Leadership Chapter 14 and 13

An action plan: a. breaks a strategic plan into manageable parts. b. details a futuristic view of the institution. c. outlines the steps in performing a procedure. d. provides a strategic plan for actualizing the mission.

ANS: A An action plan breaks a strategic plan into manageable parts

The guiding framework that describes the organization's purpose and future direction is the: a. futuristic guidelines. b. mission and vision. c. strategic plan. d. core purpose.

ANS: B The organizational mission and vision collectively is a guiding framework that describes the organization's purpose and future direction

Operational choices for action that are made to implement a strategy are called: a. tactics. b. objectives. c. core values. d. strategic plans.

ANS: A Tactics are operational choices for action that are made to implement a strategy

Part of the evaluation design process when developing a strategic plan includes: a. delineation of measures of success. b. designing a form to critique the guidelines. c. formulating an implementation outline. d. writing the vision and mission statement.

ANS: A The final step in the strategic planning process is developing the evaluation design. Planning for evaluation is imperative to ensure that systems and measurements are in place to determine whether the strategic plan has been achieved. During the strategic planning process, measures of success are delineated, responsible individuals are identified, and frequency of evaluation and reporting of these measures is determined.

The statement, "We will provide high-quality care and services to our patients. We are committed to maintaining excellence, respect, and integrity in all aspects of our operations and our professional and business conduct," is an example of: a. a mission statement. b. the core values of an organization. c. a strategic plan. d. the core purpose of an organization.

ANS: A The mission defines what the organization does; the core purpose delineates why.

Strategic management, long used in business to ensure a competitive advantage over similar enterprises, involves: (Select all that apply.) a. setting targets. b. establishing goals. c. evaluating success. d. developing an action plan. e. defining the core purpose. f. conducting an environmental scan.

ANS: A, B, C, D, F Strategic management involves conducting an environmental scan, knowing the competition, establishing goals, setting targets, developing an action plan, implementing the plan, and evaluating success. This approach has long been used in business to ensure a competitive advantage over similar enterprises. The core purpose is the reason the organization is in business.

The purpose of strategic management is to: (Select all that apply.) a. ensure customer satisfaction. b. establish a competitive position. c. reach strategic objectives or goals. d. develop the organizational mission. e. provide a blueprint for operating a business.

ANS: A, B, C, E Strategic management involves strategic planning and implementation. It provides a blueprint for operating a business, establishing a competitive position, ensuring customer satisfaction, and reaching strategic objectives or goals.

Characteristics of strategic management include: (Select all that apply.) a. alignment with the external environment. b. helps identify best practices on the nursing unit. c. future orientation. d. engagement of the entire workforce in organizational leadership. e. use of change management strategies to achieve performance goals. f. facilitation of decision making with well-communicated decisions.

ANS: A, C, D, E, F According to Jasper and Crossan (2012), the five characteristics of strategic management are engagement of the entire workforce in organizational leadership, alignment with the external environment, future orientation, use of change management strategies to achieve performance goals, and facilitation of decision making with well-communicated decisions.

A new cancer center is being built in the local hospital. A patient survey has revealed that patients are not certain which caregiver is the registered nurse (RN) during their hospital stay. A group is formed to recommend methods to help patients identify which caregiver is their RN for the new cancer center. Which of the following groups best represents those who should be involved in forming recommendations? a. Chief medical officer, public relations vice president, and human resources b. Oncology clinical nurse specialist, nurse's aides, and RNs c. Physicians, unit secretaries, and vice president of finance d. Vice president of nursing, decentralized pharmacist, and licensedpractical/vocational (LPN/LVN) nurses

ANS: B Involving individuals at all levels of the organization will ensure a variety of perspectives and more buy-in to the final product. Including the patient's perspective may provide additional insight about the issue. Ideally, those involved in all levels of patient care, such as the vice president of nursing, nurse manager, oncology clinical nurse specialist, LPN/LVNs, and nurses' aides, as well as patients of the RN, may need to be included to gain additional perspective

A nurse manager enjoys implementing new programs and beginning new projects. She is beginning to find herself overwhelmed and needs to decrease her workload. Which of the following ideas might best help decrease her workload? a. Comparing her vision with that of the institution b. Following the strategic objectives and mission of the hospital c. Reviewing the action plan and vision of the hospital system d. Using her intuition to determine which project should continue

ANS: B Strategic objectives provide a way of converting the rather abstract mission of an organization into concrete terms. Following the mission of the hospital will help keep the nurse manager focused.

The concept of strategic management includes strategic planning and the implementation of: a. core values. b. strategy. c. tactics. d. objectives.

ANS: B The concept of strategic management includes strategic planning and strategy implementation

A hospital with a large surgery department is concerned about surgeons starting their own surgical centers. In relation to the environmental assessment process, this is an example of: a. an economic monopoly. b. an external threat. c. marketplace competition. d. political strength.

ANS: B The external components are described as opportunities and threats, and they are identified in the same manner as the internal factors. Opportunities and threats may include changes in industry, marketplace, economy, political climate, technology, and competition

For organizational strategy to be implemented successfully it must be: (Select all that apply.) a. specific and inflexible. b. applied in a timely manner. c. agreed upon by all stakeholders. d. executed proficiently and efficiently. e. aligned with the organizational culture.

ANS: B, D, E Strategy must be implemented proficiently and efficiently, as well as in a timely manner, if it is to be effective. For this to occur, the organization must attend to its capabilities, the reward structure, available support systems, and the organizational culture. If any of these characteristics are not in place, implementation of the strategy will surely fail.

Addressing the strategic planning process questions involves considering environmental factors. An example of an external environmental factor to be considered is: a. financial factors. b. human resources. c. political climate. d. organizational culture

ANS: C A key component of the strategic planning process is to assess the environment. This assessment, called environmental scanning, consists of analyzing both internal and external environmental factors. External opportunities and threats may include changes in industry, marketplace, economy, political climate, technology, and competition

The statement, "We will increase our profit by 8% each year," is an example of a(n): a. strategic plan. b. mission statement. c. organization objective. d. implementation strategy.

ANS: C Objectives are defined as the targets an organization wants to achieve. These can be financial or performance based with short-range or long-range targets.

SWOT is an acronym for: a. stability, wealth, opportunistic, and timeliness. b. strategies, work ethic, oppositions, and team. c. strengths, weaknesses, opportunities, and threats. d. strong, worthy, oppositional, and tactical.

ANS: C SWOT is an acronym for strengths, weaknesses, opportunities, and threats. SWOT analysis is used in developing strategic plans for an organization.

Answering questions such as "What business are we in?" and "What business do we want to be in?" can lead the organization to define the: a. mission. b. objectives. c. core purpose. d. strategic plan.

ANS: C The core purpose can be defined and refined by asking, "Why are we in business?" As a result, the initial response, "We are in the business of health care," may be further refined to "We want to contribute to the community in which we exist." Thus asking "why" may result in the core purpose of providing needed health care services to the community in which the organization is located.

Most strategic plans result in a written document. Strategic plan documents generally contain which of the following sections? (Select all that apply.) a. Forward b. Glossary c. Goals and strategies d. Executive summary e. Mission, vision, and values

ANS: C, D, E Generally, strategic plan documents contain an executive summary; background; mission, vision, and values; goals and strategies; and appendixes.

Strategic management is useful for nursing leaders and managers because it: (Select all that apply.) a. helps identify best practices on the nursing unit. b. rewards those who carry out strategy successfully. c. can be used to set measurable, achievable goals and plans. d. can be used to analyze the environment for opportunities and threats. e. can help determine the future of the nursing area, such as a department or unit.

ANS: C, D, E Strategic management is useful for nursing leaders and managers because it can be used to analyze the environment for opportunities and threats; to set measurable, achievable goals and plans; and to help determine the future of the nursing area, such as a department or unit. Success in strategic planning and implementing that strategic plan will position nursing well in an institution. The process provides an opportunity for nursing to shine, because the similarities between the nursing process and the strategic planning process allow nurses to shortcut the learning curve and begin to move forward with the implementation phase while others may still be grappling with the planning process.

A highly respected staff RN on the medical-surgical unit has volunteered to be the champion for the implementation of a new nursing protocol. What does champion mean in this situation? The staff nurse will: a. accept an award on behalf of her unit regarding this protocol. b. display a winning attitude in support of the new protocol. c. educate others in continuous quality improvement protocols. d. passionately commit to the implementation of the process and inspire others.

ANS: D A champion is an individual who is passionate and committed to the implementation process and who can inspire others. Often a champion appears as the strategic planning process unfolds; generally, this individual that contributes freely, is engaged in the work groups, and expresses interest in the process. Champions can be selected as well, but those who volunteer are usually more enthusiastic about the work than those who are "drafted."

Objectives are: a. bylaws used to govern the organization. b. financial minimums needed to operate. c. performance-based criteria for accreditation. d. targets that the organization wants to achieve.

ANS: D Objectives are defined as the targets that an organization wants to achieve.

The first step of the strategic planning process is to: a. develop strategic goals. b. survey the environment. c. implement the action plan. d. formulate the organization's mission and vision

ANS: D The first step of the strategic planning process is to formulate or review and update as needed the organization's mission and vision in alignment with the organization's core purpose and values. The mission delineates what the organization does, while the vision articulates the preferred future state of the organization.

The 2011 Future of Nursing report published by the Institute of Medicine (IOM), calls for: a. an improved educational system that promotes seamless academic progression. b. the baccalaureate in nursing to be established as the minimal educational level for entry into practice. c. the master's degree to be established as the minimal requirement for a leadership position in nursing. d. increased participation in leadership among nurses.

ANS: D The leadership role of nurses has become an area of increasing focus since the Institute of Medicine (IOM, now called the National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division), in its 2011 Future of Nursing report, called for increased leadership development and participation in leadership among nurses.

A key component of the strategic planning process is to assess the environment. Place the steps of the assessment process in order: a. Identify strengths and weaknesses internal to the organization. b. Shape strategies into a strategic plan on which strategic management is based. c. Establish priorities for the critical issues so that strategies are based on the priority issues. d. Analyze strengths, weaknesses, opportunities, and threats for their impact on the organization. e. Analyze internal components for the purpose of drafting a picture of the critical features of the organization.

ANS:A, E, D, C, B

Institutions organize and structure themselves by defining departmental function and authority to achieve a more coordinated effort. In institutions where the executive leader retains more decision-making authority, the operation takes on a more _____ philosophy. a. Centralized b. Decentralized c. Autocratic d. Democratic

a. Centralized Centralization and decentralization are organizational philosophies about power distribution that pertain to the hierarchical level of decision-making authority in the institution. Centralization means that decisions are made at the top levels. Decentralization means that decision making is diffused throughout the organization.

In Magnet organizations, shared governance needs to be manifested through what mechanisms for nurses' decision making? a. Unit practice councils b. Democratic leaders c. Authoritarian leaders d. System-wide practice councils

a. Unit practice councils In a national study of the nursing practice environment, Clavelle and colleagues (2013) found that in Magnet organizations, the primary governance structure was shared governance, which was significantly and positively related to an improved professional practice environment. To be real and make a difference for nurses, the shared governance needs to be manifested through point-of-care structures where direct-care nurses make decisions about patient care and unit operations. Unit practice councils (UPCs) are an example.

At its start, shared governance requires the education and support of organizational executives, managers, and point-of-care staff. Organizational benefits include: (Select all that apply.) a. accountability of the nurse. b. reduction in liability claims. c. reduction in workers' compensation claims. d. improved financial outcomes. e. more expert involvement at the point of care.

a. accountability of the nurse. d. improved financial outcomes. e. more expert involvement at the point of care. Shared governance has far-reaching implications for leaders in today's health care environment, in which the focus is to provide patient care safely, efficaciously, and efficiently. Organizational benefits include increased commitment of staff to the organization; accountability of the nurse; a new level of professional autonomy; a more efficient model for point-of-service decision making; more expert involvement at the point of service; a more assured, confident patient advocate; and improved financial outcomes. Patients benefit from a more efficient model of health care service, more committed health care professionals, quicker responses at the point of service, and a more assured, confident patient advocate.

In an organization that has a decentralized organizational philosophy, decision-making authority rests in levels closer to the point of service rather than in the executive levels. Benefits of a decentralized organizational philosophy include: (Select all that apply.) a. encouraging more input. b. supporting greater innovation. c. facilitating faster response times. d. permitting a narrower span of control. e. allowing for more levels of management.

a. encouraging more input. b. supporting greater innovation. c. facilitating faster response times. Decentralization encourages and facilitates greater innovation, more input, and faster response times. Centralized decision making results in a narrower span of control and more levels of management, while decentralized decision making generally means that the span of management is larger for each manager.

An employee satisfaction survey is conducted annually and shows that nurses in a particular unit are committed to their jobs and feel that they make positive contributions. These nurses are: a. engaged. b. disengaged. c. unproductive. d. at retirement age.

a. engaged. An ongoing challenge among U.S. employers, including health care systems, is to keep employees engaged. A Gallup poll (2014) indicated that only 31.5% of employees in the United States report they are "engaged at work," meaning they are committed to their job and making positive contributions. Fifty-one percent reported they are "not engaged at work," meaning they are not likely to put effort into organizational goals. Seventeen and a half percent are "actively disengaged," described as unhappy, unproductive, and likely to spread negativity. Shared governance is the gold standard for engaging nurses in solving problems at the point of care.

Organizational benefits of a culture of shared governance include: (Select all that apply.) a. improved financial outcomes. b. interdependence among staff nurses. c. increased commitment of staff to the organization. d. more senior leadership involvement at the point of service. e. a more efficient model for point-of-service decision making.

a. improved financial outcomes. c. increased commitment of staff to the organization. e. a more efficient model for point-of-service decision making. Organizational benefits include increased commitment of staff to the organization; accountability of the nurse; a new level of professional autonomy; a more efficient model for point-of-service decision making; more expert involvement at the point of service; a more assured, confident patient advocate; and improved financial outcomes.

In organizations that practice shared governance, the responsibility for unit outcomes rests with the: a. nursing team. b. nurse manager. c. individual nurse. d. chief nursing officer (CNO).

a. nursing team. In organizations that practice shared governance, staff as well as nurse managers and leaders are responsible for innovation. Innovation is considered crucial to safely and effectively solve complex care problems. The entire team is responsible for unit outcomes, not just the individual manager.

Participative leadership was first introduced in the late 1970s. It was adapted by health care organizations to form the basis of shared governance and has evolved to define the roles of nurses and resolve issues related to: a. patient care. b. nursing liability c. nursing salaries. d. nursing turnover.

a. patient care. Participative leadership—the notion of leaders turning to their team for input and ideas—was first introduced to the business world in the 1970s. It was adapted by health care organizations and nursing leaders in the early 1980s, and formed the basis of shared governance, which today has evolved to define the role of nurses as well as to resolve issues related to patient care (Gray, 2013).

The primary purpose of unit practice committees in a health care organization is to improve: (Select all that apply.) a. practice. b. processes. c. outcomes. d. reimbursement. e. turnover.

a. practice. b. processes. c. outcomes. The purpose of the unit practice council is described as being "part of the shared governance structure to promote shared decision making at the unit/clinic/program of care level. To make and implement recommendations to improve practice, processes, and outcomes" (Jordan, 2016, p. 16).

Shared governance has far-reaching implications for today's health care environment. Patients benefit due to: (Select all that apply.) a. quicker responses at the point of service. b. more committed health care professionals. c. a more stringent model of health care service. d. better decisions being made by upper management. e. nurses being more assured, confident patient advocates.

a. quicker responses at the point of service. b. more committed health care professionals. e. nurses being more assured, confident patient advocates. The focus of a health care environment that supports shared governance is to provide patient care safely, efficaciously, and efficiently. Patients benefit from a more efficient model of health care service; more committed health care professionals; quicker responses at the point of service; and a more assured, confident patient advocate.

The nurse manager should use which of the following behaviors when implementing a shared governance structure? a. Autocratic decision making of the manager b. Coaching the staff to be successful c. Harboring the vision within the team d. Reimbursing the staff for overtime

b. Coaching the staff to be successful To be successful, shared governance structures need leaders who are role models and mentors. Staff and management must be dedicated to coaching and continuous learning.

Nurses' involvement in shared governance is an important component of: a. practice models. b. Magnet recognition. c. increased reimbursement. d. physician satisfaction.

b. Magnet recognition. Nurses' involvement in governance is an important component of the American Nurses Credentialing Center's Magnet Recognition Program®.

Shared governance is a model of organizational structure in which staff nurses are: a. employed to establish mutual goals with clients. b. empowered through autonomy and accountability.c . engaged in problem-solving strategies and techniques. d. equipped with evaluative thinking methodologies.

b. empowered through autonomy and accountability. Shared governance is a model of organizational structure in which staff nurses are empowered through autonomy and accountability.

Research about shared governance suggests that it is: a. enhancing the role of the nurse's aide within the organization. b. improving organizational and patient outcomes. c. not a cost-effective program when examining all areas of care. d. too much additional work for the already overwhelmed RN.

b. improving organizational and patient outcomes. Shared governance has far-reaching implications for leaders in today's health care environment, in which the focus is to provide patient care safely, efficaciously, and efficiently. Organizational benefits include increased commitment of staff to the organization; accountability of the nurse; a new level of professional autonomy; a more efficient model for point-of-service decision making; more expert involvement at the point of service; a more assured, confident patient advocate; and improved financial outcomes. Patients benefit from a more efficient model of health care service, more committed health care professionals, quicker responses at the point of service, and a more assured, confident patient advocate.

One obstacle in the implementation of a shared governance model is that nurses have: a. empowered participation in committee meetings. b. limited time to work on projects. c. the same basic educational foundation. d. traditionally worked in decentralized structures.

b. limited time to work on projects. Implementing a shared governance structure can take years; it does not happen overnight. It takes commitment, ongoing education, transparency, time, and dedication. "Shared Governance is not easy to develop... It takes time to be effective. Neither staff nor leaders/managers should assume that the approach relieves leaders and managers of their responsibility to do their jobs" (Finkelman & Kenner, 2016, p. 457). "The biggest barrier to shared governance is having dedicated time for meetings and for work on projects" (Mathias, 2015).

In organizations that practice shared governance, the nurse manager's role is to: (Select all that apply.) a. hire new employees. b. mentor the nursing staff. c. train new nurses in patient care. d. support the decisions of the nursing team.e. enable the staff to become effective leaders.

b. mentor the nursing staff. d. support the decisions of the nursing team. e. enable the staff to become effective leaders. The nurse manager is primarily responsible for mentoring, facilitating, enabling, and supporting the staff personnel. Sustainable change can occur at the unit and organizational level if the nurse manager works within the framework of transformational leadership, shared governance, and action processes.

A nurse works in the critical care unit (CCU). She enjoys being on the unit charge nurse team, the recruitment and retention team, and the peer evaluation team. The recruitment and retention team is responsible for hiring new employees into the CCU. The five-member team, consisting of three registered nurses (RNs), a unit clerk, and a nurse's aide, conduct the interviewing process with key questions that were developed by the team. This is an example of: a. centralized power. b. shared governance. c. span of control. d. vertical authority.

b. shared governance. For shared governance to be effective, decision making must be shared by empowered staff at the point where patients receive care.

The local hospital has a new specialty unit for women and children. The nursing staff has created a family advisory council to assist in reviewing educational materials used at discharge. This shared governance structure is an example of: a. interprofessional education. b. whole-system integration. c. engagement. d. collaboration.

b. whole-system integration. Some see the benefits of decentralization and the shared governance model extending beyond nurses and all care providers to all employees. "As for the future of Shared Governance, Susan Allen PhD, RN (assistant vice president, Cincinnati Children's Hospital) says it would be ideal to see whole-system integration involving all hospital staff. Clearly, the next steps in this vision are to include patients and the community more deliberatively into the shared governance model. Allen says Cincinnati Children's Hospital has a family advisory council and a teen council that get involved in projects, including reviewing potential educational materials and designing a new learning center (Gray, 2013).

Shared governance is a vehicle for engaging organizations and creating the necessary forums and intersections that assure the decisions and actions remain dynamic and as close to the point of service as possible. Shared governance promotes: a. dependence. b. non-punitive culture. c. Collaboration d. executive decision making.

c. Collaboration Shared governance is an accountability-based model through which nurses actively engage in making decisions regarding nursing practice, quality of patient care, education, nursing peer issues, and issues in the work environment. In a shared governance environment, staff take ownership of decision making. This is "a dynamic staff-leadership partnership that promotes collaboration, shared decision making, and accountability for improving quality of care, safety, and enhancing work life" (Mathias, 2015).

Which of the following leadership styles is best suited for implementation of a shared governance structure? a. Authoritarian b. Autocratic c. Participative d. Laissez-faire

c. Participative Participative leadership—the notion of leaders turning to their team for input and ideas—was first introduced to the business world in the 1970s. It was adapted by health care organizations and nursing leaders in the early 1980s, and formed the basis of shared governance, which today has evolved to define the role of nurses as well as to resolve issues related to patient care.

The __________ of an organization is the formulation of ideas, plans, or dreams that help shape the future and ability to persuade colleagues and associates to share those dreams. a. Mission b. core values c. Vision d. organizational chart

c. Vision The mission, core values, and vision are the instruments that give voice to the organization's philosophy. "The mission is a simple and direct expression of a company's goals and objectives. It defines what a company stands for" (Kurian, 2013, p. 186). The vision is the formulation of ideas, plans, or dreams that "help shape the future and ability to persuade colleagues and associates to share those dreams."

The instruments that give voice to the organization's philosophy include which of the following? (Select all that apply.) a. Goals b. Focus c. Vision d. Mission e. Core values

c. Vision d. Mission e. Core values The mission, core values, and vision are the instruments that give voice to the organization's philosophy. The mission is an aim to be accomplished. It influences the philosophy, goals, and objectives of an organization. The vision is a mental image or the power of imagination to see something that is not actually visible.

Decentralization occurs when: a. equipment is being purchased from approved vendors. b. hiring decisions are made at the executive level. c. power is distributed to those closest to the work of caregiving. d. supplies are distributed from one central supply area in the hospital.

d. It shows organizational positions and relationships in a visual representation. The organizational chart is a diagrammatic representation that displays "the flow of authority, chain of command, titles, and functions.

In organizations that practice shared governance, staff, managers, and leaders are responsible for: a. technology. b. budgeting. c. education. d. innovation.

d. innovation. In organizations that practice shared governance, staff as well as nurse managers and leaders are responsible for innovation. Innovation is considered crucial to safely and effectively solve complex care problems. The entire team is responsible for unit outcomes, not just the individual manager. The manager is primarily responsible for mentoring, facilitating, enabling, and supporting.

The purpose of an organization's philosophy is to: a. influence the goals and objectives of an organization. b. display how the parts of an organization are connected. c. be an instrument that gives voice to the organization s mission. d. serve as the institutional framework that shapes the direction of knowledge and skill acquisition.

d. serve as the institutional framework that shapes the direction of knowledge and skill acquisition. Hospitals are organized and their work is structured around a guiding philosophy. The philosophy serves as the institutional framework that shapes the direction of knowledge and skill acquisition. It is the pivotal factor in the long-term development of the institution.

Traditionally, nurses have worked in strong, hierarchical institutions with centralized decision making and clear authority structures, rigid approval mechanisms, and extensive policies and procedures that have resulted in barriers to creating a shared governance system. One such barriers is: a. lack of role clarity. b. lack of time management. c. poor time management skills. d. that development takes a long time.

d. that development takes a long time. Effective shared governance is an ongoing process. Both staff and unit managers need to become comfortable with how governance is shared. Development is gradual and time consuming. To be successful, shared governance structures need leaders who are role models and mentors. Staff and management must be dedicated to coaching and continuous learning.