When the answer is not delegate but escalate

KEEP IT, AND GO UP

Some stems look like delegation questions and are not. The correct action is to keep the work, move upward, and keep moving until someone acts.

1 · The unstable patient was delegated

The most tested harm in this domain. Take the patient back, assess personally, and notify the charge nurse. Do not send the assistive personnel back with better instructions.

2 · The receiver says they have not done it before

Competence is not assumed from role. Do not proceed on the strength of a job title. Teach it, supervise it directly, or keep the task.

3 · The finding was reported and nothing changed

You reported, no order came, and the patient is still deteriorating. Escalate. Do not report the same thing to the same person a third time and call that action.

4 · The assignment is unsafe

Too many high-acuity patients, or a skill mix the unit cannot support. Voice it to the charge nurse, propose a specific redistribution, document the concern through the facility's process, and continue to provide care to the patients you have. Walking off an accepted assignment without transferring care can constitute patient abandonment. Raise the concern, do not disappear.

5 · You were asked to perform outside your competence

Decline that task, state the reason plainly, and request orientation or reassignment of that task only. Declining one procedure you have never performed is not the same as refusing an assignment.

6 · The escalation script

Situation, background, assessment, recommendation, said in that order and ending with a specific ask and a time frame. If the concern is not resolved, escalate the concern itself: state the concern, state that you are uncomfortable, and state that this is a safety issue.

7 · What the exam rewards

The option that goes up exactly one level is usually correct. Jumping to the administrator past an available charge nurse is usually wrong, and documenting instead of acting is always wrong. The exception is the branch: a patient deteriorating in front of you goes to rapid response without a stop at any other level.

Watch outescalation is an action, not a complaint. An option that only records a concern has not helped the patient.

Margin noteone level up. Then the next.

Takeawaywhen a delegation gate fails or a report goes unanswered, the next correct action is upward, one level at a time, with a specific ask.

→ BOOK 02 · P11 for how an escalation appears inside a case-based item. → BOOK 09 · P7 for rapid response clinical criteria.