NMC CBT Leadership, Management, and Teamwork 2 — Questions and Answers
Question 1: A newly qualified nurse witnesses a senior colleague administering medication without checking the patient's identity band. What should they do?
- Ignore it as the senior is more experienced
- Report to the ward manager and complete an incident report (Correct answer)
- Confront the colleague publicly during the drug round
- Wait to see if it happens again
Correct answer: Report to the ward manager and complete an incident report
The NMC Code requires all registrants to raise and escalate patient safety concerns regardless of the other person's seniority.
NMC Code Section 16: act without delay if there is a risk to safety. A medication administration error without patient identification is a serious safety concern under the '5 Rights'. Report to ward manager; complete a Datix; document factually. Whistleblowing protection exists under the Public Interest Disclosure Act 1998.
Question 2: Which leadership style involves collaborative decision-making with the team?
- Autocratic leadership
- Democratic leadership (Correct answer)
- Laissez-faire leadership
- Transactional leadership
Correct answer: Democratic leadership
Democratic leadership involves shared decision-making, team participation, and collaborative working.
Democratic (participative) leadership encourages team input while the leader retains final responsibility. Benefits: higher satisfaction, better decisions, improved cohesion. Not always appropriate in emergencies (autocratic is better). Laissez-faire = minimal direction (least effective). Transformational = inspires change through vision.
Question 3: During a busy shift with insufficient staff, what is the nurse in charge's primary responsibility?
- Continue without escalating
- Complete a risk assessment, prioritise safety, escalate, and document (Correct answer)
- Send patients home
- Ask students to take on registered nurse responsibilities
Correct answer: Complete a risk assessment, prioritise safety, escalate, and document
Assess risk, prioritise patient safety, escalate through appropriate channels, and document all decisions and actions.
The nurse in charge must: (1) Dynamic risk assessment; (2) Prioritise essential and urgent care; (3) Escalate to matron/site manager; (4) Request additional staff; (5) Document on Datix and written record; (6) Ensure care is within each staff member's competence. NMC Code Sections 14 and 16 apply.
Question 4: What does 'duty of candour' mean in NHS practice?
- Duty to maintain patient confidentiality
- Duty to be open and honest with patients when things go wrong, including apologising (Correct answer)
- Duty to report all incidents to the CQC
- Duty to follow senior medical staff instructions
Correct answer: Duty to be open and honest with patients when things go wrong, including apologising
Duty of candour requires transparency and honesty with patients when errors or incidents occur, including an apology.
Duty of candour is both professional (NMC Code Section 14) and statutory (Health and Social Care Act 2008, Regulation 20). Requirements: be open with patients when incidents occur; provide a truthful account; offer a sincere apology (not an admission of liability); explain preventive actions; support the patient. The Francis Report (2013) strengthened this duty.
Question 5: When delegating to a healthcare assistant, which principle must be followed per NMC guidance?
- The HCA is fully responsible once tasks are delegated
- The registered nurse retains accountability for the delegation decision and must ensure the HCA is competent (Correct answer)
- Any task can be delegated if the HCA agrees
- Delegation transfers both responsibility and accountability
Correct answer: The registered nurse retains accountability for the delegation decision and must ensure the HCA is competent
The registered nurse retains accountability for the delegation decision. They must ensure the person has appropriate skills and competence.
NMC Code Section 11: only delegate within the person's competence; ensure adequate training; provide clear instructions; arrange supervision; be available for questions; monitor outcomes. Accountability for the delegation decision cannot be transferred. Tasks requiring clinical judgement (medication, assessment, care planning) should not be delegated to unregistered staff.
Question 6: What is the purpose of a root cause analysis (RCA)?
- To assign blame for a clinical incident
- To systematically investigate underlying causes and identify system improvements (Correct answer)
- To document the incident for legal proceedings
- To determine the financial cost of a clinical error
Correct answer: To systematically investigate underlying causes and identify system improvements
RCA identifies underlying causes and contributing factors, focusing on system improvements rather than individual blame.
RCA involves: gathering evidence; creating a timeline; identifying contributory factors (individual, team, task, environment, organisation); determining root causes; developing action plans. Uses fishbone diagrams, '5 Whys' technique. Adopts a 'just culture' approach recognising most incidents result from system failures.
NMC CBT Leadership, Management, and Teamwork 2
A newly qualified nurse witnesses a senior colleague administering medication without checking the patient's identity band.
What should they do?