A nurse manager is implementing strategies to improve the work environment on a busy telemetry unit after staff reported burnout and decreased morale.
Which action by the nurse manager is most effective in promoting a healthy work environment and improving patient outcomes?

Choice A rationale

Delegating in accordance with state practice acts is a core legal and professional requirement for nurse managers. They must ensure that tasks are assigned only to individuals with the appropriate license, skills, and training. This oversight prevents the unauthorized practice of nursing and protects patient safety by ensuring that the person performing the task is legally allowed and competent to do so under the law.

Choice B rationale

Nurse managers have a legal duty to communicate essential information regarding policy changes to their staff. Failure to notify employees of new medication administration protocols could lead to systemic errors and legal liability for the manager and the institution. Ensuring that staff are aware of current evidence-based practices and internal policies is a critical component of maintaining the standard of care within a healthcare unit.

Choice C rationale

Scheduling and staffing are fundamental managerial responsibilities linked to the duty of care. Providing an adequate number of qualified staff is necessary to prevent burnout, errors, and neglect. If a manager knowingly understaffs a unit to a dangerous level, they can be held legally accountable for any adverse patient outcomes that occur as a result of the inability to provide timely and safe nursing interventions.

Choice D rationale

Supervising the practice of a physician is outside the legal scope of a nurse manager. Physicians are independent practitioners governed by their own medical boards and practice acts. While a nurse manager must facilitate collaboration and report concerns through appropriate channels, they do not have the legal authority or responsibility to supervise or direct the clinical medical practice of doctors. This choice represents the exception to manager duties.

Choice A rationale

Fever causes an increased metabolic rate, leading to diaphoresis and potential dehydration. Restlessness often signals early hypoxia or neurological changes that require immediate assessment to ensure airway and circulatory stability. In triage, the nurse must prioritize clients exhibiting signs of physiological distress or mental status changes. This client is the most unstable among the group, as restlessness can escalate to agitation or respiratory failure without prompt nursing intervention and cooling measures.

Choice B rationale

A postoperative client who has recently received pain medication is currently being managed for their primary concern. While pain is significant, it does not typically pose an immediate threat to life compared to restlessness and fever. The nurse should monitor for medication effectiveness and respiratory depression later, but since the intervention has already occurred, this client is considered stable. Immediate care is directed toward those with unaddressed acute symptoms rather than those in the recovery phase.

Choice C rationale

An ambulatory client is generally considered stable and able to perform activities of daily living with minimal assistance. Their ability to walk suggests that their cardiovascular and respiratory systems are compensated and not in acute distress. While they still require nursing assessment and care throughout the shift, they do not take priority over a client with systemic symptoms like fever and restlessness. Monitoring this client can be deferred until more urgent physiological needs are met.

Choice D rationale

A client scheduled for physical therapy later in the day, specifically at 1 pm, has a predictable and non-urgent schedule. This is a routine part of their rehabilitation process and does not indicate an acute change in status. Planning care around therapy sessions is a matter of time management rather than clinical prioritization. The nurse should focus on the most symptomatic and potentially unstable clients first to prevent complications before moving to routine appointments.