Murraych 12^013 leadership PDF

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Chapter 12 Murray Questions 1. Which aspects are included in how nurses develop nursing judgment? Select all that apply. 1. Academic experience 2. Use of experience to help form an opinion 3. Analysis of information to help arrive at a decision 4. Leadership style 5. Level of administrative experience as opposed to being a staff nurse Nursing judgment represents a clinical decision process based on analysis of information supported by education and experience that are used to form an opinion. One's leadership style and/or the level of administrative experience is not uniquely attached to the formation of nursing judgment, as nursing judgment rests with the individual nurse rather than being ascribed to the roles that are performed. Nurses exhibit nursing judgment independent of their leadership style or the level of their administrative experience. 2. Which examples represent improper use of delegation in the clinical setting by a registered nurse (RN), licensed practical nurse (LPN), or unlicensed assistive personnel (UAP)? Select all that apply. 1. UAP delegating a task to a LPN 2. RN delegating a task to a UAP or a LPN 3. LPN delegating a task to a RN 4. RN delegating a task to a RN 5. UAP delegating a task to a RN In terms of delegation, a RN can delegate tasks to another RN, LPN, or UAP. LPNs may not delegate to a RN but can delegate to a UAP. UAPs cannot delegate tasks. 3. Which actions should not be delegated to a licensed vocational nurse (LPN) on a medical unit in a hospital setting by a registered nurse (RN)? Select all that apply. 1. Initiating a blood transfusion 2. Inserting a urinary catheter 3. Administering chemotherapy infusion 4. Completing initial admission assessment 5. Performing post-operative dressing changes Certain tasks cannot be delegated by an RN to a LVN, such as but not limited to initiation of a blood transfusion, administration of chemotherapy infusions, and completion of an initial admission assessment. The LVN can perform as a delegated task insertion of a urinary catheter along with changing of a post-operative dressing. 4.

A registered nurse (RN) delegated specimen collection to an unlicensed assistive personnel (UAP) for a patient who had a urine analysis ordered by the physician. The UAP did not obtain the specimen. When checking the patient's chart later in the shift, the RN noticed that there was no documentation that a urine specimen was collected. The RN asked the UAP to provide an explanation for why the specimen was not obtained. The UAP told the RN that she was going to obtain the specimen from the patient after lunch. Which stated action would correlate with the delegation right of right communication? 1. The RN followed up later in the shift checking the patient's chart for documentation of the specimen collection. 2. The RN delegated the task to the UAP. 3. The UAP told the RN that she was going to obtain the specimen from the patient after lunch. 4. The RN monitored the task completion process. Right communication refers to providing clear and concise information between both delegator and the delegate. The RN following up by checking the patient's chart and monitoring the task completion process is an example of right supervision. The RN delegating the task itself to the UAP is an example of the delegation process. 5. Which statement best reflects the concept of accountability with regard to delegation of tasks? 1. Nursing state practice acts do not require nurses to be held accountable for their actions. 2. Accountability exists at both nursing and organizational levels. 3. An organization's obligation to accountability is based on its ability to offer quality care regardless of nurse staffing. 4. The competency of the nurse is not considered as being relevant to accountability. Accountability is defined as being held responsible for direct or indirect actions provided in the context of delegation. Accountability exists both at nursing and organizational levels. Nurses are accountable for their actions, and the organization is responsible for providing sufficient resources for nurses to deliver care. Nursing state practice acts address roles and responsibilities of nurses in terms of accountability to provide safe, prudent practice to the public. Adequate nurse staffing contributes to being able to maintain accountability by having resources that allow for delivery of care. Nursing competency provides a framework for helping to support the concept of accountability 6. A group of nurse managers are reviewing a new job description for a staff nurse on a medicalsurgical unit. Which observation if found would indicate that the job description needs revision with regard to delegation? 1. Delineation of roles and responsibilities 2. A listing of tasks that the nurse can complete 3. No mention of the nursing position authority 4. Listing of minimum qualifications for the nursing position It is critical that job descriptions for nursing positions provide information relative to the nurse's authority, responsibility, and accountability for delegation. Delineation of roles and

responsibilities, a listing of tasks that the nurse can complete, and a listing of minimum qualifications for the nursing position could be included in a job description. 7. A registered nurse (RN) is working on a medical-surgical unit functioning as a team leader for five patients with a licensed practical nurse (LPN) and a certified nurse's aide (CNA). Which action should not be delegated to the CNA? 1. Positioning the patient for comfort by raising the head of the bed 2. Performing a pain assessment 3. Assisting the patient with transfer from bed to chair 4. Offering the patient fluids In terms of delegation, the registered nurse can use delegation to improve delivery of care to patients by allowing some patient care tasks to be provided by other licensed or nonlicensed personnel. In this care, the RN is delegating aspects of patient care to a CNA. As this individual is a nonlicensed person, the RN should never delegate patient assessment as that remains within the role and responsibility of the RN. Positioning the patient for comfort, assisting the patient with transfers, and offering the patient hydration can be performed by the CNA. 8. Nonlicensed staff members (unlicensed assistive personnel [UAP]) have asked for a meeting with the nurse manager as they are unhappy with how some of the nursing staff (Registered Nurse [RN]) has been delegating tasks with regard to patient care. Which statement if made by a nonlicensed staff member would indicate that additional instruction is needed for the nursing staff with regard to effective delegation principles? 1. "The RN told me that I couldn't obtain a urine specimen from a patient." 2. "I was told by the RN that I had to wait until the order was written in the patient's chart before I could act on it." 3. "The RN told me that I should wait until after lunch before I gave the patient AM care as the patient had just been medicated for pain." 4. "The RN told me that I had to change all of the bed linen for the patients before I went home at the end of the shift." With regard to delegation by an RN to an UAP, UAPs are allowed to obtain specimen collection. Therefore, the nursing staff would require additional instruction in what can and cannot be delegated. The other options are within the scope of practice for the UAP and do not reflect any inconsistency with delegation of tasks. 9. A nurse manager is educating a staff nurse with regard to the five rights of delegation. Which statement by the staff nurse indicates that additional training is needed with regard to right supervision or evaluation? 1. Once a task has been delegated, the nurse is absolved of responsibility. 2. Nurses should provide feedback relative to task completion. 3. It is important to provide clear directions relative to task delegation.

4. Performance of the delegated task should be monitored. Inherent in the delegation of tasks with regard to right supervision or evaluation, the nurse who has delegated the tasks remains responsible and accountable for completion. If this statement was made, it clearly indicates that the staff nurse requires additional training in this area. The other statements referring to providing feedback, giving clear directions, and monitoring performance of the delegated tasks demonstrate the concept is understood. 10. Which patient activity could be performed by either a registered nurse (RN) or a licensed practical nurse (LPN) or delegated as a task even if there is an unlicensed assistive personnel (UAP) present on the unit? 1. Initiation of blood transfusion 2. Tracheostomy care 3. Assisting a patient with feeding 4. Obtaining daily weight Tracheostomy care can be performed by either a RN or LPN. The task could also be delegated by the RN to the LPN. Initiation of a blood transfusion should be performed by a RN. Assisting a patient with feeding can be performed by a UAP. Obtaining a daily weight can be performed by a UAP. The RN could delegate assisting the patient with feeding and obtaining a daily weight to the UAP. 11. Which observation if made by a registered nurse (RN) who is working with a licensed practical nurse (LPN) and an unlicensed assistive personnel (UAP) would require immediate intervention based on the delegation process? 1. UAP was transferring a patient out of bed who was 2 days postoperative laparoscopic surgery 2. LPN was administering oral pain medication following performing a pain assessment 3. LPN was monitoring a blood transfusion 4. UAP was providing information to a patient who was just placed on isolation relative to neutropenic precautions Client teaching remains under the direction of the RN. Client teaching can be reinforced by LPN as licensed individuals once the initial health information has been provided. The UAP can assist with transfers for the 2-day postoperative patient. The LPN can administer oral pain medication following performing a pain assessment, and the LPN can monitor ongoing blood transfusions. 12. A physician has ordered a rectal suppository to be administered to a 25-year-old male patient. The registered nurse (RN) delegates this task to the licensed practical nurse (LPN). The LPN would prefer not to complete this task. The RN tells the nurse manager about this issue. How would the nurse manager interpret this refusal by the LPN to perform a delegated task? 1. Underdelegation 2. Possibility of a delegate-related barrier

3. Overdelegation 4. Possibility of a delegator-related barrier Refusal by a delegate to perform a task may represent that the delegate is uncomfortable with the procedure, or is feeling overworked, or may be unable to perform the task physically. Underdelegation is when the delegator assumes all or most of the tasks remaining to be the sole one responsible for providing care. Overdelegation is when a delegator delegates most or all tasks to a delegate. There is no information provided here in this scenario that indicates multiple tasks have been provided. Possibility of a delegator-related barrier is not supported in this scenario for the RN has elected to delegate a task. 13. Which task should not be delegated to a licensed vocational nurse (LVN) by a registered nurse (RN) who is working with a LVN and unlicensed assistive personal (UAP) as part of the team? 1. Performing oral hygiene for a patient who has oral ulcerations 2. Feeding a patient with dysphagia 3. Transferring a patient from the bed to a chair 4. Monitoring a blood transfusion In terms of delegation, effective use of both licensed and nonlicensed personnel is the mainstay of establishing effective delegation of tasks. Transferring a patient from the bed to a chair should not be delegated to the LVN as it would be more applicable to the role function of the UAP. The other options: performing oral hygiene for a patient who has oral ulcerations, feeding a patient with dysphagia, and monitoring a blood transfusion can be performed by the LVN.

14. A registered nurse (RN) refuses to delegate any patient care tasks to other members of the nursing unit staff preferring to complete all tasks herself. What type of delegation practice would this demonstrate? 1. Underdelegation 2. Effective delegation 3. Overdelegation 4. Recognition of right person This is an example of underdelegation, whereby the nurse may feel that she represents the best individual to accomplish and provide patient care. Effective delegation would require appropriate use of task delegation based on the five rights of delegation—right task, right person, right circumstance, right direction or communication, and right supervision. Overdelegation is when all tasks are delegated to others. Right person is one of the five rights of delegation, and while the RN in question may well feel that she is the best person to do the job, the process of delegation implies that tasks will be delegated to others.

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Which situation provides an example of the right circumstances as defined by the five Rights of Delegation? 1. Completion of the task does not require nursing judgment 2. Assessing needs of the population in the context of available resources 3. Identifying competency level 4. Providing correct information to a patient

A nurse considers available resources based on the assessment of needs of the population in determining the right circumstances of delegation. The fact that completion of the task does not require nursing judgment refers to the right task. Identifying competency level refers to the right person. Providing correct information to a patient refers to the right direction or communication. Chapter 13 Murray Questions

1. Which action would help to promote a nurse in becoming a skilled communicator? 1. Limit reflective practices and focus on present interaction. 2. Focus on individual thoughts and beliefs. 3. Believe that all conversations contain credible information. 4. Become more candid. Factors that would contribute to becoming a skilled communicator include becoming aware of self-deception, reflective, authentic, mindful, and candid. It is important to be able to reach out, understand, reflect, and be open to communication. Believing that all conversations contain credible information may lead to inappropriate analysis in that the veracity of all conversations cannot be proven. 2. A nurse is reviewing a chart in which a medication error occurred as part of a performance improvement (PI) evaluation. Which notation if observed would indicate a potential contributory factor to the incident based on the concept of nurse fatigue? 1. Clinical response to antibiotic oral medication given by the nurse was not documented. 2. The physician's order was signed off. 3. The pain assessment profile prior to medication being administered was noted as 9 out of 10. 4. The nurse who had administered the medication was working his third shift in a row, which was considered to be an overtime shift. Research has shown that an increased number of errors is related to increased number of work hours in the clinical setting. Therefore, the fact that the nurse was working an overtime shift would increase the likelihood for an error to occur. Typically, there is no need to indicate a clinical response to oral antibiotic medication unless there is an observed adverse reaction. The physician's order being signed off is an appropriate action. The pain assessment profile being completed is also an appropriate action.

3. A group of nurses are discussing safe patient handling and mobility on the nursing unit in relation to nurses sustaining musculoskeletal disorders (MSDs). Which statement made by one of the nurses would indicate that additional training was needed? 1. The most common occurrence for MSDs is when nurses are transferring, lifting, or repositioning patients/clients. 2. It is important to maintain body principles when repositioning a patient/client. 3. If done properly, no nursing action will result in acquiring an MSD. 4. Use of body mechanics while required does not mean that a nurse will not get an MSD. Research has shown that even if a task/action is done properly, there is still a risk that a nurse could acquire an MSD. The most common occurrences for MSDs arise from nurses performing the tasks of transferring, lifting, and/or repositioning patients/clients. Use of body principles is advised, but even if used does not guarantee that a nurse will not get an MSD. 4. What factors would help to contribute to nurses being injured during delivery of client care? Select all that apply. 1. Implementation of manual lifting 2. Two-person lift 3. One-person lift 4. Hook-and-toss method 5. Discontinuing "no lift" policy Implementation of manual lifting over time can cause microinjuries to the spine. A one-person lift can also lead to a nurse being injured during delivery of client care. It is important to have adequate resources available in terms of personnel as well as equipment to facilitate lifting. Evidence-based practice suggests that the "no lift" policy be continued and supported in the clinical environment. American Nurses Association (ANA) supports the implementation of a "no lift" policy in clinical facilities in order to maintain nurse safety. A two-person lift and the hookand-toss method are considered to be acceptable techniques for lifting. 5. Which statement is inaccurate with regard to work-related injuries and illness? 1. Health-care workers are more likely to experience work-related injuries and illness. 2. Stress does not play a role in work-related injuries and illness. 3. Musculoskeletal complaints are typically seen. 4. Working overtime appears to lead to more work-related injuries and illness. Current research has shown that health-care workers have a higher incidence of work-related injuries and illness. This in part can be due to acute and chronic effects of stress and overwork. The most common reported disability is musculoskeletal injuries. 6. Which situation if observed would warrant immediate action by the nurse manager?

1. Staff nurse asks for additional clarification from the physician related to a written order. 2. Unit secretary asks the nurses to answer the unit phone when she is busy. 3. Unit secretary draws caricature images of nursing staff with sarcastic comments. 4. Two nurses who work days are switching their days for the last 2 weeks of the schedule. A caricature with noted sarcastic comments requires that the nurse manager take immediate action in order to prevent an escalation of workplace violence. This action could be construed as bullying by humiliation. The staff nurse asking for clarification of a physician order is an appropriate action and does not require any further action by the nurse manager. The unit secretary asking for assistance with answering phones from nursing staff does not require any further action by the nurse manager. The nurse manager may have to communicate with the two staff nurses who are switching their schedules, but an immediate action is not required. 7. Which characteristic is included in the American Nurses Association (ANA) Nurses' Bill of Rights? 1. To function as a patient/client advocate without fear of retribution 2. Compensation for clinical practice is based solely on the fiscal budget of the employer 3. Practice setting safety addresses patient/client only 4. Negotiation for conditions of employment is not included as a basic right According to ANA Nurses' Bill of Rights, nurses are expected to function as advocates for both themselves as well as their patients/clients without fear of retribution. Nurses have the right to fair compensation for their work, consistent with knowledge, experience, and professional responsibilities. While the fiscal budget of the employer may affect the ability to determine a salary schedule, fair compensation based on the noted criteria is the position held by the ANA. Practice setting safety according to the ANA Nurses' Bill of Rights is for both nurse and patient/client. According to ANA, nurses have the right either individually or collectively to negotiate conditions of employment. 8. What hallmarks help to support a healthy work environment based on American Association of Colleges of Nurs...