failing to monitor a subordinate who needs supervision or assigns client needs to a subordinate who is unqualified.
A charge nurse is delegating tasks to a licensed practical nurse (LPN). Which of the following criteria is the priority for the charge nurse to consider when delegating? A. Facility policies B. The acuity of the clients C. The documented skill level of the LPN D. State Nurse Practice Act
Correct Answer: D. State Nurse Practice Act According to evidence-based practice, the nurse should first consider the state Nurse Practice Act, which provides the legal authority for nursing practice. A state's Nurse Practice Act specifies the qualifications and responsibilities of nurses and outlines the specific tasks that nurses can legally perform based upon their educational preparation. Essential Elements of Delegation Criteria Included in Nurse Practice Acts 1. Definition of delegation 2. Tasks that cannot be delegated 3. Description of professional nursing practice 4. Role description and limitations for PNs and AP 5. Degree of supervision required when working with PNs and AP 6. Guidelines for minimizing risks to delegation 7. Inappropriate delegation Vital Concept: Delegation provides the RN with a means of managing client care. Care should be taken to ensure that delegated tasks are completed safely and that the staff member assigned to the task is legally permitted to do so. The nurse should keep in mind that nursing practice cannot be delegated to an LPN or an AP, including the steps of the nursing process, developing care plans for clients, and developing teaching plans for clients, because these require the professional skill and knowledge of an RN.
A nurse manager is planning to implement a procedural change involving the responsibilities of the charge nurses using Lewin's stages of change theory. Which of the following actions should the nurse manager plan to take during the moving stage of change? A. Identify the problem. B. Inform the charge nurses that a change to established procedures is needed. C. Require the charge nurses to comply with the new procedures. D. Set a target date for the implementation of the new procedures.
Correct Answer: D. Set a target date for the implementation of the new procedures. The second stage of Lewin's change theory is the moving stage. During the moving stage, the nurse manager should develop the plan for change and set the target date for the implementation of the new procedures. Tasks Associated With the Change Stage • Develop a plan for introducing and implementing the change, including goals, objectives and strategies. • Include all team members who will be affected by the change in the planning process. • Identify those who support the change and those who are resistant. • Set a target date for implementing the strategies. • Implement the strategies. • Offer support and encouragement to team members throughout the change process. • Devise and implement strategies to meet resistance to change. • Evaluate the integration of the change and revise strategies as needed. Incorrect Answers: A. There are three stages involved in Lewin's change theory. The first stage is the unfreezing stage in which the nurse manager should identify the problem, determine the need for a change, and then obtain buy-in from the members of the group. B. During the unfreezing stage, the nurse manager should make the charge nurses aware that a change is needed. This should be based upon the assessment findings and can take the form of conversations with the charge nurses as a group. C. The third stage of Lewin's change theory is the refreezing stage. During this time, the nurse manager should focus on integration of the new procedure with the charge nurses. This includes engaging with the charge nurses to support the change and encouraging them through the change process. It also includes requiring the charge nurses to integrate the procedural changes into their work.
A nurse is assigning client care tasks to an LPN. Which of the following tasks is most appropriate to assign for a client with COPD and a nursing diagnosis of ineffective breathing pattern? A. Develop a nursing care plan B. Assist the client with activities of daily living C. Consult with a dietician for dietary modifications D. Encourage sustained deep breathing by asking the client to yawn and encouraging use of an incentive spirometer E. Decide when to administer a PRN albuterol nebulizer treatment
Correct Answer: D. Encourage sustained deep breathing by asking the client to yawn and encouraging use of an incentive spirometer An LPN can reinforce education provided by the RN but cannot appropriately initiate education or provide discharge education. Encouraging sustained deep breathing and using an incentive spirometer when delegated by a nurse is within the scope of practice of an LPN, although initial teaching must be by the RN. Incorrect Answers: A. An LPN cannot provide initial assessment and nursing care plan. B. It would be most appropriate to delegate assistance with ADLs to unlicensed assistive personnel. C. This falls under the plan of care, which is within the scope of practice of the RN. E. An LPN cannot give PRN medications without RN approval.
The Registered Nurse is providing care for a group of clients on a medical-surgical nursing unit. Which of the following tasks is the most appropriate to delegate to unlicensed assistive personnel (UAP)? A. Providing client teaching for a client who is being discharged and will need wet to dry dressing at home B. Assessing the incision line of a newly admitted client who has had a cholecystectomy C. Instructing a client in the proper procedure for injecting insulin D. Completing vital signs on clients and recording in the chart
Correct Answer: D. Completing vital signs on clients and recording in the chart This is an appropriate task for UAP. UAP should be used in the most effective manner possible. Having the UAP take and record vital signs will allow the nurse to access them quickly as needed. Incorrect Answers: A. Client teaching should not be delegated by the RN B. Initial assessments, and assessments that required nursing judgment, should not be delegated by the RN C. Client teaching and/or tasks that require nursing judgment should not be delegated by the RN Vital Concept: The RN must understand appropriate delegation principles. In order to provide safe and effective care, they must remain aware of the scope of practice levels or personnel.
A registered nurse is assigning care to an unlicensed assistive personnel (UAP) and a licensed practical nurse (LPN). Which of the following is the most appropriate task to assign to the LPN? A. Administer a prescribed pain medication via intravenous push. B. Plan discharge teaching for a client with a new prescription for metoprolol. C. Measure and record fluid intake and output. D. Monitor the client's overall condition
Correct Answer: D. Monitor the client's overall condition When delegating a task to less knowledgeable personnel, the needs of the client, skill of the staff, scope of practice, facility policies, and job description of the staff member should be taken into consideration. When assigning care to others, the "Five Rights of Delegation" must be considered: Incorrect Answers: A. Although licensed practical nurses can administer some intravenous medications if IV-certified, they cannot administer intravenous pain medications. B. The LPN can reinforce teaching, but the RN cannot delegate the act of teaching or planning to a less knowledgeable staff member. C. The UAP or LPN can measure and record fluid intake and output for a stable client. Since the UAP is available, the more appropriate task for the LPN is assessment of pain in a stable client.
The medical/surgical unit staff consists of a registered nurse (RN), licensed practical nurse (LPN), and 2 unlicensed nursing assistants. Which of the following tasks should the supervisor assign to the LPN (select all that apply)? A. Assessing bowel sounds for changes in a stable client who is two days post operative following a hysterectomy B. Reinforcing diabetic teaching on insulin injections for a client with newly diagnosed type I diabetes mellitus C. Conducting an initial assessment of a client admitted to begin anticoagulation for deep vein thrombosis D. Inserting a urinary catheter E. Bed-bathing a client admitted after a hip fracture
Correct Answers: A. Assessing bowel sounds for changes in a stable client who is two days post operative following a hysterectomy B. Reinforcing diabetic teaching on insulin injections for a client with newly diagnosed type I diabetes mellitus D. Inserting a urinary catheter An LPN can perform several high-level tasks in stable clients, some of which vary by state. These include administration of regular and injection medication, suctioning and tube feeding, sterile procedures including dressing changes and placement of urinary catheters, and higher-level assessments of stable clients. Although the RN should perform initial teaching for client education, an LPN can reinforce teaching provided by the RN. Assessment of bowel sounds for changes in a stable client is an appropriate task, but if changes are noted, the LPN must notify the RN.
A nurse is caring for a client with an indwelling urinary catheter. Which tasks should the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) A. Anchoring the catheter to the client's thigh to secure it B. Monitoring urine color and document on the client's chart C. Documenting urine output in the catheter collection bag D. Holding the client's adipose tissue out of the way during a catheter insertion E. Providing education about the urinary catheter
Correct Answers: A. Anchoring the catheter to the client's thigh to secure it C. Documenting urine output in the catheter collection bag D. Holding the client's adipose tissue out of the way during a catheter insertion Unlicensed assistive personnel function in a supportive role to provide client care as delegated by an RN or LPN. Although client care tasks can be delegated, the delegator retains accountability for the outcome of the task. When delegating tasks to unlicensed assistive personnel, the nurse must be certain the tasks assigned are within the scope of practice for the UAP. Clear instructions should be provided and the nurse should evaluate the outcome. The scope of practice of UAPs includes hygiene, assistance with activities of daily living, change of linens, positioning the client, documenting stable vital signs, and documenting input and output. Routine tasks such as securing a catheter with an anchor are also within the scope of practice of unlicensed assistive personnel.
Which of the following describes characteristics of a transformational leader? (Select all that apply.) A. Engaging stakeholders in the leadership process B. Promoting "top down" authority C. Focusing on what others are trying to say D. Commanding expectations rather than asking E. Maintaining high levels of integrity and responsibility
Correct Answers: A. Engaging stakeholders in the leadership process C. Focusing on what others are trying to say E. Maintaining high levels of integrity and responsibility A transformational leader is someone who embraces change and is adaptable to the working environment to facilitate change for the better. This type of leader promotes growth among those she leads. The transformational leader engages others in the leadership process and focuses on what they have to say, rather than assigning tasks from the top down. This type of leader also maintains high levels of integrity and is responsible for those she works with. Instead of commanding expectations, she consults and asks. Vital Concept: A transformational leader focuses on innovation and change, motivates and empowers staff, and focuses on team development. Team input and sharing ideas is important to a transformational leader. Team members are held accountable, but they are recognized for good work and supported by the leader.
A nurse is assigned to a client who is receiving continuous bladder irrigation to gravity after a transurethral resection of the prostate. Which of the following tasks can be delegated to unlicensed assistive personnel (select all that apply)? A. Measuring the output volume in the drainage bag B. Increasing the irrigation rate if the urine becomes red or dark C. Assessing a client who complains of pain D. Calculating the intake and output associated with the irrigation and drainage E. Cleaning the catheter insertion site
Correct Answers: A. Measuring the output volume in the drainage bag E. Cleaning the catheter insertion site Continuous bladder irrigation is used to prevent the obstruction of urine outflow after transurethral prostate resection by clotted blood from the bladder. A 3-way catheter infuses fluid into the bladder by gravity, and the fluid drains out through a urinary catheter into a drainage bag with urine and blood. The nurse should consider the "5 rights of delegation" when delegating a task to less knowledgeable personnel. These are: Incorrect Answers: B. The outflow should be light pink. If it darkens, the irrigation rate should be increased. The UAP does not have the knowledge or skill to titrate inflow. This task must be performed by the RN. C. Assessment of pain is a nursing task. The UAP can report pain to the RN, but the RN must perform the assessment. D. Changes in the difference between input and outflow may indicate obstruction of drainage. The nurse must calculate this difference and determine if there is a need to use manual irrigation to reestablish a patent outflow catheter.
Which of the following tasks can the nurse assign to a Licensed Practical Nurse (LPN)? (Select all that apply.) A. Administer Acetaminophen PO to a client B. Recheck the temperature of a febrile 6-year-old C. Complete discharge teaching with a client following an uncomplicated appendectomy D. Assess breath sounds in an 83-year-old bed-bound client E. Start the admission assessment of a client who just arrived on the floor
Correct Answers: A. Administer Acetaminophen PO to a client B. Recheck the temperature of a febrile 6-year-old D. Assess breath sounds in an 83-year-old bed-bound client Delegation and assignment require clinical judgment by the nurse, who retains accountability for client care when delegating a task. Assignment refers to giving someone a task within their own scope of practice. Assignment is based on job descriptions and policies within the healthcare organization. Delegation refers to giving someone a task within the delegator's scope of practice. The person to whom the task is delegated would otherwise not be able to perform the task. The nurse should ensure that the LPN is qualified to perform the delegated task. Administration of medication and taking vital signs in stable clients are within the LPN's scope of practice and can be assigned to the LPN. The LPN can perform client assessments. However, the initial triage or admission assessment must be completed by the RN. The LPN must work under the supervision of a physician or registered nurse. The scope of practice of the LPN is governed by the Nurse Practice Act in the state, and can vary greatly across the county.
The nurse is assigning clients to licensed vocational nurse (LVN). Which of the following clients are appropriate to assign to an LVN? Select All That Apply A. A client immediately following coronary artery bypass graft surgery (CABG) B. A client admitted with increased blood sugar levels who needs their blood glucose reading completed before meals and at bedtime. C. A client who was admitted three days ago with a COPD exacerbation D. A client who was admitted with gastrointestinal bleeding 2 days ago and whose hemoglobin and hematocrit have remained stable. E. A client who was admitted with pyelonephritis thirty six hours ago and it is treated with oral antibiotics.
Correct Answers: B. A client admitted with increased blood sugar levels who needs their blood glucose reading completed before meals and at bedtime. C. A client who was admitted three days ago with a COPD exacerbation D. A client who was admitted with gastrointestinal bleeding 2 days ago and whose hemoglobin and hematocrit have remained stable. E. A client who was admitted with pyelonephritis thirty six hours ago and it is treated with oral antibiotics. The LVN should be assigned standard, stable clients who are not likely to experience change. These clients are not likely to experience change rapidly. Incorrect Answers: A. This client is likely to experience rapid changes and will require frequent, ongoing assessment. They should not be assigned to an LVN. Vital Concept: RN should master how to effectively and appropriately delegate. In doing so, the RN will learn more effectively be able to manage their time and resources. This will allow the RN to provide the highest quality of care possible to clients.
9. A nurse is using time management techniques when planning activities for patients. Which nursing action reflects effective time management? A. The nurse asks patients to prioritize what they want to accomplish each day B. The nurse includes a "nice to do" for every "need to do" task on the list C. The nurse "front loads" the schedule with "must do" priorities D. The nurse avoids helping other nurses if scheduling does not permit it
a. By asking the patient to prioritize what they want to accomplish each day, the nurse is demonstrating an effective time management technique. In order to manage time, the nurse should establish goals and priorities for each day, differentiating "need to do" from "nice to do" tasks; the nurse should include the patient in this process. The nurse should also establish a time line, allocating priorities to hours in the workday in order to keep track of falling behind and correct the problem before the day is lost. The nurse should use teamwork appropriately to enhance the schedule
5.A nurse manager is attempting to update a health care provider's office from paper to electronic health records (EHR) by using the eight-step process for planned change. Place the following actions in the order in which they should be initiated: A. The nurse devises a plan to switch to EHR. B. The nurse records the time spent on written records versus EHR. C. The nurse attains approval from management for new computers. D. The nurse analyzes all options for converting to EHR. E. The nurse installs new computers and provides an in-service for the staff. F. The nurse explores possible barriers to changing to EHR. G. The nurse follows up with the staff to check compliance with the new system. H. The nurse evaluates the effects of changing to EHR.
b, f, d, c, a, e, h, g. Planned change involves the following steps: (1) recognize symptoms that indicate a change is needed and collect data, (2) identify a problem to be solved through change, (3) determine and analyze alternative solutions, (4) select a course of action from possible solutions, (5) plan for making the change, (6) implement the change, (7) evaluate the change, and (8) stabilize the change.
10.A new nurse manager at a small hospital is interested in achieving Magnet status. Which action would help the hospital to achieve this goal? A. Centralizing the decision-making process B. Promoting self-governance at the unit level C. Deterring professional autonomy to promote teamwork D.Promoting evidence-based practice over innovative nursing practice
b. Magnet hospitals use a decentralized decision-making process, self-governance at the unit level, and respect for and acknowledgment of professional autonomy. In Magnet hospitals, 14 characteristics, the Forces of Magnetism, have been recognized that identify quality patient care, excellent nursing care, and innovations in professional nursing practice.
8. An RN on a surgical unit is behind schedule administering medications. Which of the RN's other tasks can be safely delegated to a UAP? A. The assessment of a patient who has just arrived on the unit B. Teaching a patient with newly diagnosed diabetes about foot care C. Documentation of a patient's I & O on the flow chart D. Helping a patient who has recently undergone surgery out of bed for the first time
c. Documenting a patient's I & O on a flow chart may be delegated to a UAP. Professional nurses are responsible for the initial patient assessment, discharge planning, health education, care planning, triage, interpretation of patient data, care of invasive lines, administering parenteral medications. What they can delegate are assistance with basic care activities (bathing, grooming, ambulation, feeding) and things like taking vital signs, measuring intake and output, weighing, simple dressing changes, transfers, and post mortem care.
A nurse working on a cardiac unit delegated taking vital signs to an experienced unlicensed assistive personnel (UAP). Four hours later, the nurse notes the clients blood pressure is much higher than previous readings, and the clients mental status has changed. What action by the nurse would most likely have prevented this negative outcome? a. Determining if the UAP knew how to take blood pressure b. Double-checking the UAP by taking another blood pressure c. Providing more appropriate supervision of the UAP d. Taking the blood pressure instead of delegating the task
c. Providing more appropriate supervision of the UAP
7. A nurse is asked to act as a mentor to a new nurse. Which nursing action is related to this process? A. The nurse mentor accepts payment to introduce the new nurse to his or her responsibilities B. The nurse mentor hires the new nurse and assigns duties related to the position C. The nurse mentor makes it possible for the new nurse to participate in professional organizations D. The nurse mentor advises and assists the new nurse to adjust to the work environment of a busy emergency department
d. Mentorship is a relationship in which an experienced person (the mentor) advises and assists a less experienced person (protégé). This is an effective way of easing a new nurse into leadership responsibilities. An experienced nurse who is paid to introduce an employee to new responsibilities through teaching and guidance describes a preceptor, not a mentor. The nurse mentor does not hire or schedule new nurses. Nurses do not need mentors to join professional organizations
4. A nurse is a servant leader working in an economically depressed community to set up a free mobile health clinic for the residents. Which actions by the leader BEST exemplify a key practice of servant leaders? Select all that apply A. The nurse motivates coworkers to solicit funding to set up the clinic. B. The nurse sets only realistic goals that are present oriented and easily achieved. C. The nurse forms an autocratic governing body to keep the project on track. D. The nurse spends time with supporters to help them grow in their roles. E. The nurse first ensures that other's lowest priority needs are served. F. The nurse prizes leadership because of the need to serve others.
✅a, d, f. In order to serve as servant leaders, nurses need to invest in those who support the organization's values, show passion, can play to their strengths, and demonstrate a positive attitude. They should develop their vision to see the future related to a current anticipated need, and motivate others to follow and engage. They also need to provide ongoing opportunities for collaborations, sharing, reflection, encouragement, and celebration, as well as hard work. The servant leader allows others to have a voice, to exercise control, and to practice leading themselves. The servant first makes sure that other people's highest priority needs are being served. The best test, and most difficult to administer, is: Do those served grow as people? Do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servants?
6. A nurse manager who is attempting to institute the SBAR process to communicate with health care providers and transfer patient information to other nurses is meeting staff resistance to the change. Which action would be most effective in approaching this resistance? A.Containing the anxiety in a small group and moving forward with the initiative B. Explaining the change and listing the advantages to the person and the organization C. Reprimanding those who oppose the new initiative and praising those who willingly accept the change D. Introducing the change quickly and involving the staff in the implementation of the change
✅b. Change is ubiquitous, as is resistance to change. The manager should explain the proposed change to all affected, list the advantages of the proposed change for all parties, introduce the change gradually, and involve everyone affected by the change in the design and implementation of the process. The manager should not use the reward/punishment style to overcome resistance to change.
3. A nurse manager of a busy cardiac unit observes disagreements between the RNs and the LPNs related to schedules and nursing responsibilities. At a staff meeting, the manager compliments all the nurses on a job well done and points out that expected goals and outcomes for the month have been met. The nurse concludes the meeting without addressing the disagreements between the two groups of nurses. Which conflict resolution strategy is being employed by this manager? A. Collaborating B. Competing C. Compromising D. Smoothing
✅d. The manager who resolves conflict by complimenting the parties involved and focusing on agreement rather than disagreement is using smoothing to reduce the emotion in the conflict. The original conflict is rarely resolved with this technique. Collaborating 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. Competing results in a win for one party at the expense of the other group. Compromising occurs when both parties relinquish something of equal value.
2. A nurse who is newly hired to manage a busy pediatric office is encouraged to use a transactional leadership style when dealing with subordinates. Which activities best exemplify the use of this type of leadership? Select all that apply. A. The manager institutes a reward program for employees who meet goals and work deadlines. B. The manager encourages the other nurses to participate in health care reform by joining nursing organizations. C. The manager promotes compliance by reminding subordinates that they have a good salary and working conditions. D. The manager makes sure all the employees are kept abreast of new developments in pediatric nursing. E. The manager works with subordinates to accomplish all the nursing tasks and goals for the day. F.The manager allows the other nurses to set their own schedules and perform nursing care as they see fit.
✅ ANS: a, c. Instituting a reward program and reminding workers that they have a good salary and working conditions are examples of transactional leadership, which is based on a task-and-reward orientation. Team members agree to a satisfactory salary and working conditions in exchange for commitment and compliance to their leader. Encouraging nurses to participate in health care reform is an example of a transformational leadership style. Ensuring that employees keep abreast of new developments in nursing care is a characteristic of quantum leadership. The group and leader work together to accomplish mutually set goals and outcomes with the democratic leadership style, and the laissez-faire style encourages independent activity by group members, such as setting their own schedules and work activities.
A charge nurse is delegating activities to a volunteer assigned to the pediatric unit. The nurse should identify that which of the following assignments is inappropriate to delegate to a volunteer? A. Transporting a school-age child who is in traction to another department B. Playing a video game with an adolescent who has sickle cell disease C. Reading a book to a preschool-age child who has AIDS D. Rocking an infant who was admitted for croup
Correct Answer: A. Transporting a school-age child who is in traction to another department To ensure client safety, the nurse is responsible for delegating tasks to the appropriate people. The nurse should avoid assigning this task to the volunteer because the individual who performs this task must understand the principles of traction. A volunteer does not have the requisite skill to perform this task. Vital Concept: Delegation involves explaining the task, determining who can complete the task, letting the individual know the expectation for completing the task, monitoring the situation, and asking for feedback. The nurse should follow the five rights of delegation, which includes right task, right circumstances, right person, right directions and communication, and right supervision and evaluation. Tasks to delegate are determined by the nurse according to the individual's skill level and to maintain safety. The volunteer can spend time interacting with the children and providing comfort, socialization, and diversional activities. The nurse should avoid assigning a task to the volunteer that is not within the volunteer's role, such as understanding the principles of traction.
A nurse is caring for a client who is 1 day postoperative following an abdominal hysterectomy. The assistive personnel (AP) reports to the nurse that the client's dressing is saturated with blood. Which of the following tasks should the nurse delegate to the AP? A. Change the abdominal dressing. B. Obtain dressing supplies. C. Palpate for possible bladder distention. D. Notify the provider.
Correct Answer: B. Obtain dressing supplies. A client who is 1 day postoperative and develops incisional bleeding might be unstable, limiting the tasks the AP can safely perform for this client. Obtaining the needed dressing supplies is within the range of function of an AP. Therefore, the nurse can delegate this task to the AP. Additionally, this will allow the nurse to remain with the client. Vital Concept: Delegation is used in emergency situations as well as during routine client care. The nurse should always follow the state's Nurse Practice Act and facility policies and procedures with regard to delegation. Assigning a task to the AP that is outside of the AP's range of function places the client's safety in jeopardy and can ultimately have a negative impact on the employment status and the licensure of the nurse.
An RN is working with a UAP and an LPN. Which of the following tasks should not be delegated by the RN? A. Bed baths and routine hygiene B. Transporting the client to nuclear medicine C. Administration of routine oral medications D. Evaluating a change in the client's heart rate
Correct Answer: D. Evaluating a change in the client's heart rate A nurse cannot delegate any part of the nursing process, which includes evaluation, assessment, and education. Nursing judgment and knowledge are necessary to evaluate the client. Although it is appropriate to assign others to monitor routine vital signs, only the RN can evaluate any changes. Incorrect Answers: A. UAPs can provider routine hygiene for a stable client. B. This is a task that can be carried out by the UAP. C. An LPN can administer routine oral medication.
1. A charge nurse in a busy hospital manages a skilled nursing unit using an autocratic style of leadership. Which leadership tasks BEST represent this style of leadership? Select all that apply. A. The charge nurse polls the other nurses for input on nursing protocols. B. The charge nurse dictates break schedules for the other nurses. C. The charge nurse schedules a mandatory in-service training on new equipment. D.The charge nurse allows the other nurses to divide up nursing tasks. E.The charge nurse delegates nursing responsibilities to the staff. F. The charge nurse encourages the nurses to work independently.
✅b, c, e. Autocratic leadership involves the leader assuming control over the decisions and activities of the group, such as dictating schedules and work responsibilities, and scheduling mandatory in-service training. Polling other nurses is an example of democratic leadership, which is characterized by a sense of equality among the leader and other participants, with decisions and activities being shared. In laissez-faire leadership, the leader relinquishes power to the group and encourages independent activity by group members. Examples of laissez-faire leadership style are allowing the nurses to divide up the tasks and encouraging them to work independently.
