Delegation

Correct ans: 3 Registered nurses are professionals in a healthcare organization who can be delegators. The registered nurses allocate a portion of work related to client care to other individuals. Assistants, technicians, and client care associates in a healthcare organization can be delegatees.

correcgt ans: 3 The UNP should inform the registered nurse about the condition of the client immediately, as the RN is accountable and responsible for the client. The UNP is not eligible to administer medication to the client. Informing the licensed practical nurse (LPN) is not beneficial because the LPN is not directly responsible for client care. The LPN can give client care only under the supervision of the RN. Discussing with other UPN is not appropriate.

correct ans: 1 Authority is the ability to perform duties in a specific role. Responsibility refers to reliability, dependability, and obligation to accomplish work. Accountability determines whether a person's actions were appropriate and provides a detailed explanation of what occurred. Legal authority is the ability to transfer selected nursing activities in a given situation to a competent individual.

ans: 4 Accountability is the expectation that actions performed are appropriate and that a detailed explanation of what occurred is provided. Authority is the ability to perform duties in a specific role, such as accomplishment of the task and fulfillment of the expected outcomes. Provision of guidance and oversight of a delegated nursing task is supervision. Responsibility is reliability, dependability, and the obligation to accomplish work.

correct ans: 2 Renewing is the task achieved by the delegator when he or she engages in self-care to enhance his or her ability to care for the healthcare team. Managing is achieved when the delegator assists the staff in planning, priority-setting, and decision-making. Explaining occurs when the delegator teaches and interprets information for client well-being. Motivating is achieved when the delegator inspires the staff to fulfill a mission.

ans: 3 The ANA outlined the principles of delegation for registered nurses. The Nurse Practice Act of each state examines the value of unlicensed personnel in client care delivery and declares that the importance of delegation decisions is the safety and welfare of the public. The multilevel nursing model consists of registered nurses, licensed practical nurses, and unlicensed nursing professionals. The National Council of State Boards of Nursing (NCSBN) stated that the state boards of nursing should regulate nursing assistive personnel across multiple settings.

ans: 2 In the co-primary nursing model or practice partnership model, the registered nurse (RN) is paired with technical assistance. The team nursing model is a modification of the functional nursing model. The focused care model is the care delivered in client-focused care. The functional model of nursing is a method of providing care by each licensed and unlicensed staff member who performs specific tasks for a large group of clients.

correct ans: 1 Span of control, the number of people for whom one is ultimately responsible, increases with the number of individuals under a person's control. The nurse manager is the person responsible for the tasks performed by registered nurses, patient care associates, licensed vocational nurses/licensed practical nurses, and other nursing professionals, and, therefore, has the maximum span of control.

correct ans: 1 The UAP should be assigned tasks that are simple and do not involve any complications. Positioning the bed at 30 degrees or more is one of the essential tasks that can be assigned to the UAP under supervision. Evaluating vitals is the duty of the registered nurse. Tube feeding the client is a very sensitive procedure that can be done by a registered nurse or trained licensed practical nurse. Determining the calorie needs of the client is the job of a dietician.

ans: 4 Accountability is retained by the delegator while delegating a client's care task to the nursing aide. Every individual on the healthcare team has authority for the delegated task. The nursing aide is just responsible for the delegated task, so the delegator retains the accountability. Supervision is a right of delegation.

ans: 1 Delegation is the transfer of responsibility for the performance of an activity. Personal liability defines each person's responsibility and accountability for individual actions or omissions. Supervision is defined as the active process of directing, guiding, and influencing the outcome of an individual. Assignment is the transfer of both the accountability and the responsibility from one person to another.

correct ans: 1 When the registered nurse gives a task to another RN, the task can be assigned, but cannot be delegated. When any work is being assigned, the recipient is accountable and responsible for the work. LPNs, LVNs and UNPs can be delegated work for which they can be responsible, but only the delegator is accountable.

correct ans: 3 The registered nurse is delegated to teach the client about using a meter dose inhaler for asthma. Oral administration of drugs is under the scope of practice of a licensed practical nurse (LPN) and a licensed vocational nurse (LVN). Administration of intramuscular medications will also be tasks delegated to an LPN or LVN. Reinforcing teachings is the task of an LPN, LVN, or unlicensed assistive personnel (UAP).

correct ans: 4 Implementation of certain tasks can be delegated by the registered nurse based on the ability and willingness of the delegatee. The pervasive functions of assessment, planning, evaluation, and nursing judgment cannot be delegated by the registered nurse. These nursing processes should be performed by the registered nurse only.

ans: 4 & 5 Licensed vocational nurses and licensed practical nurses are authorized to administer drugs through oral and intramuscular routes. Analyzing vital signs should be performed by the registered nurse. Hygiene maintenance can be delegated to unlicensed nursing practitioners (UNP). Administering intravenous drugs should be done by the registered nurse.

correct ans: 2 Delegation is a process of sharing the responsibility of client care. It involves the transfer of responsibility for the performance of an activity from one individual to another, with the delegator retaining accountability for the outcome. Leadership is the use of individual traits and abilities in relationship with others, the ability to interpret the context where a situation is emerging, and entering that situation in the absence of a script or defined plan that could have been projected. Supervision is defined as the active process of directing, guiding, and influencing the outcome of an individual's performance of an activity. Assignment is the transfer of both the accountability and the responsibility from one person to another.

correct ans: 1 The licensed practical nurse (LPN) scope of practice includes administering oral, topical, intramuscular, and subcutaneous except for intravenous medications. Client A is prescribed non-steroidal anti-inflammatory drugs for dental pain that can be either administered orally or intramuscularly. This client care falls under the scope of LPN. Client B is prescribed replacement fluids for severe dehydration, which must be given intravenously. This intervention is out of scope for the LPN. Blood products transfusion should be made only by the registered nurse. Client C care is out of scope for the LPN. Dextran is administered intravenously to maintain the volume of blood during hemorrhage. This intervention in client D is out of scope for the LPN.

ans: 1, 3, 4 The nurse can assist other registered nurses with delegation decisions by using three strategies: asking, offering, and doing. Telling and participating are the strategies used by the nurse to communicate with the delegatee.

correct Ans: 3 & 5 Unlicensed nursing personnel (UNP) can delegate simple and straightforward client teaching, such as asking the client to wash his or her hands before meals and wear footwear while walking. Complex and multifaceted teaching, such as detailing the care plan to the client, cannot be delegated to a UNP. The UNP has less knowledge and professional skills with which to perform complex procedures such as infusing intravenous fluids into the client and does not have a complete knowledge of medications with which to coach the client about medications.

ans: 4 The American Nurses Association (ANA) and National Council of State Boards of Nursing (NCSBN) collaboratively defined delegation as the "process for the nurse to direct another person to perform nursing tasks and activities." Collective actions are the "activities that are undertaken by a group of people who have common interests." Transferring both accountability and responsibility from one person to another is referred to as an assignment. Strategy is an "organized and innovative plan that assists an organization to achieve the objectives."

correct ans: 2 According to Hersey's model of situational leadership, the delegator should act according to the situation. When there is an established relationship between the delegator and the delegatee, little guidance needs to be provided to the delegatee. When the relationship is new and a new task is delegated, an explanation is required about how to perform the task. When the delegatee is newly assigned, then the delegator checks the ability of the delegatee by asking how to perform the procedure. When the relationship between the delegatee and delegator is new, and it is for a limited period, then the delegator just informs the delegatee what is to be done.

ans: 3 Hersey's 2006 model provides a solid foundation for delegation decisions. The main motto of this model is situational leadership. The core competencies of a situational leader are the ability to diagnose the performance, competence, and commitment of others; to be flexible; and to partner for performance. Anthony and Vidal describe characteristics of communication that interfere with the delegation process, such as information decay. They also describe information salience, or the quality, meaning, and clarity of the information. Ana mentioned individual accountability, the expectation of accountability and responsibility in 2011, specifically referencing delegation.

correct ans: 1 Improper follow-through on the part of a delegatee is failure to report results and findings. Improper follow-through occurs when the delegator does not understand the skills and abilities of the delegatee and does not provide clear and concise directions to the delegatee. The lack of cooperation with team members may be improved by educating, guiding, and monitoring the delegatee.

ans 1 & 4 The delegator has to determine right task by assessing whether the task is legally appropriate to delegate. The delegator must also check that the task is appropriate to delegate based on institutional policies and procedures. The right circumstance can be assessed by asking, "Is the environment conducive to completing the task safely?" The right direction and communication is assessed by asking, "Does the delegator provide clear and concise directions for the task?" The right person eligible to accomplish the task is assessed by asking, "Does the delegatee have the knowledge and experience to perform the specific task safely?"

correct ans: 3 The licensed practical nurse can give oral medication to a client. The registered nurse gives IV medication to a client. Patient care associates assist and monitor vital signs. Unlicensed assistive personnel perform all hygienic tasks.

correct ans: 4 Both accountability and responsibility are transferred from one person to the other in assignment. When a nurse manager delegates the task of client care to an RN, responsibility is transferred to the RN. The nurse manager shares accountability with the RN in delegation. The nurse manager, as leader, manages the healthcare team and delegates tasks to members of the healthcare team. In supervision, the nurse manager oversees the RN in completing the task.

correct ans: 1 & 2 The tasks within the scope of unlicensed assistive personnel (UAP) include recording vital signs and providing basic hygiene, such as assisting the client with activities of daily life such as bathing. Administering oral medications is under the scope of licensed practical nurse (LPN) or licensed vocational nurse (LVN), but not the UAP. Depending on the state, administering intravenous antibiotics can be performed by either the RN or an LPN/LVN. Preparing the care plan for the client should be performed by the registered nurse only.

correct ans 4 The licensed practical nurse can be delegated the task of administering oral medications or vaccines. Technicians, patient care associates, and certified nursing aides are unlicensed assistive personnel who are not appropriate for delegation of tasks such as administering medication or vaccines as per the delegation rights. The scope of practice for unlicensed assistive personnel providing client care is limited to providing basic care, comfort, and hygiene.

correct ans 4 A delegatee is identified as less able to perform a specific work when he or she has a knowledge deficit. When the delegatee is upset, bored, or anxious, the delegator will identify that the delegatee is unwilling to perform a specific task.

correct ans: 3 & 4 The greater the stability of a client, the more likely it is that unlicensed nursing personnel (UNP) can provide safe client care. It is also easy for a UNP to care for a client who is recovering. A client with pain is anxious and agitated, and it will take the UNP time to calm the client. Client care may be affected when the client is psychologically upset and has suicidal intentions.

correct ans: 3 The registered nurse (RN) supervises UNPs and also licensed practical nurses (LPNs) in providing care to the client. The charge nurse and the nurse manager may supervise RNs. The charge nurse delegates the tasks to the LPN and UNP when the RN does not delegate. The nursing manager is in charge of the RN, LPN, and UPN. The patient care associate does not supervise the UNPs and is delegated tasks by an RN.

correct ans 1 Delegating work is the most effective professional management strategy that an RN can implement in clinical practice to improve the safety and quality of client care. RNs can delegate work to LPNs, UNP, or UAP.

correct ans 1 The charge nurses act as a delegator on the basis of knowledge and experience in clinical settings. In the absence of a registered nurse, the charge nurse usually delegates the tasks. A patient care associate assists and monitors vital signs. Licensed practical nurses and unlicensed nursing personnel are considered delegatees due to insufficient experience and training.

correct ans: 2 & 5 Nurses, PCAs, and UNPs can perform the task of maintaining hygiene; however the best use of resources is to delegate to UNPs and PCAs so the nurses can complete medication administration and other skills the UNPs and PCAs are not legally able to perform under their scope of practice.

correct ans 1 The registered nurse is accountable for the initial assessment and ongoing evaluation of the client. A licensed practical nurse is not accountable for initial assessment and ongoing evaluation of the client. The primary health care provider is accountable for diagnosing the problem and reviewing the client responses. An unlicensed nursing personnel performs the tasks delegated by the registered nurse or other delegators.