13 minute read
Chapter 09: Delegation in Nursing
Huber: Leadership & Nursing Care Management, 6th Edition
Multiple Choice
1. The process for a nurse to direct another person to perform nursing tasks and activities is: a. authorization. b. delegation. c. empowerment. d. supervision.
ANS: B
In their Joint Statement on Delegation (NCSBN, 2005b), the ANA and the NCSBN defined delegation in nursing as “the process for a nurse to direct another person to perform nursing tasks and activities.”
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
2. The provision of guidance or direction, evaluation, and follow-up by the licensed nurse for accomplishment of a nursing task delegated to unlicensed assistive personnel (UAP) is: a. authorization. b. delegation. c. observation. d. supervision.
ANS: D
Supervision is the provision of guidance or monitoring of a delegated nursing task. It may occur in a variety of ways, including written and verbal communication (such as giving or receiving reports), observation of the performance of the delegated task, or assessing the patient for evidence that the delegated task has been completed successfully.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
3. Individuals who are trained to help the registered nurse (RN) in the provision of patient-client care activities as delegated by and under the supervision of the RN are known as: a. certified assistive personnel. b. health care assistive personnel. c. medical assistive personnel. d. unlicensed assistive personnel.
ANS: D
The NCSBN (2016) defined unlicensed assistive personnel (UAP) as any unlicensed personnel trained to function in a supportive role and to whom a nursing responsibility can be delegated.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
4. When considering whether to delegate a task, the nurse needs to assess the patient and: a. how many nurses are available to supervise. b. how complex the delegated action is. c. the severity level of the patient population. d. the expiration date of the license.
ANS: B
When considering whether to delegate a task, the nurse needs to assess the patient and determine whether the action delegated is complex or if the plan of care of the patient could change rapidly (Catalano, 2015).
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Evaluation
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
5. According to the American Association of Critical-Care Nurses, there are five factors that a nurse should assess when making a decision to delegate nursing tasks. These factors are assessing the potential for harm, the complexity of the task, the amount of problem solving and innovation required, the unpredictability of the outcome, and the: a. amount of time that the task will take. b. degree of comfort the delegatee has with the task. c. level of patient interaction. d. method of measuring outcomes.
ANS: C
The level of patient interaction is the fifth factor that nurses should assess when making delegation decisions.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
6. The five rights of delegation are right task, right circumstance, right person, right direction and communication, and right: a. interaction. b. outcome. c. supervision. d. time.
ANS: C
The delegation process, as outlined by the ANA/NCSBN joint statement (2005) and the NCSBN national guidelines (2016), begins with the preparation/assessment phase and then goes on to outline a five-step process. These steps are (1) the right task, (2) under the right circumstance, (3) to the right person, (4) with the right directions and communication, (5) under the right supervision and evaluation.
DIF: Cognitive Level: Remember (Knowledge)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
7. If an error occurs as a result of delegation, the nurse is accountable for supervision, follow-up, intervention, and: a. corrective action of the event. b. documentation of the event. c. evaluation of the process. d. summation of the occurrence.
ANS: A
The nurse is also responsible for corrective action in case of an error.
DIF: Cognitive Level: Analyze (Analysis)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
8. The nurse has asked a nurse’s aide to greet a postoperative patient who has just arrived on the unit and to determine whether he is in stable condition. This act of delegation is an example of a nurse inappropriately delegating: a. assessment of the patient. b. evaluation of an intervention. c. nursing judgment. d. teaching to a delegate.
ANS: A
The RN is responsible for assessment, evaluation, and nursing judgment, and should not delegate these professional responsibilities.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Chief executive officer b. Institution where the LPN/LVN works c. Risk manager d. UAP
9. If a licensed practical/vocational nurse (LPN/LVN) provides discharge teaching, who is ultimately responsible?
ANS: B
Organizational leadership in building the skills related to delegation enhances individuals and builds high-performing teams, as well as enhancing team member awareness of roles and responsibilities and their individual capabilities and limitations (Lanfranchi, 2013). The organization is accountable for the delegation processes in place and for upholding values of safe patient care and staff development.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
10. Being answerable to oneself and others for one’s own choices, decisions, and actions as measured against a standard is: a. accountability. b. authority. c. supervision. d. delegation.
ANS: A
The National Council of State Boards of Nursing (NCSBN, 2016) defined accountability as being answerable to oneself and others for one’s own choices, decisions, and actions as measured against a standard.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. UAP who can be spared to sit with the client b. LPN/LVN who has grown attached to the family c. RN who has experience as a hospice nurse d. Newly graduated RN
11. Which staff member should be assigned to a dying client who is experiencing symptoms of emotional distress?
ANS: C
The delegation process, as outlined by the ANA/NCSBN joint statement (2005) and the NCSBN national guidelines (2016), begins with the preparation/assessment phase and then goes on to outline a five-step process. These steps are (1) the right task, (2) under the right circumstance, (3) to the right person, (4) with the right directions and communication, (5) under the right supervision and evaluation. The right person is the one who has the education and competency to perform the element of care. A hospice nurse has experience in managing symptoms associated with the dying process. This is the best nurse to care for this patient.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Planning
MSC: Client Needs: Physiological Integrity: Physiological Adaptation a. Client who had a vaginal hysterectomy and still has an indwelling catheter b. Client who had an open cholecystectomy and has gray drainage in the T-tube drainage tube and bag c. Client who had a hip replacement and stated that something popped while walking d. Client who had a Whipple procedure and is reporting being thirsty all the time
12. The charge nurse is making assignments on a surgical unit. Which client should be assigned to the least experienced nurse?
ANS: A
The delegation process, as outlined by the ANA/NCSBN joint statement (2005) and the NCSBN national guidelines (2016), begins with the preparation/assessment phase and then goes on to outline a five-step process. These steps are (1) the right task, (2) under the right circumstance, (3) to the right person, (4) with the right directions and communication, (5) under the right supervision and evaluation. The right person is the one who has the education and competency to perform the element of care. Options b, c, and d indicate the possibility of postoperative complications, but option a does not. The least experienced nurse should have the client who is not displaying the possibility of postoperative complications.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Right task b. Right circumstance c. Right person d. Right direction/communication e. Right supervision/evaluation
13. When determining that delegation of an element of patient care needs to occur, the nurse delegates with a clear, concise description of the task, including its objectives, limits, and expectations. The nurse allows the delegate to clarify without fear of repercussion. Which of the following five rights of delegation is being demonstrated?
ANS: D
The right direction/communication of delegated elements of care will be a clear, concise description of the task, including its objective, limits, and expectations. The nurse allows for clarification without the fear of repercussions.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. The nurse who delegated the task b. The UAP who accepted the task c. The nursing manager d. The hospital CEO
14. Who is ultimately accountable for the appropriateness and supervision of the delegated task?
ANS: A
Accountability in delegation means being obligated to answer for one’s actions, including the act of supervision. The nurse is ultimately accountable for the appropriateness and supervision of the delegated task. Thus the nurse may be found liable if found negligent in the process of delegating and supervising. The delegatee is accountable for accepting the delegation and for the actions in carrying out the delegated task.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. negotiation b. communication c. corrective action d. planning
15. Delegating requires clear and skillful _____ to avoid liability.
ANS: B
Delegating requires skillful written and verbal communication to avoid liability. If an activity is not documented, it is considered that it was not done. Clear documentation of assignments and additional clarification of the delegated tasks for each health care team member are required when delegating.
DIF: Cognitive Level: Remember (Knowledge)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. American Nurses Association (ANA) b. Agency for Healthcare Quality and Research (AHRQ) c. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) d. Institute for Healthcare Improvement (IHI)
16. The nurse manager determines that communication style is contributing to problems with delegation on her unit. What tool is used to teach principles of communication, leadership, situation monitoring, and mutual support?
ANS: C
Invariably there will be potential problems as the use of delegation expands in health care. The nurse leader will need to be aware of techniques to address these potential problems. One such method is the TeamSTEPPS 2.0 (Team Strategies and Tools to Enhance Performance and Patient Safety) program. The framework followed is based on a foundation of team competencies including knowledge, attitudes, and performance. The principles the program abides by include team structure and the teachable principles of communication, leadership, situation monitoring, and mutual support.
DIF: Cognitive Level: Remember (Knowledge)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
Multiple Response
1. Which of the following colleagues would a nurse typically delegate to in the health care setting? (Select all that apply.)
a. Nurse apprentices b. Personal care attendants c. Family members at bedside d. Physicians e. Nursing assistants
ANS: A, B, E
Nurses often delegate to unlicensed assistive personnel (UAPs). UAPs include a number of health care disciplines, such as nursing assistants, medical assistants, nurse apprentices, and personal care attendants. A nurse would not delegate to a family member or a physician.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Potential for harm b. Complexity of the task c. Amount of problem solving required d. Predictability of the outcome e. Level of patient interaction
2. When making a decision to delegate a nursing task, which of the following factors are assessed? (Select all that apply.)
ANS: A, B, C, E
In making a decision to delegate nursing tasks, the following five factors can be assessed: potential for harm, complexity of the task, amount of problem solving and innovation required, unpredictability of the outcome, and the level of patient interaction.
DIF: Cognitive Level: Remember (Knowledge)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. The nurse assesses the situation and need for delegation. b. A plan for specific task delegation is established. c. The needs of the nurse are considered. d. The nurse determines the available resources and patient safety. e. Accountability is transferred to the manager.
3. When the licensed nurse makes a determination to delegate a task, which of the following occurs in the process? (Select all that apply.)
ANS: A, B, D
With the qualifications of both the delegator and the delegatee as a baseline in place, the licensed nurse enters the continuous process of delegation decision making. The situation is assessed, and a plan for specific task delegation is established, considering patient needs, available resources, and patient safety. The nurse needs to ensure accountability for the acts and process of delegation.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
4. With regard to delegation, what organizational principles are considered? (Select all that apply ) a. Legal guidelines and policies b. Patient safety and accountability c. Relationship management and patient support d. Cost containment e. Knowledge and education
ANS: A, B, E
At the core of the five rights of delegation and the roles of the UAP and nurse are three organizational principles that are present in many health care settings today. These principles include organizational and legal guidelines and policies, patient safety and accountability, and knowledge and education (Craftman et al., 2012).
DIF: Cognitive Level: Remember (Knowledge)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. accountability b. good faith c. cost efficiency d. reasonable e. prudent
5. The legal and ethical standards to consider when questioning if delegation is appropriate include: (Select all that apply.)
ANS: B, D, E
Nurses are held to a standard of patient care in which they use their expertise, knowledge, and skill in decision making (Wilkinson, 2016). When considering a questionable situation, the standards of “reasonable,” “prudent,” and “good faith” form the foundations for legal and ethical decision making.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Tasks are delegated that will challenge the UAP to use critical thinking. b. Assess the condition and stability of the patient. c. Delegate tasks that are within the expertise of the RN, particularly if the UAP is a student. d. Evaluate the complexity of the task. e. Determine the potential for harm to the patient.
6. Which principles are important to consider when an RN delegates tasks to UAP? (Select all that apply.)
ANS: B, D, E
When considering whether to delegate a task, the nurse needs to assess the patient and determine whether the action delegated is complex or if the plan of care of the patient could change rapidly (Catalano, 2015). In making a decision to delegate a nursing task, the following five factors should be assessed:
1. Potential for harm: The nurse must determine how much risk the activity carries for an individual patient.
2. Complexity of the task: The more complex the activity, the less desirable it is to delegate.
3. Amount of problem solving and innovation required: If an uncomplicated task requires special attention, adaptation, or an innovative approach, it should not be delegated.
4. Unpredictability of outcome: When a patient’s response to the activity is unknown or unpredictable it is not advisable to delegate that activity
5. Level of patient interaction: It is not advisable to delegate so many tasks that the amount of time the nurse spends with the patient is decreased to the point that a therapeutic relationship cannot be established between the nurse and the patient (AACN, 2004, p.10).
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. State nurse practice act b. Organization’s policies and procedures c. The Joint Commission (TJC) d. American Nurses Association (ANA) e. Board of Registered Nursing
7. A unit manager is utilizing her staff as a resource for educational presentations. An RN in her unit has been requested to create a PowerPoint on delegation and supervision. What resources should she include for staff to obtain additional information on delegation and supervision?
(Select all that apply.)
ANS: A, B, D, E
Nurses are accountable for following their state nurse practice act, standards of professional practice, policies of the organization, and ethical-legal models of behavior. The ANA and each state’s board of nursing regulate nursing practice.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Corrective action b. Own acts c. Accepting the delegation d. Appropriate notification and reporting e. Accomplishing the task
8. Which of the following are the responsibilities of the delegatee in a situation? (Select all that apply.)
ANS: B, C, D, E
The delegatee accepts accountability for his or her own acts, accepts the delegation, uses appropriate notification and reporting, and accomplishes the task.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Prefers to do everything themselves so as not to transfer control. b. Wants to be everyone’s friend. c. Comes across as a pushover. d. Often stays late to complete documentation. e. Micromanages the UAP.
9. Leadership style may be a significant barrier to effective delegation. Which of the following describes the “invincible” style? (Select all that apply.)
ANS: A, D
Many nurses fall into the “invincible” nurse style; they prefer to do everything themselves so as not to risk delegating to the UAP or transfer some control to someone else. This nurse often stays late after the shift completing documentation and may miss some cares that should have been completed due to trying to do everything him- or herself. The “pal” is the nurse who wants to be everyone’s friend. These nurses do not want to be viewed as pushy or demanding. This type of delegator may come across as a pushover to the UAP. The “watchdog” nurse views delegation as a real risk and is constantly monitoring and micromanaging the UAP to the point that resentment may enter the nurse/UAP team and lead to poor teamwork and outcomes.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Lack of ability to direct b. Fear of criticism for mistakes c. Overwhelming workload d. Lack of confidence e. Lack of resources
10. The process of delegation may be undermined in the health care setting as one member of the team moves work in a downward direction. What are some of the reasons for delegatees to resist responsibility? (Select all that apply.)
ANS: B, C, D, E
The delegatee may resist responsibility for a number of reasons, including fear of criticism, overwhelming workload, lack of confidence, and lack of resources.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
