Nursing Leadership, Management, and Ethics
This domain tests delegation, leadership style, conflict resolution, resource management and ethical-legal decision-making. Questions often ask who is accountable or what the nurse should do first.
Core rules and concepts
- Delegation: the right task, circumstance, person, direction and communication, supervision and evaluation. The registered nurse retains accountability and cannot delegate assessment, diagnosis, planning, evaluation or teaching.
- Leadership styles: autocratic (crisis and rapid decisions), democratic (shared decisions), laissez-faire (low guidance), transformational (vision and motivation).
- Conflict: address early, use “I” statements, focus on the problem and negotiate.
- Ethical principles: autonomy, beneficence, non-maleficence, justice, veracity and confidentiality.
- Informed consent: capacity, disclosure, voluntariness and documentation; the provider obtains consent, the nurse witnesses and advocates.
- Incident reporting: factual, timely and non-punitive, for safety learning.
Worked example
A ward is busy and a stable patient needs routine vital signs. The registered nurse may delegate this to a trained assistant because it is a standard, predictable task with clear parameters. The nurse may not delegate assessment of a deteriorating patient or discharge teaching, because those require nursing judgement and accountability.
Traps that cost marks
- Delegating nursing judgement or teaching.
- Breaching confidentiality, including on social media.
- Accepting verbal orders without verification and documentation.
- Choosing autocratic leadership when collaboration is required.