Ch. 3: Organization climate and culture

4. Characteristics of a Magnet hospital include: a. multidisciplinary collaboration. b. nursing leader authority. c. physician control. d. social worker retention.u]u]]]7

ANS: A Characteristics of a Magnet hospital include nursing autonomy, practice control, and collaboration. Nursing support, collaborative partnerships with physicians, and nursing practice are other aspects.

3. A professor at the local college of nursing is teaching at a new clinical site. She notes that the nurses greet each other and their clients with warmth and a smile. She also notes that the policies and procedures encourage nursing autonomy. Nurses and physicians seem to have a collegial relationship. These observations best describe the _____ of the unit. a. climate b. culture c. interactions d. operation

ANS: A Climate is the perception that individuals have about a particular unit or environment.

13. How is culture represented at the unit level, with an underlying belief in patient-centered care? a. Open visiting hours in the critical care unit (CCU) b. Strict visiting hours in the CCU c. Tape-recorded report d. Verbal handoff conducted at the nurses' station

ANS: A Open visiting hours in the CCU convey the importance of family as partners in care delivery. This is a representation of culture within a nursing unit where a relationship-based nursing care model is used, and it represents an underlying belief in patient-centered care.

4. Researchers study organizational climate in order to examine how the work environment influences behaviors. Which of the following characteristics are utilized to study climate? (Select all that apply.) a. Supervisor support b. Unit staffing and its effect on incident reporting c. Autonomy d. Peer cohesion e. Rewards and recognition

ANS: A, C, D, E Some characteristics that are used to study climate are decision making, leadership, supervisor support, peer cohesion, autonomy, conflict, work pressure, rewards, feeling of warmth, and risk.

1. Culture is best defined as (the): a. deviation from the majority. b. differences in likes and dislikes. c. shared beliefs and values. d. similar views and opinions.

ANS: C Culture is described as shared beliefs and values. It provides a common belief system among its members but is not expected to hold similar views and opinions of its members.

18. Which of the following exemplifies a safety climate within a nursing unit? a. Asking nursing staff to work a double shift b. Encouraging nurses to take the blame when a medication error occurs c. Asking staff to report medication errors only d. Asking staff to report near-misses of adverse events

ANS: D Safety climate refers to keeping both patients and nurses safe. Part of a safety culture encourages nurses to report adverse events as well as near-misses of adverse events. Factors that influence avoidance of errors include staffing levels, excess fatigue, education, and experience.

19. Culture change within nursing homes was initiated by the: a. Nursing Home Reform Act. b. National Citizens' Coalition for Nursing Home Reform. c. Pioneer Network. d. Eden Alternative.

ANS: A A series of quality improvement programs were implemented in nursing homes following the passage of the Nursing Home Reform Act legislation in 1987.

17. Organizational _____ affects the quality of nursing care and patient outcomes. a. culture b. climate c. fiscal stability d. case mix

ANS: A Organizational culture affects the quality of nursing care and patient outcomes. The manner in which staff perceives culture, manages boundaries, and translates values has an impact on patient care.

2. What drivers of change are impacting nursing care? (Select all that apply.) a. Transparent communication b. Overabundance of nursing staff c. Evidence-based practice d. Information technology e. Reduced acute care needs

ANS: A, C, D An explosion in information technology capacity is altering the speed and transparency of communication and information delivery. The impact of a nursing shortage, increased demand for nursing care, and the drive to incorporate evidence-based practice are changing the face of nursing care.

5. Hospitals and long-term care facilities wishing to achieve Magnet Recognition Program® must meet which of these components? (Select all that apply.) a. Transformational leadership b. Incident reporting c. New knowledge d. Actual staffing ratios e. Empirical outcomes

ANS: A, C, E Today, hospitals and long-term care facilities wanting to achieve Magnet Recognition Program® status must meet five key components identified by the ANCC (2016): transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovations, and improvements; and empirical outcomes.

1. The IOM report, To Err Is Human: Building a Safer Health System, recommends building a safety culture within an organization. This refers to keeping both patients and nurses safe. The organization supports nursing by: (Select all that apply.) a. moving from a reactive culture to one that is fair and just. b. demonstrating authoritarian behaviors. c. mandating nurses to meet patient needs. d. providing a safe and efficient workspace.

ANS: A, D Included in the concept of a safety climate is a focus on nurse's health and safety. Nurses working in hospitals have one of the highest rates of work-related injuries, especially back injuries and needlesticks. One major shift in an organization's safety climate is the move from a punitive and reactive culture to a fair and just culture. In a fair and just culture, expectations for system and individual learning and accountability are transparent.

2. Climate is best defined as the: a. health and well-being of the structure of a facility. b. perceptions that individuals have about an environment. c. style in which individuals treat each other. d. temperature in the nursing units of an institution.

ANS: B Climate is defined as the perceptions that individuals have about a particular unit or environment

7. The nursing manager of a telemetry unit has developed a policy in which all nurses automatically are scheduled to have a day off from work on their birthday unless they request to work on that day. He also gives a small gift to each nurse who becomes certified in his or her specialty area. This manager's actions are positively affecting the _____ of the unit. a. climate b. culture c. interactions d. operation

ANS: B Key areas under the leader's control in which culture can be affected are staff recruitment and retention, welcoming new staff, orientation, celebrating and recognizing staff accomplishments, facilitating change, and promoting a learning environment.

11. The Institute of Medicine (IOM) report, Crossing the Quality Chasm, was useful in describing the challenges related to moving from _____-centered to _____-centered care. a. patient; provider b. provider; patient c. patient; facility d. provider; financially

ANS: B The IOM report, Crossing the Quality Chasm, describes challenges in care provision and details the shift of moving from provider-centered care to patient-centered care. The need for patient and family participation is a dominant force in treatment decisions.

6. Which of the following statements reflects just culture within an organization? (Select all that apply.) a. Just culture is a punitive reaction to patient errors. b. Just culture occurs when the organization is transparent about its mistakes. c. Interpersonal learning is balanced with personal accountability and discipline. d. Expectations for system and individual learning are apparent. e. Serious safety events are reported to senior leadership and kept confidential.

ANS: B, C, D In a just culture, organizational, individual, and interpersonal learning are balanced with personal accountability and discipline. In a fair and just culture, expectations for system and individual learning and accountability are transparent. The organization freely discusses mistakes with the intention of learning from them.

20. The nurse manager of a medical-surgical unit realized that there are differences in dealing with the varied generations of her nursing staff. How does the nurse manager communicate effectively with the Generation Y staff members (those born after 1980)? a. Typewritten memos b. Staff meetings held monthly for 2 hours c. E-mails or text messages d. Face-to-face interactions

ANS: C A work environment supportive to each generation is an important retention strategy. Tailoring the work environment to meet generational and life needs is a recurrent theme in being able to address staff retention

6. The nursing manager wants to change the culture of the nursing unit. Some of the older nurses are bullying the newer nurses, which seems to be affecting self-confidence in their new nursing roles. Which of the following strategies would be helpful in this endeavor? a. Assign mentors to the new nurses. b. Determine the roles of each nurse. c. Interview each nurse about his or her perspective. d. Suspend the bullying nurses for harassment.

ANS: C Changing the culture requires the following to be done: (1) identify the desired change; (2) assess the current status of the group; (3) create a shared need and group commitment to change; (4) use appropriate communication skills and personal contact to establish open discussion; (5) identify shared values and mission so that the group knows where it is going; (6) determine strategies; and (7) develop an action plan for change. Interviewing each nurse would provide an opportunity for personal contact and attempt to establish open discussion.

12. What is the purpose of culture in an organization? a. To provide a perception of what it feels like to work in the organization b. To provide an organization's response to economic, social, and financial challenges c. To provide a common bond so that members know how to relate to one another and show others outside the organization what is valued d. To provide a small geographic area within the organization where nurses provide care

ANS: C Culture is the set of values, beliefs, and assumptions that are shared by members of an organization. The purpose of culture is to provide a common bond so that members know how to relate to one another and to show others outside the organization what is valued.

9. Patient surveys reveal that patients do not know which caregiver is the registered nurse (RN). A task force consisting of nursing staff is formed to develop a plan to address this issue. Many ideas are discussed to reinforce the role of the professional nurse and to make it easy for patients to recognize the RN, such as changing the dress code. Decisions resulting from this task force will mostly reflect the: a. goals. b. mission. c. climate d. values.

ANS: C The climate of the unit is evident in policies, unit norms, dress code and appearance, environment, communication, and teamwork.

15. A small geographic area within a larger hospital system, where nurses work interdependently to care for a group of patients, is known as the: a. nurses' station. b. subculture. c. nursing work group. d. community.

ANS: C The nursing unit, or nursing work group, is a small geographic area within a larger hospital system, where nurses work interdependently to care for a group of patients.

8. A nurse is interviewing for a position at a prominent hospital in her community. She notes a separate physicians' dining room, but all other professionals and visitors eat in the same dining area. The physicians have a separate parking area. Nurse practitioners and physician assistants are asked to park in the staff lot. What might these observations suggest? a. The mission statement supports collaborative care. b. The philosophy of the organization depicts inequality. c. The values and actions may not be congruent. d. The vision for nursing is defined clearly.

ANS: C The values drive the way that resources are distributed. In this case, the values of nursing and actions of the organization may not be congruent.

3. Why is it important for nursing staff to have insight into the culture of their unit? (Select all that apply.) a. So they can understand religious practices b. To allow time for peers to access the Internet more often c. To enable nurses to understand staff behaviors d. To improve staff communication e. To allow nursing staff insight into expectations and norms

ANS: C, D, E Nurses' insight into culture enables them to better understand staff behaviors and relationships, norms, change processes, expectations, and communication.

5. A process used to achieve and internalize knowledge, skills, and behaviors of professional nursing in order to belong and participate is referred to as professional: a. actions. b. conduct. c. ownership. d. insight.

ANS: D Insight can be described as a process used to achieve knowledge, skills, and behaviors of a certain group to belong and participate. Nurses' insight enables them to better understand behaviors, relationships, norms, change processes, expectations, and communication.

14. How is culture measured within an organization? a. Through the use of time-motion studies b. Through the use of quantitative instruments c. Through the use of qualitative instruments d. With a combination of qualitative and quantitative measures

ANS: D The choice of a measurement instrument would be directed by definition, purpose, and context for the cultural assessment. It is likely that a combination of qualitative and quantitative measures would be the best means of capturing the culture of an organization.

16. What is the purpose of a mission statement? a. To provide a method of achieving success and a competitive advantage b. To aid recruitment c. To guide members on problem solving and relationship management d. To offer a snapshot of strategic priorities

ANS: D The mission statement for an organization offers a snapshot of strategic priorities and is an important way to get a sense of organizational values. A deeper understanding of cultural issues in an organization helps people understand how to improve outcomes.

10. Determining the origin of errors with a focus on prevention is known as which of the following? a. A civil investigation b. A voluntary reporting program c. An administrative review d. A root cause analysis

ANS: D To change the culture from "who dunnit?" to an environment that is respectful and open to learning, it is necessary for the climate to change. It is essential to be able to discuss mistakes freely, with the intention of learning from them by doing a root cause analysis.