Leadership and prioritizing
A client has severe pain related to degenerative joint disease. On which aspect of care will the nurse need to focus first? a) The effects of social isolation b) Client education on pathophysiology c) Ability to perform daily activities d) Client's financial resources
Ability to perform daily activities Correct Explanation: Severe pain can decrease a person's ability to carry out activities of daily living and function; therefore, this is the primary concern of the home health nurse at this time since this is a basic need. The other areas can be addressed at a later time.
The registered nurse (RN) is preparing to delegate tasks to an unlicensed assisted personnel (UAP). Which tasks would be appropriate for the RN to delegate to the UAP? a) Measuring intravenous therapy intake b) Monitoring intracranial pressure (ICP) c) Calculating fluid volume resuscitation d) Assessing oxygen (O2) saturation
Assessing oxygen (O2) saturation Correct Explanation: When delegating the RN must determine the skill level, education of the UAP, client?s condition, complexity of the client, and potential for harm. Assessing O2 saturation is within the scope of an UAP. Monitoring ICP, measuring intravenous therapy intake, and calculating fluid volume resuscitation should be performed by a licensed professional.
A nurse manager and the charge nurse have two employees who are disagreeing with the accomplishment of client care. The manager determines a mutually agreed-upon time to discuss this situation with all the members involved. This activity is a) Problem solving b) Conflict resolution c) Delegation d) Client protection
Conflict resolution Correct Explanation: To produce high-quality care, the manager must constantly be developing the staff to meet new challenges. Along with their managers, nurses engage in conflict resolution.
In a nursing unit, the RN delegates nursing tasks to the nursing assistant. Keeping in mind the delegation guidelines, which statement denotes the right communication for the nursing assistant? a) ?Discontinue the IV solution.? b) ?Check the infusion rate.? c) ?Inspect the site for thrombophlebitis.? d) ?Dispose of the disconnected IV set.?
Dispose of the disconnected IV set.? Correct Explanation: The statement, ?Dispose of the disconnected IV set? is in accordance with the delegation guidelines of right communication. The nurse should provide all the necessary information to carry out the assigned task. The other statements do not follow the delegation guideline of right communication. The tasks mentioned in the other instructions are not a nursing assistant's role
The nurse manager is aware that nurses in the operating room are concerned about a proposed change in their working hours. Which of the following is the nurse manager's best approach in addressing this problem and the nurses? a) Relate the proposed change to the group's existing beliefs and values. b) Discuss the disadvantages for the hospital if the change is not made. c) Explain the rationale for this change in an e-mail to each of the nurses. d) Discourage the nurses from discussing the problem because the change is going to occur.
Relate the proposed change to the group's existing beliefs and values. Explanation: Approaches to overcoming resistance to change include relating the proposed change to the group's existing beliefs and values; explaining the rationale for change in clear, concise language and allowing for opportunities of open discussion; and listing the advantages of this change both for individuals and the group
You are assigned to care for an elderly stroke patient who will soon be going home. When the nurse is actually doing the discharge planning, it is a nursing priority to: a) plan reachable goals with the patient and family. b) realize that goals may not be met after discharge. c) realistically assist the patient to establish what he wants after discharge. d) involve the family in when the patient will go home.
plan reachable goals with the patient and family. Correct Explanation: Goals are best met when mutually set by both the patient and the nurse. If the patient is involved in setting the goals, it is more likely that the expected outcomes of the plan will be met
The nurse is working to enhance time management skills and has to administer pain medications to several patients, obtain vital signs, and assist clients with bathing. What should the nurse do next? a) Bathe clients. b) Administer pain medications. c) Delegate bathing and vital signs tasks. d) Obtain vital signs.
Delegate bathing and vital signs tasks. Correct Explanation: Steps to enhancing time management include: establish goals, evaluate ability to meet goals and identify tasks that can be delegated, establish a timeline, evaluate success of the plan, and use the evaluation to make future plans. Goals were established in the stem of the question and therefore, the next step would be to delegate task
How should a nurse leader best address nurses' resistance to a change in the shift-scheduling protocol on their hospital unit? a) Explain the cost savings for the hospital that the change will bring about b) Allow those who remain unconvinced to temporarily opt out of the proposed change c) Put the matter to a vote and respect the wishes of the majority d) Explain the benefits of the change and elicit honest feedback
Explain the benefits of the change and elicit honest feedback Correct Explanation: Strategies for overcoming resistance to change include maximizing explanations in terms of those affected and encouraging feedback. Emphasizing benefits to the institution is not likely to overcome resistance while allowing skeptics to opt out or putting the matter to a vote are likely impractical and unrealistic and may lead to further conflict and resistance.
A nurse manager must provide care to her clients and her employees under the constraints of her resources. This involves maintaining the financial constraints of her division. What term best describes this scenario? a) Financial management b) Allocation c) Resource management d) Management
Resource management Explanation: In modern healthcare organizations, managers usually are responsible for accomplishing the work of the unit within the constraints of available resources. This process is called resource management
April and Sara are nurse managers for different units in the hospital. They are planning for a major change to occur on both units. Sara tells April she has identified a key power player on her unit. Choose which one of the following that describes what Sara means by this term? a) A regular employee who is a natural leader b) Someone who spreads untrue rumors c) An employee who will resist the change d) Someone in whom Sara can confide
A regular employee who is a natural leader Correct Explanation: There are some people who are "natural leaders" because of their demonstrated ability to influence others. These are the "key power players" whose support is essential to effecting change. The other choices do not describe persons who necessarily have power
A client is received into the emergency department after getting shot in the chest. The client is hemorrhaging profusely and is in hypovolemic shock. The nurse calls a code blue. What type of leadership style will be most effective during the management of the code? a) Laissez-faire leadership b) Transactional leadership c) Autocratic leadership d) Democratic leadership
Autocratic leadership Explanation: Autocratic leadership will be most effective in this scenario. Autocratic leadership involves the leader assuming control over the decision and activities of the group. During code blue, a leader is needed to direct the actions needed and make quick decisions to positively affect the client. Laissez-faire leadership would ultimately lead to the demise of the client. Democratic leadership could possibly delay the client receiving life-sustaining measures and would be less effective than autocratic leadership. Transactional leadership would involve a reward system which would be unethical in this situation.
A registered nurse is delegating activities to UAPs on a hospital unit. Which activities could this nurse normally delegate? (Select all that apply.) a) Giving a bed bath to a patient b) Taking routine vital signs c) Transferring a patient to another floor d) Administering medications to patients e) The determination of a nursing diagnosis for a patient with breast cancer f) Planning patient education for a patient with a colostomy
Giving a bed bath to a patient • Transferring a patient to another floor • Taking routine vital signs Correct Explanation: The nurse should be familiar with guidelines for delegating nursing care. The nurse could delegate the following tasks: giving a bed bath to a client, taking routine vital signs, and transferring a client to another floor. The nurse could not delegate the administering of medications, planning client education for a client with a colostomy, or the determination of a nursing diagnosis
A single parent, aged 17 years with one child and pregnant with her second child, has the mental age of a 12-year-old. As the home care nurse, what is your greatest concern in caring for this woman? a) Her physical care abilities b) Her ability to receive financial aid c) Her ability to bond with her children d) Her cognitive ability to understand
Her cognitive ability to understand Correct Explanation: The cognitive ability of this individual is of greatest concern regarding all aspects of her survival. The cognitive ability to understand how to organize work, manage financial responsibilities, and ensure safety within the home is essential
The proficient nurse wants to become a more effective leader. Which step will be appropriate for the nurse to take? a) Promote a healthy work environment and become a nurse mentor. b) Become a preceptor and work extra shifts on the nursing unit. c) Start a transformational change on the nursing unit and engage staff in the movement. d) Review the Nurse Manager Leadership Collaborative model and write delegation competencies.
Promote a healthy work environment and become a nurse mentor. Correct Explanation: Research indicates that a nurse can become a more effective leader by striving to become an authentic leader, developing leadership skills including reviewing modules such as the Nurse Manger Leadership model and incorporating knowledge into personal practice, promoting a healthy work environment, engaging staff to commit their best effort at work, and assisting new graduates to transition into the RN role through mentorship or preceptorship. Working extra shifts will not help leadership skills. Abruptly starting transformational change on a unit and engage staff can disrupt harmony on the unit. Writing delegation competencies does not improve leadership skills.
The exchange of information among the patient, the caregivers, and those responsible for care while the patient is in a care setting and after the patient returns home is key to a successful: a) community service. b) proper referral. c) discharge planning. d) guaranteed transfer.
discharge planning. Correct Explanation: The key to successful discharge planning is an exchange of information among the patient, the caregivers, and those responsible for care while the patient is in a care setting and after the patient returns home. This coordination of care is usually the nurse?s responsibility
A senior student nurse has been elected class president. What type of power will the student have in this position? a) explicit power b) implied power c) assumed power d) absolute power
explicit power Explanation: Leadership is the ability to direct or motivate others to achieve set goals. An elected class leader has explicit power.
A nurse working in a physician's office uses the managerial function known as "organizing." What is involved in this function? a) evaluation b) resources c) workforce d) problems
resources Explanation: The organizing function of the nurse manager involves acquiring, managing, and mobilizing resources to meet both clinical and financial objectives.
The new graduate nurse is having difficulty managing the time required to care for a group of complex clients and is several hours behind in completing nursing interventions. Of the following outstanding tasks, which nursing intervention should the nurse complete first? a) Perform a dressing change to an abdominal abscess that is three hours behind schedule. b) Obtain discharge orders for a client who is ready to be transferred to a long-term nursing facility. c) Complete a medication reconciliation form on a client who has recently been admitted to the hospital. d) Administer a dose of digoxin (lanoxin) that is two hours behind schedule.
Administer a dose of digoxin (lanoxin) that is two hours behind schedule. Correct Explanation: The first step in time management is to determine which tasks are priority tasks. Digoxin (lanoxin) is a critical client medication and therefore takes priority when considering the other options. Dressing changes, discharge orders, and completing facility forms can be delayed until critical tasks are complete
The nurse is working at a facility that is applying for Magnet® Recognition. The nurse recognizes that research supports Magnet® hospitals as having which direct effect on client care? a) Higher nurse retention b) Improved job satisfaction scores c) Longer lengths of stays d) Better patient outcomes
Better patient outcomes Correct Explanation: Magnet® hospitals have better patient outcomes than facilities without the recognition. Magnet® hospitals have higher nurse retention and job satisfaction scores, but this does not have a direct effect on client care. Magnet® hospitals have shorter lengths of stays
Which activity by the nurse exhibits the role of family educator? a) Demonstrating how to suction the oropharynx. b) Supporting the client's wish to die at home. c) Obtaining a sputum specimen for laboratory testing. d) Arranging for a swallowing evaluation by the speech pathologist.
Demonstrating how to suction the oropharynx. Correct Explanation: The home healthcare nurse provides teaching, such as demonstration of a skill, to the family as a client educator. The home healthcare nurse develops and implements the plan of care in the caregiver role, such as obtaining a sputum specimen. As a client advocate, the home healthcare nurse protects and supports the client's rights. The home healthcare nurse coordinates direct care to the client and services of other healthcare providers
A nurse can improve his or her skill with time management by doing which of the following? a) Starting each day as a new day without considering the previous day b) Evaluating success with accomplishment of goals in client care c) Allowing the flow of the day to control how time is managed d) Setting priorities without involving clients or their families
Evaluating success with accomplishment of goals in client care Explanation: Time management is a skill that can be improved for nurses by taking time during the day to evaluate whether goals have been accomplished, and setting new priorities based on this. Goals and priorities should be established at the beginning of each day, and clients and their families should be involved in this. At the end of the day, a nurse should look back and determine what has and has not been accomplished; this helps to set a time line for the next day. If a timeline is not set each day, then the nurse will allow the flow of the day to control the day, rather than having a plan for what needs to be accomplished
A nurse leader is planning to change the scheduling process in order to improve staffing on the unit. Which of the following would be the next step in implementing a change? a) Describe to the staff how the change will be implemented. b) Develop a timetable for making the change to a new system. c) Explore the pros and cons of potential scheduling models. d) Select a group of nurses to help champion the change process.
Explore the pros and cons of potential scheduling models. Correct Explanation: Before a nurse leader can begin planning the process of change, a selection of a new system by fully exploring different models should be completed. Once a selection is made, the process for the change can begin by describing how change will be implemented with the timetable that is developed and enlisting support from the staff who will champion the cause.
A charge nurse on a medical-surgical unit is asked by the nurse manager to serve as a mentor to another staff nurse who is less experienced. Which of these would best describe this role? a) The charge nurse is being paid to supervise the staff nurse. b) The staff nurse is learning about all the hospital policies from the charge nurse. c) The charge nurse is providing support for the staff nurse in new responsibilities. d) The staff nurse is orienting to the unit as a newly hired graduate nurse.
The charge nurse is providing support for the staff nurse in new responsibilities. Explanation: A mentor is not a paid position, but, instead, is a person who provides support and encouragement to a less experienced nurse who is learning new responsibilities with their current role or an expanded one. Preceptorship typically is a paid position, and is for a new or experienced nurse who is training for a new position on a unit. The preceptor would teach the new nurse about hospital policies and procedures, as well as supervise the nurse in their daily assignments
When a multidisciplinary team is involved in meeting the home care needs of a patient, who is the person responsible for the coordination of the care provided? a) The registered nurse b) The social worker c) The home healthcare aid d) The chaplain or minister
The registered nurse Correct Explanation: Regardless of the number of providers for home healthcare, the responsibility for care coordination remains with the registered nurse.
A specific nursing unit practices functional nursing. What was the basis for this concept? a) industrial assembly line b) case management c) primary nursing d) individual patient care
industrial assembly line Explanation: In functional nursing, which is based on the assembly line concept found in industry, nursing and other staff are assigned to specific tasks for a group of patients. Specializing tasks in this way increases efficiency but results in impersonal care.
The nurses who provide care on a medical unit are skeptical about the planned change from a traditional narcotic cupboard to a computerized medical supply and management system. Which of the following statements demonstrates mistrust about the benefits of this proposed change? a) "I've heard those machines don't even cut down on med errors like they say they do." b) "There's no way that I'm going to be able to learn to deal with a computer." c) "Those machines cost a fortune and there are way better ways to spend that money." d) "I think that they want us to use these machines just so they can track our work activity closer."
"I've heard those machines don't even cut down on med errors like they say they do." Explanation: Resistance to change takes many forms, including doubts about the benefits of a change. Expressing doubt that a new process will reduce medication errors expresses such a doubt. Fears about the necessary learning, cost, and effects on workload are also common points of resistance, but these do not focus on the purported benefits.
Which of the following nurse leaders most clearly exemplifies transformational leadership? a) A leader who is careful to thoughtfully assess the issues and priorities surrounding a problem prior to acting b) A leader who prioritizes the delegation of leadership to the individual members of the group c) A leader who is dynamic and inspiring and promotes change by the power of her convictions d) A leader who prioritizes the fact that every member of the team is considered valuable and equal
A leader who is dynamic and inspiring and promotes change by the power of her convictions Explanation: Transformational leaders can create revolutionary change. They are often described as charismatic and they are unique in their ability to inspire and motivate others. A careful examination of contextual factors is associated with situational leadership while delegation to group members and an emphasis on equality are typical of laissez-faire and democratic leadership.
Conflict has emerged on a nursing unit due to the perception by new graduates that some of the more experienced nurses are manipulating the patient assignment to ensure a lighter workload during night shifts. How should the manager of the unit best address this conflict? a) Arrange a meeting where the issue can be discussed and addressed by as many of the nurses as possible b) Arrange for the newer nurses to organize the patient assignment for a trial period c) Reassure the new graduates that the more experienced nurses are acting in the interests of both staff and patients d) Gather evidence over the next several weeks in order to determine if the practice is indeed happening
Arrange a meeting where the issue can be discussed and addressed by as many of the nurses as possible Correct Explanation: Open, explicit, and participatory conflict resolution that is based on collaboration is an effective strategy for the management of conflict. Gathering evidence does not directly address the conflict that presently exists and reassurance may be unwarranted and false. Allowing the new graduates to create the patient assignment may perpetuate selfish practices and does not resolve animosity between the two camps
A nurse leader is planning to change the scheduling process in order to improve staffing on the unit. Which of the following would be the next step in implementing a change? a) Describe to the staff how the change will be implemented. b) Select a group of nurses to help champion the change process. c) Develop a timetable for making the change to a new system. d) Explore the pros and cons of potential scheduling models.
Explore the pros and cons of potential scheduling models. Explanation: Before a nurse leader can begin planning the process of change, a selection of a new system by fully exploring different models should be completed. Once a selection is made, the process for the change can begin by describing how change will be implemented with the timetable that is developed and enlisting support from the staff who will champion the cause
A nurse manager is implementing the function of directing in his or her role by doing which of the following? a) Utilizing a weekly system for keeping workforce budget balanced b) Hiring an adequate amount of nurses to staff the unit on all shifts c) Identifying a goal for the nurse-client ratio on the clinical unit d) Helping manage unit flow with client care if there is a staff call-out
Helping manage unit flow with client care if there is a staff call-out Explanation: The four managerial functions are planning, organizing, directing, and controlling. Directing is leading others to achieve the goals of the unit; in this case, helping on the unit with client care, if there is inadequate staffing. Planning involves identifying a problem, which, in this case, involves having an adequate amount of staff for the clinical unit; this function also involves having goals and strategies to achieve an adequate nurse-client ratio. The controlling phase includes implementing mechanisms for ongoing evaluation; the nurse manager will do this when checking the budget weekly to be sure the resources are adequate. The organizing phase would involve hiring the staff.
The nurse manager notices a trend in nurses routinely arriving to work late. How can the nurse use the transactional leadership style to get nurses to arrive to work on time? a) Monitor time clock reports on a monthly basis and enter all nurses who have not been tardy into a raffle for a paid day vacation. b) Emphasize the importance of arriving to work on time during a monthly unit meeting. c) Allow the nursing staff to develop a plan to decrease tardiness within the unit. d) Generate a report of nurses who routinely arrive to work late and set an example by firing the nurse who has been tardy the most.
Monitor time clock reports on a monthly basis and enter all nurses who have not been tardy into a raffle for a paid day vacation.
A nurse arranges all the resources available to teach a teenage girl how to manage her asthma. Which role is this nurse performing? a) Planning role b) Organizing role c) Controlling role d) Directing role
Organizing role Correct Explanation: The role of management is to plan, organize, direct, and control available human, material, and financial resources to deliver quality care to clients and families organizing would include acquiring, managing, and mobilizing resources to meet both clinical and financial objectives. Planning would include identifying problems and developing goals, objectives, and related strategies to meet the demands identified. Directing would include leading others in achieving goals within the constraints of the setting. Controlling would include implementing mechanisms for ongoing evaluation in the setting
You have been notified that a patient is being admitted from emergency with abdominal pain. The patient will be admitted by wheelchair to the unit for observation. You delegate the preparation of the room to the unlicensed worker with these instructions: a) Place a "No Visitors" sign on the patient's door until admission is complete. b) Bring the patient's bed to the highest position for easy transfer. c) Place an admission pack in the room. d) Prepare an open the bed in the low position. e) Bring all equipment for vital signs to the patient's room.
Place an admission pack in the room. • Bring all equipment for vital signs to the patient's room. • Prepare an open the bed in the low position. Correct Explanation: Preparing the room for admission may be delegated by the nurse. The bed should be placed for easiest access: low if the patient is ambulatory/can stand, and high if being transferred from a stretcher. Room preparation includes assembling all needed equipment and patient supplies. It remains the nurse's responsibility to determine that all preparations are completed
The case manager works in a facility that supports a participative leadership style. Which of the following should the nurse recognize as an example of democratic leadership style? a) The interdisciplinary health care team collectively developing plans of care for clients b) The nurse implementing the physician?s written orders for client care c) The dietitian completing a nutritional assessment for a registered nurse (RN) d) The unlicensed assistive personnel (UAP) taking vital signs for several nurses
The interdisciplinary health care team collectively developing plans of care for clients Correct Explanation: Democratic leader or participative leadership style is characterized by a sense of equality among the leader and other participants. The interdisciplinary health care team collectively developing plans of care for clients is the only option that shows shared responsibility to achieve the same client outcome
The nurse manager who asks staff members to give suggestions on how to improve collaboration between nurses and physicians is exhibiting what style of leadership? a) Transactional b) Laissez-faire c) Democratic d) Autocratic
Democratic Correct Explanation: The nurse manager who involves staff members in decision-making by asking for suggestions is exhibiting a democratic style of leadership. Autocratic leadership style would be exhibited by a leader who gave staff little opportunity to give feedback or suggestions. Transactional leadership also involves little input by staff into decision-making and is instead focused on providing rewards when tasks are completed. A leader with a laissez-faire style would give all control to staff members to determine how to improve collaboration.
The nurse and unlicensed assistive personnel (UAP) are working together to admit a client newly diagnosed with diabetes to a nursing unit. Which task would be inappropriate to delegate to the UAP? a) Offering sugar-free popsicles b) Monitoring insulin requirements c) Obtaining a fingerstick glucose d) Measuring blood pressure
Monitoring insulin requirements Correct Explanation: When delegating the RN must determine the skill level, education of the UAP, client?s condition, complexity of the client, and potential for harm. The nurse should monitor the need for insulin. The UAP can monitor blood pressure, offer nurishment, and obtain fingerstick glucose. The UAP should report the results of the fingerstick glucose to the nurse and the nurse should determine the need for insulin based on physician orders.
A nurse manager has asked staff to create a plan to improve patient outcomes. In the past, the staff have not met deadlines. How can the nurse manager use transactional leadership style to ensure the deadline is met? a) Offer two days paid vacation. b) Ask politely. c) Give extensions as needed. d) Demand efficiency.
Offer two days paid vacation. Explanation: The transactional leadership style involves a task and reward system. Paid vacation is a reward for meeting the deadline. Asking politely, demanding efficiency, and giving extensions are not rewarding behaviors
The new graduate nurse is evaluating the effectiveness of her assigned nurse mentor. Which characteristic should the new graduate recognize as being inappropriate for the nurse mentor to role model? a) Advising the new graduate to consult her before making decisions regarding client care b) Introducing the new graduate to members of the interdisciplinary team c) Providing daily feedback to the new graduate d) Encouragings the new graduate to enroll in continuing education courses
Advising the new graduate to consult her before making decisions regarding client care Correct Explanation: Effective mentors should provide feedback to the mentee, encourage opportunities for continued growth, and provide resources that will be supportive in the new role of nurse including members of the interdisciplinary team. Effective mentors should promote confidence in new nurse in the decision making process. Requiring the new nurse to report to her before making decisions can hinder the new graduate?s confidence level.
The charge nurse on a postoperative surgical unit is responsible for making patient assignments for staff nurses. Two staff nurses have voiced not wanting to assume care for any new postoperative surgical clients during their shift. How can the charge nurse resolve this conflict using the strategy of compromise to address the immediate concerns of the two staff nurses? a) Reassign all nurses? clients in a manner that ensures the two staff nurses will not have to care for new postoperative surgical clients. b) Coerce the staff by complimenting on them on how well they care for new postoperative surgical clients. c) Consult with the nurse manager to decide how postoperative surgical clients should be assigned to the two nurses. d) Approach both nurses to discuss incentives that can be given for agreeing to accept new postoperative surgical clients.
Approach both nurses to discuss incentives that can be given for agreeing to accept new postoperative surgical clients. Explanation: Compromise involves approaching all involved parties and finding a mutually agreeable solution. For this conflict, the charge nurse should discuss what can be done to make the two staff nurses agree to accept the new clients. Coercing the staff, consulting with the nurse manager, and reassigning the clients do not involve compromise among the charge nurse and the staff nurses
A nurse is in charge of a large group of employees on a busy surgical floor. Today's care must be completed early due to a special event involving most of the employees. Which management style would work best in this situation? a) Authoritarian b) Democratic c) Laissez-faire d) Coercive
Authoritarian Correct Explanation: With authoritarian, or autocratic, leadership, the activities of the group are primarily directive, with activities determined by the leader and dictated to the followers, with no input from the followers on decisions. Coercive management forces actions upon staff. Democratic leadership is appropriate when the task, or decision at hand, is not one that requires urgent action, when subordinates can be expected to make meaningful contributions, and when their input can be taken into account. Laissez-faire management provides little or no direction; coworkers develop their own goals, make their own decisions, and take responsibility for their own management
A nurse graduate applies for a job working in a hospital that achieved magnet status. Which conditions would this nurse expect? (Select all that apply.) a) Higher staff turnover b) Higher levels of staff burnout and exodus from the bedside c) Focus on positive patient care outcomes d) Supportive nurse managers e) Centralized decision making f) Autonomous, accountable professional nursing practice
Autonomous, accountable professional nursing practice • Focus on positive patient care outcomes • Supportive nurse managers Correct Explanation: A magnet status facility would focus on positive client care outcomes, value autonomous and accountable professional nursing practice, and be supportive of nurse managers. A magnet status facility would not have centralized decision making, rather focus on self-governance. A magnet status facility would have lower staff turnover and lower levels of staff burnout and low numbers of nursing staff leaving the bedside
A nurse manager of a hospital unit is working within a decentralized management structure. Which nursing action best exemplifies this type of system? a) Senior managers make all the decisions. b) Nurses are not intimately involved in decisions involving patient care. c) Nurse managers are not accountable for patient, staffing, supplies, or budgets. d) Decisions are made by those who are most knowledgeable about the issue.
Decisions are made by those who are most knowledgeable about the issue. Explanation: The best example of a nurse manager of a hospital unit working within a decentralized management structure would be that decisions are made by those who are most knowledgeable about the issue. Nurses would be greatly involved in decisions involving client care. Senior managers would not make all the decisions within a decentralized management structure. Nurse manages could be accountable for client, staffing, supplies, and/or budgets
Sara (RN) is the designated charge nurse on the telemetry unit. She organizes and facilitates the unit meetings; however, during most of the meetings, Betsy (RN) runs the show and influences staff decisions just by her charisma and personality. Betsy's power to lead is defined by which of the following terms? a) Democratic b) Situational c) Implied d) Explicit
Implied Explanation: Implied power arises when a person who has no official assigned role, assumes a leadership role by virtue of the force of her/his personality and charisma. Sara's official assigned role gives her explicit power by virtue of that assignment. Situational and democratic are types of leadership rather than power.
The nurse and unlicensed assistive personnel (UAP) are working together to admit a pediatric client to a nursing unit. Which task would be inappropriate to delegate to the UAP? a) Soothing the client during the procedure b) Initiating intravenous therapy c) Gathering equipment needed for intravenous therapy d) Securing the client on a papoose board
Initiating intravenous therapy Correct Explanation: When delegating the RN must determine the skill level, education of the UAP, client?s condition, complexity of the client, and potential for harm. Initiating intravenous therapy is reserved for the nurse due to the potential for harm and scope of the UAP. The UAP can assist the nurse by obtaining equipment, securing the client, and soothing the client
A registered nurse checks the ANA regulations prior to delegating tasks to UAPs on a burn unit. Which principles regarding the regulation, education, and use of the UAP are recommended by the American Nurses Association? (Select all that apply.) a) It is the role of the assistive personnel to carry out tasks to enable the professional nurse to concentrate on nursing care for the patient. b) It is the health care institution that determines the scope of nursing practice. c) It is the registered nurse who is responsible and accountable for nursing practice. d) It is the role of the LPN to assign nursing duties to the UAP. e) It is the purpose of assistive personnel to work in a supportive role to the registered nurse. f) It is the LPN who supervises any assistant involved in providing direct patient care.
It is the purpose of assistive personnel to work in a supportive role to the registered nurse. • It is the registered nurse who is responsible and accountable for nursing practice. • It is the role of the assistive personnel to carry out tasks to enable the professional nurse to concentrate on nursing care for the patient. Correct Explanation: The nurse must be familiar with the delegation guidelines when working as a registered nurse. The purpose of assistive personnel is to work in a supportive role to the registered nurse. It is the role of the assistive personnel to carry out tasks to enable the professional nurse to concentrate on nursing care for the client. It is the registered nurse who is responsible and accountable for nursing practice. The LPN does not supervise the assistant, the RN does. It is not the role of the LPN, rather the RN, to assign nursing duties.
Janet works on a surgical unit where the nurse leader allows the staff to make all decisions and direct themselves. The staff nurses fill out the work schedule and sometimes there are days where the unit is short staffed. Janet feels the unit needs better leadership. The nurse leader is practicing which of the following leadership styles? a) Autocratic b) Laissez-Faire c) Democratic d) Transformational
Laissez-Faire Explanation: In laissez-faire leadership, also called nondirective leadership, the leader relinquishes power to the group, such that an outsider could not identify the leader in the group. The democratic leadership styles is characterized by a sense of equality among the leader and other participants. The autocratic leader assuming complete control over the decisions and activities of the group. Transformational leaders create intellectually stimulating practice environments and challenge themselves and others to grow personally and professionally and to learn.
A nurse on a telemetry unit is admitting a client and has an unlicensed assistive person (UAP) helping with the admission process. Which task can the nurse delegate to the UAP? a) Listing the client?s home medications on a medication reconciliation form b) Obtaining an admission weight for the client utilizing the client?s bed scale c) Gathering information about the client?s medical history and any allergies d) Determining what heart rhythm the client is in based on telemetry reading
Obtaining an admission weight for the client utilizing the client?s bed scale Correct Explanation: The nurse should delegate obtaining the initial weight to the UAP, as this is within the capability of the UAP. The task of obtaining a history, including home medications, is a responsibility of the nurse with documentation in the medical record. The nurse should also interpret the initial rhythm of the client. Although UAPs may be able to interpret the rhythm based on special training, there is no indication of this being true for the UAP in the scenario and the nurse should still verify the initial rhythm interpretation is correct
Carol is considering applying for a leadership role on her medical unit. She asks her colleagues what they consider to be good personal leadership skills. Which of the following would be appropriate? Choose all that apply. a) Religious values b) Problem solving c) Communication d) Self-evaluation e) Knowledge of all nursing
Problem solving • Communication • Self-evaluation Correct Explanation: Communication, problem solving, and self-evaluation are three of the four basic nursing leadership skills, but are not all inclusive. Religious values are personal and may contribute to a person's strength, but are not included in what is needed for a public leader. No one nurse can ever know everything there is to know about nursing
Megan is the nurse manager for a surgical unit and is planning a significant change in how the unit functions. She plans to include some things that will help to overcome any resistance to the change from the staff. Which of the following might help overcome resistance to Megan's planned change? a) Threaten to end staff's employment b) Demand loyalty and commitment c) Provide incentives, such as time off d) Refuse to hear any discussion
Provide incentives, such as time off Explanation: Nurses acting as change agents would it beneficial to: (1) explain the proposed change to all affected people in simple, concise language; (2) list the advantages of the proposed change, both for the individual and for members of the group; (3) relate the proposed change to the person's or group's existing beliefs and values; (4) help overcome resistance by providing opportunities for open communication and feedback; (5) indicate clearly how the change will be evaluated; (6) introduce change gradually and involve everyone affected by the change in the design and implementation of the process; (7) provide incentives for commitment to change, such as money, status, time off, or a better working environment. Threatening to end employment, demands for loyalty, and refusal to listen to discussion are sure ways to turn staff against the planned change.
A nurse manager best demonstrates effective leadership characteristic by which action? a) Knowing all information about the unit processes b) Sharing a vision for the unit and enlisting support c) Indicating an interest in becoming a role model d) Being very structured and rigid with the unit flow
Sharing a vision for the unit and enlisting support Correct Explanation: The nurse leader on a nursing unit should have a vision for the unit and be able to share this with the staff in order to enlist support and cooperation among the staff. The nurse leader should already be a role model, rather than just demonstrating interest. This would be related more to someone who was developing leadership qualities. The nurse leader should be flexible, not rigid, and does not have to know all information about the unit; rather, the nurse leader needs to know what resources are available among the staff and other leadership in helping reach expected goals and outcomes
A nurse in an intensive care unit places a request with the nurse manager to modify her work schedule. The nurse desires to return to college and advance her nursing degree. Which of the following illustrates that the nurse manager approaches the situation using a transformational leadership style? a) She suggests that the nurse postpone attending nursing school at the present time. b) She disregards the nurse?s request and continue scheduling the nurse as previously agreed upon. c) She rearranges the nurse?s schedule in a manner that will allow her to attend college. d) She advises the nurse to consider finding another job that will better fit within her class schedule.
She rearranges the nurse?s schedule in a manner that will allow her to attend college. Correct Explanation: Transformational leaders empower their staff by encouraging learning and promoting and verifying a sense of value about the powerful, life-saving work that nurses perform. Rearranging the nurse?s schedule in a manner that will allow her to attend college shows support of continuing education and appreciation of her value as an employee. Postponing school, disregarding her request, and advising the nurse to find another job devalues continuing education and the nurse as an employee.
A nurse manager of a physician's office uses the laissez-faire style of leadership with the staff. Which nursing actions exemplify this management style? (Select all that apply.) a) The manager views staff as equal partners in the practice. b) The nurse manager is the authority on all issues. c) Manager and staff work independently, making task accomplishment difficult. d) The nurse manager allows the staff to choose their own schedules. e) The nurse manager allows dominant staff members to direct the group activities. f) The nurse manager inspires and motivates staff to provide excellent patient care.
The nurse manager allows the staff to choose their own schedules. • The nurse manager allows dominant staff members to direct the group activities. • Manager and staff work independently, making task accomplishment difficult. Explanation: In laissez-faire leadership, also called nondirective leadership, the leader relinquishes power to the group, such that an outsider could not identify the leader in the group. The nurse manager would allow the staff to choose their own schedules. The nurse manager could allow dominant staff members to direct the group activities. The nurse manager and staff work independently, making task accomplishment difficult. The nurse is not always the authority on all issues. The nurse manager does not view staff as equal partners. The nurse manager does not inspire and motivate staff to provide excellent client care
The registered nurse (RN) wants to delegate a task to an unlicensed assistive personnel (UAP) but is unsure if the task can be delegated. What is the best resource for the RN to use in determining if the task is appropriate? a) A nurse mentor or a nurse preceptor b) A more experienced nurse working on the same unit c) The medical practice act website d) The nurse practice act or facility?s policy and procedures
The nurse practice act or facility?s policy and procedures Correct Explanation: The RN should consult the nurse practice act or the facility?s policy and procedures. The nurse mentor or preceptor and the more experienced nurse are good resources, but may mistakenly give inaccurate information. The medical practice act is designed to govern physician practice and may not contain information on the task that is to be delegated
Two new graduate nurses are requesting the same preceptor for unit orientation. Both new graduates have been very vocal about being unhappy if they do not receive their choice of preceptors. Which illustrates the nurses using a compromise approach to conflict resolution? a) The nurses make an arrangement for the preceptor. One nurse will obtain the preceptor for orientation in exchange for that nurse working each weekend. b) The nurses decide to share the preceptor. The preceptor will precept one nurse at the beginning of the orientation and precept the other nurse at the end of the orientation. c) The nurses ignore the other nurse?s request for the preceptor. d) The nurses will allow the preceptor to decide which nurse she will precept.
The nurses decide to share the preceptor. The preceptor will precept one nurse at the beginning of the orientation and precept the other nurse at the end of the orientation. Correct Explanation: Compromise involves both parties willing to relinquish something of equal value. The nurses decision to share the preceptor, one at the beginning of the orientation and the other one at the end of the orientation, demonstrates compromise. Each nurse ignoring the other's request illustrates avoidance. Allowing the preceptor to decide which nurse she will precept encourages competition. Competition involves a win-lose approach to conflict. The nurses' making an arrangement illustrates accommodation. Accommodation involves one party deciding to let the other party win in exchange for something else of value
The registered nurse (RN) wants to delegate measuring a client's urinary output to an unlicensed assistive personnel (UAP). Which factors should the nurse consider before delegating the task? a) Predictability of the UAP, the amount of time required for the task, and RN?s skill level b) The complexity of the activity, age of the UAP, and predictability of the outcome c) The stability of the patient?s condition, potential for harm, and complexity of the activity d) The context of the other patient needs, the desired outcome, and autonomy of the patient
The stability of the patient?s condition, potential for harm, and complexity of the activity Correct Explanation: RNs should consider the following when delegating tasks to UAPs: qualifications and capabilities of the UAP, stability of the patient?s condition, complexity of the activity to be delegated, potential for harm, predictability of the outcome, and overall context of other patient needs
Which of these statements regarding a nurse manager role is accurate? a) A healthy work environment is not within the scope of the nurse manager?s role. b) The nurse manager will decide on the financial targets for the nursing unit. c) To effectively manage the nursing unit, the nurse manager should also be a leader. d) The nurse manager?s main role in the nursing unit is to manage the unit budget.
To effectively manage the nursing unit, the nurse manager should also be a leader. Correct Explanation: In order to be an effective nurse manager, the nurse manager must also be a leader. This is important with management of a healthy work environment, which is a responsibility of the nurse manager. This is done by helping ensure that interpersonal conflicts are resolved. The nurse manager is also accountable for client census, staffing, supplies, and budget, but is not responsible for setting financial targets for the budget; this is usually managed at the executive level.
A nurse is discharging a patient from the hospital. Which nursing actions should occur when a patient is discharged from a health care setting? (Select all that apply.) a) Preferably, the nurse who conducts the initial nursing assessment will determine the special needs of the patient being discharged. b) The physician ensures that referrals are made to such agencies as home health care or social services to provide support and assistance during the recovery period. c) The nurse performs discharge planning, which begins upon admission to the facility to ensure continuity of care. d) The nurse assesses the patient to ensure that the patient does not require any complicated treatment or care performed by family members. e) A hospital administrator coordinates and performs an approved handoff for the patient to a new facility. f) The nurse ensures that the family members are taught the knowledge and skills needed to care for the patient.
• The nurse performs discharge planning, which begins upon admission to the facility to ensure continuity of care. • The nurse ensures that the family members are taught the knowledge and skills needed to care for the patient. • Preferably, the nurse who conducts the initial nursing assessment will determine the special needs of the patient being discharged. Explanation: Discharge planning is started as soon after admission as possible in order to provide adequate time for teaching and arranging any necessary care following discharge from a facility. The nurse must validate that any family members that are going to be caring for the patient understand and can perform necessary care. Continuity of care is improved if the nurse that performed the detailed admission assessment determines the discharge needs. The nurse, not the hospital administrator, prepares and performs the patient handoff to the new facility. As long as family members are capable and are adequately taught and evaluated, they may perform complicated procedures required for caring for the patient.
