Leadership & Management HESI Study Guide
Legal Aspects of Nursing
Laws Governing Nursing
• A. Nurse Practice Acts provide the laws that control
... [Show More] and regulate nursing practice in each state to protect the public from harm. Mandatory Nurse Practice Acts authorize that, under the law, only licensed professionals can practice nursing. All states now have mandatory Nurse Practice Acts. Laws affecting nursing practice vary from state to state.
• B. Nurse Practice Acts govern the nurse’s responsibility in making assignments. Each state sets its own educational and examination requirements.
o Client assignments should be commensurate with the nursing personnel’s educational preparation, skills, experience, and knowledge.
o The nurse should supervise the care provided by unlicensed assistive personnel (UAP) or any individual for which the nurse is administratively responsible.
o Sterile or invasive procedures should be assigned to or supervised by an RN.
o Documenting client care is a legal task.
HESI Hint
Assignments are often tested on the NCLEX-RN. The Nurse Practice Acts of each state govern policies related to making assignments. Usually, when determining who should be assigned to do a sterile dressing change, for example, a licensed nurse should be chosen—that is, a registered nurse (RN) or licensed practical nurse (LPN) who has been checked off on this procedure.
Torts (Violation of Client’s Private Right)
Unintentional Torts
• Definition: An act involving injury or damage to another (except breach of contract) resulting in civil liability (i.e., the victim can sue) instead of criminal liability (see Crime).
• Negligence and malpractice.
o Negligence: Performing an act that a reasonable and prudent person would not perform. The measure of negligence is “reasonableness” (i.e., would a reasonable and prudent nurse act in the same manner under the same circumstances?). That is, did the nurse provide care that did not meet the standard?
o Malpractice: Negligence by professional personnel (e.g., professional misconduct or unreasonable lack of skill in carrying out professional duties). Malpractice is a negligent act performed by an individual in a professional role that results in an injury.
• Four elements are necessary to prove malpractice; if any one element is missing, malpractice cannot be proved.
o Duty: Obligation to use due care (what a reasonable, prudent nurse would do); failure to care for and/or to protect others against unreasonable risk. The nurse must anticipate foreseeable risks. Example: If a floor has water on it, the nurse is responsible for anticipating the risk of a client fall.
o Breach of duty: Failure to perform according to the established standard of conduct in providing nursing care.
o Injury/damages: Failure to meet the standard of care, which causes actual injury or damage to the client (physical injury). Neither emotional nor mental injury is enough to prove malpractice, either physical or mental.
o Causation: A connection exists between conduct and the resulting injury, referred to as proximate cause or remoteness of damage.
• Hospital policies provide a guide for nursing actions. They are not laws, but courts generally rule against nurses who have violated the employer’s policies. Hospitals can be liable for poorly formulated or poorly implemented policies.
• Incident reports alert the administration to possible liability claims and the need for investigation; they do not protect against legal action being taken for negligence or malpractice.
• Examples of negligence or malpractice:
o Burning a client with a heating pad
o Leaving sponges or instruments in a client’s body after surgery
o Performing incompetent assessments
o Failing to heed warning signs of shock or impending myocardial infarction
o Ignoring signs and symptoms of bleeding
o Forgetting to give a medication or giving the wrong medication
HESI Hint
Nurses can avoid negligence and malpractice by following their organization’s policies and procedures.
Intentional Torts
• Assault and battery
o Assault: Mental or physical threat (e.g., forcing [without touching] a client to take a medication or treatment)
o Battery: Actual and intentional touching of one another, with or without the intent to do harm (e.g., hitting or striking a client). If a mentally competent adult is 10 forced to have a treatment he or she has refused, battery occurs.
• Invasion of privacy: Encroachment or trespassing on another’s body or personality
o False imprisonment: Confinement without authorization
o Exposure of a person:
Body: After death, a client has the right to be unobserved, excluded from unwarranted operations, and protected from unauthorized touching of the body.
Personality: Exposure or discussion of a client’s case or revealing personal information or identity.
o Defamation: Divulgence of privileged information or communication (e.g., through charts, conversations, or observations)
• Fraud: Illegal activity and willful and purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property. Examples of fraud include
o Presenting false credentials for the purpose of entering nursing school, obtaining a license, or obtaining employment (e.g., falsification of records).
o Describing a myth regarding a treatment (e.g., telling a client that a placebo has no side effects and will cure the disease, or telling a client that a treatment or diagnostic test will not hurt, when indeed pain is involved in the procedure).
Crime
• An act contrary to a criminal statute. Crimes are wrongs punishable by the state and committed against the state, with intent usually present. The nurse remains bound by all criminal laws.
• Commission of a crime involves the following behaviors:
o A person commits a deed contrary to criminal law.
o A person omits an act when there is a legal obligation to perform such an act (e.g., refusing to assist with the birth of a child if such a refusal results in injury to the child).
o Criminal conspiracy occurs when two or more persons agree to commit a crime.
o Assisting or giving aid to a person in the commission of a crime makes that person equally guilty of the offense (awareness must be present that the crime is being committed).
o Ignoring a law is not usually an adequate defense against the commission of a crime (e.g., a nurse who sees another nurse taking narcotics from the unit supply and ignores this observation is not adequately defended against committing a crime).
o Assault is justified for self-defense. However, to be justified, only enough force can be used to maintain self-protection.
o Search warrants are required before searching a person’s property.
o It is a crime not to report suspected child abuse.
HESI Hint
The nurse has a legal responsibility to report suspected child abuse.
Nursing Practice & the Law
Psychiatric Nursing
• Civil procedures: Methods used to protect the rights of psychiatric clients
• Voluntary admission: The client admits himself or herself to an institution for treatment and retains civil rights.
• Involuntary admission: Someone other than the client applies for the client’s admission to an institution.
o This requires certification by a health care provider that the person is a danger to self or others. (Depending on the state, one or two health care provider certifications are required.)
o Individuals have the right to a legal hearing within a certain number of hours or days.
o Most states limit commitment to 90 days.
o Extended commitment is usually no longer than 1 year.
• Emergency admission: Any adult may apply for emergency detention of another. However, medical or judicial approval is required to detain anyone beyond 24 hours.
o A person held against his or her will can file a writ of habeas corpus to try to get the court to hear the case and release the person.
o The court determines the sanity and alleged unlawful restraint of a person.
• Legal and civil rights of hospitalized clients
o The right to wear their own clothes and to keep personal items and a reasonable amount of cash for small purchases
o The right to have individual storage space for one’s own use
o The right to see visitors daily
o The right to have reasonable access to a telephone and the opportunity to have private conversations by telephone
o The right to receive and send mail (unopened)
o The right to refuse shock treatments and lobotomy
• Competency hearing: Legal hearing that is held to determine a person’s ability to make responsible decisions about self, dependents, or property
o Persons declared incompetent have the legal status of a minor—they cannot
Vote
Make contracts or wills
Drive a car
Sue or be sued
Hold a professional license
o A guardian is appointed by the court for an incompetent person. Declaring a person incompetent can be initiated by the state or the family.
• Insanity: Legal term meaning the accused is not criminally responsible for the unlawful act committed because he or she is mentally ill
• Inability to stand trial: Person accused of committing a crime is not mentally capable of standing trial. He or she
o Cannot understand the charge against himself or herself
o Must be sent to the psychiatric unit until legally determined to be competent for trial
o Once mentally fit, must stand trial and serve any sentence, if convicted.
Patient Identification
• The Joint Commission has implemented new patient identification requirements to meet safety goals
• Use at least two patient identifiers. Ask the client to tell you his or her name and date of birth (DOB) whenever taking blood samples, administering medications, or administering blood products.
• The patient room number may not be used as a form of identification.
Surgical Permit
• Consent to operate (surgical permit) must be obtained before any surgical procedure, however minor it might be.
• Legally, the surgical permit must be
o Written
o Obtained voluntarily
o Explained to the client (i.e., informed consent must be obtained)
• Informed consent means the procedure and treatment or operation has been fully explained to the client, including
o Possible complications, risks, and disfigurements
o Removal of any organs or parts of the body
o Benefits and expected results
• Surgery permits must be obtained as follows:
o They must be witnessed by an authorized person, such as the health care provider or a nurse.
o They protect the client against unsanctioned surgery, and they protect the health care provider and surgeon, hospital, and hospital staff against possible claims of unauthorized operations.
o Adults and emancipated minors may sign their own operative permits if they are mentally competent.
o Permission to operate on a minor child or an incompetent or unconscious adult must be obtained from a legally responsible parent or guardian. The person granting permission to operate on an adult who lacks capacity to understand information about the proposed treatment (e.g., because of advanced Alzheimer disease or unconscious adult) must be identified in a Durable Power of Attorney or an Advance Health Directive.
HESI Hint
Often an NCLEX-RN question asks who should explain and describe a surgical procedure to the client, including both complications and the expected results of the procedure. The answer is the health care provider. Remember that it is the nurse’s responsibility to be sure that the operative permit is signed and is in the client’s medical record. It is not the nurse’s responsibility to explain the procedure to the client. The nurse must document that the client was given the information and agreed to it.
Consent
• The law does not require written consent to perform medical treatment.
o Treatment can be performed if the client has been fully informed about the procedure.
o Treatment can be performed if the client voluntarily consents to the procedure.
o If informed consent cannot be obtained (e.g., client is unconscious) and immediate treatment is required to save life or limb, the emergency laws can be applied. (See the subsequent section, Emergency Care.)
• Verbal or written consent
o When verbal consent is obtained, a notation should be made.
It describes in detail how and why verbal consent was obtained.
It is placed in the client’s record or chart.
It is witnessed and signed by two persons.
o Verbal or written consent can be given by
Alert, coherent, or otherwise competent adults
A parent or legal guardian
A person in loco parentis (a person standing in for a parent with a parent’s rights, duties, and responsibilities) in cases of minors or incompetent adults
• Consent of minors
o Minors 14 years of age and older must agree to treatment along with their parents or guardians.
o Emancipated minors can consent to treatment themselves. Be aware that the definition of an emancipated minor may change from state to state.
Emergency Care
• Good Samaritan Act: Protects health care providers against malpractice claims for care provided in emergency situations (e.g., the nurse gives aid at the scene to an automobile accident victim).
• A nurse is required to perform in a “reasonable and prudent manner.”
HESI Hint
Often NCLEX-RN questions address the Good Samaritan Act, which is the means of protecting a nurse when she or he is performing emergency care.
Prescriptions & Health Care Providers
• A nurse is required to obtain a prescription (order) to carry out medical procedures from a health care provider.
• Although verbal telephone prescriptions should be avoided, the nurse should follow the agency’s policy and procedures. Failure to follow such rules could be considered negligence. The Joint Commission requires that organizations implement a process for taking verbal or telephone orders that includes a read-back of critical values. The employee receiving the prescription should write the verbal order or critical value on the chart or record it in the computer and then read back the order or value to the health care provider.
• If a nurse questions a health care provider’s (e.g., physician, advanced practice RN, physician’s assistant, dentist) prescription because he or she believes that it is wrong (e.g., the wrong dosage was prescribed for a medication), the nurse should do the following:
o Inform the health care provider.
o Record that the health care provider was informed and record the health care provider’s response to such information.
o Inform the nursing supervisor.
o Refuse to carry out the prescription.
• If the nurse believes that a health care provider’s prescription was made with poor judgment (e.g., the nurse believes the client does not need as many tranquilizers as the health care provider prescribed), the nurse should
o Record that the health care provider was notified and that the prescription was questioned
o Carry out the prescription because nursing judgment cannot be substituted for a health care provider’s judgment
• If a nurse is asked to perform a task for which he or she has not been prepared educationally (e.g., obtain a urine specimen from a premature infant by needle aspiration of the bladder) or does not have the necessary experience (e.g., a nurse who has never worked in labor and delivery is asked to perform a vaginal examination and determine cervical dilation), the nurse should do the following:
o Inform the health care provider that he or she does not have the education or experience necessary to carry out the prescription.
o Refuse to carry out the prescription.
• The nurse cannot, without a health care provider’s prescription, alter the amount of drug given to a client. For example, if a health care provider has prescribed pain medication in a certain amount and the client’s pain is not, in the nurse’s judgment, severe enough to warrant the dosage prescribed, the nurse cannot reduce the amount without first checking with the health care provider. Remember, nursing judgment cannot be substituted for medical judgment.
HESI Hint
If the nurse carries out a health care provider’s prescription for which he or she is not prepared and does not inform the health care provider of his or her lack of preparation, the nurse is solely liable for any damages.
If the nurse informs the health care provider of his or her lack of preparation in carrying out a prescription and carries out the prescription anyway, the nurse and the health care provider are liable for any damages.
Restraints
• Clients may be restrained only under the following circumstances:
o In an emergency
o For a limited time
o For the purpose of protecting the client from injury or from harm
• Nursing responsibilities with regard to restraints
o The nurse must notify the health care provider immediately that the client has been restrained.
o It is required and imperative that the nurse accurately document the facts and the client’s behavior leading to restraint.
• When restraining a client, the nurse should do the following:
o Use restraints (physical or chemical) after exhausting all reasonable alternatives.
o Apply the restraints correctly and in accordance with facility policies and procedures.
o Check frequently to see that the restraints do not impair circulation or cause pressure sores or other injuries.
o Allow for nutrition, hydration, and stimulation at frequent intervals.
o Remove restraints as soon as possible.
o Document the need for and application, monitoring, and removal of restraints.
o Never leave a restrained person alone.
HESI Hint
Restraints of any kind may constitute false imprisonment. Freedom from unlawful restraint is a basic human right and is protected by law. Use of restraints must fall within guidelines specified by state law and hospital policy.
Health Insurance Portability & Accountability Act of 1996
• Congress passed the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to create a national patient-record privacy standard.
• HIPAA privacy rules pertain to health care providers, health plans, and health clearinghouses and their business partners who engage in computer-to-computer transmission of health care claims, payment and remittance, benefit information, and health plan eligibility information, and who disclose personal health information that specifically identifies an individual and is transmitted electronically, in writing, or verbally.
• Patient privacy rights are of key importance. Patients must provide written approval of the disclosure of any of their health information for almost any purpose. Health care providers must offer specific information to patients that explains how their personal health information will be used. Patients must have access to their medical records, and they can receive copies of them and request that changes be made if they identify inaccuracies.
• Health care providers who do not comply with HIPAA regulations or make unauthorized disclosures risk civil and criminal liability.
Review of Legal Aspects of Nursing
1. What types of procedures should be assigned to professional nurses? Sterile or Invasive Procedures.
2. Negligence is measured by reasonableness. What question might the nurse ask when determining such reasonableness? Would a reasonable and prudent nurse act in the same manner under the same circumstances?
3. List the four elements that are necessary to prove malpractice (professional negligence). Duty: Failure to protect client against unreasonable risk. Breach of duty: Failure to perform according to established standards. Causation: A connection exists between conduct of the nurse and the resulting damage. Damages: Damage is done to the client, whether physical or mental.
4. Define an intentional tort and give one example. Conduct causing damage to another person in a willful or intentional way without just cause. Example: Hitting a client out of anger, not in a manner of self-protection.
5. Differentiate between voluntary and involuntary admission. Voluntary: Client admits self to an institution for treatment and retains his or her civil rights; he or she may leave at any time. Involuntary: Someone other than the client applies for the client’s admission to an institution (a relative, a friend, or the state); requires certification by one or two health care providers that the person is a danger to self or others; the person has a right to a legal hearing (habeas corpus) to try to be released, and the court determines the justification for holding the person.
6. List five activities a person who is declared incompetent cannot perform. Vote, make contracts or wills, drive a car, sue or be sued, hold a professional license.
7. Name three legal requirements of a surgical permit. Voluntary, informed, written.
8. Who may give consent for medical treatment? Alert, coherent, or otherwise competent adults; a parent or legal guardian; a person in loco parentis of minors or incompetent adults
9. What law protects the nurse who provides care or gives aid in an emergency situation? The Good Samaritan Act.
10. What actions should the nurse take if the nurse questions a health care provider’s prescription—that is, believes the prescription is wrong? Inform the health care provider; record that the health care provider was informed and the health care provider’s response to such information; inform the nursing supervisor; refuse to carry out the prescription.
11. Describe the nurse’s legal responsibility when asked to perform a task for which he or she is unprepared. Inform the health care provider or person asking the nurse to perform the task that he or she is unprepared to carry out the task; refuse to perform the task.
12. Describe nursing care of the restrained client. Apply restraints properly; check restraints frequently to see that they are not causing injury and record such monitoring; remove restraints as soon as possible; use restraints only as a last resort.
13. Describe six patient rights guaranteed under HIPAA regulations that nurses must be aware of in practice. A patient must give written consent before health care providers can use or disclose personal health information; health care providers must give patients notice about providers’ responsibilities regarding patient confidentiality; patients must have access to their medical records; providers who restrict access must explain why and must offer patients a description of the complaint process; patients have the right to request that changes be made in their medical records to correct inaccuracies; health care providers must follow specific tracking procedures for any disclosures made that ensure accountability for maintenance of patient confidentiality; patients have the right to request that health care providers restrict the use and disclosure of their personal health information, although the provider may decline to do so.
Leadership & Management
• Nurses act in both leadership and management roles.
• A leader is an individual who influences people to accomplish goals.
• A manager is an individual who works to accomplish the goals of the organization.
• A nurse manager acts to achieve the goals of safe, effective client care within the overall goals of a health care facility.
HESI Hint
Motivation comes from within an individual. A nurse leader can provide an environment that will promote motivation through positive feedback, respect, and seeking input. Look for responses that demonstrate these behaviors.
HESI Hint
NCLEX-RN questions often include examples of nursing interventions that do or do not demonstrate the skills and characteristics of the nurse manager.
Maintaining a Safe Work Environment
• Nurse managers are responsible for addressing
o Workplace violence
o Nursing staff substance abuse
o Incivility and bullying
Incivility and bullying includes actions taken and not taken.
Example: Refusing to share pertinent information with another nurse regarding a client’s stats, thus jeopardizing the client’s safety.
Example: Deliberately withholding information pertinent to the client’s well-being and safety, such as not telling a nurse that the HCP requested that a client’s medication should be held.
o Inappropriate use of social media
o Inappropriate nurse-client relationships
• Nurse leaders and staff members must provide systems to educate staff for heightened awareness of common behaviors 14 associated with the items mentioned above, as well as providing mechanisms for reporting.
o In dire cases, nurse managers must implement remediation and training to protect clients from these egregious behaviors that infringe on patients’ safety.
o The Joint Commission, the American Nurses Association, and other entities are addressing the dangerous impact of incivility and bullying on patients.
Communication Skills
• Assertive communication
o Includes clearly defined goals and expectations
o Includes verbal and nonverbal messages that are congruent
o Is critical to the directing aspect of management
Organization Skills
• Organizational skills encompass management of:
o People
o Time
o Supplies
Delegation Skills
• The authority, accountability, and responsibility of the RN are based on the state Nurse Practice Act, standards of professional practice, the policies of the health care organization, and ethical-legal models of behavior.
• Definitions:
o Delegation is the process by which duties, tasks, and coordination of care are transferred to ancillary and assistive personnel, as well as other nurses. The nurse maintains responsibility and accountability for the quality and quantity of supervision in regard to delegated assignments.
o Responsibility is the obligation to complete a task.
o Authority is the right to act or command the actions of others.
o Accountability is the ability and willingness to assume responsibility for actions and related consequences.
• The nurse transfers responsibility and authority for the completion of delegated tasks, but the nurse retains accountability for the delegation process. This accountability involves ensuring that the five rights of delegation have been achieved.
• The five rights of delegation (as defined by the National Council of State Boards of Nursing)
o Right task: Is this a task that can be delegated by a nurse?
o Right circumstance: Considering the setting and available resources, should delegation take place?
o Right person: Is the task being delegated by the right person to the right individual?
o Right direction/communication: Is the nurse providing a clear, concise description of the task, including limits and expectations?
o Right supervision: Once the task has been delegated, is appropriate supervision maintained?
HESI Hint
Delegating to the right person requires that the nurse be aware of the qualifications of the delegatee: appropriate education, training, skills, experience, and demonstrated and documented competence.
HESI Hint
Remember the nursing process: Assessments, analysis, diagnosis, planning, and evaluation (any activity requiring nursing judgment) may not be delegated to UAP. Delegated activities fall within the implementation phase of the nursing process.
HESI Hint
UAP generally do not perform invasive or sterile procedures.
HESI Hint
RNs should give clear instructions—be specific, communicating the objectives of the delegated task and the expected results.
Remember that even though a task may be delegated under law and facility policy, you, the nurse, are responsible for its outcome.
HESI Hint
Assertive communication starts with “I need” rather than with “You must.”
Organizational Skills
Supervision Skills
• Direction/guidance
o Clear, concise, specific directions
o Expected outcome
o Time frame
o Limitations
o Verification of assignment
• Evaluation/monitoring
o Frequent check-in
o Open communication lines
o Achievement of outcome
• Follow-up
o Communication of evaluation findings to the LPN or UAP and other appropriate personnel
o Need for teaching or guidance
HESI Hint
The RN is accountable for adhering to the three basic aspects of supervision when delegating to other health care personnel, such as LPNs, graduate nurses, inexperienced nurses, student nurses, and UAP.
Critical Thinking Skills
• Nurses are accustomed to using the nursing process as the model for problem solving in client care situations.
• Use this model to think critically in leadership and management situations.
o Assessment: What are the needs or problems?
o Analysis: What has the highest priority?
o Planning:
What outcomes and goals must be accomplished?
What are the available resources?
• Nursing staff
• Interdisciplinary team members
• Time
• Equipment and supplies
• Space (client rooms, home environment, etc.)
o Implementation
Communicating expectations
Is documentation complete?
o Evaluation
Were the desired outcomes achieved?
Was safe, effective care provided?
HESI Hint
Priorities often center on which client the nurse should assess first. Ask yourself the following questions: Which client is the most critically ill and unstable? Which client is most likely to experience a significant change in condition? Which client requires assessment by an RN?
HESI Hint
The nurse manager must analyze all the desired outcomes involved when assigning rooms for clients or assigning client care responsibilities. For example, a client with an infection should not be assigned to share a room with a surgical or immunocompromised client. A nurse’s client care management should be based on the nurse’s abilities, the individual client’s needs, and the needs of the entire group of assigned clients. Safety and infection control are high priorities.
Skills Needed by Change Agents
• Problem solving
• Decision making
• Interpersonal relationships
HESI Hint
Change causes anxiety. An effective nurse change agent uses problem-solving skills to recognize factors such as anxiety that contribute to resistance to change and uses decision making and interpersonal skills to overcome that resistance. Interventions that demonstrate these skills include seeking input, showing respect, valuing opinions, and building trust.
Nurse Leaders & Managers as Collaborators
• Interprofessional health care teams require
o Shared goals, commitment, and accountability
o Open and clear communication
o Respect for the expertise of all team members
• Critical pathways
o Are interprofessional plans of care
o Are used for diagnoses and care that can be standardized
o Are guides to track client progress
o Do not replace individualized care
• Case management
o Coordinates care provided by an interprofessional team
o Manages resources effectively
o Uses critical pathways to organize care
• Quality assurance
o Involves continuous quality improvement/total quality management
o Is an organized approach to the improvement of
Outcome achievement
Quality of care provided
HESI Hint
The Interprofessional Education Collaborative Expert Panel (IPEC) recommended development of four core competencies for interprofessional collaborative practice. Those competency domains among health care professionals include 1) values/ethics for interprofessional practice; 2) roles/responsibilities; 3) interprofessional communication; and 4) teams and teamwork.
Review of Leadership & Management
1. By what authority may RNs delegate nursing care to others? State Nurse Practice Act
2. A UAP may perform care that falls within which component of the nursing process? Implementation.
3. Which type of communication is necessary to implement a democratic leadership style? Assertive Communication Skills.
4. What are the five rights of delegation? Right task, right circumstance, right person, right direction or communication, and right supervision
5. Which of the following tasks can be delegated to a UAP? A. Inserting a Foley catheter, B. Measuring and recording the client’s output through a Foley catheter, C. Teaching a client how to care for a catheter after discharge, D. Assessing for symptoms of a urinary tract infection - A. Is a sterile invasive procedure and should not be delegated to a UAP
B. Falls within the implementation phase of the nursing process and does not require nursing judgment. Evaluation of the I&O must be done by the nurse.
C. Client teaching requires the abilities of a nurse and should not be delegated. The UAP may be instructed to report anything unusual that is observed and any symptoms reported by the client, but this does not replace assessment by the nurse.
D. Assessment must be performed by the nurse and should not be delegated. The UAP may be instructed to report anything unusual that is observed or any symptoms reported by the client, but this does not replace assessment by the nurse.
6. What are the essential steps of effective supervision? Direction, evaluation, and follow-up
7. Which of the following is an example of assertive communication? A. “You need to improve the way you spend your time so that all of your care gets performed.” Or B. “I’ve noticed that many of your clients did not get their care today.” - A. This is an aggressive communication, which causes anger, hostility, and a defensive attitude.
B. Assertive communication begins with “I” rather than “you” and clearly states the problem.
8. What are common signs of substance? Common signs of substance are clients complaining that pain medication does not relieve pain when administered by a certain nurse, frequent inaccuracies of controlled medication counts for a specific nurse, and client reports not taking pain medications, but several doses are signed out for that client.
9. Describe common characteristics of incivility/bullying among nurses. Common characteristics of incivility/bullying are refusing to work with others, yelling or cursing at peers, making degrading comments, and verbal abuse. Workplace violence contributes to high staff turnover rate and decline in client care.
More HESI Hints:
HESI Hint
Often an NCLEX-RN® question asks who should explain a surgical procedure to the client. The answer is the health care provider. Remember that it is the nurse’s responsibility to be sure that the operative permit is signed and is on the chart. It is not the nurse’s responsibility to explain the procedure to the client.
HESI Hint
Often questions are asked regarding the Good Samaritan Act, which is the means of protecting a nurse when she or he is performing emergency care.
HESI Hint
Assignments are often tested on the NCLEX-RN.The Nurse Practice Acts of each state govern policies related to making assignments. Usually, when determining who should be assigned to do a sterile dressing change, for example, a licensed nurse should be chosen—that is, an RN or licensed practical nurse (LPN) who has been checked off on this procedure.
HESI Hint
Effective leadership involves assertive management skills. Look for responses that demonstrate that the nurse is using assertive communication skills.
HESI Hint
Delegating to the right person requires that the nurse be aware of the qualifications of the delegatee: Appropriate education, training, skills, experience, and demonstrated and documented competence.
HESI Hint
UAPs generally do not perform invasive or sterile procedures. [Show Less]