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WorksheetsChapter 20: Delegation in Nursing - Core Concepts
Total questions: 102
Worksheet time: 51mins
Which statement best defines delegation in nursing practice?
Transferring task responsibility while retaining accountability
Passing accountability and responsibility to another
A nurse plans to delegate vital sign collection for one stable patient. Which principle applies to the time frame of this delegation?
One task, one time, one patient
All tasks during the current shift
Which task is NOT appropriate to delegate to an unlicensed assistive personnel (UAP)?
Initial nursing assessment of a new admission
Ambulating a stable postoperative patient
A CNA is specially trained and certified in catheterization. Which delegation is appropriate?
Insert a Foley catheter per protocol
Independently diagnose urinary retention
Which items represent the Five Rights of Delegation? Select all that apply.
Right Task for safety and appropriateness
Right Circumstance based on stability
Right Person with proper skill set
What is the primary purpose of walking rounds during shift change?
Provide real-time feedback while seeing the patient
Speed up handoff by skipping bedside checks
Allow private discussion away from patient rooms
Reduce documentation by verbal reports only
Which risk is specifically reduced by walking rounds?
Missed changes in patient condition
Duplicate charting of vital signs
Overstaffing during night shifts
Medication reconciliation delays
Which communication approach pairs documentation with verbal exchange to promote safe care?
Using structured tools like SBAR consistently
Relying on memory during end-of-shift reports
Sharing only abnormal findings verbally
Documenting first and skipping any discussion
In the SBAR framework, which element presents the immediate issue needing attention?
Situation describes the current problem clearly
Background outlines the patient's life story
Assessment lists every lab result chronologically
Recommendation states no action is required
Which statement best characterizes effective coaching for staff?
Helps improve skills and is done respectfully
Highlights errors publicly to deter mistakes
Focuses only on annual evaluation periods
Relies mainly on formal written warnings
Which examples illustrate positive reinforcement in a clinical unit? Select all that apply.
Spontaneous praise after excellent care
Employee of the Month recognition
Private counseling about tardiness
Suspension for repeated policy violations
Key expectations for counseling a staff member include which features? Select all that apply.
Private and brief conversation
Non-confrontational tone
Document the discussion
Conduct it during public rounds
What content should be included in a counseling conversation note?
Behavior, reasons, corrective actions, improvement plan
Personal opinions, rumors, peer complaints, emotions
Unit census, staffing matrix, supply issues, budget
Future vacation approvals, shift swaps, preferences
Order these disciplinary actions from least to most severe: verbal warning, written warning, suspension, termination.
Verbal, written, suspension, termination
Written, verbal, suspension, termination
Suspension, verbal, written, termination
Written, suspension, verbal, termination
Which infraction may warrant immediate termination rather than progressive discipline?
Medication diversion from the unit
Occasional tardiness to shift
Charting done after the shift
Requesting additional orientation
Effective discipline requires which elements? Select all that apply.
Fairness and documentation
Specific examples of behavior
Calm, emotion-controlled communication
Public criticism during staff meeting
What is the primary aim of a performance appraisal?
Evaluate performance against job expectations
Compare peers to create unit rankings
Record only recent achievements for bonuses
Replace all ongoing coaching interactions
Which components should a robust performance appraisal include? Select all that apply.
Regular midyear and end-of-year reviews
Goals and objectives for the role
Focus on future improvement plans
Strict comparison to coworkers' metrics
Choose the correctly constructed SMART goal for a new graduate nurse.
Complete central line dressing training by Friday
Be better at IV starts soon
Do more patient education when possible
Improve documentation when I have time
Which situation exemplifies the recency effect during performance appraisal?
Rating based only on a recent event
One positive trait coloring all ratings
Comparing the nurse directly to peers
Giving everyone an average rating
A manager rates an employee highly overall because the nurse is very friendly, despite documentation errors. Which bias is this?
Halo effect influencing the evaluation
Spillover effect from prior year
Strict/lenient rater tendency
Contrast effect with coworkers
Which statement best reflects the legal and professional standard for nursing documentation?
If it is undocumented, it is considered not done
Late entries are preferred over timely notes
Backdating is acceptable for workflow gaps
Sign-offs transfer responsibility to others
A nurse completes a procedure and immediately charts the actions and patient response. This demonstrates which documentation principle?
Document immediately after tasks are performed
Chart only at the end of the shift
Delay entries to gather more details
Rely on team notes for accuracy
Which action violates ethical documentation practices?
Entering data with the correct time stamp
Using standardized terminology and abbreviations
Altering records to match verbal orders
Recording objective patient assessments
A nurse’s username appears on an inaccurate note. Which responsibility applies?
They are responsible for entries signed in their name
Responsibility belongs to the charge nurse only
Only the unit clerk holds accountability
Only the EHR vendor shares liability
Which list best represents dimensions commonly included under diversity in nursing?
Age, gender, language, orientation, religion
Height, handedness, eye color, posture
Favorite food, hobbies, travel history
Credit score, home size, car ownership
A diverse nursing workforce most directly improves which outcomes?
Morale among staff
Retention of nurses
Cultural competence
Quality of care
Supply costs
Which managerial action best supports inclusion on a unit?
Ensure hiring practices support inclusion
Ignore discriminatory microaggressions routinely
Screen out non-native speakers consistently
Assign schedules based on favoritism alone
Match each conflict type to its description.
Intrapersonal: within oneself
Interpersonal: between individuals
Organizational: structural or policy related
All types: only physician to nurse
Which conflict type is most commonly encountered on nursing units?
Interpersonal conflict between individuals
Intrapersonal conflict within oneself
Organizational or policy conflict
International conflict across systems
Which factors commonly cause conflict in healthcare teams?
Stress and role ambiguity
Values or ethics differences
Poor communication patterns
Staffing shortages on shifts
Abundant financial resources
Which effect most likely results from unresolved unit conflict?
Poor morale among team members
Emotional exhaustion and burnout
Higher productivity consistently
Unsafe patient care conditions
Improved satisfaction reliably
A family becomes upset after feeling excluded from care decisions. Which conflict source fits best?
Patient and family conflict due to exclusion
Nurse-nurse conflict from cliques
Organizational conflict about policy
Interdisciplinary conflict over power
Which behaviors illustrate lateral or horizontal bullying among nurses?
Ignoring reasonable requests for help
Rolling eyes at a colleague frequently
Withholding essential information
Providing supportive peer coaching
Sharing timely updates professionally
A nurse hesitates to call the physician due to fear and power differences. What is the nurse’s duty?
Advocate for the patient despite fear
Wait for rounds to avoid conflict
Document concerns but take no action
Delegate calling to unlicensed staff
Which general strategy is foundational for resolving conflict in clinical settings?
Use clear and respectful communication
Raise your voice to show urgency
Avoid discussing the issue entirely
Focus on blame and past mistakes
Which elements define active listening during difficult conversations?
Avoid interrupting the speaker
Maintain appropriate eye contact
Paraphrase to confirm understanding
Formulate rebuttals while they talk
Break eye contact to end dialogue
Place the DDEAFP steps in the most accurate order of use during feedback.
Describe, Don’t attack, Explain, Ask, Follow up, Plan
Explain, Describe, Ask, Plan, Follow up, Don’t attack
Ask, Describe, Explain, Don’t attack, Plan, Follow up
Plan, Ask, Follow up, Explain, Don’t attack, Describe
In the DDEAFP method, which step comes immediately after explaining the impact?
Ask for what you need instead
Plan ahead to avoid reactions
Follow up with consequences
Describe the observed behavior
What is the primary purpose of negotiation in conflict resolution?
Reach mutually acceptable solutions
Win arguments using authority
Delay decisions until emotions fade
Collect evidence for discipline
Which statement best explains why understanding change matters for modern nursing practice?
It preserves traditional routines during uncertainty
It reduces patient variation through strict rules
It guides improvement using measurable outcomes
It eliminates chaos from daily clinical work
A student nurse feels unsettled as paper exams switch to computer-based testing. What concept does this experience illustrate?
Homeostasis in professional education
Chaos resulting from organizational change
Linear progression of technology adoption
Delegation of academic responsibilities
Which measures are now central to judging nursing success in healthcare organizations?
Patient outcomes across key indicators
Cost effectiveness of provided care
Compliance with physician authority
Adherence to rigid task procedures
Which indicators most directly reflect patient outcomes that drive decisions today?
Fall rates within inpatient units
Safety indicators across services
Staff overtime distribution patterns
Cost effectiveness per intervention
Decisions about staffing and protocol development in contemporary systems are primarily informed by which elements?
Quality improvement data trends
Personal experience of leaders
Statistical outcome measures
Historical routines in units
An effective nurse on a busy unit rapidly adapts to an unexpected emergency while supporting colleagues. This behavior reflects which principle?
Embracing chaos with collaborative agility
Maintaining order through isolated work
Following preset tasks without deviation
Deferring to hierarchy during surprises
Which characteristic aligns with the Newtonian (old science) model of healthcare?
Person-centered over task-focused processes
Orderly, rigid, and linear organization
Team-based collaboration and empowerment
Adaptive responses to unpredictability
Select all features typically associated with Newtonian thinking in clinical settings.
Compartmentalized work in silos
Nurses unquestioningly follow orders
Focus on tasks, machinery, procedures
Holistic view of whole human experiences
Which concise summary captures the Newtonian approach to practice culture?
Empowerment, collaboration, flexible care
Control, predictability, directive orders
Holism, creativity, shared decisions
Chaos-tolerant, adaptive problem-solving
Under the New Science model, which behaviors are encouraged for nurses when encountering unsafe directives?
Question the order to ensure safety
Comply to preserve strict hierarchy
Document quietly without escalation
Delegate the task without discussion
Which set of attributes best represents the New Science perspective in nursing?
World is chaotic and unpredictable
Collaboration and teamwork emphasized
Task-focused over person-centered care
Creative problem-solving encouraged
Which theoretical alignments are most consistent with New Science thinking?
Jean Watson’s Caring Theory alignment
Maslow’s Hierarchy of Needs relevance
Exclusive reliance on machine protocols
Fragmentation into specialized silos
Which phrase best captures the idea of chaos in a healthcare unit?
Gradual shifts toward predictable routines
Movement away from order with disorganization
Strict adherence to linear task lists
Centralized control preventing any variability
Chaos Theory in nursing blends which two perspectives?
Classical physics and behavioral therapy
Newtonian order and new science empowerment
Epidemiology models and pharmacology principles
Systems biology and purely random chance
Which workplace factors commonly generate chaos for nurses and physicians?
Conflicting priorities across teams
High acuity patient populations
Perfect staffing ratios each shift
Rapid adoption of new technologies
In the Strange Attractor concept, what do groups in chaotic conditions tend to do?
Fall apart into isolated silos
Wait for directives before acting
Self-organize and create new order
Freeze operations to stop variance
A unit faces a sudden surge of high-acuity patients. Nurses informally redistribute tasks, cover each other, and re-route workflows. What concept does this illustrate?
Rigid hierarchy enforcement
Strange attractor self-organization
Top-down contingency planning
Delay tactics to maintain status quo
Primary goal of the nurse manager during chaos is to:
Eliminate change and variability
Create order out of chaotic conditions
Document issues without intervening
Transfer risk to external agencies
Which leadership actions help a nurse manager harness chaos constructively?
Believe in team members’ potential
Provide empowering environments
Discourage collaboration to reduce noise
Invite contributions from quieter staff
Which skill set most prepares clinicians for inevitable chaos in healthcare?
Flexibility and adaptability
Critical thinking capacity
Comfort with uncertainty
Strict rule-following only
Legal reality for nurses during chaotic events:
Only direct actions determine liability
Documentation can place you in legal chain
Verbal reports prevent legal exposure
Unassigned patients remove all responsibility
Which attributes describe the Newtonian age of healthcare organizations?
Orderly, siloed structures
Task-focused operations
No questioning physicians
Holistic, empowerment focus
New Science or Quantum Age in care delivery emphasizes:
Empowerment and collaboration
Holistic care orientation
Creative problem-solving approaches
Strict prohibition of change
Core insights from Chaos Theory for nursing practice include:
Chaos is natural and constant
Nurses self-organize under pressure
Managers should craft order from chaos
Best outcomes require zero variability
Which are essential skills for today’s nurse in dynamic settings?
Adaptability and communication
Collaboration across disciplines
Critical thinking under stress
Avoiding change whenever possible
Which statement best defines change in a healthcare context?
Altering the flow of events and moving forward
Maintaining established routines without deviation
Eliminating uncertainty by standardizing all tasks
Returning systems to previous comfortable states
Which is a common reason people resist change in clinical settings?
It reduces anxiety and fear for most staff
It requires reorganizing habits and schedules
It guarantees immediate performance improvement
It removes the need for management oversight
Planned change is best characterized by which feature?
Deliberate action based on identified problems
Uncoordinated shifts due to system imbalance
Resistance-driven steps without clear goals
Spontaneous decisions led by frontline staff
Which example most closely illustrates planned change in a hospital?
Switching from paper charts to an EHR system
Adopting a new workflow after sudden turnover
Gradually skipping huddles due to time pressure
Reassigning roles during an unexpected outage
Change by drift most likely occurs under which condition?
Careful planning with stakeholder engagement
Imbalance within the system over time
Evidence-based protocols with training
Formal approval from administration
A staff member says, “We’ve done it this way for years; now it’s different.” What type of change does this reaction reflect?
Planned change with high acceptance
Change by drift with hostility
Transformational change with incentives
Pilot change with strong leadership
When initiating change, what should be the first step for a nurse manager?
Identify the problem needing change
Set goals and select methods
Recruit a team of stakeholders
Create awareness through discussion
Selecting an informal leader for a change initiative should prioritize which attribute?
Title within administrative hierarchy
Ability to influence respected peers
Availability for overtime scheduling
Years employed on the same unit
Which actions help create awareness during a change effort? Select all that apply.
Discussing the problem openly with staff
Ensuring everyone knows why change is needed
Skipping concerns to avoid negativity
Sharing only final goals without rationale
Which step directly engages those affected by a proposed practice change?
Recruit a team to participate
Define the clinical problem
Set goals and methods
Appoint a formal sponsor
Which statement best defines the Unfreezing phase in Lewin’s theory?
Preparing mindsets for change to occur
Installing the new workflow immediately
Stabilizing the new normal state
Measuring outcomes after long-term use
During Unfreezing, which manager action is most appropriate?
Explain why change is needed using data
Roll out multiple changes at once
Reinforce finalized policies only
Avoid discussing reasons to prevent bias
In the Moving phase, what should managers prioritize?
Teaching, supporting, and reinforcing behavior
Auditing only after six months
Replacing all processes simultaneously
Limiting questions to avoid confusion
Which reaction is typical among employees during the Moving phase?
Feeling anxious or high-energy
Feeling fully settled and calm
Showing long-term habit stability
Demonstrating no need for support
What is the main goal of the Refreezing phase?
Stabilize the change as the new normal
Announce the plan without action
Experiment with unrelated innovations
Return to the previous baseline
Which element is required in Refreezing to maintain change?
Integration into workflow and policies
Frequent unrelated policy shifts
Minimal documentation and oversight
Exclusive reliance on verbal reminders
Select all practices managers should use in the Refreezing phase.
Teach new employees regularly
Re-evaluate the change periodically
Make small adjustments if needed
Delay reinforcement until resistance fades
Which example illustrates a driving force for change in health care?
Desire for better patient outcomes
Fear of failure during training
Preference for familiar routines
Anxiety about new technology
Restraining forces are best described as which of the following?
Barriers, fears, or consequences
Motives encouraging improvement
Rewards for early adopters
Metrics tracking progress only
Which is the key rule before implementing a change initiative?
List driving and restraining forces
Begin rollout during peak stress
Ignore psychological safety needs
Adopt multiple changes at once
Which statement best describes a change agent?
A person who helps make change happen
A regulator who punishes noncompliance
A consultant who ends staff input
A leader who avoids management ties
Which mistake should a change agent avoid?
Skipping a structured plan or process
Inviting staff decision-making input
Providing psychological safety early
Identifying forces that affect change
What does good change typically include?
Natural resistance over time
Immediate full acceptance
Minimal support from managers
No need for formal procedures
Which combination fits Lewin’s Moving phase best?
Trying new behaviors with support
Stabilizing outcomes with policies
Analyzing forces before planning
Reverting to prior practices quickly
Which action aligns with evidence-based leadership during change?
Use accurate, validated information
Rely on anecdotes exclusively
Ignore outcome data completely
Select changes by seniority vote
Which statement best defines Evidence-Based Practice (EBP) in healthcare?
Using best current evidence with clinical expertise
Following organizational traditions without review
Relying on expert opinions over data
Using any available online information
Which practice change illustrates EBP improving patient outcomes regarding catheter use?
Insert Foley catheters for every ER patient
Avoid all Foley catheters in the ER entirely
Insert Foley only with proper indications
Insert Foley based on patient preference
What outcome is reduced when Foley catheters are inserted only with proper indications?
CAUTI rates decrease
Sepsis incidence increases
Pressure injuries decrease
Pain scores increase
Which actions reflect the LPN role in EBP? Select all that apply.
Be aware of relevant research
Use credible sources for information
Adopt changes without evaluation
Evaluate research before changing practice
Which source should an LPN avoid when seeking credible evidence?
Peer-reviewed journals
Professional guidelines
Wikipedia entries
Systematic reviews
EBP primarily aims to replace old habits with which of the following?
Tradition, hierarchy, convenience
Research, current evidence, proven outcomes
Experience, intuition, anecdotal stories
Policy, protocol, authority commands
A unit policy mandates catheters for all febrile patients. Using EBP, what should the LPN advocate?
Keep policy to maintain consistency
Use catheterization only for clear indications
Ask patients whether they prefer catheters
Delay changes until leadership retires
During professional transitions, which feelings are most likely?
Only excitement and confidence
A mix of anxiety and growth
Complete indifference to change
Constant satisfaction with status
Which strategy best supports self-care during a role transition?
Ignore stress signals entirely
Use credible mentors and feedback
Avoid asking questions at work
Work extra shifts continuously
Which example best shows evaluating evidence before changing practice?
Changing based on a single blog post
Reviewing systematic reviews and outcomes
Copying another unit’s routine blindly
Using tradition to guide all decisions
Which combination captures the core elements of EBP decision-making?
Best evidence plus clinical expertise
Manager preference plus budget limits
Physician order plus patient demand
Personal beliefs plus workplace culture
Which transition type might an LPN experience early in a career?
Retirement to volunteer shift
Student to practicing nurse role
Administrator to physician role
Pediatrician to surgeon pathway
