leadership 1
A nurse is applying the traditional problem-solving model when mediating a conflict between two colleagues. When applying this model, the nurse should prioritize what task? a. Identifying the root cause of the conflict b. Implementing a solution as quickly as possible c. Eliciting input from other nurses d. Encouraging each nurse to reflect on their actions
ANS: A Feedback: The traditional problem-solving model attempts to identify the root problem in situations, a task that requires much time and energy. Efficiency is desirable, but trying to implement a solution as quickly as possible can result in a hasty and incorrect solution. Outside input may or may not be necessary; this varies with each individual problem. Reflective thinking is always beneficial, but this is not a specific component of the traditional problem-solving model.
. A nurse is considering applying for a management job that will require the nurse to make many difficult decisions. What question should the nurse ask when considering his or her ability to make difficult decisions? a. "How comfortable am I with taking risks?" b. "Am I able to apply the nursing processes in varied circumstances?" c. "Am I usually able to please my coworkers?" d. "How quickly do I think?"
ANS: A "How comfortable am I with taking risks?" Feedback: An individual's comfort level with risk has a major bearing on that person's ability and willingness to make difficult decisions. It also affects the outcomes of decisions. The nursing process can have application in the decision-making process, but it is not among the most common decision-making models in management situations. A focus on pleasing other people may make it difficult to arrive at a decision when there are no ideal options available. Quick thinking can be beneficial when making some decisions, but people who are more methodical thinkers are not necessarily at a is advantage, as quick thinking does not always lead to wise decisions.
A nurse-manager is planning to apply a decision-making model to a clinical challenge. When using a decision-making tool, what should the manager do? a. Be aware that the tool cannot eliminate the risk of human error. b. Have an impartial colleague apply the tool, if possible. c. Apply the tool as quickly as possible. d. Recognize that the tool will negate the effect of the manager's values
ANS: A Be aware that the tool cannot eliminate the risk of human error. Feedback: Management decision-making aids are subject to human error and do not remove the effects of individual values, which always affect decision making. There is no particular reason that a tool would have to be applied by another person. Making the correct decision can take time; moving too quickly can compromise the quality of the process.
A novice nurse has been trying to apply the nursing process to each client interaction. What should the nurse do to enhance the effectiveness of this process for making decisions and solving problems? a. Ensure that specific goals are identified during the planning process. b. Conduct assessment and diagnosis simultaneously whenever possible. c. Prioritize ethics during each phase of the nursing process. d. Avoid evaluating the process until every outcome has been met.
ANS: A Ensure that specific goals are identified during the planning process. Feedback: The weakness of the nursing process, like the traditional problem-solving model, is in not requiring clearly stated objectives. Goals should be clearly stated in the planning phase of the process, but this step is frequently omitted or obscured. Assessment and diagnosis often cannot be performed at the same time. Ethics should always be considered, of course, but this variable is not identified as enhancing the overall effectiveness of the nursing process. Evaluation is recommended as an ongoing, iterative process that is not reserved for when all outcomes have been met. Indeed, it is impossible to determine whether outcomes have been met without performing evaluation.
A nurse-manager had to intervene in a conflict between a client and a staff member. The manager chose to make a decision "in the moment" rather than applying a methodical or deliberate decision-making tool. How should this manager's actions be best interpreted? a. The manager applied heuristics to a problem that required a quick solution. b. The manager should have used a decision-making tool before responding. c. The manager's decision was likely made on the basis of emotion. d. The manager demonstrated an autocratic leadership style.
ANS: A The manager applied heuristics to a problem that required a quick solution. Feedback: Most individuals rely on discrete, often unconscious processes known as heuristics, which allows them to solve problems more quickly and to build on experiences they have gained in their lives. This manager's prompt decision making exemplifies this rapid approach. This does not necessarily lead to worse outcomes than a slower, more methodical approach. Heuristics can be based on experience and knowledge and are not simply expressions of emotion. Heuristics and rapid decision making are not synonymous with an autocratic leadership style that downplays input from others.
A unit manager has created a decision grid in order to assist with a difficult staffing decision that will affect many nurses. The decision grid will allow the manager to: a. examine alternatives visually and compare each against the same criteria. b. ensure that the decision is made objectively rather than subjectively. c. plot the outcomes of a decision over time and evaluate the decision-making process. d. predict when events must take place to complete a project on time.
ANS: A examine alternatives visually and compare each against the same criteria. Feedback: A decision grid allows one to visually examine the alternatives and compare each against the same criteria. This assists with the decision-making process, but it cannot guarantee that the decision will be completely objective. A decision grid is not a tool for tracking the outcomes of a decision. Decision grids are not synonymous with project planning tables.
22. Which statements demonstrate a characteristic of a critical thinker? Select all that apply. a. "Since that didn't work effectively, let's try something different." b. "The solution has to be something the client is willing to do." c. "I'll talk to the client's primary care giver about the problem." d. "Maybe there is no new solution to this particular problem." e. "It's important that we do not give up; our clients deserve it."
ANS: A, B, C, E Feedback: A critical thinker displays persistence, empathy, and assertiveness. Trying a new approach shows persistence. Considering the client's participation shows empathy. Speaking to the care provider on the client's behalf shows assertiveness. Stating "It's important that we do not give up; our clients deserve it" shows persistence and empathy. Concluding that there is no solution to a problem reflects an inability to think outside the box.
A team of nurse-managers is considering the purchase of pressure-reducing mattresses to reduce the incidence of pressure ulcers among long-term care residents. In order to use a payoff table to assist with the decision making, what must the managers know? Select all that apply. a. The cost for each new mattress b. Clients' expectations for how a mattress should feel c. The prognosis for recovery from a pressure ulcer d. The cost of treating pressure ulcers e. The amount of time between ordering the mattresses and their delivery
ANS: A, D Feedback: Payoff tables can be used to make decisions involving cost, profit, and volume. To make a decision, the team would need to know how much it costs to introduce a mattress and how much it costs to treat a pressure ulcer. Other variables such as client expectations, timing, and prognosis would be considered when making a decision, but these variables would not be quantified into a payoff table
A nurse-manager is applying the decision-making process when addressing a nurse's high rate of absenteeism. This process should result in: a. an outcome that is desired by all. b. a chosen course of action. c. an action that guarantees success. d. a new understanding of the problem.
ANS: B Feedback: A decision is made when a course of action has been chosen. A decision may not always be pleasing to everyone involved in the situation, and success can never be fully guaranteed. The manager should seek to fully understand the problem, but this is a phase in decision making, not the result of the process.
An experienced nurse-manager has been described as being a "right-brained thinker." Which is an example of this manager's decision-making process? a. Uses data sets to generate solutions b. Uses thinking that is outside the normal standards to find a solution c. Has the ability to ask all those involved in the decision making d. Focuses on the intended process to reach a solution or goal
ANS: B Feedback: Right-brained thinkers have traditionally been characterized as creative and intuitive, and thinking outside of normal standards to find a solution. Linear analysis, such as the ability to generate solutions based on data sets, is more closely aligned with left-brained thinking. Transparency, such as getting all those involved, and efficiency, which focuses on the process to reach a goal, are desirable qualities that are not particularly aligned with either of these two paradigms
A nurse is working with a group of students who are learning a high-risk procedure. How should the nurse best ensure learning while protecting the safety of clients? a. Create an unfolding case study featuring the procedure. b. Use simulation for the students to learn and practice the skill. c. Help the students use a decision-making model to choose the safest technique. d. Teach the students about the traditional problem-solving process before they practice the procedure.
ANS: B Feedback: Simulation provides learners opportunities for problem solving that have little or no risk to clients or to organizational performance, while also providing models, either mechanical or live, to provide experiences for the learner. Simulation is generally considered to be more realistic (and conducive to learning) than a case study. A decision-making or problem-solving model is not normally implemented when learning new skills or procedures.
Which statement is true regarding decision making? a. Scientific methods provide identical decisions by different individuals for the same problems. b. Decisions are greatly influenced by each person's value system. c. Personal beliefs can be adjusted for when the scientific approach to problem solving is used. d. Past experience has little to do with the quality of the decision.
ANS: B Feedback: Values, life experience, individual preference, and individual ways of thinking will influence a person's decision making. No matter how objective the criteria will be, value judgments will always play a part in a person's decision making, either consciously or subconsciously. It is not possible for a nurse to fully "set aside" personal beliefs when making a decision, even if the nurse applies the principles of self-reflection.
The nurses on a medical unit are using several different techniques for performing wound care and the manager recognizes a need to implement evidence-based practice (EBP). What should the manager do first when applying the principles of EBP? a. Identify the main peer-reviewed journals in the field of wound care. b. Formulate a specific, searchable clinical question about wound care. c. Perform a review of the literature about wound care. d. Identify how expert nurses typically perform wound care.
ANS: B Formulate a specific, searchable clinical question about wound care. Feedback: The implementation of EBP usually follows a linear approach that begins with formulating a specific question that can be used to guide a literature search. This should be done before starting a literature review or consulting experts in the field
A nurse-manager has realized that the data gathering process before a recent decision may have been influenced by confirmation bias. How can the manager best prevent this in the future? a. Delegate data gathering to a trusted colleague who has different values. b. Make sure not to prioritize information that supports their own beliefs. c. Consider all of the implications of an alternative before making a decision. d. Collect only the minimum quantity of data before making a decision
ANS: B Make sure not to prioritize information that supports their own beliefs. Feedback: Confirmation bias refers to our tendency to search for and favor information that confirms our beliefs while simultaneously ignoring or devaluing information that contradicts our beliefs. Self-awareness and reflection can reduce this tendency. Delegating the data-gathering process may be beneficial in some situations, but every person is prone to confirmation bias, although in differing ways. Considering the implications of a decision is an important part of decision making but does not address the issue of confirmation bias. Minimizing data collection may reduce confirmation bias but could compromise the quality of a decision
What is the value of using a structured approach to problem solving for the novice nurse? a. Facilitates effective time management b. Supports the acquisition of clinical reasoning c. Supplements the orientation process d. Encourages professional autonomy
ANS: B Supports the acquisition of clinical reasoning Feedback: A structured approach to problem solving and decision making increases clinical reasoning and is the best way to learn how to make quality decisions because it eliminates trial and error and focuses the learning on a proven process. This is particularly helpful to the novice nurse with limited clinical experience and intuition. The other options are outcomes of the possession of critical thinking skills and clinical reasoning.
Which statement concerning the role of the most powerful individuals in organizational decision making is true? a. They exert less influence on decisions than was previously thought. b. They often make decisions that are in congruence with their own values. c. They tend to delegate decision making rather than making decisions themselves. d. They usually make important decisions with consideration of the effect on others.
ANS: B They often make decisions that are in congruence with their own values. Feedback: Not only does the preference of the powerful influence decisions of others in an organization but the powerful are also able to inhibit the preferences of the less powerful. Powerful people in organizations are more likely to have decisions made that are congruent with their own preferences and values. Powerful people tend to make decisions on their own rather than delegating them. Often, the effect on others is not prioritized as highly as it should be.
A nurse is applying a decision-making process to a clinical challenge. When applying this process, the nurse must: a. analyze the root causes of a situation. b. begin by solving the underlying problem. c. choose between different courses of action. d. prioritize the maximum good for the maximum number of people
ANS: C Feedback: Decision-making is a complex, cognitive process often defined as choosing a particular course of action. Problem-solving is part of decision making and is a systematic process that focuses on analyzing a difficult situation. It is not always realistic for the nurse to solve each of the problems contributing to a larger challenge, especially at the beginning of the decision-making process. The nurse often lacks the time, information, or resources to analyze the root causes of a situation. Many times, the nurse makes a decision that benefits the largest number of people, but this is not always feasible or desirable.
A nurse-manager is applying an evidence-based approach to a clinical question around client mobilization. When using a PICO (patient or population, intervention, comparison, and outcome) format to search for evidence, the nurse should identify what? a. The role of intuition in the decision-making process b. The preferences of clients and their families c. The clients for whom the intervention would be relevant d. Costs associated with a potential change in practice
ANS: C Feedback: The PICO format is used in evidence-based practice to guide the search for the current best evidence to address a problem. Client and family preferences and cost are included in evidence-based practice but are not explicit components of the PICO format. Intuition is a component of decision making but is not specifically included in the PICO format.
The nurse-manager of a short-staffed unit needs to make a decision about a nurse's request for an unpaid leave of absence. In order to increase the chance of making a good decision, the manager should: a. involve as many people in the decision-making process as possible. b. begin the decision-making process by presuming the status quo to be the best option. c. generate as many different alternatives as possible. d. prioritize the option that is most innovative.
ANS: C Feedback: The greater the number of alternatives that can be generated by the decision maker, the better the final decision will be. Generating multiple alternatives may require involving more people in the decision-making process, but the process can easily become unwieldy if too many people are involved. The manager should always consider the status quo as a possible option, but this is not always considered to be the default option. Innovation is often a desirable characteristic, but it would be inappropriate to choose an option solely because it is innovative; many other values must be considered.
A nurse has accepted a management position in a busy ambulatory clinic and recognizes that the day-to-day operations of the clinic will require many decisions. What is the nurse's best initial action when preparing for this new role? a. Identify staff who are likely to be allies. b. Determine where organizational power exists in the clinic. c. Clarify and reflect on their own values. d. Collaborate with the previous manager of the clinic.
ANS: C Feedback: Values clarification is an imperative first step when preparing for a role that requires decision making and problem solving. This form of internal examination must precede strategic interactions with others or an analysis of where power lies in the organization. Internal examination should come before external examination.
Which statement concerning critical thinking is true? a. It is a simple approach to decision making. b. It is narrower in scope than decision making. c. It requires reasoning and creative analysis. d. It is a synonym for the problem-solving process.
ANS: C It requires reasoning and creative analysis. Feedback: Critical thinking has a broader scope and is more complex than decision-making and problem solving. It is sometimes referred to as reflective thinking. Critical thinking also involves reflecting on the meaning of statements, examining the offered evidence and reasoning, and forming judgments about facts
What characteristic of a nurse-manager best demonstrates left-brained thinking? a. The manager highly values innovation and intuition when making decisions. b. The manager's relationships with peers are prioritized when evaluating decisions. c. The manager applies a linear, analytical model when making a decision. d. The manager is open to feedback from staff when making a decision.
ANS: C The manager applies a linear, analytical model when making a decision. Feedback: Left-brained thinkers process information in a linear, analytical way, which is different from the creative and intuitive approach of right-brained thinkers. Placing a value on relationships and being open to feedback are not specifically associated with one or the other side of the brain.
A nurse-manager is preparing to use the program evaluation and review technique (PERT) tool when making a staffing decision. This tool will primarily address what component of the decision-making process? a. Values b. Consequences c. Timing d. Ethics
ANS: C Timing Feedback: PERT is a popular tool to determine the timing of decisions; it is essentially a flowchart that predicts when events and activities must take place if a final event is to occur. This tool does not explicitly address some of the other relevant considerations when making decisions, including values and ethics, and it does not focus on consequences.
A nurse-manager is faced with a difficult decision in a situation that involves the manager's values. What is the manager's best action? a. Try to base a decision on intuition rather than values. b. Set aside their own values and make a rationale decision. c. Defer the decision to a colleague with different values. d. Identify and reflect on their own values.
ANS: D Feedback: Every person has a value system, and this cannot simply be "set aside." Awareness and reflection are necessary to make good decisions in the context of one's own values. Intuition and values are not counterpoints, and prioritizing intuition does not negate the importance of values. Values influence every decision to varying degrees, and it is impractical to defer every value-laden decision to someone else.
A nurse-manager has to make some difficult decisions around the allocation of vacation time during the holiday season. When making a decision, what should the manager do first? a. Elicit ideas from as many staff members as possible. b. Consider how the issues have been addressed in the past. c. Think of as many alternatives as possible. d. Clearly identify each of the desired objectives in the situation.
ANS: D Clearly identify each of the desired objectives in the situation. Feedback: Regardless of what decision-making or problem-solving tool a manager is going to use, the process must necessarily begin with clear identification of the objectives. Once these are determined, subsequent steps like engaging stakeholders, creating alternatives, and considering previous approaches can be performed.
A nurse-manager has made a decision and is now preparing to evaluate that decision. What question should best guide the nurse's evaluation process? a. Is evaluation necessary when using a good decision-making model? b. Can evaluation be eliminated if the problem is resolved? c. Is every party happy with the outcomes of the decision? d. Did the outcomes align with the original objectives?
ANS: D Did the outcomes align with the original objectives? Feedback: The evaluation phase is necessary to find out more about one's ability as a decision maker and to find out where the decision making was faulty. This step cannot be eliminated from the decision-making process because it provides the means for determining whether a good decision was made. Happiness is not the criterion by which decisions are usually evaluated. Rather, evaluation is done by comparing actual outcomes to desired outcomes
One of the nurses on the unit said, "My Vietnamese client won't look me in the eye, but I know that Asian clients avoid making eye contact as a way of showing respect." This nurse is demonstrating what type of illogical thinking? a. Affirming the consequences b. Arguing from analogy c. Deductive reasoning d. Overgeneralizing
ANS: D Overgeneralizing Feedback: This type of flawed thinking occurs when one believes that because one person has a particular characteristic, every other person in the same category also has the same characteristic. It is an overgeneralization to assign one meaning for an action to every person from dozens of countries. This kind of oversimplified deduction is exemplified when stereotypical statements are used to justify arguments and decisions. When affirming the consequences, the nurse thinks that if B is good, but someone is doing A, then A must not be good. When arguing from analogy, the nurse applies a component that is present in two separate concepts and then states that because A is present in B, then A and B are alike in all respects.
Which statement is true regarding an "economic man" style manager? a. The manager may lack complete knowledge and generate few alternatives. b. The manager makes decisions that may not be ideal but result in solutions that have an adequate outcome. c. The manager is primarily motivated by their own financial gain. d. The manager gathers as much information as possible and produces many alternatives.
ANS: D The manager gathers as much information as possible and produces many alternatives. Feedback: Managers with an "economic man" style gather as much information as possible and generate many alternatives. However, most management decisions are made by using the "administrative man" model of decision making, in which the manager never has complete knowledge and generates fewer alternatives. The "administrative man" carries out decisions that are "satisficing," a term used to describe decisions that may not be ideal but result in solutions that have adequate outcomes. The term "economic man" does not suggest that the manager is motivated by personal financial gain.
A nurse has accepted a job in a workplace where organizational power has a pronounced effect. This characteristic may have what effect on the nurse and the workplace? a. Many decisions will be delegated to the nurse by supervisors. b. There will be high levels of mistrust and suspicion at the workplace. c. Communication will be compromised at the workplace. d. The nurse may have to accept decisions contrary to their own values.
ANS: D The nurse may have to accept decisions contrary to their own values. Feedback: The ability of the powerful to influence individual decision making in an organization often requires adopting a private personality and an organizational personality. The nurse will often have to accept decisions that solely reflect the values of more powerful individuals. This may lead to a feeling of powerlessness but not necessarily mistrust and lack of communication. Delegation of decision-making is likely to be rare, not common, because it is concentrated with those in power
A sales representative is describing the benefits of a new brand of incontinence brief to a manager. The representative states, "These are a superior product. With what you're currently using, you're actually causing harm to your clients." How should the manager best interpret this statement? a. The representative is arguing from analogy. b. The representative is overgeneralizing about the new briefs. c. The representative is overgeneralizing about the briefs the unit currently uses. d. The representative is affirming the consequences.
ANS: D The representative is affirming the consequences. Feedback: Affirming the consequences is a logical fallacy where a person decides that if B (i.e., the new brief) is good and someone is using A (i.e., the old brief), then A must not be good. The fact that the new brief is good does not mean the old brief is bad. Arguing from analogy is an illogical thinking that applies a component that is present in two separate concepts and then states that because A is present in B, then A and B are alike in all respects. Overgeneralizing involves extending characteristics of an individual to a group.
