Chapter 16 Flashcards
The provision of guidance, direction, evaluation, and follow-up by a licensed nurse for tasks provided by an NAP (nursing assistive personnel) is:
a. delegation. c. authority.
b. accountability. d. supervision.
D: According to the ANA (1997, p. 20), supervision is “the active process of directing, guiding, and influencing the outcome of an individual’s performance of an activity.” The supervisory nurse provides clear direction and information to staff concerning what tasks are to be accomplished, for what patients, at what time, and how the tasks are to be done.
Three types of supervision identified by Hansten and Washburn (2004) are:
a. unsupervised, supervised, and periodic inspection.
b. unsupervised, initial direction, and assessment.
c. continuous supervision, periodic inspection, and initial assessment.
d. initial direction, unsupervised, and continuous supervision.
D: Hansten and Washburn’s levels of supervision are 1) unsupervised, 2) initial direction and periodic supervision, and 3) continuous supervision. They are based upon the type of task delegated, education, competency, experience, and working relationship of all of the people to be involved.
As an RN, you recognize that delegation involves which of the following?
a. Assigning your staff to tasks that need to be completed
b. Transferring responsibility for the performance of a task from one individual to another while retaining accountability for the outcome
c. Identifying the appropriate individual to give care and demonstrate accountability for that care
d. Transferring accountability for the provision of care to the individual assigned to give the care
B: As an RN, you would recognize that delegation involves the transfer of responsibility for the performance of a task from one individual to another while retaining accountability for the outcome. When making assignments, you would identify the appropriate staff members to complete specific tasks. While the staff members are responsible for their assigned tasks, you as the RN always retains accountability.
As the nurse manager of the unit, it is important for you to consider which of the following when making patient assignments?
a. Staff education levels, skill sets, cultural traditions, willingness to be a team player
b. Staff education levels, scope of practice, experience, and patient acuity
c. Staff skill sets, education levels, timeliness, and patient acuity
d. Patient acuity, staff experience, education, and ethnicity
B: When making patient care assignments, you must consider staff education levels, scope of practice, experience, and patient acuity. An assignment is a distribution of work that each staff member is to accomplish during a given time period according to their scope of practice. An NAP should not be assigned to irrigate a colostomy or do a dressing change of a stage II decubitus ulcer even if the NAP is very experienced. Willingness to be a team player and skill level are important, but they should not be the sole factors when making assignments.
Delegation is important for which reason?
a. It is a means to organize the patient care needs according to acuity, desired outcomes, and staff levels.
b. It provides a way to assign difficult patients to uncooperative nurses.
c. It enables new nurses to gain experience with difficult patients by themselves.
d. It is a means to organize the patient care needs according to acuity, desired outcomes, and staff levels, and it provides a way to assign difficult patients to uncooperative nurses.
A: While delegation, as defined by the ANA, is “the transfer of responsibility for the performance of an activity from one individual to another while retaining accountability for the outcome,” the RN can use this skill to organize how the staff is utilized to meet the patient care needs for the shift. When delegating tasks to nursing personnel, the RN should take into consideration the patient’s condition (acuity), staff skills and experience, complexity of the task assigned, staff workload, desired outcomes, and the amount of supervision needed to achieve the desired outcomes for the shift.
As an RN, you maintain accountability for overall patient care on the unit. The obligation of the NAPs to correctly perform their assigned duties is the NAP’s:
a. accountability. c. assignment.
b. delegation. d. responsibility.
D: The act of being responsible (responsibility) for one’s actions includes reliability, dependability, the obligation to accomplish work once the assignment has been accepted, and the desire to perform at an acceptable level in accordance with one’s educational level and experience.
According to the ANA (2005), delegation is:
a. the transfer of responsibility for the performance of an activity from one individual to another without transfer of the accountability for the outcome.
b. a legal and management concept and process that involves assessment, planning, action, intervention, and evaluation.
c. trust, empowerment, responsibility, and authority to perform the task.
d. the responsibility for the completion of tasks is given to others as a means of saving time, energy, and leader blame.
A: According to the ANA (2005), the act of delegation involves the transfer of responsibility for the performance of actions while the accountability for the outcomes remains with the delegator; it does not shift to the person performing the task. The nurse retains the accountability for the delegation. Delegation is a legal and management concept and process involving the four-step process of assessment, planning, intervention, and evaluation. Action, while important and a means of accomplishing the task goals, is not a part of this four-step process.
A nursing instructor evaluates whether the students know the five rights of delegation. The students would be correct if they responded that these rights are which of the following?
a. Right task, right circumstance, right route, right communication, and right person
b. Right task, right circumstance, right person, right communication, and right supervision
c. Right communication, right person, right task, right time, and right evaluation
d. Right time, right task, right person, right communication, and right supervision
B: The five rights of delegation have to do with identifying and providing the correct (right) task, in the correct (right) circumstance, to the correct (right) person, with the correct (right) direction/communication, and under the correct (right) supervision and evaluation.
The act of being responsible for the actions or inactions of yourself and of others in nursing is:
a. accountability. c. assignment.
b. authority. d. delegation.
A: Accountability is being responsible for the actions or inactions of oneself and of others. Authority refers to a right to delegate based upon the state’s Nurse Practice Act and nursing management. Assignment refers to the duties (i.e., patients) assigned to individuals generally on a daily basis. Delegation is the transferring of the authority to perform a selected nursing task in a selected situation to a competent individual.
A new graduate RN assigns a NAP to provide basic ADL (activities of daily living) to several patients on her unit. The NAP obtains vital signs and helps to bathe and feed the patients assigned. The nurse is:
a. accountable only for the actions done by herself.
b. accountable for all her own actions and those of the NAP.
c. accountable only for the basic ADL provided by the NAP.
d. not accountable for anything the NAP does outside of the NAP’s scope of practice.
B: Through the act of delegation, the nurse is accountable for the actions or inactions of the assigned NAP. The NAP is always responsible for completing the tasks assigned, but accountability stays with the RN.
A nursing instructor evaluates whether the nursing students know the steps in the NCSBN decision-making tree. Which response by a student would indicate that further teaching is needed?
a. Assessment, planning, and communication
b. Intervention and delegation
c. Surveillance and supervision
d. Evaluation and feedback
B: Further teaching would be needed if a student included intervention and delegation as one of the steps. The NCSBN decision-making tree consists of assessment and planning, communication, surveillance and supervision, and evaluation and feedback. While intervention and delegation are important decision-making factors, they are not as vital as these other components because they relate to delegation to nursing assistive personnel.
Poole, Davidhizar, and Giger (1995) have noted several cultural phenomena to be considered when working with culturally diverse staff. Which of the following would be included?
a. Communication, space, social organization, time, environmental control, biological variations, cultural expectations, and traditional barriers
b. Space, social organization, biological variations, communication, environmental factors, and cultural norms
c. Biological variations, traditional barriers, time, environmental control, space, communication, and social organization
d. Social organization, time, space, environmental control, biological variations, and communication
D: Six cultural phenomena suggested by Poole, Davidhizar, and Giger that should also be considered when delegating to a culturally diverse nursing staff are social organization, time, space, environmental control (locus of control), biological variations, and communication. All of these factors can impact how staff organize and perform their tasks. While traditional barriers, cultural expectations, and norms are also important factors to be considered when working with culturally diverse staff and patients, they are not described by Poole et al. as being as critical as those mentioned above.
The degree to which people perceive they have power over their environment is:
a. control c. fate and luck.
b. transcultural delegation. d. environmental control.
D: How people perceive that they can control or have power over their environment is called environmental control. Two types of this perceived control are internal locus of control, where the person relies upon his own inner (internal) resources to handle stimuli from the environment, and external locus of control, which is when a person relies more upon external forces such as luck and chance for control over what is experienced from the environment.
Your supervisor compliments you on your ongoing ability to integrate and apply the knowledge, skills, judgment, and personal attitudes required to practice safely and ethically. The supervisor is commenting on which of your qualities?
a. Authority c. Responsibility
b. Competence d. Right
B: The supervisor is complimenting you on your competence as an RN. Competence is the ongoing ability of a nurse to integrate and apply the knowledge, skills, judgment, and personal attitudes required to practice safely and ethically in a designated role and setting (Canadian Nurses Association, 2004).
The nurse manager would assign patient care that requires problem solving and innovation to which of the following staff members?
a. RN c. NAP
b. LPN/LVN d. Physician
A: A patient care assignment that requires problem solving and innovation should be given to an RN. These assignments require the RN to use critical thinking and specific knowledge and skills. Also, the nurse manager would not be assigning patient care of any type to the physician.
