Leading, Delegating, and Collaborating
Holiday scheduling is always a sensitive issue on the nursing unit, and the manager is trying something different this year. The manager says that whoever works the most extra shifts when asked to do so will get first pick for the holiday schedule. Which type of conflict resolution does this represent? a. Competition resolution b. Win-win resolution c. Sacrifice resolution d. Active resolution
A Competition resolution is when one or both of the parties work competitively, instead of cooperatively, toward resolution; one party wins and one party loses. Win-win resolution is illustrated when both parties come together and decide on mutual goals, design interventions, and work together to evaluate outcomes. Sacrifice resolution is when both parties give up their positions so no one gets exactly what they want or when one party wants to end the conflict and gives up his or her position for the other party. Active resolution was not discussed.
A nurse manager must confront an employee about excessive absenteeism. During the confrontation with this employee, which introductory statement is most appropriate? a. "Is there something occurring in your life that is interfering with your attendance at work?" b. "What is your understanding of our absenteeism policy and being placed on probation?" c. "You are always calling in sick and leaving the staff in a real mess." d. "Let's pull the policy manual out and read the absenteeism policy together."
A Similar to a focused patient assessment when a complaint pain is given, a manager must also assess and gather more information about an employee's excessive absenteeism. With this in mind, the statement asking about the employee's life occurrences interfering with work is an appropriate way to start this conversation. Asking the employee about the absenteeism policy and offering to read the policy together give no opportunity to engage in a healthy discussion. Attacking the employee by saying "You are always calling in sick and leaving the staff in a real mess" is not a respectful and professional way to begin this conversation.
While talking with the nursing supervisor, a graduate RN expresses frustration that a Mexican American client always has several family members at the bedside. The most appropriate action by the nursing supervisor to help the graduate RN become a patient advocate is to a. ask about the graduate RN's personal beliefs about family support during hospitalization. b. remind the graduate RN that this cultural practice is important to the family and the patient. c. suggest that the graduate RN ask family members to leave the room during patient care. d. have the graduate RN explain to the family that too many visitors will tire the patient.
A The first step in providing culturally competent care is to understand one's own beliefs and values related to health and health care. Asking the nurse about personal beliefs will help to achieve this step. Reminding the graduate nurse that this cultural practice is important to the family and patient will not decrease the graduate nurse's frustration. The remaining responses are not culturally appropriate, nor do they advocate for the patient.
The RN is planning care for the day. Which would be the most appropriate task to assign to the nursing assistant? a. Collecting a 24-hour urine specimen b. Feeding the patient who has difficulty swallowing c. Changing the dressing on an abdominal wound d. Monitoring a tube feeding
A The nursing assistant is qualified to collect a 24-hour urine specimen. An LPN/LVN can change the dressing on an abdominal wound. Feeding the patient with dysphagia and monitoring a tube feeding calls for the specialized knowledge of the RN.
According to the American Nurses Association (ANA), which elements of nursing cannot be delegated? (Select all that apply.) a. Initial and subsequent nursing assessments requiring professional judgment b. The determination of nursing diagnoses, goals, plans of care, and progress c. Interventions that require the application of professional knowledge and skills d. Interventions that require additional knowledge and skills e. Routine daily care elements including recording vital signs
A, B, C Initial and subsequent nursing assessments requiring professional judgment; the determination of nursing diagnoses, goals, plans of care, and progress; and interventions that require the application of professional knowledge and skills are the three elements of nursing that cannot be delegated. LPN/LVNs and nursing assistants can perform additional skills for which they have been trained, following the appropriate evaluation. The RN may delegate components of care like activities of daily living and vital signs but does not delegate the nursing process itself.
Which question or statement by the nurse is most helpful in ensuring that a nursing assistant new to the unit understands what is expected of the assistant? a. "Are you ready to begin work now?" b. "Now, repeat for me what I have just asked you to do." c. "Do you know what I expect from you?" d. "Let me know if you need any help."
B Asking the assistant to repeat the instructions just given helps to assure the nurse that the assistant knows what is expected. Asking whether the assistant is ready to begin work, whether the assistant knows what is expected of the assistant, or whether the assistant needs any help does not ensure that the assistant understands what is expected.
The best way for a nurse to determine that a newly hired certified nursing assistant (CNA) is competent to transfer a patient safely from the bed to the commode would be to a. look in the CNA's personnel file to determine previous experience. b. observe the CNA perform the procedure the first time and discuss the outcome. c. have the CNA explain the procedure before doing it. d. establish that the CNA is comfortable performing the transfer.
B Directly observing the CNA perform the task first and discussing the outcome comprise the best answer. The nurse can ensure that the patient and the CNA are safe during execution of the transfer. Looking in personnel files for previous experience is an inappropriate action. Asking the CNA to explain the procedure does not equate to performing the action correctly and safely. Establishing a comfort level of the procedure does not equate to mastery of the skill.
A newly admitted patient has several orders the physician has written. As manager of care, a graduate RN knows that three of the following tasks can be routinely delegated to a nursing assistant, but one of them must be reserved for the RN to complete. Which task must the RN complete? a. Reminding to use the incentive spirometer b. Irrigating of a urinary catheter c. Conducting fingerstick glucose tests d. Collecting data for intake and output
B Irrigating a urinary catheter is a nursing skill and cannot be delegated to unlicensed personnel. Reinforcement of health teaching done by the RN, conducting fingerstick glucose tests, and collecting data for intake and output are all included in the nursing assistant's education and scope of practice.
Which of these nursing interventions for the patient who has had right-sided breast-conservation surgery and axillary lymph node dissection is appropriate to assign to an LPN/LVN? a. Teaching the patient how to avoid injury to the right arm b. Administering an analgesic 30 minutes before the scheduled arm exercises c. Assessing the patient's range of motion for the right arm d. Evaluating the patient's understanding of discharge instructions about drain care
B LPN/LVN education and scope of practice include administration and evaluation of the effects of analgesics. Assessment, teaching, and evaluation of a patient's understanding of instructions are more complex tasks that are more appropriate to RN-level education and scope of practice.
Which statement best reflects that the nurse manager has taken the first action in the decision-making process? a. "We could hire four additional nursing assistants." b. "We need to decrease patient falls." c. "Patient falls have decreased by 20%." d. "Here is the revised staffing schedule."
B Stating that patient falls need to be decreased is setting a desired goal or outcome and is the first step in the decision-making process. "We could hire four additional nursing assistants" offers an option, the second step in the process. "Patient falls have decreased by 20%" indicates that evaluation has occurred, which is the last step of the decision-making process. "Here is the revised staffing schedule" indicates that an option has been implemented.
Which patient described below most needs an advocate? a. A 68-year-old female patient who tells you that she always relies on her husband to decide what is best. b. An 80-year-old patient who states, "Why do people talk over my head as if I was a child?" c. A 4-year-old patient whose mother visits each evening but goes home to care for her other two children each night. d. A 36-year-old patient who states, "I really wish this surgery wasn't necessary. I want to look at my other choices, again."
B The 80-year-old patient needs an advocate to assist her in engaging in conversation that takes place in her presence about her care. The 68-year-old patient has her husband to help make decisions for her. The 4-year-old patient has an attentive parent who splits her time and attention between her hospitalized child and the rest of her family. The 36-year-old patient is engaged and involved in his or her personal health care decisions.
Which patient should be assigned to an experienced LPN/LVN? a. One day post-op coronary artery bypass graft (CABG) who is on telemetry with T 37.1 C, BP 95/50, P 92, R 18 b. Two day post-op appendectomy with T 36.8 C, BP 118/78, P 78, R 18 c. Snake bite 2 days prior with hematuria, melena, and blood seepage at the IV site with stable vital signs d. One day post cerebral vascular accident (CVA) on a heparin drip experiencing increasing hemiplegia, with stable vital signs
B The best patient to assign to the LPN/LVN is the 2-day postoperative appendectomy patient because there is nothing that requires immediate advanced interventions. The patient on telemetry who had a CABG is still critical and requires close monitoring for sudden changes in condition and anticipated advanced nursing interventions. The patient with a snake bite is experiencing active complications of that snake bite and may require advanced interventions. The patient with a CVA is currently experiencing effects of the stroke despite the heparin drip and requires advanced interventions.
A charge nurse and staff nurse are in disagreement over the team assignment for the shift that is about to begin. What is the charge nurse's best first step to resolving the conflict collaboratively? a. Determine the shared goal. b. Open a respectful dialogue to bring forth each point of view. c. Design a plan to meet the shared goal. d. Determine the roles of those involved in the plan.
B The steps to collaborative conflict resolution are as follows: (1) open a dialogue that brings forth and is respectful of each individual's point of view; (2) determine a group or shared goal; (3) identify the expertise and contribution of each individual as the group agrees on the shared goal; (4) review the goal and move to accept or reject it honestly (acceptance requires the consensus of the group); (5) design a plan to meet the new goal by using the expertise of the group to design interventions to meet the goal; (6) determine the roles of the members in carrying out the interventions; a role must be within the capacity of the member and mutually accepted as fairly defined; and (7) set an evaluation point, and include all individuals in the evaluation process, maintaining respect for everyone's input or contribution and focusing on interventions and actions rather than personalities, feelings, or prejudices.
Which statement by the RN best represents the "right communication" when delegating a task to an unlicensed individual? a. "Feed the patient and watch for cheeking and choking." b. "I want you to help the patient to eat his lunch. You should elevate the head and feed him slowly enough so he does not choke." c. "Feed the patient his pureed diet at lunchtime. Elevate the head of the bed to 90 degrees and make certain he swallows each bite." d. "Assist the patient with lunch, and make sure he sits up and doesn't store food in his cheek in between bites."
C "Feed the patient his pureed diet at lunchtime. Elevate the head of the bed to 90 degrees and make certain he swallows each bite" is stated in the most specific manner. The other statements are open for interpretation. The statement discussing "cheeking and choking" is vague and does not have any instruction on what diet to expect, the position of the patient, or what "cheeking or choking" means. The statement starting with "I want you to help the patient to eat his lunch" is also vague because it has no instruction on diet type, the level of elevation of the head of the bed, or how slowly to feed the patient. (The patient may store food in his mouth without swallowing and without choking.) The statement beginning with "Assist the patient with lunch" gives no instruction on diet type or the proper elevation the patient should sit up.
A family member of an elderly Hispanic patient admitted to the hospital tells the nurse that the patient has traditional beliefs about health and illness. Being a patient advocate, the best action by the nurse is to a. avoid asking any questions unless the patient initiates conversation. b. obtain further information about the patient's cultural beliefs from the family member. c. ask the patient whether it is important that cultural healers are contacted. d. explain the usual hospital routines for meal times, care, and family visits.
C Because the patient has traditional health care beliefs, it is appropriate for the nurse to ask whether the patient would like a visit by a cultural healer. There is no cultural reason for the nurse to avoid asking the patient questions, and questions may be necessary to obtain important health information. The patient, rather than the family member, should be consulted about personal cultural beliefs. The hospital routines should be adapted to the patient's preferences, rather than expecting the patient to adapt to the hospital schedule.
In a patient care conference one of the nurses makes a controversial statement about the patient's behavior. The other health care providers raise their eyebrows, and silence follows the original comment. A democratic leader would a. agree with the comment about the patient, and direct the group to the next topic on the agenda. b. ignore the statement about the patient's behavior and the nurse's judgmental attitude. c. gather input from the group about the patient's behavior, and elicit suggestions about how to best work with the patient. d. respond to the nurse that the comment is judgmental and inappropriate, and ask the nurse to stay after the meeting.
C Gathering input from the group on how to best work with the patient exemplifies the democratic leader. This type of leader bases decisions on mutual agreement within the group. Agreeing with the comment and moving on to the next topic and chastising the nurse in front of the group demonstrate lack of leadership.
Nurse A is in conflict with Nurse B regarding holiday scheduling. Because Nurse A really wants to avoid being in this conflict, and because Nurse A just wants to fill the holiday schedule, Nurse A agrees to give up one favored holiday. This is an example of which type of conflict resolution? a. Competition resolution b. Win-win resolution c. Sacrifice resolution d. Active resolution
C In sacrifice resolution, one person may strongly want to avoid or end the conflict and will therefore accommodate the other by essentially sacrificing his or her position, thus allowing the other to have his or her way. Competition resolution describes one or both parties working competitively to get their way; ultimately, one wins and the other loses. Win-win resolution is illustrated when both parties come together and decide on mutual goals, design interventions, and work together to evaluate outcomes.
Which of these tasks is appropriate for the RN to delegate to a licensed practical nurse/license vocational nurse (LPN/LVN)? a. Documenting patient teaching about a routine surgical procedure b. Teaching a patient how to self-administer insulin c. Administering an oral medication to a patient d. Completing the initial assessment and plan of care
C The education and scope of practice of the LPN/LVN include administration of oral medication. Patient teaching and the initial assessment and development of the plan of care are nursing actions that require RN-level education and scope of practice.
A nurse is assigned to care for a patient who has been admitted with an opiate overdose and tells the nursing supervisor, "This is a waste of my time. The patient will be back on the needle right after being discharged." The most appropriate response by the nursing supervisor is a. "Your lack of professionalism will make it difficult for you to provide adequate care." b. "You know we are obligated to provide appropriate care no matter how we feel." c. "It is important to recognize these feelings and then figure out how to deal with them." d. "Since you feel so strongly, perhaps you should be assigned to care for a different patient."
C To provide nonjudgmental care for substance-abusing patients, the nurse must examine his or her own values and feelings. This statement validates the nurse's feelings but recognizes the need to care for the patient in a nonjudgmental way. The response about the lack of professionalism is critical of the nurse and is unlikely to lead to a change in the nurse's attitude. The response about the obligation to care for this patient is accurate but does not encourage the nurse to examine his or her own values. The response about feeling strongly about the patient would solve the immediate problem but would not encourage self-examination.
All of these nursing actions are included in the plan of care for a patient who is malnourished. Which action is appropriate for the RN to delegate to a nursing assistant? a. Assist the patient in choosing high-nutrition items from the menu. b. Monitor the patient for skin breakdown over the bony prominences. c. Assess the patient's strength while ambulating the patient in the room. d. Offer the patient the ordered nutritional supplement between meals.
D Feeding the patient and assisting with oral intake are included in nursing assistant education and scope of practice. Assessing the patient's strength and assisting the patient in choosing high-nutrition foods require LPN/LVN- or RN-level education and scope of practice.
The nurse is a very busy charge nurse with responsibilities for a unit with 24 acute care patients. An experienced nursing assistant is assigned to the unit. The nursing assistant notes that the IV pump is beeping because the tubing appears kinked. The assistant unkinks the tubing, and this resets the pump. The assistant reports the action to the nurse. It is most important that the nurse a. thank the nursing assistant for taking the initiative to correct the problem and to "keep up the good work." b. provide the assistant with additional instructions on safety in IV management. c. warn the other staff to watch out for the nursing assistant because she works beyond her scope. d. explain that help is appreciated; however, legally the nursing assistant cannot perform the action.
D IV management is not a part of a nursing assistant's education or scope of practice. Explaining that the assistant's help was appreciated but further explaining that the actions cannot legally be performed is the appropriate response. Commending the assistant for taking the initiative does not reestablish the proper boundaries for the nursing assistant. Warning the other staff about the nursing assistant can be considered gossip and unprofessional.