Chapter 26: Delegation: An Art of Professional Nursing Practice Nursing School Test Banks

Chapter 26: Delegation: An Art of Professional Nursing Practice
Yoder-Wise: Leading and Managing in Nursing, 6th Edition

MULTIPLE CHOICE

1. You are a member of a team assigned to care for 15 general medical/surgical clients. You have all worked well together in the past in this same type of care. If you are assigned to coordinate this teams work, your best strategy, based on the Hersey and Blanchard model, would be to:
a. Have a list of tasks to be accomplished and tell each member of the team what he or she must do.
b. Encourage people to discuss their frustrations in providing this care.
c. Ignore themtheyve done it before.
d. Provide minimal direction and let them come to you with questions.
ANS: D
According to the Hersey and Blanchard model, when ability (skills, job knowledge) and willingness are strong, the role of the delegator is less (delegating behavior).

REF: Page 493 TOP: AONE competency: Knowledge of the Health Care Environment

2. The nurse manager is setting up the room assignments for the unit. She has one critical patient on the unit, who is going to require more care than the others. Before delegating a task, a nurse manager should:
a. Delegate the admission assessment to the LPN.
b. Review the employees performance assessment for the most recent period.
c. Assess the amount of guidance and support needed in a particular situation.
d. Create a task analysis of critical behaviors for the individual.
ANS: C
To delegate effectively, the nurse manager must assess the abilities required in the situation and the abilities that staff have to anticipate the amount of direction, monitoring, explanation, and independence that can be assumed.

REF: Page 499 TOP: AONE competency: Knowledge of the Health Care Environment

3. A key advantage that a nurse manager has in terms of delegating is that:
a. Clients receive less attention because too many staff make it difficult to coordinate care.
b. Nurses report less pressure to perform necessary tasks themselves.
c. Administration can predict overtime more accurately.
d. Team skills can be used more effectively.
ANS: D
The use of multilevel healthcare providers enables healthcare organizations and nursing to provide patient-centered care, with a focus on abilities and skills that can be employed to perform what is needed now. As tasks become more complicated, delegating skills to others enables the nurse to effectively deliver a complex level of care.

REF: Page 496 TOP: AONE competency: Knowledge of the Health Care Environment

4. The nurse on the 7-7 shift is assigning a component of care to an unlicensed nursing personnel (UNP) employee. The night nurse should remain:
a. Accountable.
b. Responsible.
c. Authoritative and liable.
d. Responsible and task-oriented.
ANS: A
When a registered nurse delegates care to a UNP, responsibility is transferred; however, accountability for patient care is not transferred. Thus, accountability rests within the decision to delegate while responsibility rests within the performance of the task (Anthony and Vidal, 2010, p. 3).

REF: Page 496 TOP: AONE competency: Professionalism

5. The night nurse understands that certain factors need to be considered before delegating tasks to others. These factors include the:
a. Complexity of the task and the age of the delegatee.
b. Potential for benefit and the complexity of the task.
c. Potential for benefit and the number of staff.
d. Complexity of the task and the potential for harm.
ANS: D
In delegating tasks to others, the nurse considers factors such as stability of the patient, safety of the situation and of the patient, time and intensity involved, and level of critical thinking required to achieve desired outcomes.

REF: Page 487 | Page 499
TOP: AONE competency: Knowledge of the Health Care Environment

6. During a fire drill, the nurse manager becomes very assertive and directive in her communications with staff. This type of situational leadership depends on:
a. Supportive behavior by the leader and immature followers.
b. The development level of the followers and the type of behavior of the leader.
c. Well-developed followers combined with a strong leader who acts quickly.
d. The leaders ability to evaluate personnel and communicate that evaluation.
ANS: B
When abilities, relationships, and/or time is limited (as in a crisis situation), the leader assumes a bigger role in guiding and in making decisions (Hersey and Blanchard and telling behavior).

REF: Page 493 TOP: AONE competency: Leadership

7. The unit manager is working in a large metropolitan facility and is told that two UNPs are to be assigned to work with her. Delegation begins with:
a. Acknowledging the arrival of the second UNP on the unit.
b. Providing clear directions to both UNPs.
c. Matching tasks with qualified persons.
d. Receiving reports from the prior shift.
ANS: C
In delegating to the UNPs, the nurse must consider what cannot be delegated, as well as the factors of safety, time, critical thinking, and stability of patients.

REF: Page 487 | Page 499
TOP: AONE competency: Knowledge of the Health Care Environment

8. During staff development programs, staff nurses verbalize their frustration about their workloads and having to delegate so many tasks to others. One of the main reasons that delegation has emerged as an issue is because of:
a. The amount of paperwork required to complete care.
b. The complexity of client care.
c. Earlier discharge practices.
d. The numbers of other disciplines present on a given unit.
ANS: B
Complexity of client care, a multilevel nursing model (registered nurses, mixed with LPNs/LVNs, and UNPs), and community-based care provide many challenges in determining the care required and outcomes desired and/or mandated, and in matching needs with various abilities and authority of regulated and unregulated healthcare providers. The nurse manager should ensure that staff is clinically competent and trained in their roles in patient safety.

REF: Page 486 TOP: AONE competency: Knowledge of the Health Care Environment

9. The day shift nurse asks an LPN/LVN to complete a component of care for a client. The day shift nurse is engaging in what function?
a. Delegating
b. Assigning
c. Sharing
d. Authorizing
ANS: B
Delegation refers to transfer of responsibility for work; the day shift nurse retains accountability for the outcomes of patient care.

REF: Pages 494-496
TOP: AONE competency: Knowledge of the Health Care Environment

10. You are working in a home health service and have three unlicensed nursing personnel (UNPs) assigned to your team. You have worked with two of them for 2 years; the third is new. The two experienced UNPs have patients with complex illnesses for whom they provide basic care. The third member of the team has been assigned to patients with less complex illnesses. Your best approach to supervising their care is to:
a. Remain in the office and ask each UNP to check in with you upon arrival at their first patient care site.
b. Ask another RN to supervise the two experienced assistants so you can be with the new person full time.
c. Meet the new staff member at the first patient care site and ask the others to call if anything is unusual.
d. Meet the new staff member at the first patient care site and call the others with questions to determine whether anything is unusual.
ANS: D
When ability and willingness are strong, the involvement of the delegator is less (Hersey and Blanchard).

REF: Page 493 | Page 494
TOP: AONE competency: Knowledge of the Health Care Environment

11. With delegation, responsibility and accountability remain with the:
a. Physician.
b. Professional who delegates.
c. Individual who receives the delegation.
d. Individual who previously performed the task.
ANS: B
Even though the delegatee (the one who receives the delegation) receives direction from the professional who delegates a task and must have the authority to complete it, the delegator retains accountability for the overall outcome and completion of the activity. The delegatee has responsibility (obligation to engage in the task) and authority for the task.

REF: Page 488 TOP: AONE competency: Professionalism

12. Which of the following exemplifies accountability? Karen, the nurse manager on 5E:
a. Consistently submits her budgets on time.
b. Gets along well with her staff and with other managers.
c. Outlines her rationale for reduction of RN coverage on nights to the Nursing Practice Committee after serious patient injury.
d. Actively solicits ideas regarding scheduling from her staff.
ANS: C
Reliability, dependability, and obligation to fulfill the roles and responsibilities of the nurse manager are consistent with responsibility. Accountability refers to being answerable for actions and results.

REF: Page 488 TOP: AONE competency: Professionalism

13. Which of the following indicates safe delegation?
a. The nurse supervisor for a large urban acute care department asks the unit manager to accept two new acutely ill patients, which the manager does. The unit is short two staff, and the replacement is inexperienced.
b. A unit manager agrees to release a staff from her unit to Unit B. The staff member she agrees to release is experienced on Unit B and is agreeable to the change. The unit managers unit is fully staffed and patients are stable.
c. The nurse supervisor asks the head nurse for Unit A to make do without a replacement for an ill staff member because Unit A was originally overstaffed anyway. Patient acuity levels are very high on Unit A and two staff are orientating.
d. The nurse supervisor asks the charge nurse on Unit B to cover Unit F, which is two floors up, because the charge nurse for Unit F is ill. The charge nurse for Unit B is an experienced manager but has no experience with the nursing care required on Unit F.
ANS: B
When span of control (number of individuals for whom a manager is responsible) is compromised by geographic factors such as lack of proximity, instability in patients conditions, or lack of experience, the span of control that is being delegated may lead to unsafe care.

REF: Page 492 TOP: AONE competency: Knowledge of the Health Care Environment

14. Which of the following would be most in line with Hersey and Blanchards concepts?
a. The team of caregivers on day shift are familiar with their roles and with the patients. The nurse manager decides to work on the unit budget in her office.
b. After a year of working on the unit, Shari, an LPN, is still hesitant about many policies and procedures. The charge nurse decides to challenge Shari with more difficult patients.
c. The nursing supervisor asks one of her charge nurses to lead a technology integration project. The supervisor continuously demands involvement in decisions that the charge nurse is making in the project.
d. Team members complain that Alysha, an RN, is unmotivated, and that she refuses assignments that are complex or difficult. The charge nurse suggests that Alysha is relatively new and that she needs time to adjust.
ANS: A
The Hersey and Blanchard framework suggests that when ability (skills, job knowledge) and willingness are strong, the involvement of the delegator is less.

REF: Page 493 TOP: AONE competency: Business Skills

15. In delegating to a UNP in a home health setting, which of the following represents the most appropriate delegation communication?
a. You will be taking care of Mrs. S., who needs assistance with her bath.
b. You will need to help Mrs. S. get into and out of her shower. Ensure that you check the condition of her feet, and let me know if you have any concerns when you check in.
c. I am not sure that you know how to do this, but I am giving you Mrs. S. She is quite obese and needs skin care.
d. Mrs. S. needs help to get into and out of her bathtub. Her bath will need to be completed by 10:00. When you are helping her to dry, please check between her toes and toenails, and phone me by 10:30 if you notice nail discoloration or redness.
ANS: D
Delegation communication includes what is being delegated (and what is not), outcomes, specific deadlines (if applicable), specific reporting guidelines (what, when), and who may be consulted. Communication also includes conveying recognition of the authority to do what is expected.

REF: Page 499 TOP: AONE competency: Knowledge of the Health Care Environment

16. An RN colleague, who is a long-standing and collaborative member of your team, is performing a complex and novel dressing for the first time for the patient to whom she has been assigned. Which of the following would be the most appropriate communication with her?
a. How do you usually do this kind of dressing?
b. The dressing needs to be done today and tomorrow with the supplies on this cart.
c. Here is what you need for the dressing, and I will show you what needs to be done.
d. I know you know what you are doing. Let me know if you have any problems.
ANS: C
If a situation involves a new task and the relationship is ongoing (two individuals who will usually continue to work together), the delegator explains what to do and how to do it. Hersey described the leaders behavior as explaining or persuading, which, is characterized as selling. The RN who is assigned to the patient is an experienced nurse and team member, but is new to this specific situation. In situations where the nurse is experienced but the task is new, explain (and demonstrate) what needs to be done.

REF: Page 493 TOP: AONE competency: Knowledge of the Health Care Environment

17. Sally is an experienced nurse on the unit and is very experienced with ICP monitoring. She is assigned David, a patient who has been admitted with a severe head injury. In communicating with Sally, you would:
a. Provide a detailed explanation of what she needs to do with ICP monitoring.
b. Tell her when she needs to provide an update about Davids status.
c. Ask her to tell you what she knows about ICP monitoring and share expectations about reporting.
d. Advise her that you are available if she needs you.
ANS: D
You and Sally have a well-established relationship and Sally has the expertise to work effectively with David; therefore, you would need to provide little guidance but would need to communicate that you are available if needed. Hersey refers to this leader behavior as delegating.

REF: Page 493 TOP: AONE competency: Knowledge of the Health Care Environment

18. You ask Evelyn, a new UNP, to check what is left in Mrs. N.s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. This incident is an example of:
a. Incompetence of the UNP.
b. Failure to follow through.
c. Skills but no motivation.
d. Lack of accountability.
ANS: B
The nurse should maintain open lines of communication and seek information, and the UNP should know how, when, and what to report. Communication of delegation of tasks includes specific information about what is being delegated, expected outcomes, and deviations (which includes what immediate action needs to be taken). This two-way communication and follow-through allows patient care to be altered, if necessary, in a timely manner.

REF: Page 499 TOP: AONE competency: Knowledge of the Health Care Environment

19. You ask Evelyn, a new UNP, to check what is left in Mrs. N.s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. Before assigning Evelyn to Mrs. N.s care, the most appropriate action of the care coordinator would have been to:
a. Determine Evelyns educational background and preparation for this role.
b. Ask Evelyn if she has worked with inhalers before and to describe what she knows about them.
c. Advise that if Evelyn has any questions about what to do with the inhaler, she should come to the coordinator.
d. Advise Evelyn that working the inhaler is not really complicated and that she should ask the patient how to check medication levels in the inhaler.
ANS: B
When delegating tasks, in addition to specifying the task to be completed, outcomes, priorities, timelines, deviations, report time frames, monitoring, and resources, asking the delegatee to give examples of each is helpful in ensuring that communication is clear and has been understood. Preparation of UNPs lacks consistency; therefore, the safest practice is to determine the knowledge and skill level of the UNP in relation to the skill and the patient before delegating.

REF: Page 492 TOP: AONE competency: Knowledge of the Health Care Environment

20. You ask Evelyn, a new UNP, to check what is left in Mrs. N.s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. Determination of Evelyns educational preparation and certification is related to the concept of:
a. Accountability.
b. Authority.
c. Role performance.
d. Assignment.
ANS: B
Authority refers to the right to do and may be designated by law, educational preparation, or job description.

REF: Page 488 TOP: AONE competency: Business Skills

21. County Hospital has position descriptions for all staff, including RN Team Leaders. Sarah, a team leader on the rehab unit, assesses the needs of the patients in her area, assesses the skills and backgrounds of each of the individuals on her team, and then assigns and delegates the appropriate care provider to each patient and task. Sarahs activity in the example described is termed:
a. Passive delegation.
b. Passive accountability.
c. Active delegation.
d. Active responsibility.
ANS: C
When a position description contains functions that are considered to be the normal practice of the person in that role, then it is considered a passive delegation act. When Sarah decides what is best for the patients in her care in terms of who should perform the care and then holds the person accountable, she is engaging in active delegation.

REF: Page 492 TOP: AONE competency: Knowledge of the Health Care Environment

22. Functions such as delegates tasks to assistive personnel that are outlined in a position description for an RN Team Leader would be considered:
a. Active delegation.
b. Passive delegation.
c. Passive accountability.
d. Active responsibility.
ANS: B
Delegation of functions that are normally considered part of or an essential part of the practice of a licensed person through a position description is considered passive delegation.

REF: Page 492 TOP: AONE competency: Knowledge of the Health Care Environment

23. County Hospital has position descriptions for all staff, including RN Team Leaders. Sarah, a team leader on the rehab unit, assesses the needs of the patients in her area, assesses the skills and backgrounds of each of the individuals on her team, and then assigns and delegates the appropriate care provider to each patient and task. Sarah provides Colleen, her RN colleague with details regarding the patients to whom Colleen has been assigned on the day shift. This is an example of:
a. Accountability.
b. Responsibility.
c. Assignment.
d. Delegation.
ANS: C
When an RN assigns care to another RN, it is termed an assignment and not delegation, because both accountability and responsibility are transferred.

REF: Pages 494-496
TOP: AONE competency: Knowledge of the Health Care Environment

24. Leslie, a UNP, transfers a patient while using improper technique. The patient is injured, and as a result, a suit is launched in which both Sarah (the delegator) and Leslie (the delegatee) are named. Sarah is named in the suit because she:
a. Retains accountability for the care of the patient.
b. Worked the same shift as Leslie.
c. Has passive accountability for delegation.
d. Retains accountability for the outcomes of care for the patient.
ANS: D
Whenever care is provided by someone other than a registered nurse, accountability for care remains with the manager/delegator even though others provide aspects of care.

REF: Page 496 TOP: AONE competency: Knowledge of the Health Care Environment

25. Ali, an RN on your unit, is consistently late to work and makes remarks such as Do you really want me to do that? when patients and care are assigned to her. You have spoken with her frequently about her:
a. Ability.
b. Skills.
c. Attitude.
d. Personal issues.
ANS: C
Hersey and Blanchard explained followership in terms of ability and willingness. Attitude refers to willingness or reluctance to perform work.

REF: Page 493 TOP: AONE competency: Communication and Relationship-Building

MULTIPLE RESPONSE

1. An example of a care activity that would likely not be delegated by an RN to a UNP is (select all that apply):
a. Teaching self-catheterization to a patient with paraplegia who has limited English.
b. Basic care for a patient with a head injury who is rapidly deteriorating.
c. One-to-one observation with a suicidal patient.
d. Assessment of patients being admitted through the Emergency Department.
e. Basic hygienic care for a patient who is post MI and stable.
ANS: A, B, D
Functions such as assessment, diagnosis, planning, and evaluation cannot be delegated. In addition, stability, critical thinking, time, and safety are factors that are considered in assessing whether or not to delegate care to a UNP. Teaching self-catheterization to a patient with limited English requires critical thinking; basic care for a patient who is rapidly deteriorating exemplifies concern with stability; and assessment of patients through Emergency is related to the factor of time. An exception to safety and stability in which patients may be delegated to UNPs is when patients are placed on suicide precautions.

REF: Page 487 | Page 499
TOP: AONE competency: Knowledge of the Health Care Environment

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