Nurse Delegation and Management Questions to Know

SimpleNursing Editorial Team Jan 24, 2018
Standing on a walkway inthe hospital atrium area, two female nurses discuss the schedule for the day.

Essential NCLEX topics include delegation, prioritization, and leadership. Among those that were mentioned, delegation-type questions are a huge part of nursing schools.

The NCLEX examination is a critical milestone for nursing postgrads, as it determines their eligibility to become licensed registered nurses. The exam assesses their knowledge, skills, and ability to provide safe and effective patient care.

Among the various topics covered on the NCLEX, nurse delegation and management play a vital role in evaluating a nurse’s competency to oversee and assign tasks to other healthcare personnel. 

Nurse Delegation and Management on the NCLEX

Delegation is essential to nursing management, allowing registered nurses to assign specific tasks to other healthcare team members while maintaining accountability for patient outcomes. 

Effective delegation promotes efficiency, teamwork, and optimal patient care. On the NCLEX, nursing postgrads can expect questions that assess their ability to delegate appropriately based on patient needs, staff competency, and legal and ethical considerations.

Nursing Tasks That Cannot be Delegated

While delegation is a fundamental skill for nurses, it’s important to recognize that not all tasks can be delegated. The NCLEX often presents scenarios where nursing postgrads must identify which tasks should be kept from other healthcare personnel. 

Some nursing tasks cannot be delegated due to the specialized knowledge, skills, and judgment required to perform them safely and effectively. Registered nurses undergo extensive education and training to ensure their competency in these areas, enabling them to provide optimal patient care and mitigate potential risks or complications.

Here are some examples:

  1. Administration of Medications by Injection 

The administration of medications by injection requires specialized knowledge and skills that only registered nurses (RNs) possess. This task involves assessing the patient’s condition, calculating the appropriate dosage, selecting the correct injection site, and safely administering the medication. 

RNs receive extensive training in medication administration, including knowledge of different injection techniques and potential complications. The risk of adverse reactions or complications associated with injections necessitates the involvement of an RN who can promptly recognize and respond to any unexpected events.

  1. Sterile Procedures

Sterile procedures, such as wound care, inserting urinary catheters, or performing intravenous (IV) catheter insertions, require strict adherence to aseptic techniques to prevent infection. Registered nurses receive comprehensive education and training on maintaining sterility and preventing healthcare-associated infections. 

They are knowledgeable about sterilization methods, sterile techniques, and the appropriate use of personal protective equipment (PPE). These procedures demand meticulous attention to detail and the ability to handle potential complications that may arise, making them unsuitable for delegation to unlicensed personnel.

  1. Central Line Maintenance 

Central lines are invasive catheters inserted into large blood vessels to provide long-term access to medications, fluids, or blood products. Their maintenance involves monitoring for complications, assessing the insertion site for signs of infection, flushing the lines, and dressing changes. 

Due to the potential risks associated with central lines, such as bloodstream infections or catheter-related complications, the task of central line maintenance requires the expertise of an RN. RNs are equipped to promptly identify and manage any issues that may arise, ensuring the safety and well-being of the patient.

  1. Acts That Require Nursing Judgment

Nursing judgment is a critical component of nursing care, encompassing the ability to assess, analyze, and make decisions based on a patient’s unique circumstances. RNs possess the knowledge and experience to integrate clinical data, interpret complex situations, and identify appropriate interventions. 

When making nursing judgments, they consider factors such as patient preferences, current evidence-based practice, and ethical considerations. 

Delegating acts that require nursing judgment to unlicensed personnel may compromise patient safety and quality of care, as it involves making critical decisions based on a holistic understanding of the patient’s condition.

The PACET Method

When dealing with client and task delegations, there are five things you cannot entrust to other people, broken down into the acronym, PACET (pronounced as “paket”). As a registered nurse, you cannot delegate the nursing process, which is also known in other schools as SOAPIE, ADPIE, or DAR

P (Planning)

If you are an RN, one of your main tasks is to plan and collaborate for client goals. So you must delegate planning to someone other than an LPN or a CNA. This is because you are expected to take on the full responsibility of your client as a registered nurse, and you cannot share that responsibility with other healthcare teams.

A (Assessment)

Secondary assessments can be delegated. However, you can only pass primary assessments to some. That said, can you pick which is the right answer to the question below?

Q: Which of the following clients would you delegate?

  1. A post-op client who just came out from the operating room
  2. New admissions
  3. Three-day-old chest pain

When picking the right answer, you always have to remember that nurses do the first assessment. Now, among the three situations given above, which needs first assessment?

Answer: The client who just came out of the operating room is unstable and needs initial assessment, which is also termed as vigilant assessment. On the other hand, nurses are required to gather more information from new admissions. Therefore, both post-op (A) and new admissions (B) are NOT to be delegated.

So now, you’re left with the post-operative client who’s already been in the hospital for a couple of days and is considered stable. So the answer to the question above is “C”.

C (Collaboration)

Collaboration is for working with other health care team members to achieve client goals. Some collaborations inside the hospital are wound consult, social services, dietary services, and if the client needs a respiratory therapist. Only the RN does this kind of collaboration, not the LVNs.

E (Evaluation)

LPNs and CNAs can take note of the pain scale and vital signs but are not allowed to evaluate because it’s specifically the RN’s role – to think critically and evaluate efficiently. Therefore, the nurse should evaluate:

  • Care plans
  • Client goals
  • Vital signs
  • Pain scale

T (Teaching)

Primary education or client teaching cannot be delegated. LVNs can reinforce education, but they are not responsible for providing exemplary client education to decrease complications that might occur after discharge.

Answering Nurse Delegation and Management NCLEX Questions

Keep in mind, during your NCLEX, that if you see any of the PACET keywords in multiple choice questions, it’s automatically the correct answer under the topic of delegation. Once again, those that you should not delegate and are your primary responsibilities are:

  • Planning
  • Assessment
  • Collaboration
  • Evaluation
  • Teaching

As registered nurses, you have to assume obligation and accountability for the five keywords mentioned above. Furthermore, being keen on identifying if it’s primary or secondary evaluation can help you quickly point out the right answer to your NCLEX.

Don’t forget PACET.

Don’t Miss Out on the Opportunity to Excel on the NCLEX

Mastering the concepts of nurse delegation and management is essential for nursing postgrads preparing for the NCLEX. By demonstrating a solid understanding of delegation principles and the ability to make appropriate decisions, you can enhance your chances of passing the NCLEX.

SimpleNursing provides interactive practice questions, comprehensive content review, and personalized study plans to help you identify your strengths and areas for improvement. So, if you’re ready to take your NCLEX preparation to the next level, explore our platform and boost your confidence for the exam.

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