Platform 5: Leading and Managing Nursing Care and Working in Teams

Scope and weight

These ten questions are about the nurse as a leader, even for a newly registered nurse. In UK wards, a registered nurse routinely coordinates healthcare assistants, nursing associates and students, often leading a bay or a team. Candidates trained in systems with different role boundaries can find the content unfamiliar. The questions are not about management theory. They test sound judgement about who does what, who is told what and when to speak up.

What is tested

• Delegation. Delegating to healthcare support workers and nursing associates while keeping accountability.
• Organising work. Prioritising workload, managing time and coordinating care for a group of patients such as a bay.
• Communication. Handover and SBAR, and assertiveness when challenging unsafe practice.
• Supervision. Practice supervisor and practice assessor roles for student nurses, mentoring and preceptorship.
• Leadership. Leadership styles, role modelling, managing conflict and challenging behaviour.
• Staffing and resources. Escalating unsafe staffing and managing equipment and stock.
• Quality. Leading change and quality improvement (PDSA), clinical governance and clinical audit.
• Complaints and wellbeing. Informal resolution of complaints and supporting colleague wellbeing.
• Teamwork. Interprofessional and multidisciplinary working.

Local points to anchor your answers

• You remain accountable. Code 11: you are accountable for the decision to delegate. You delegate tasks to someone competent, with appropriate support and supervision, and you do not delegate what is outside their role.
• Working within competence. Code 13: refer in a timely way, and complete training before a new role.
• Escalate unsafe staffing. The Code expects you to raise concerns when staffing places people at risk, and to record that you did. Informal grumbling is not escalation.
• SBAR. Situation, Background, Assessment, Recommendation. It is the standard structure for handover and for escalation to senior colleagues.
• PDSA. Plan, do, study, act: small tests of change are the standard quality improvement approach.
• Student supervision. UK practice separates the practice supervisor, who supports daily learning, from the practice assessor, who confirms achievement. Confirm role details at source.

Three typical traps

1. Delegating the assessment. A healthcare assistant can record observations, but interpreting a deteriorating patient's score and deciding the response remains the registered nurse's responsibility. An option that hands over that decision is wrong.
2. Solving the problem quietly. When a colleague's practice puts a patient at risk, the nurse acts promptly and escalates through the proper route. Waiting for the next shift or confronting the colleague in public are weaker options.
3. Prioritising by task order or seniority. The first patient to see is the one with the greatest clinical need or risk, not the one who asked first or the one with the most paperwork.

How the questions are framed

Platform 5 stems put you in charge of a bay, a shift or a small team. A healthcare assistant reports a patient who is more drowsy than earlier, a student asks to do a procedure they have not yet been assessed on, two patients need attention at the same moment, or a colleague arrives late and unwell. The question asks what the registered nurse should do. The scoring reflects the Code: protect people, stay within competence, communicate clearly and escalate when needed.

What the exam asks about each group

• Delegation. Check the task, the person's competence and the supervision available, and keep responsibility for the outcome. Do not delegate assessment or judgement that needs a registered nurse.
• Prioritisation. Rank by clinical risk, using tools such as NEWS2, and revisit the ranking as the situation changes.
• Handover and escalation. Use SBAR, include the essentials, and ask for a response from the right person. A vague message to the wrong person is weaker than a structured call to the right one.
• Supervision and learning. Support students and new colleagues without compromising safety, and know that responsibility for the patient stays with the registered nurse.
• Conflict and complaints. Listen, acknowledge, resolve informally where possible and escalate according to policy when it cannot be resolved.
• Quality and governance. Know that audit measures practice against a standard, PDSA tests a change, and governance is how an organisation assures quality.
• Wellbeing. Notice a colleague under strain, offer support and signpost to occupational health or employee support.

When in doubt, pick the option that keeps patients safe now, then addresses the underlying problem through the proper route.

Practise with a simple rule: first make the immediate situation safe, then tell the right person, then record what happened. Options that reverse that order, or skip the middle step, rarely score.

How to revise it

1. Write the delegation test: is the task within the person's role and competence, is supervision available, and who stays accountable?
2. Learn SBAR by drafting three examples, such as escalating a deteriorating patient, reporting unsafe staffing and handing over at shift end.
3. Practise prioritisation lists with five or six patients and rank them by risk.
4. Revise quality terms in a line each: PDSA, audit, governance, incident learning.
5. Study conflict and complaints scenarios, choosing options that listen, de-escalate and follow policy.

Pair with Platform 1 for accountability and Platform 6 for incident reporting.