Unit B - Chapter 6 - Delegation And Supervision

Question 1

Delegation

Answer 1

process of transferring the performance of a task to another while retaining accountability

Question 2

Supervision

Answer 2

process of directing, monitoring, and evaluating the performance of tasks by another team member

Question 3

Nurses are responsible for supervising the

Answer 3

performance of client care tasks they delegate to others

Question 4

Licensed personnel

Answer 4

nurses who have completed a course of study in nursing and successfully passed either a PN or RN examinatio

Question 5

Unlicensed personnel

Answer 5

individuals who have had training to function in an assistive role to licensed nurses in providing client care

Question 6

unlicensed individuals might be

Answer 6

(certified nursing assistants [CNAs],
certified medication assistants [CmAs]) or
non‐nursing personnel (dialysis technicians, monitor technicians, phlebotomists)

Question 7

NAP

AP

Answer 7

nursing assistive personnel or

assistive personnel.

Question 8

DELEGATION
A licensed nurse is responsible for

Answer 8

providing clear directions when delegating a task initially

periodic reassessment and evaluation of the outcome of the task.

Question 9

RNs can delegate to

RNs must be knowledgeable about their state’s nurse practice act and the regulations that guide the use of

Answer 9

RNs, PNs, and AP

PNs and AP.

Question 10

RNs must delegate tasks so that they can

Answer 10

complete higher-level tasks that only RNs can perform.

Question 11

Delegation allows

Answer 11

more efficient use of all team members.

Question 12

PNs can delegate to

Answer 12

other PNs and to AP

Question 13

Nurses can only delegate tasks

Answer 13

appropriate for the skill and education level of the individual who is receiving the assignment (the delegatee)

Question 14

delegatee

Answer 14

Person being assigned the task

Question 15

TASK FACTORS

Answer 15

● Predictability of the outcome:

● Potential for harm

● Complexity of care

● Need for problem solving and innovation

● Level of interaction with the client:

Question 16

Predictability of the outcome:

Answer 16

Will the completion of
the task have a predictable outcome?
◯ Is it a routine treatment?
◯ Is it a new treatment for that client?

Question 17

Potential for harm

Answer 17

◯ Is there a chance that something negative could
happen to the client (bleeding, aspiration)?
◯ Is the client unstable?

Question 18

Complexity of care

Answer 18

◯ Does the client’s care require complex tasks?
◯ Does the state’s practice act or the facility’s policy
allow the delegatee to perform the task, and does the
delegatee have the necessary skills?

Question 19

Need for problem solving and innovation

Answer 19

◯ Is judgment essential while performing the task?
◯ Does it require nursing assessment or data-collection skills?

Question 20

Level of interaction with the client

Answer 20

Does the delegatee need psychosocial support or education during the of the task?

Question 21

DELEGATEE FACTORS

Answer 21

● Education, training, and experience
● Knowledge and skill to perform the task
● Level of critical thinking the task requires
● Ability to communicate with others as it pertains to the task ● Demonstration of competence
● The facility’s policies and procedures
● Licensing legislation (state’s nurse practice acts) (6.1)

Question 22

Examples of tasks nurses may delegate to PNs

(provided the facility’s policy and state’s practice guidelines permit)

Answer 22

● monitoring findings ● (as input to the RN’s ongoing assessment)
● Reinforcing client teaching from a standard care plan
● Performing tracheostomy care
Suctioning
Checking NG tube patency
Administering enteral feedings
● Inserting a urinary catheter
● Administering medication (excluding Iv medication in some states)

Question 23

Examples of tasks nurses may delegate to APS

(provided the facility’s policy and state’s practice guidelines permit)

Answer 23

Activities of daily living (ADLs)
Bathing
◯ Grooming
◯ Dressing
Toileting Ambulating
Feeding (without swallowing precautions)
◯ Positioning
● Routine tasks
Bed making
Specimen collection
◯ Intake and output
vital signs (for stable clients)

Question 24

ADLs

What do ADLs include

Answer 24

Activities of daily living

Bathing
◯ Grooming
◯ Dressing
Toileting
Ambulating
Feeding (without swallowing precautions)

Question 25

Use the five rights of delegation to decide

Answer 25

Right task Right circumstance Right person Right direction and communication Right supervision and evaluation

Question 26

Right task

Answer 26

● Identify hich tasks appropriate to delegate for specific client. ● A right task is repetitive, requires little supervision, and is relatively noninvasive for the client. ● Delegate activities to appropriate levels of team members (RN, PN, AP) according to professional standards of practice, legal and facility guidelines, and available resources

Question 27

WHICH IS THE RIGHT TASK? Delegate an AP to assist a client who has pneumonia to use a bedpan. Delegate an AP to administer a nebulizer treatment to a client who has pneumonia.

Answer 27

RIGHT TASK: Delegate an AP to assist a client who has pneumonia to use a bedpan

Question 28

Right circumstances

Answer 28

● Determine health status / complexity of care client requires. ● Match complexity of care to skill level of the delegatee. ● Consider workload of the delegatee.

Question 29

WHICH IS THE RIGHT CIRCUMSTANCE Delegate an AP to measure the vital signs of a client who is postoperative and stable. Delegate an AP to measure the vital signs of a client who is postoperative and required naloxone to reverse respiratory depression.

Answer 29

RIGHT CIRCUMSTANCE: Delegate an AP to measure the vital signs of a client who is postoperative and stable.

Question 30

Right person

Answer 30

● Determine and verify the competence of the delegatee. ● The task must be within the delegatee’s scope of practice or job description. ● The delegatee must have the necessary competence and training. ● Continually review the performance of the delegatee and determine care competence. ● Evaluate the delegatee’s performance according to standards, and when necessary, take steps to remediate any failure to meet standards.

Question 31

WHICH IS THE RIGHT PERSON Delegate a PN to administer enteral feedings to a client who has a head injury. Delegate an AP to administer enteral feedings to a client who has a head injury.

Answer 31

RIGHT PERSON: Delegate a PN to administer enteral feedings to a client who has a head injury.

Question 32

Right direction and communication in writing, orally, or both

Answer 32

● Communicate what data to collect. ● Provide a method and timeline for reporting, including when to report concerns and assessment findings. ● Communicate specific task(s) to perform and client-specific instructions. ● Detail expected results, timelines, and expectations for follow-up communication.

Question 33

WHICH IS RIGHT DIRECTION AND COMMUNICATION: Delegate an AP to assist mr. martin in room 312 with a shower before 0900. Delegate an AP to assist mr. martin in room 312 with morning hygiene.

Answer 33

RIGHT DIRECTION AND COMMUNICATION: Delegate an AP to assist mr. martin in room 312 with a shower before 0900.

Question 34

Right supervision and evaluation

Answer 34

● Provide supervision, either directly or indirectly (assigning supervision to another licensed nurse). ● Monitor performance. ● Intervene if necessary (for unsafe clinical practice). ● Provide feedback: ◯ Did the delegatee complete the tasks on time? ◯ Was the delegatee’s performance satisfactory? ◯ Did the delegatee document and report unexpected findings? ◯ Did the delegatee need help completing the tasks on time? ● Evaluate the client and determine the client’s outcome status. ● Evaluate task performance and identify needs for performance-improvement activities and additional resources.

Question 35

WHICH IS THE RIGHT SUPERVISION: Delegate an AP to assist with ambulating a client after the RN completes the admission assessment. Delegate an AP to assist with ambulating a client prior to the RN performing an admission assessment.

Answer 35

RIGHT SUPERVISION: Delegate an AP to assist with ambulating a client after the RN completes the admission assessment. .

Question 36

1. A nurse on a medical‐surgical unit has received change‐of‐shift report and will care for four clients. Which of the following tasks should the nurse assign to an assistive personnel (AP)? A. Updating the plan of care for a client who is postoperative B. Reinforcing teaching with a client who is learning to walk using a quad cane C. Reapplying a condom catheter for a client who has urinary incontinence D. Applying a sterile dressing to a pressure injury

Answer 36

C. CORRECT: The application of a condom catheter is a noninvasive, routine procedure that can be delegated to an AP. A. Updating the plan of care for a client requires professional nursing knowledge and judgment. Therefore, it is outside the range of function of an AP. B. Reinforcing teaching a client for a client requires professional nursing knowledge and judgment. D. Applying a sterile dressing on a client requires professional nursing knowledge, skills, and judgment.

Question 37

2. A nurse manager is assigning care of a client who is being admitted from the PACU following thoracic surgery. The nurse manager should assign the client to which of the following staff members? A. Charge nurse B. Registered nurse (RN) C. Practical nurse (PN) D. Assistive personnel (AP)

Answer 37

B. CORRECT: A client who is postoperative following thoracic surgery requires professional nursing knowledge, skills, and judgment of an RN to provide safe and effective client care. A. Although the charge nurse can provide all the care this client requires in the immediate postoperative period, administrative responsibilities might prevent the close monitoring and assessment this client needs. C. A client who is postoperative following thoracic surgery requires professional nursing knowledge, skills, and judgment that is outside the range of function of a PN. D. A client who is postoperative following thoracic surgery requires professional nursing knowledge, skills, and judgment that is outside the range of function of an AP.

Question 38

3. A nurse is delegating the ambulation of a client who had knee arthroplasty 5 days ago to an AP. Which of the following information should the nurse share with the AP? (Select all that apply.) A. The roommate ambulates independently. B. The client ambulates wearing slippers over antiembolic stockings. C. The client uses a front‐wheeled walker when ambulating. D. The client had pain medication 30 min ago. E. The client is allergic to codeine. F. The client ate 50% of breakfast this morning.r

Answer 38

B. CORRECT: To complete this assignment safely, the AP should make sure the client wears stockings and slippers. C. CORRECT: To complete this assignment safely, the AP should make sure the client uses a front‐wheeled walker. D. CORRECT: To complete this assignment safely, the AP should know that the client should be feeling the effects of the pain medication. A. The AP does not need to know the status of the client’s roommate to complete this assignment. E. The AP does not need to know the client’s allergy status to complete this assignment. F. The AP does not need to know the client’s food intake to complete this assignment.

Question 39

4. A charge nurse is assigning client care for four clients. Which of the following tasks should the nurse assign to a PN? A. Creating a plan of care for a client who is recovering following a stroke B. Assessing a pressure injury on a client who is on bed rest C. Providing nasopharyngeal suctioning for a client who has pneumonia D. Teaching a client who has asthma to use a metered‐dose inhaler

Answer 39

C. CORRECT: Providing nasopharyngeal suctioning is within the scope of practice of the PN. ' A. Creating a plan of care requires professional nursing knowledge, skills, and judgment that is outside the scope of care of a PN. B. Assessing a pressure injury requires professional nursing knowledge, skills, and judgment that is outside the scope of care of a PN. D. Teaching requires professional nursing knowledge, skills, and judgment that is outside the scope of care of a PN.

Question 40

5. A nurse is preparing an in‐service program about delegation. Which of the following are components of the five rights of delegation? (Select all that apply.) A. Right place B. Right supervision and evaluation C. Right direction and communication D. Right documentation E. Right circumstances

Answer 40

B. CORRECT: The right supervision and evaluation is one of the five rights of delegation. They also include the right task and the right person. C. CORRECT: Right direction and communication is one of the five rights of delegation. They also include the right task and the right person. E. CORRECT: The right circumstances is one of the five rights of delegation. They also include the right task and the right person. A. The right route is one of the rights of medication administration, not delegation. D. The right documentation is one of the rights of medication administration, not delegation.

Question 41

List at least five tasks the delegating nurse must perform when supervising and evaluating a delegatee.

Answer 41

NURSING INTERVENTIONS ● Provide supervision, either directly or indirectly (assigning supervision to another licensed nurse). ● monitor performance. ● Intervene if necessary (for unsafe clinical practice). ● Provide feedback: ◯ Did the delegatee complete the tasks on time? ◯ Was the delegatee’s performance satisfactory? ◯ Did the delegatee document and report unexpected findings? ◯ Did the delegatee need help completing the tasks on time? ● Evaluate the client and determine the client’s outcome status. ● Evaluate task performance and identify needs for performance‐improvement activities and additional resources.