Leadership Chapter 4

The patient who had a colonoscopy one hour ago suddenly experiences bright red rectal bleeding, becomes diaphoretic, and is short of breath. The nurse decides to implement standing emergency orders and initiates oxygen per mask and increases the patient's Ⅳ rate, while a colleague contacts the patient's physician. Which critical element of nursing is this nurse demonstrating? Select all that apply. 1. Autonomy 2. Responsibility 3. Delegation 4. Accountability 5. Relevance

ANS: 1, 2, 4 Explanation: 1. Autonomy in clinical decision making occurs whenever a nurse makes an independent judgment about the presence of a clinical issue and then provides the resolution. This nurse identified that the patient was experiencing distress and made the clinical judgment to use emergency orders. The nurse could have also made a clinical judgment not to use them. 2. This nurse was entrusted with a particular function, in this case, caring for a postop patient. 3. There is no indication that the nurse delegated care of this patient to anyone. 4. Accountability is the acceptance of responsibility of the outcomes of care. 5. This term is not one of the critical elements of nursing.

Several small rural hospitals have been acquired by a large nationwide healthcare organization. Six months after the acquisition, the rural hospitals remain in conflict with the management team and with one another. Choose the questions that the management team should ask in order to identify the reasons for this continued discord. Select all that apply. 1. How are the hospitals communicating with the organization and with one another? 2. Are the goals of the hospitals aligned with those of the organization? 3. Are the rural hospitals too focused on patient-centered care and safety? 4. How is the organization handling decision making with the hospitals? 5. Aren't buyouts always this way?

ANS: 1, 2, 4 Explanation: 1. Communication is paramount in successfully working in a large organization. 2. When subsections of the organization are separated by distance, it is easy for goals to be out of alignment. 3. There can never be too much focus on being patient-centered and safety-minded. 4. If the organization is making all of the decisions and passing them down to the hospitals, discord is likely to occur and continue. 5. This question minimizes the issue and does not address the problems. If management takes this attitude, the problems will likely continue.

The marketing process includes which three elements listed below? Select all that apply. 1. A determination of what is wanted and needed 2. A method(s) for reaching what is wanted or needed 3. A description of the cost and quality of what is needed 4. A specific plan to evaluate the service needed 5. An understanding of the patient, customer, or consumer and service needed

ANS: 1, 2, 5 Explanation: 1. This is one of the elements. 2. This is one of the elements. 3. Cost and quality of services is not one of the three elements, though it is related to the determination of what is wanted or needed. 4. Evaluation of the service is not one of the three elements. 5. This is one of the elements.

The primary physician identifies a healthcare provider to manage the care of a patient on the general medical unit of a hospital. Depending upon the facility, which healthcare provider may fill this role? Select all that apply. 1. Nurse practitioner 2. Physician intensivist 3. Physician hospitalist 4. Registered nurse 5. Clinical nurse specialist

ANS: 1, 3 Explanation: 1. Either a physician or a nurse practitioner can fill the role as hospitalist in many facilities. The hospitalist is a generalist and provides medical coverage for hospitalized patients instead of the patient's personal or primary care physician. 2. Intensivists cover patients in the intensive care units and have considerable intensive care experience, something that most primary care physicians do not have. 3. Either a physician or a nurse practitioner can fill the role as hospitalist in many facilities. The hospitalist is a generalist and provides medical coverage for hospitalized patients instead of the patient's personal or primary care physician. 4. R Ns work under the direction of a physician. 5. Intensivists cover patients in the intensive care units and have considerable intensive care experience, something that most primary care physicians do not have.

Which of the following are related to the development and use of alternative or complementary therapies? Select all that apply. 1. There is an institute in N I H that focuses on this area of healthcare. 2. We have developed significant research to either support or dispute these therapies. 3. Healing touch, herbal therapy, and acupuncture are examples of these therapies. 4. There is effective reimbursement for these therapies

ANS: 1, 3 Explanation: 1. The National Center for Complementary and Integrative Health 2. There is research, but not enough. 3. These are examples of these therapies; other examples are massage, energetic healing, acupressure, and more. 4. Reimbursement is highly variable.

These four principles of marketing are used to guide development of a marketing plan, focusing on the critical elements of the plan. Select all that apply. 1. Place 2. People 3. Product 4. Pricing 5. Promotion

ANS: 1, 3, 4, 5 Explanation: 1. The principles are referred to as the 4 Ps and include product, promotion, pricing, and place. 2. The principles are referred to as the 4 Ps and include product, promotion, pricing, and place. People is not included as a specific focus of the principles. 3. The principles are referred to as the 4 Ps and include product, promotion, pricing, and place. 4. The principles are referred to as the 4 Ps and include product, promotion, pricing, and place. 5. The principles are referred to as the 4 Ps and include product, promotion, pricing, and place.

What are the responsibilities of the nurse manager in most shared governance models? Select all that apply. 1. Staffing 2. Direct patient care 3. Program evaluation 4. Allocation of resources 5. Long-range planning

ANS: 1, 3, 4, 5 Explanation: 1. This is a responsibility of the nurse manager in most shared governance models. 2. In most shared governance models, the nurse manager is not responsible for providing direct patient care. 3. This is a responsibility of the nurse manager in most shared governance models. 4. This is a responsibility of the nurse manager in most shared governance models. 5. This is a responsibility of the nurse manager in most shared governance models.

The organizational analysis documentation describes the organization as one with centralized leadership with a clearly defined organization chart hierarchy. The organization is divided into departments and follows detailed rules and regulation. This organization follows which theories? Select all that apply. 1. Classical 2. Systems 3. Integrated delivery system 4. Vertical integration theory 5. Bureaucratic

ANS: 1, 5 Explanation: 1. The first principle of classical organization theory is division of labor, which is done in this organization through establishing departments. This theory is also demonstrated by the clear delineation of the policies and procedures and a defined hierarchy. 2. In systems theory, there is one entity with multiple elements that interact independently. 3. This system focuses on a continuum of care, using a decentralized leadership style. There is a merging (horizontal or vertical) of various components of the system. 4. This is an organizational style that is part of an integrated delivery system. Bureaucratic organizations incorporate the key principles of classical theory with a division of labor, clearly defined hierarchy, and detailed rules and regulations

Which statement should be included in a classroom discussion about organizational process? 1. It is a philosophy that becomes the basis for operationalizing the mission of the institution. 2. It answers the question of "what does the organization look like?" 3. It directs staff as to whom they report. It is a graphical representation of an organization's flow of responsibility

ANS: 1. It is a philosophy that becomes the basis for operationalizing the mission of the institution. Explanation: 1. The organizational process focuses on how the organization operates. 2. The organizational process answers the question of "why" for the organization. 3. This statement describes chain of command. 4. This is a description of an organizational chart.

The nurse is organizing a smoking cessation group for the residents of a retirement center. What level of healthcare services does this represent? 1. Primary care 2. Secondary care 3. Tertiary care 4. Rehabilitation care

ANS: 1. Primary care Explanation: 1. The nurse is providing health promotion and education, which falls within the level of primary care. 2. Secondary care focuses on the diagnosis and treatment of an existing problem. 3. Tertiary care services include long-term care, rehabilitation, and care of the dying. 4. Rehabilitation care is a tertiary service.

What is a disadvantage of using the team approach for care delivery? 1. The team leader might not have the necessary leadership skills required to successfully lead the team. 2. There is a risk that care will be fragmented. 3. This approach often leads to greater staff dissatisfaction, with staff members feeling they are just grinding out tasks. 4. This approach may lead to decreased collaboration and redundancy in patient care.

ANS: 1. The team leader might not have the necessary leadership skills required to successfully lead the team. Explanation: 1. Using the team approach requires that the team leader have the necessary leadership skills to coordinate and delegate patient care. 2. The team approach helps keep care from becoming fragmented. 3. In this approach, each team member can contribute his or her own special expertise or skill in caring for the patient. 4. There is generally a greater amount of collaboration and less redundancy of care.

What is the oldest of the nursing care models? 1. Total patient care 2. Functional nursing 3. Team nursing 4. Primary nursing

ANS: 1. Total patient care Explanation: 1. This is the oldest of the models. Nurses have provided this type of care for generations. 2. This model is not as old as total patient care. 3. This model is not as old as total patient care. 4. This model is not as old as total patient care.

The nursing student clinical group is attending the first clinical session of the semester. What nursing care delivery model do students usually expect to follow? 1. Total patient care model 2. Functional nursing model 3. Primary nursing model 4. Care management model

ANS: 1. Total patient care model Explanation: 1. Typically, student nurses follow the total patient care model and provide all of the care for a patient while in the clinical area. This model may be altered slightly to accommodate the student's progress in the nursing program or the policies of the facility. For example, the nursing student may provide all care except giving Ⅳ meds. 2. Functional nursing is a task-oriented approach where staff members are assigned to provide a specific task, such as wound care. 3. In primary nursing, the R N assumes 24-hour responsibility for planning, directing, and evaluating the patient's care, from admission to discharge. 4. The care management model, which is similar to case management, focuses on the needs of the integrated delivery system.

The nurse manager supervises the neurologic intensive care unit, surgical intensive care unit, and cardiac intensive care unit. Each unit employs 35 nurses and 15 support staff. The span of control for this manager is . Record your answer rounding to the nearest whole number.

ANS: 15O Explanation: The manager's span of control is the total number of employees managed. In this case, 105 nurses and 45 support staff.

Compare and contrast input, process, and output in systems organizational theory by selecting the options that represent process. Select all that apply. 1. The physician admits a patient to the hospital. 2. The nurse provides excellent care to a patient postoperatively. 3. The dietary manager orders supplies based upon cost-effectiveness. 4. The patient delivers a healthy infant. The nursing unit secretary identifies a potential medical error before it occurs.

ANS: 2, 3, 5 Explanation: 1. This is a system input. 2. This represents process. 3. This represents process. 4. This is an outcome. 5. This represents process.

Which options are included in the six dimensions of shared governance? Select all that apply. 1. Informal authority base 2. Access to information about the organization 3. Delegation of care to others 4. Ability to set goals and negotiate conflict 5. Control over professional practice

ANS: 2, 4, 5 Explanation: 1. Shared governance requires formal authority granted by the organization. 2. This is a part of shared governance. 3. This is not a part of shared governance, though it occurs in a shared governance organization. 4. This is a part of shared governance. 5. This is a part of shared governance.

The nurse is interviewing for a position in a newly opened hospital. Which observation would best indicate to this nurse that the organization follows a shared governance model? 1. Among the documents provided by the human resources department is an organizational chart of the nursing department, indicating that the director is the highest ranking member. 2. Conversation with a staff nurse reveals that the nurse feels empowered in making patient care decisions. 3. The mission statement of the hospital describes centralized power. 4. A staff nurse mentions that each individual staff member has complete autonomy.

ANS: 2. Conversation with a staff nurse reveals that the nurse feels empowered in making patient care decisions. Explanation: 1. This documents that the hospital follows the classical theory of organization. 2. Shared governance increases each nurse's influence over the organization, empowering staff. 3. This is a classical organizational model. 4. Although the shared governance model does provide some autonomy, there is also an understanding that staff is expected to collaborate and function cooperatively with both management and colleagues.

This morning, the R N is assigned to administer medications to all of the patients on the medical-surgical unit. From this assignment, the R N knows that this organization adheres to which type of patient care delivery model? 1. Total patient care model 2. Functional nursing model 3. Primary nursing model 4. Care management model

ANS: 2. Functional nursing model Explanation: 1. The staff working for an organization that uses the total patient care model is assigned to provide all of the care for a patient while in the clinical area. 2. Functional nursing is a task-oriented approach where staff members are assigned to provide a specific task, such as passing out medications for the unit. 3. In primary nursing, the R N assumes 24-hour responsibility for planning, directing, and evaluating the patient's care, from admission to discharge. 4. The care management model, which is similar to case management, focuses on the needs of the integrated delivery system.

What is the most significant change today in healthcare providers that impacts all types of healthcare settings? 1. Use of hospitalists 2. Increased emphasis on interprofessional teams 3. Development of the doctor of nursing practice degree 4. Use of unlicensed assistive personnel

ANS: 2. Increased emphasis on interprofessional teams Explanation: 1. Hospitalists are new, but they are only used in hospitals and not all hospitals use them. 2. Interprofessional teams are the major focus today in healthcare delivery—in practice and need to develop education—meeting the healthcare professions core competency to utilize interprofessional teams. 3. The doctor of nursing practice is important, but it is not important to all settings and not clear what its long-range impact will be. 4. Unlicensed assistive personnel are not new to healthcare delivery.

The director of nursing education for a hospital has been asked to provide continuing education on safety precautions to physicians, nurses, and all other disciplines providing patient care. Although the director is responsible for providing this education, the director is not responsible for assuring that physicians and healthcare managers adhere to the procedures. What type of healthcare organizational structure is present in this hospital? 1. Vertical structure 2. Staff authority 3. Span of control 4. Horizontal structure

ANS: 2. Staff authority Explanation: 1. Vertical structure uses centralized decision making. 2. When staff members function in an advisory capacity and cannot force other staff to do something, they are operating under staff authority structure. 3. Span of control describes the number of people supervised by one person or position. 4. Horizontal structure uses decentralized decision making, and is organized around customer-oriented processes.

You are orienting a new staff nurse to the unit's nursing model, which is the Synergy Model for Patient Care™. As you describe the model, you make a mistake and another nurse points out your error. What would that nurse identify? 1. The model matches nurses' competencies with patient characteristics, needs, and the unit. 2. The model is for critical-care units. 3. The model supports the healthcare professions core competency to use patient-centered care. 4. Nurses are expected to be competent in clinical inquiry.

ANS: 2. The model is for critical-care units. Explanation: 1. The model identifies a list of patient characteristics and a list of nurse competencies that should correlate with one another. 2. The model was created by the American Association of Critical-Care Nurses, but it used in a variety of patient care units. 3. Patient-centered care is a key patient characteristic-participation in decision-making. 4. Clinical inquire or the ongoing process of questioning and evaluating is an expected nurse competency in the model.

Choose the statements that are correct about not-for-profit healthcare organizations. Select all that apply. 1. There are stockholders who own stock in the organization. 2. These organizations do not have to make a profit to survive. 3. Typically, these organizations are funded by charitable institutions, the government, or churches, as well as by the typical reimbursement sources. 4. These organizations experience more ethical and legal problems. 5. Organizations are called voluntary or public health organizations.

ANS: 3, 5 Explanation: 1. Stockholders or shareholders own stock or shares in for-profit organizations. 2. Both for-profit and not-for-profit organizations have to make a profit to survive. The not-for-profit organizations invest all profits back into the organization. 3. This is the typical funding source for not-for-profit healthcare organizations. 4. Since for-profit organizations have a need for financial success, as a group they typically have more ethical and legal problems. 5. Not-for-profit healthcare organizations are also known as voluntary or public health organizations.

The American Organization of Nurse Executives (A O N E) emphasizes "the core of nursing is knowledge and caring." To which portions of the Institute of Medicine core competencies does this statement relate? Select all that apply. 1. Use of interprofessional teams 2. Informatics 3. Evidence-based practice 4. Quality improvement 5. Patient-centered care

ANS: 3,5 Explanation: 1. Using interprofessional teams relates to managing the journey. 2. Informatics applies to the synthesis of knowledge. 3. This statement relates to both evidence-based practice and patient-centered care. 4. Quality improvement applies to the synthesis of knowledge. 5. This statement relates to both evidence-based practice and patient-centered care.

A nurse who has the ability to make decisions and has competence to do so is best described as demonstrating which of the following? 1. Responsibility 2. Delegation 3. Autonomy 4. Accountability

ANS: 3. Autonomy Explanation: 1. Responsibility refers to specific accountability or liability associated with performance. 2. Delegation is the assignment to another to complete a task. 3. Autonomy focuses on the individual's ability to make decisions and has competence to do so. 4. Accountability means a person is answerable for their actions.

The obstetrics department, which is composed of labor and delivery, postpartum, nurseries, and the neonatal intensive care unit, operates under what organizational structure? 1. Decentralized structure 2. Matrix organizational structure 3. Departmentalization 4. Line authority

ANS: 3. Departmentalization Explanation: 1. Decentralized structure spreads tasks and authority out over components of the organization. 2. Matrix organization is used when staff members belong to a functional department, such as nursing, and to a service or product department, such as radiology. 3. Departmentalization occurs when divided tasks are grouped based on related responsibilities or location. 4. Line authority or chain of command identifies to whom each staff member reports up through the chain of command.

The patient is being discharged from the hospital after having a coronary artery bypass graft (C A B G). Which level of the healthcare system will best serve the needs of this patient at this point? 1. Primary care 2. Secondary care 3. Tertiary care 4. Public healthcare

ANS: 3. Tertiary care Explanation: 1. The patient already has coronary heart disease, so primary care would not be appropriate for this problem. 2. The patient has just been discharged from secondary care level services, where diagnosis and treatment were done. 3. A patient recovering from a C A B G will best be served by rehabilitation services, which are at the tertiary care level. 4. There is no indication that the patient was having difficulty accessing healthcare prior to this episode, so public healthcare does not apply.

The healthcare organization is undergoing reorganization to a service-line structure. What are the benefits of this structure? 1. There is a clear delineation of the organization's rules. 2. Each staff member reports to only one supervisor. 3. Staff members are not encouraged to use creative problem solving. 4. Departments are less likely to place blame on one another. 5. The nursing presence is strong and unified.

ANS: 4. Departments are less likely to place blame on one another. Explanation: 1. This is not true of a service-line organization, but of a classical or bureaucratic organization. 2. This is not true of a service-line organization, but of a classical or bureaucratic organization. 3. This is not true of a service-line organization, but of a classical or bureaucratic organization. 4. A service-line organization groups activities according to product or service. Therefore, one department cannot place blame on another department, because all departments are a part of the same service line. 5. This is not true of a service-line organization, but of a classical or bureaucratic organization.

An outside accreditation team is evaluating the organization's mission statement. Which action, taken by the organization, is the most important in regard to this statement? 1. The organization must provide a current copy of the mission statement. 2. The organization must be certain that the mission statement is prominently displayed in public access areas. 3. The organization must provide the team with a written plan about how the mission statement will be followed. 4. The organization must provide evidence of how the mission statement is being followed.

ANS: 4. The organization must provide evidence of how the mission statement is being followed. Explanation: 1. This is important, but not as important as evidence that the organization is actually following the mission. 2. This is important, but not as important as evidence that the organization is actually following the mission. 3. This is important, but not as important as evidence that the organization is actually following the mission. 4. The fact that the mission statement is indeed being followed is the most important evidence that the organization can provide.

Which factor would least likely be included in the analysis of an organization? 1. Whether the organization's mission and vision match staff performance 2. Results from a staff opinion survey regarding the organization's decision-making processes 3. How the organization's communication patterns have affected the change process 4. The turnover rate of nursing personnel in a given unit

ANS: 4. The turnover rate of nursing personnel in a given unit Explanation: 1. The vision and mission statements are the driving forces behind all decisions, and provide critical information about the organization's values and philosophy. 2. It is important to analyze how staff members believe decisions are made. 3. It is essential to analyze communication patterns because communication runs an organization and its ability to function effectively. 4. Organizational analysis does take staffing issues into consideration. However, of the options provided, the turnover rate of a particular unit is least likely to be considered. Analysis would likely be focused on the turnover rate in the entire organization.

What has caused some of the concern about the use of unlicensed assistive personnel (U A P)? 1. Supervision is provided by the registered nurse. 2. U A Ps do not provide quality care. 3. Home health aides are not supervised. 4. There is variability of education and training of all types of UAPs.

ANS: 4. There is variability of education and training of all types of UAPs. Explanation: 1. Supervision by the registered nurse is not a concern as long as the RN assures they are able to provide safe care. 2. Most U A Ps do provide quality care with appropriate supervision. 3. Home health aides, although they work more independently than do U A Ps in other organizations, are supervised by the home health R N. 4. The amount of education and training of U A Ps is highly variable, which has caused some concern about what they are able to do and the effect on the quality of care.