Nursing Leadership, Management and Delegation
What this domain tests
Nursing Leadership, Management and Delegation tests prioritization, delegation, supervision, conflict resolution, staffing, and change management.
Core rules
- Delegation transfers a task, not accountability. The nurse retains responsibility for assessment, teaching, evaluation, and judgment.
- Five rights of delegation: right task, right circumstance, right person, right direction and communication, right supervision and evaluation.
- Delegate stable, predictable tasks to unlicensed assistive personnel: vital signs on stable patients, hygiene, ambulation, intake and output. Do not delegate assessment, teaching, medication administration, or evaluation.
- Prioritize using ABCs, Maslow, and stable versus unstable; the first assessment is not always the first action.
- Conflict resolution moves from collaboration to compromise to accommodation; use I-statements and address behavior, not personality.
- Change is more likely to succeed with clear rationale, stakeholder involvement, small tests of change, and visible support.
Worked example
You lead a team with a licensed practical nurse and a nursing assistant. One patient is newly admitted with chest pain, another needs a dressing change, and a third needs a bath. How do you delegate? Reasoning: assess the chest pain patient yourself because assessment and judgment cannot be delegated. Assign the stable dressing change to the practical nurse if within scope and competency, and the bath to the assistant. Give clear directions, a time frame, and the expected findings to report, then follow up.
Traps
- Delegating teaching or initial assessment to unlicensed staff.
- Assuming delegation ends your responsibility for the outcome.
- Using accommodation as the first response to every conflict.
- Prioritizing routine care because it is easy to complete.