Leadership, Management & Team Working

A registered nurse delegates a task to a healthcare assistant. Where does accountability for the decision to delegate lie?

• AWith the ward manager, as the person in charge of the ward that day
• BWith the registered nurse who delegated the task✓
• CWith the patient who received the care, once they have given consent
• DWith the healthcare assistant, once they have accepted the delegated task

Answer: The registered nurse remains accountable for the decision to delegate and must ensure the task is appropriate and the person is competent. The healthcare assistant is responsible for carrying out the task safely.

When delegating a task, which factor is most important for the registered nurse to confirm first?

• AThat the person delegated to is competent to perform it safely✓
• BThat the task is the least pleasant of the jobs left to do on the ward
• CThat there is no one else available on the ward to take the task on
• DThat handing the task over will save the registered nurse the most time

Answer: Safe delegation requires confirming the person has the competence to perform the task and the patient will not be put at risk. The NMC Code makes the delegating nurse responsible for ensuring this.

A newly qualified nurse is unsure about a complex decision during a busy shift. What does effective team working suggest they do?

• AMake the decision alone and say nothing about it to the rest of the team
• BSeek advice and support from a senior colleague✓
• CGuess to avoid appearing inexperienced
• DDelay all care until the next shift

Answer: Effective team working and the NMC Code support asking for help and seeking advice when unsure. Seeking timely support from senior colleagues protects patient safety and aids professional development.

A nurse leading a shift notices the ward is short-staffed and patient safety may be compromised. What is the most appropriate action?

• ACarry on through the shift without informing anyone, to avoid complaints
• BEscalate the staffing concern to the senior manager and document it✓
• CRefuse to provide any further care until the staffing level improves
• DSend patients home early to reduce workload

Answer: The NMC Code requires nurses to raise concerns about anything that may compromise safe care, including inadequate staffing. Escalating to management and documenting the concern is the responsible leadership action.

Which statement best describes good practice when raising a concern (whistleblowing) about patient safety?

• AConcerns should only be raised if you have absolute proof
• BConcerns should be raised promptly through the appropriate channels even if you are not certain✓
• CConcerns should be ignored if a colleague might be affected
• DConcerns are best kept anonymous and raised only on social media

Answer: The NMC Code expects nurses to raise concerns promptly and through the correct channels whenever they believe patient safety may be at risk. Certainty is not required, and concerns must never be aired on social media.

After delegating a task to a healthcare assistant, what does the NMC Code require of the registered nurse?

• ATo make no further checks once the task is handed on
• BTo complete the task again to be certain it was done
• CTo confirm the outcome meets the required standard✓
• DTo ask the patient to report any problems themselves

Answer: The Code says registrants must confirm that the outcome of any task they have delegated meets the required standard, and give support and supervision as needed.

In which UK nation is the nursing associate role regulated by the NMC?

• AScotland
• BWales
• CEngland✓
• DNorthern Ireland

Answer: Nursing associates are regulated by the NMC for practice in England. The role is not currently used in the other UK nations.

At the start of a shift, which patient should you assess first?

• AA patient with noisy breathing and oxygen saturation of 88%✓
• BA patient asking for help to choose tomorrow's menu
• CA patient waiting for transport home after discharge
• DA patient due to have their evening medicines in two hours

Answer: Prioritising using ABCDE puts airway and breathing problems first. Noisy breathing and low oxygen saturation suggest a potentially life-threatening problem.

You disagree with a colleague about how a patient's care is being handled. What is the best first step?

• ASay nothing and leave the problem for someone else
• BComplain about them to other staff on the ward first
• CRaise it with them in front of the patient and family
• DTalk it through privately and respectfully✓

Answer: Addressing a disagreement directly, privately and respectfully usually resolves it and maintains team working. Escalate if patient safety is at risk or it cannot be resolved.

In human factors, what is meant by 'situational awareness'?

• ABeing aware of which staff members are on their breaks
• BUnderstanding the layout of the building in case of fire
• CKnowing what is happening around you and what may happen✓
• DKnowing the name of every patient and relative on the ward

Answer: Situational awareness means perceiving what is going on, understanding what it means and anticipating what will happen next. Losing it is a common factor in errors.

What is a safety huddle?

• AA formal disciplinary meeting after a serious incident
• BA meeting with patients to discuss hospital food
• CA long weekly meeting to review the ward budget
• DA short team briefing to act on safety risks✓

Answer: Safety huddles are brief, regular meetings where the team shares information about patients at risk and agrees actions to keep people safe.

Under the NMC's Standards for student supervision and assessment, who assesses a student's practice?

• AA fellow student
• BA mentor
• CA practice assessor✓
• DThe ward clerk

Answer: The NMC's standards separate the roles of practice supervisor, practice assessor and academic assessor. The practice assessor assesses and confirms the student's achievement in practice.

When should discharge planning begin for a patient admitted to hospital?

• AOn or soon after admission✓
• BOnce the patient asks to leave
• COn the day of discharge
• DAfter the final ward round

Answer: Planning discharge from admission gives time to arrange services, equipment and support, reducing delays and the risk of readmission.

A patient is coughing when they drink and seems to have difficulty swallowing. Who should they be referred to?

• AA podiatrist
• BA physiotherapist
• CAn occupational therapist
• DA speech and language therapist✓

Answer: Speech and language therapists assess and manage swallowing difficulties (dysphagia). Keep the patient safe, for example nil by mouth, until they are assessed, following local policy.