Leadership Exam 2

A nurse manager is disciplining a nurse for poor behavior. The nurse asks why teamwork is so important. Which response by the nurse manager is best? "It is a skill that is only used by nursing staff." "It helps to reduce health care costs to the consumer." "Most patients consider it as a basic prerequisite of care." "It indicates a shared mutual respect for other team members."

"Most patients consider it as a basic prerequisite of care.": Most patients consider teamwork to be a basic prerequisite of care when they are obtaining health care services. When a team is not able to work together, this indicates that there may be an issue with the quality of care.

A patient asks the nurse why he must be referred to another health care facility for care and wishes to refuse the referral. How should the nurse reply? "Of course; you can always refuse a referral." "You will be happier at the new facility—it's not the hospital." "Your insurance carrier will no longer cover your medical care here, so you will need to leave." "Unfortunately, you don't have a choice in the matter. We can no longer care for your medical condition here."

"Of course; you can always refuse a referral." A patient can always refuse a referral to another health care facility if he or she wishes. The patient should be counseled regarding the reason for the referral and the benefits and risks of refusing it. Incorrect: "You will be happier at the new facility—it's not the hospital." This statement minimizes the patient's wishes and does not address or respect the patient's desire to refuse the referral. It is not the best response in this situation. "Your insurance carrier will no longer cover your medical care here, so you will need to leave." While this may be true, it does not address or respect the patient's wish to refuse the referral. It is not the best response by the nurse. "Unfortunately, you don't have a choice in the matter. We can no longer care for your medical condition here." While this may or may not be true, this statement is not sensitive or respectful to the patient's wish to refuse care. It is not the best response in this situation.

What statement explains the purpose of the Patient Protection and Affordable Care Act (PPACA)? "The PPACA was designed to manage asset control, revenue collection, and strategic planning in health care." "The PPACA was designed to expand insurance programs, control health care costs, and improve quality of care." "The PPACA was designed to identify long-term financial needs and develop strategic partnerships in health care." "The PPACA was designed to switch from a value-based payment system to a fee-based payment system in health care."

"The PPACA was designed to switch from a value-based payment system to a fee-based payment system in health care."The focus actually shifted from a fee-for-service system to a value-driven system to increase the value and quality of care. This new focus means that health care practitioners no longer set the fees for their services; many fees are predetermined. The goal is to decrease the overuse of medical treatments and incentivize valuable quality care.

Which statements indicate that the nursing student understands the influence of technological advances on the health care environment? SATA "Technological advances have limited the need for remote patient monitoring." "The development of electronic health records changed the way nurses chart.". "Technological advances create a way for nurses to share real-time patient information." "Increased global information sharing because of technological advances created more access to research." "Electronic health record technology advances negated the need for the 'do not use' abbreviation patient safety goal."

"The development of electronic health records changed the way nurses chart."The majority of health care organizations all have electronic health records. Nurses switched to computer charting from paper when these advances occurred. "Technological advances create a way for nurses to share real-time patient information."When a nurse charts a set of vital signs, other health care providers can see that information in real time on the computer. "Increased global information sharing because of technological advances created more access to research."Technological advances, such as computers and the Internet, have increased the ability to share information, including results of medical research, internationally.

Which set of data should be represented using a simple bar graph? A comparison of errors per nurse per month in 2010 A comparison of nursing turnover under two different nurse managers The identification of the most likely cause of increased falls over the last year The identification of the best food supplier based on cost effectiveness and patient preference

A comparison of nursing turnover under two different nurse managers: A simple bar graph measures one set of data that does not need to be subcategorized, such as a single measurement (nursing turnover) with a single variable (the two nursing managers).

What are examples of the key components of the Patient Protection and Affordable Care Act (PPACA)? SATA A hospital increases quality control for value-based purchasing. A patient with heart disease receives health insurance at a reasonable rate. A legal resident had to pay a penalty because she did not have health insurance coverage. A 25-year-old graduate student is covered by his parents' health insurance plan. A business saves money on insurance requirements by opting out of preventive care coverage. A child has health care and dental insurance; however, vision care is not included.

A hospital increases quality control for value-based purchasing. Hospital value-based purchasing was established by the PPACA. Hospitals are now paid based on performance instead of a fee-based system. A patient with heart disease receives health insurance at a reasonable rate. The PPACA eliminates preexisting conditions as barriers to acquiring health insurance at a reasonable rate. A legal resident had to pay a penalty because she did not have health insurance coverage. The PPACA requires citizens and legal residents to have a qualified insurance plan or pay a fine. Increased state-based insurance programs were developed to help provide affordable insurance so citizens could avoid fines. A 25-year-old graduate student is covered by his parents' health insurance plan. The PPACA changed the laws regarding how long a dependent child can be covered on a parent's health insurance plan, making the age limit 26 years. This helped unemployed college students who could not afford their own health insurance.

A nurse manager is looking to hire a nurse facilitator to promote the collaborative process on the stroke unit. All candidates have similar years of experience in the field. Which candidate should the nurse consider? A nurse who avoids conflict A nurse who specializes in critical care A nurse who has excellent communication skills A nurse who has primarily worked autonomously in home health care

A nurse who has excellent communication skills: Excellent communication skills along with a willingness to learn and respect for other collaborators are key components for a successful interprofessional collaboration. This nurse would make an excellent choice for the nurse facilitator position.

Which factors led to an increased focus on health care quality in the United States? SATA A rise in the cost of insurance Public disclosure of safety issues Initiation of quality improvement (QI) A decrease in patient numbers at hospitals A call to provide safe care regardless of race

A rise in the cost of insurance: Increased liability insurance costs forced hospitals to evaluate safety practices and take steps to improve patient safety and health care quality. Public disclosure of safety issues: Public disclosure of safety issues within hospitals forced organizations to improve patient safety, thereby improving health care quality.

Match the QI tools to the information they are used to determine. Set 1 A) Determine the relationship between patient age and positive outcomes B) Graph patient mortality rates after gastric surgery over the last 10 years C) Observe the procedure from receiving discharge orders to discharge teaching D) Record the number of patients treated per nurse per day over a week Set 2 1) Scatter diagram 2) Check sheet 3) Flow process chart 4) Decision matrix

A) Determine the relationship between patient age and positive outcomes 2) Check sheet B) Graph patient mortality rates after gastric surgery over the last 10 years 4) Decision matrix C) Observe the procedure from receiving discharge orders to discharge teaching 3) Flow process chart D) Record the number of patients treated per nurse per day over a week 1) Scatter diagram

Match the safety initiative with the example of its use in health care. Set 1 A) Using recent global studies to identify and address major safety issues B) Creating an organizational taskforce to anticipate and avoid safety issues C) Acting to improve productivity while maintaining patient safety Set 2 1) Performance improvement (PI) 2) Quality improvement (QI) 3) Continuous quality improvement (CQI)

A) Using recent global studies to identify and address major safety issues 2) Quality improvement (QI) B) Creating an organizational taskforce to anticipate and avoid safety issues 3) Continuous quality improvement (CQI) C) Acting to improve productivity while maintaining patient safety 1) Performance improvement (PI)

Which principle is common to all quality improvement (QI) models? An emphasis on patient needs The use of intuition over research The idea that an organization can eventually achieve all performance goals A hierarchical structure with leaders having primary responsibility for safety

An emphasis on patient needs One principle common to all QI models is a focus on the patient. Health care organizations must understand patient needs, meet patient requirements, and strive to exceed patient expectations.

A young male is visiting his mother in the Intensive Care unit. He is muttering and complaining about the facility. Which is the most appropriate response by the nurse? Ask the visitor what he needs Ask the visitor to speak clearly Call security to remove the visitor Stand close to the visitor to offer support

Ask the visitor what he needs This response could potentially deescalate the situation by addressing his concerns.

Hospital team members teach the staff to work more efficiently without sacrificing patient care. Which health care initiative is this hospital using? Quality improvement (QI) Performance improvement (PI) Total quality management (TQM) Continuous quality improvement (CQI)

Performance improvement (PI) PI focuses on increasing competence and productivity while still ensuring patient safety and delivery of quality health care.

A project was initiated to decrease the number of patient falls on the geriatric unit by installing additional temporary hand rails in all patient rooms. After a 3-month trial period, the number of patient falls did not decrease. What is the next step in the quality improvement (QI) process to address patient falls? A.) Plan B.) Do C.) Study D.) Act *Plan-Do-Study-Act (PDSA) is the process used to evaluate the improvement plan. In this step, assess the intervention, and monitor the changes and costs of the changes. Remember to present the data in graphic form and to compare the information to baseline data (LoBiondo-wood, 2014).

Act "Act" involves taking action based on the results of a study. The proposed intervention did not achieve the desired results so this is when to take appropriate action in this situation. The "action" in this case would be abandoning the solution and determining a new one. Not Correct: Plan "Plan" involves planning to implement change. In this case, planning would have occurred prior to installation of the temporary hand rails. Study "Study" involves measuring the impact of the intervention. In this case, the impact has already been measured, and the intervention did not result in a decrease in patient falls. Do "Do" implies implementing the intervention. In this scenario, the intervention was installing additional hand rails and has already been completed.

A student nurse on the Medical-Surgical unit is ignored when asking the preceptor a question about the patient. Instead of listening, the preceptor continues scrolling through her cell phone. Which is the most appropriate action for the student nurse to take? File a complaint about bullying Address the preceptor politely and directly Tell the patient the preceptor is too busy to help Ignore the preceptor next time he or she speaks

Address the preceptor politely and directly In an effort to open communication, addressing the preceptor's incivility politely and directly is the most appropriate action by the student at this time.

The nursing student understands that the activities of Sigma Theta Tau International (STTI) include which actions? Select all that apply. Funds nursing research Accredits nursing schools Guarantees job placement Advances nursing knowledge Advocates for health care policies

Advances nursing knowledge STTI advances nursing knowledge through educational activities. Advocates for health care policies STTI advocates for health care policies by supporting nursing research and best practice implementation. Funds nursing research STTI funds nursing research to support the advancement of the profession.

How can a nurse manager prevent horizontal violence? SATA Advocate for safe-staffing ratios and workloads Provide multiple avenues for staff to share concerns Assign experienced staff to mentor newly hired nurses Recognize that only staff can role model appropriate behavior Provide educational opportunities to increase self-awareness

Advocate for safe-staffing ratios and workloads: Advocating for safe-staffing ratios and workloads prevents horizontal violence by decreasing overwhelming workloads. Provide multiple avenues for staff to share concerns: Providing avenues for staff to share concerns prevents horizontal violence by providing a safe environment for communication. Assign experienced staff to mentor newly hired nurses: Mentoring by an experienced nurse can prevent horizontal violence by providing a model of professional behavior and promoting civility. Provide educational opportunities to increase self-awareness: Providing educational opportunities prevents horizontal violence by allowing the staff an opportunity for intrapersonal exploration.

Which organizations maintain databases with nursing-sensitive data to be used for improving health care outcomes? SATA The Joint Commission American Nurses Association California Nursing Outcomes Coalition American Nurses Credentialing Center United States Department of Veterans Affairs

American Nurses Association:The American Nurses Association maintains the National Database of Nursing Quality Indicators®, which collects and evaluates unit-specific nursing-sensitive data from U.S. hospitals. California Nursing Outcomes Coalition: The California Nursing Outcomes Coalition (CalNOC) is a data repository of unit-level workforce characteristics and processes of care. CalNOC also provides nursing-sensitive outcome measures. United States Department of Veterans Affairs: The United States Department of Veterans Affairs houses the Veterans Affairs Nursing Outcomes Database, which stores unit- and hospital-level data to facilitate benchmarking within Veteran Affairs facilities.

Which financial principles can be used by the nurse manager to help shape the health care environment? SATA Economic incentives help nurse managers with revenue and cost management. Nurse managers use volume-based reimbursement systems to regulate staffing ratios. Auditing helps the nurse manager provide accurate numbers in reported data to promote financial integrity. Evidence-based financial management helps the nurse manager provide accurate, comprehensive data and make informed decisions. Controllership helps the nurse manager analyze cost and revenue, identify long-term financial needs, and create strategic partnerships.

Auditing helps the nurse manager provide accurate numbers in reported data to promote financial integrity.Financial function is compromised when nurse managers are functioning with inaccurate numbers or a culture of dishonesty. Auditing activities ensure nurse managers have accurate information and shape the health care environment by supporting a culture of honesty. Evidence-based financial management helps the nurse manager provide accurate, comprehensive data and make informed decisions.Financial management includes identifying and reporting costs, understanding data, and reviewing financial forecasts to make decisions. Evidence-based financial management provides nurse managers with proven principles that actually work. Controllership helps the nurse manager analyze cost and revenue, identify long-term financial needs, and create strategic partnerships.The financial principle of controllership involves analyzing costs and revenues. It encourages strategic partnerships to help the nurse manager shape the health care environment by maximizing the use of resources. This strategy leaves revenue for other needed initiatives or equipment.

The nurse leader, using the quality improvement (QI) process, proposes modifications to health care delivery on the unit to increase efficiency. Which step should the nurse leader take first? A.)List five strategies to increase efficiency on the unit. Generating possible interventions is the third, not the first, step in the QI process. Before interventions can be identified, the nurse leader must define the problem. B.)Determine areas of care needing improved efficiency. Assessment of the situation and determining goals for improvement are parts of step 1 of the quality improvement process. C.)Hire more nurses to provide patient care more efficiently. Hiring more nurses is part of the fourth step, test, and implementation, not the first step in the QI process. The nurse leader must first identify a problem, analyze the problem, and develop interventions. D.)Attend an annual conference on efficiency in health care. By attending an annual meeting on efficiency, the nurse leader is collecting data related to improving health care delivery. This represents the second, not the first, step in the QI process.

B.) Determine areas of care needing improved efficiency. Assessment of the situation and determining goals for improvement are parts of step 1 of the quality improvement process.

The nurse draws two sets of blood cultures at least 20 minutes apart for every blood draw because this procedure has been shown to be the most accurate way to obtain blood cultures. Which feature of quality improvement does this action represent? Indicator Benchmarking Best practices Standardized tools

Best practices are a methodology that, through experience and research, has proven to reliably lead to the best result. The nurse draws two sets of blood cultures at a set time apart because this process has been shown by past experience to be most accurate.

How has the uninsured and underinsured population influenced health care finance? By creating the need for controllership By shifting the focus to greater accessibility to preventive care By shifting the focus of health care to a fee-based payment system By creating a need for economic incentive plans for medical treatment

By shifting the focus to greater accessibility to preventive careIt is common for members of the uninsured or underinsured population to go without preventive care and often without acute care because they cannot afford it and may already have medical debt. This influences the health care environment because many diseases developed by this population could have been prevented.

A nurse is caring for a young patient who is struggling emotionally after being diagnosed with a terminal illness. Who should the nurse consider adding to the health care team caring for this patient? Chaplain Pharmacist Physical Therapist Occupational Therapist

Chaplain: The chaplain provides ministry and additional support to the patient and family, and would be a great addition to the health care team caring for this patient.

A nurse leader is experiencing a higher than average nursing staff turnover on a rehabilitation unit. What actions can the nurse manager take in hopes of retaining employees? Select all that apply. Execute a transactional leadership style on the unit Incorporate a new staffing plan that involves primary nursing on the unit Check the scheduling to ensure adequate staffing ratios on the floor are being maintained Set a goal to improve listening skills by allowing time for staff to contribute and voice concerns in staff meetings Improve the nurse discharge summary procedure to streamline the process of discharging a patient from the unit

Check the scheduling to ensure adequate staffing ratios on the floor are being maintained Maintaining adequate staffing ratios has been shown in studies to lower nurse burnout and improve staff retention rates. Set a goal to improve listening skills by allowing time for staff to contribute and voice concerns in staff meetings Good communication skills improve mutual respect between nurse leaders and health care staff and may be one of the most vital keys to long-term retention of nursing staff. Improve the nurse discharge summary procedure to streamline the process of discharging a patient from the unit Effective work redesign processes can lead to an increase in staff retention and improvement in patient safety and patient outcomes.

A nurse manager is evaluating new marketing strategies to attract new nurses. How can the nurse manager most effectively find quality applicants to fill staff nursing positions?SATA Collaborate with the hospital marketing department Include virtual tours and testimonials on the hospital web page Post ads that include job duties, key qualifications, and benefits on local job boards Develop a web page with job openings, relocation benefits, and other useful information Rely primarily on the human resources (HR) department to create new ideas for posting ads and interview potential new hires

Collaborate with the hospital marketing department: Hospital marketing departments usually have large budgets and can collaborate on marketing strategies to attract quality nurses for recruiting efforts, while leveraging advertising costs. Include virtual tours and testimonials on the hospital web page: Stepping out of the box and avoiding routine information on web pages can help nurse managers excel in attracting more talented new staff. Develop a web page with job openings, relocation benefits, and other useful information: Developing a web page in collaboration with the hospital marketing department is an effective strategy for attracting quality nurses.

Match the specialist with the role that he or she plays on the health care team. Set 1- Provides counsel to the patient and family: Corrects physical and mental dysfunction: Evaluates the nutritional status of the patient: Assists in finding a medication regimen that works for the patient: Set 2- Dietitian therapist Chaplain Pharmacist Psychologist Physical Therapist

Evaluates the nutritional status of the patient: Dietitian Assists in finding a medication regimen that works for the patient: Pharmacist Corrects physical and mental dysfunction: Occupational therapist Provides counsel to the patient and family: Chaplain

Place the tools and concepts of benchmarking in the order they are used. Gather current information through a literature search. Implement ideas from other organizations with the best practice processes and monitor results. Collect data from other organizations through written or verbal surveys or site visits. Identify the process or quality issue to benchmark. Compare collected data with the organization's processes. Identify the process or quality issue to benchmark. Determine where the current level of performance is, and set new standards for where it should be.

Correct Order: Identify the process or quality issue to benchmark. Determine where the current level of performance is, and set new standards for where it should be. Gather current information through a literature search. Collect data from other organizations through written or verbal surveys or site visits. Compare collected data with the organization's processes. Implement ideas from other organizations with the best practice processes and monitor results.

A nurse manager is setting goals for the unit, which includes working towards interdependency and power-sharing. The nurse knows that these are characteristics of which type of environment? Collaboration Teamwork Cooperation Competency

Correct: Collaboration: Collaboration is a complex process that builds on communication, mutual respect and trust. The characteristics of true collaboration include interdependency, complementary roles among providers, mutual respect and power-sharing. Incorrect: Teamwork: Teamwork is the simple interaction of team members as they work together to provide care. Interdependency and power-sharing are not characteristics of teamwork. Cooperation: Cooperation is the process of working together with similar goals. Power-sharing and interdependency are not characteristics of cooperation. Competency: The core competencies are basic skills that should be developed in every nursing and medical professional. They were developed to be used in health care education and focus on improving patient care. Interdependency and power-sharing are not solely descriptive of the core competencies.

Which features of quality improvement (QI) differ from quality assurance (QA)? SATA Taking risks to improve overall safety Goal of continuous improvement over time A focus on assessing the quality of health care A focus on identifying weaknesses and preventing problems Relying on the leaders of the organization to solve problems

Correct: Taking risks to improve overall safety: Whereas QA draws on tradition and safe, comfortable methods, QI uses experimentation to improve practices, which may be associated with a certain level of risk. Goal of continuous improvement over time: Whereas QA focuses on reacting to quality issues after they occur, the goal of QI is to raise standards and continuously improve the quality of health care. A focus on identifying weaknesses and preventing problems: Whereas QA focuses on detecting problems after they occur, QI focuses on preventing problems before they occur. Moreover, QI relies on the organization as a whole, rather than putting all the power in the hands of the leaders. Incorrect: A focus on assessing the quality of health care: Both QA and QI focus on assessing quality of health care. Relying on the leaders of the organization to solve problems: QA, not QI, relies on leaders to solve problems. QI distributes that responsibility among all members of the organization.

A new nurse is joining the ICU team and is learning about the need to maintain a climate of mutual respect for the other members of the team. Which core competency does this demonstrate? Values/ethics Roles/responsibilities Teams and teamwork Interprofessional communication

Correct: Values/ethics The values and ethics core competency describes the need to work with individuals of other professions in order to maintain a climate of mutual respect and shared values. Incorrect: Roles/responsibilities Understanding the roles and responsibilities of each member of the team describes the second core competency of roles and responsibilities. It does not describe the need for mutual respect in the workplace. Teams and teamwork Team dynamics is described in the fourth core competency of teams and teamwork. Mutual respect is not covered in this competency. Interprofessional communication Communicating with patients, families, and other professionals is described in the interprofessional communication competency, not the need for mutual respect.

Which action can organizations take to enhance patient safety? Handling errors internally so as not to alarm the community Implementing standards for health care provider performance Allowing more freedom to treat patients by easing regulatory policies Fostering a team mentality by discouraging error reporting on colleagues

Correct: Implementing standards for health care provider performance: Because patient safety and health care provider performance are directly related, setting performance standards can enhance patient safety and, therefore, health care quality.

Mary is meeting with the rest of the Patient Services Leadership Team for the first time. The team will include which factors to facilitate successful collaboration?SATA Stakeholders Common interests Financial guarantors Criteria for success Barriers to the solution

Criteria for success Identifying the criteria for success is an important step when initiating a collaborative effort. It helps the team understand how to judge their success or failure as a team. Barriers to the solution Early identification of potential barriers can help the team address potential solutions or what may stand in the way of their success as a team. Stakeholders Teams should identify the stakeholders in the successful outcome of collaboration. This can help them recognize who will benefit from their work and how.

Which task is important to the lean model of quality improvement (QI)? Customizing the workflow according to patient needs Ensuring that all employees have enough work to keep busy Using statistics to quantify improvement in health care quality Using a core unit of interdependent individuals to focus on patient safety

Customizing the workflow according to patient needs The lean model of quality improvement relies on the identification and improvement of wasteful processes. Wasteful processes are those that do not serve the patient's needs.

DMAIC Methodology

Defining the system Measuring key aspects of the process Analyzing data to determine relationships Improving the process Controlling the new process

According to the National Academy of Medicine (NAM), in which ways can health care quality be improved in the United States? SATA Delivering care immediately when necessary Ensuring that the newest treatments are used for every patient Keeping abreast of effective interventions and indications for use Considering the patient's wishes when making medical decisions Doubling up on staff to ensure that patients are more than adequately covered at all times

Delivering care immediately when necessary: The NAM identified timely care, or care delivered when needed and without harmful delays, as a major goal for improving health care quality in the United States. Keeping abreast of effective interventions and indications for use: The NAM identified effectiveness or ensuring that evidence-based interventions are used, with patients always receiving the treatments most likely to be beneficial, as a major goal for improving health care quality in the United States. Considering the patient's wishes when making medical decisions: The NAM identified patient-centered care as a major goal for improving health care quality in the United States. This includes ensuring that patient preferences, needs, and values are prioritized in the process of clinical decision-making. Incorrect: Doubling up on staff to ensure that patients are more than adequately covered at all times: Although it is important to ensure coverage of all patients to guarantee timely care, the NAM identified efficient care, or preventing the waste of valuable human resources, as a major goal for improving health care quality in the United States. No more staff than is needed to care for patients should be used. Ensuring that the newest treatments are used for every patient: Although it is important to be up-to-date on the newest treatments, it is more important to choose interventions that will be the most effective, rather than those that are new. In some cases established methods will be the most effective for a particular patient.

A nurse is preparing a patient for discharge and is looking to make community referrals to better support the patient's recovery. What should the nurse do as the first step of this process? Contact the social worker to take over care of this patient Consult the policies and procedures about making community referrals Determine the patient's existing home and community resources Check the list of patient-sensitive resources that was developed by the nurse manager

Determine the patient's existing home and community resources: The first step in making community referrals is to assess the patient's existing home and community resources, and determine how best to use what is already available to the patient.

A nurse is reviewing the established referral policy. The other staff nurses are complaining about repeated phone calls from patients asking for phone numbers of their other providers. What is one action that the nurse can consider to help alleviate this concern? Hire a part-time assistant to answer these phone calls. Create a one-time list of resources that can be placed on the Web site. Make a new policy to stop making formal referrals to other providers. Develop a written provider resource list, and follow up with patients about their experiences.

Develop a written provider resource list, and follow up with patients about their experiences.: Developing a written provider resource list to be handed out to patients can be helpful in minimizing repeat phone calls for contact information. It is extremely important to follow up with these patients about their experiences with the referrals and change the resource list as needed.

Which situations are appropriate for the use of cognitive rehearsal? Select all that apply. Use of racial slurs by preceptor Unit recognition of team players Fiery discussion of politics in the breakroom Suspected diversion of controlled substances Coworker joking about patient's sexual orientation

Use of racial slurs by preceptor Fiery discussion of politics in the breakroom Coworker joking about patient's sexual orientation

Which are ways globalization influences the health care environment? SATA Difficulty controlling diseases, such as Ebola Increased exposure to biological and nuclear agents Reappearance of old strains of diseases, such as malaria Increased government agency involvement in health care Increased access to advances in medical technology, such as teleradiology

Difficulty controlling diseases, such as Ebola: the result of globalization's effect on international movement. International travel allows individuals exposed to disease to spread the disease to other areas. Reappearance of old strains of diseases, such as malaria Some old strains have reappeared as a result of globalization's influence on international movement. The prevention of diseases becomes more complex when larger numbers of people and products move across diverse settings increasing the risk for the spread of diseases, such as tuberculosis. Increased access to advances in medical technology, such as teleradiology Globalization and international advances in medicine increase access to a variety of medical equipment and techniques, such as teleradiology. Other Considerations: Increased international movement of people Increased exposure to infectious diseases and spread of antimicrobial-resistant genetic material Pandemic spreading of diseases, such as H1N1 (swine flu) and Ebola Re-emergence of strains of tuberculosis and methicillin-resistant Staphylococcus aureus (MRSA) Increased diabetes and cancer rates as a result of increased global food and tobacco trade Increased access to different forms of medical practice and medical equipment (e.g., telemedicine, disease prevention methods, and electronic health records) Increased ability to ship drugs to areas experiencing disease outbreaks

A mother with postpartum depression is visiting her preterm twins in the NICU. She is making sarcastic, caustic retorts, and belittling comments to the nursing tech, and has a flushed appearance and dilated pupils. How is the woman exhibiting signs of anxiety that could lead to violence? Sarcasm Dilated pupils Caustic retorts Belittling speech

Dilated pupils Dilated pupils are a sign of anxiety that could lead to violence.

The nurse leader has weekly staff meetings with the nurses on the unit and asks for input on major decisions affecting staff; some of the input has led to the creation of a task force team, and the nurse leader has asked a staff nurse to join the team. Which strategies are being used to help retain employees?SATA Respect Work redesign Empowerment Shared governance Professional practice environment

Empowerment: Leaders can unite and help retain nurses through the use of empowerment. The strategy of empowerment provides nurses with a united vision and creates a sense of community. Shared governance: Shared governance, when organizations encourage professional autonomy, such as in providing opportunities for staff to engage in unit decisions, is an example of a strategy that can be used to help retain nurses. Respect: Incorporating respect into staff-manager relationships can be done by involving staff in decisions that affect them. This is an example of a strategy that can be used to help retain nurses.

Which is the least effective strategy for the nurse leader to implement when addressing horizontal violence in the nursing department? Create a culture of safety Establish clear written policies Follow organizational chain of command Encourage staff to work out their conflicts independently

Encourage staff to work out their conflicts independently This strategy does not reduce the incidence of horizontal violence and may increase the likelihood of conflict.

It is the holiday season and the nurse leader of a busy psychiatric unit notices that many staff members seem to be experiencing nursing burnout. Which action should the nurse manager take to address this issue? Advise the staff to take a much-needed vacation Ensure an adequate nurse-patient ratio on the unit throughout the holiday season Remind staff to be loyal to the hospital and continue working long hours throughout the holiday season Understand that this is a normal part of psychiatric nursing and that the nurse will be okay once the holiday season is over

Ensure an adequate nurse-patient ratio on the unit throughout the holiday season Paying close attention to nurse-patient ratios and making sure there is enough staff to meet the patients' needs, particularly during the busy season, will lend itself to lowering the nurse burnout level.

Activities that exemplify steps in the benchmarking process

Evaluating which processes could be performed more efficiently: Identifying a process issue to benchmark is the first step in benchmarking. Evaluating processes that could be done in a more efficient manner is one way to identify issues to benchmark. Comparing current processes against those of a successful competing organization: Comparing processes with those of a successful competitor is an example of step 4 of the benchmarking process, collecting data from other organizations. This step allows for a critical review of potential procedural improvements. Assembling a team that consists of the nurse manager, staff nurse, pharmacist, and infection control to determine the best way to improve patient satisfaction: Benchmarking is the process of improving an organization's practices by comparing them to industry standards. Gathering a team to improve patient satisfaction is an example of benchmarking.

Support for nurse participation comes in the form of:

Goal setting and desire to improve Assessment and organizational openness Evaluating current structure Providing resources

A student on the high school track team is newly diagnosed with asthma. Although a bronchodilator has been prescribed, the student reports wheezing and shortness of breath after each practice. Describe the next steps.

Have the student demonstrate correct use of the inhaler. Identify if the student's breathing and asthma symptoms have improved since diagnosis. Ask if the student has been using an inhaler as instructed. Instruct the student to use the inhaler as directed to improve breathing and decrease asthma symptoms. *Identifying if the student's breathing and asthma symptoms have improved is part of the assessment. Asking if the student has been using the inhaler as instructed is part of the analysis of the problem. Having the student demonstrate correct use of the inhaler and instructing the student to use the inhaler as soon as the student remembers missing a dose is the final phase: testing and implementing.

A nurse is developing a set of policies to determine which medical transport company should be used when making a referral to another health care facility. The nurse knows that this is an example of which component of referrals? Health system Initiating facility Receiving facility Supervision and capacity-building

Health system The health system component is where each facility develops policies and procedures that simplify the referral process. Developing a policy about which medical transport company to use is an example of the health system component of the referral process.

Name successful Collaboration Strategies

Identify stakeholder in the outcome of the collaboration Identify problem(s) to be solved Identify barriers to creating a solution Clarify the desired outcomes (agree on criteria for success) Clarify the process (How will we approach the task?) Identify who will be responsible for each step in the task Establish equality among peers regardless of status Evaluate (Have we met our criteria for success?)

A nurse is cleaning out her locker after being terminated. She slams the locker door shut and yells, "What am I going to do? I have three kids!" Which principles of cognitive rehearsal should the nurse manager choose for this situation? SATA Listen to what the nurse is saying Recommend a different, low-stress career Tell the nurse to leave or security will be called Ask the nurse if she needs financial assistance Stop and process what the nurse is saying before responding

Listen to what the nurse is saying Listening is a principle of cognitive rehearsal and is most appropriate during this time of frustration. Stop and process what the nurse is saying before responding Processing information before responding is appropriate as it allows for a thoughtful and appropriate answer, rather than a quick reactionary reply.

The nurse manager of a busy medical/surgical unit is concerned because patient satisfaction on the unit has decreased from 90% to 65%, incident reports for falls on the unit have doubled in the past 30 days, and staff morale is low. How can the manager help improve patient outcomes and raise staff morale? Ask colleagues to intervene and update safety policies on the unit Implement a team nursing strategy for performing patient care on the unit Schedule a staff meeting to start a dialogue with the nursing staff on the unit about these concerns Check patterns of nurse-patient ratio to ensure adequate number of staff members have been scheduled during the past 30 days Wait to see what the numbers look like in the second quarter reports, as perhaps patient satisfaction and patient safety rates will increase

Implement a team nursing strategy for performing patient care on the unit: Both team collaboration and improved workflow have been shown in studies to increase staff morale. The nurse manager should be mindful of staff morale and find ways to improve efficiency and staff collegiality. Schedule a staff meeting to start a dialogue with the nursing staff on the unit about these concerns: Communication with the staff members would be an important step for the unit manager to take. Increased communication lends itself to improved empowerment of staff and increased staff morale, which will result in better patient outcomes and higher patient satisfaction rates on the unit. Check patterns of nurse-patient ratio to ensure adequate number of staff members have been scheduled during the past 30 days: This is a very important step for the unit manager to take, as research indicates the number of RN's on the unit correlates to positive benefits for patients and nurse sensitive outcomes (such as falls) and decreased nurse burnout rates (raising staff morale).

Which statement describes a concurrent audit? Assesses the result of patient care Completed after the patient is discharged Implemented while the patient is receiving care Evaluates the implementation of nursing procedures

Implemented while the patient is receiving care: A concurrent audit is done while the patient is receiving care and can help the nursing team make modifications or corrections to care as needed.

A nurse manager is considering hiring graduate nurses for the unit and wants to consider innovative ideas to attract them. Which actions should the nurse consider? Select all that apply. Implementing shadowing opportunities for senior nursing students Offering a residency program on the unit to senior-level nursing students Taking time each day to talk to staff about their feelings about the job and workflow Guaranteeing the automatic placement of senior students on the unit as they approach graduation Giving nursing students the number for the hospital HR department to inquire about upcoming jobs

Implementing shadowing opportunities for senior nursing students Taking steps to include shadowing opportunities is an innovative way to find talented new nursing staff, while allowing students to practice clinical skills. The nurse manager would take this step to attract new graduates. Offering a residency program on the unit to senior-level nursing students Having students work on the unit gives the nurse manager a great opportunity to observe the work ethics of new graduates just as they are eligible to begin working after graduation. The nurse manager would take this step to attract new graduates. Taking time each day to talk to staff about their feelings about the job and workflow Acting as a supportive manager who empowers others is an effective recruitment/retention strategy. The nurse manager would take this step to attract new graduates.

The benchmarking process may be used to achieve which outcomes? SATA: Staying on budget Improved practices Enhanced productivity Meeting industry standards Identification of tools to measure patient outcomes

Improved practices: Benchmarking enables organizations to evaluate what improvements are needed and where. Benchmarking can lead to improved practices that translate into enhanced patient safety and better outcomes. Meeting industry standards: Benchmarking allows organizations to compare themselves to others to ensure that the highest quality care is being delivered.

A nurse manager is introducing an initiative to improve interprofessional collaboration on the patient care unit. One of the staff nurses asks how improving collaboration will improve staff satisfaction. How does the manager reply? SATA Reduces medical errors Improves communication Reduces burnout among staff Promotes the effective use of health resources Helps to build cohesion among the team members

Improves communication: Improved communication and clarity on roles of each health care provider is a direct benefit to the staff with improved collaboration. Reduces burnout among staff: Collaboration has been shown to reduce burnout because of the increase in staff satisfaction with the employer. Helps to build cohesion among the team members: Studies have shown that collaboration and teamwork improves cohesion among members of the health care team. This is a direct benefit to the nursing staff.

A nurse manager is looking to launch a new job posting to attract new nurses to her health care facility. Which recruitment strategies would the manager expect to discuss with the marketing department? Select all that apply. Duplicating how recruiters at other facilities are attracting new candidates Including links to local real estate firms to encourage relocating nurses Adding a live chat session between prospective applicants and human resources Updating the job posting to include information about types of patients treated Delegating recruiting strategies to hospital marketing department to leverage costs

Including links to local real estate firms to encourage relocating nurses Providing information about relocation is an effective recruitment strategy because it goes above and beyond what is expected. It helps potential recruits see that the organization cares about their transition and may encourage quality nurses to apply. Adding a live chat session between prospective applicants and human resources Effective recruitment strategies go above and beyond. The nurse manager may discuss adding a live chat session with marketing, because this is a strategy that can attract qualified new talent. Updating the job posting to include information about types of patients treated Updating a job posting to include information about the types of patients treated provides more information about the posting and is a strategy that can attract qualified new talent.

An older adult patient who is known to have a hot temper is very upset because the dinner tray has meat on it, and he is a vegetarian. The nurse recognizes the violence cycle and best responds with which actions? SATA Listens to the patient respectfully Obtains a meat-free tray for the patient Tells the patient that he cannot be violent Suggests the patient push the meat aside Explains to the patient that he has no reason to be upset

Listens to the patient respectfully: Listening can defuse the violence cycle by showing empathy. Obtains a meat-free tray for the patient: Obtaining a meat-free tray could defuse the violence cycle by fixing the issue.

How do mass disasters affect the health care environment? SATA Increase the risks to patient and staff safety Increase the need for specialized medical care Increase the re-emergence of resistant organisms, such as vancomycin-resistant enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) Increase the need for more casualty disaster health care provider training Increase the need for ensuring informed consent during invasive procedures

Increase the need for more casualty disaster health care provider training Recent events have demonstrated the importance of mass disaster preparedness and casualty training for first responders and health care providers. The increased training can save lives by helping teams work together cohesively and decreasing response times. Increase the risks to patient and staff safety Criminal acts are now more common inside health care organizations and increase the risks to patient and staff safety. These criminal acts may create mass disasters and have created a need for new safety measures to protect patients and staff. Increase the need for specialized medical care Chemical, biological, radiological, or nuclear agents may be released during mass disasters and may cause pandemics or epidemics. Release of these agents may create a need for immediate medical attention with specific medications, a hazardous environment, and mass casualties. Other considerations: Criminal or natural mass disasters may result in multiple casualties. The release of chemical, biological, radiological, or nuclear (CBRN) agents may occur during mass disasters. The release of CBRN agents may cause loss of life, long-term health effects, hazardous environments, and the need for specialized care. Criminal acts may occur inside health organizations and threaten patients and staff, requiring the development of policies and training to ensure safety measures are in place. As demonstrated by recent events, when first responders and health care providers have adequate training and work cohesively, response time is better and fewer deaths occur.

How does the aging population affect the health care environment? SATA Increases the need for more rehabilitation services Increases governing agency involvement in health care Increases the need for home health and assisted living nurses Increases the need for enhanced nurse-patient communication, such as bedside reporting Increases the number of baby boomer nurses retiring from the workforce in the next 10 years

Increases the number of baby boomer nurses retiring from the workforce in the next 10 years The baby boomer population affects health care because an estimated one third of the nurses in the workforce are from this generation. If a third of nurses leave the workforce within a limited amount of time, it could create a nursing shortage. Increases the need for home health and assisted living nurses The aging population may require more assisted living or at-home help. This increase in need may lead to a delay of services because of a lack of nurses in the home health and assisted living industry if the nursing workforce is not expanded. Increases the need for more rehabilitation services The aging adult population causes an increased need for all types of health care, including rehabilitation. Other considerations: The influx of 78 million baby boomers will flood the Medicare system, thereby creating concern about how the system will be able to effectively absorb the increase. By 2029, the last round of baby boomers will reach the age of 65, the retirement age in the United States; as a result, the health care provider workforce will be significantly reduced.

Which is a benefit of the principle of patient-focused care with respect to the QI model? Instilling confidence and trust in patients Making informed decisions about patient safety Unified implementation of actions that support the organization's goals The ability to immediately take advantage of opportunities to enhance health care quality

Instilling confidence and trust in patients Improving patient loyalty—through building trust and instilling patient confidence—is a major benefit of providing patient-focused care as part of the QI model.

Barriers to Nurse Participation in QI

Insufficient staffing Lack of support from management Insufficient resources Insufficient time Lack of educational preparation about the QI process

Which barriers are the most significant to nursing involvement in quality improvement? SATA: Insufficient time Insufficient training Lack of leadership support Stakeholder involvement in QI Prohibition of nurse involvement in QI as per the accreditation process

Insufficient time A barrier to nursing involvement in QI is the time available to perform the steps necessary to improve quality. Nurses have a heavy workload and busy schedules; the time it takes to critically analyze current practices can be prohibitory. Insufficient training QI is a process that requires critical review of current processes, analysis of best practices, and the drive and means to implement change. Often, nurses are not sufficiently trained in one or more of these steps to confidently or competently participate. Lack of leadership support QI is a process with several steps and requires a unified effort from all who are involved. Lack of support from leaders and/or management is a significant barrier to nurses participating in QI.

A nurse is developing a continuing education course for nurses about the importance of collaboration. Which benefits of collaboration should the nurse include in the curriculum? Better health outcomes Improved patient-centered care Lower cost of health care expenditures Provision of organization-centered care Long-term sustainability of the health care organization

Long-term sustainability of the health care organization: Collaboration in the health care team has been associated with overall sustainability of the health care organization. Leaders must be able to balance the needs of the organization with the clinical needs of the patient. Better health outcomes: Better health outcomes for the patient have been associated with collaboration among the health care team. Improved patient-centered care: Patient-centered care is one of the hallmark characteristics of collaboration among the health care team.

The local community hospital will be offering a new insurance program for residents. The hospital should seek accreditation status with which organization? TJC RWJF ANCC NCQA

NCQA The National Committee for Quality Assurance (NCQA) is a private, not-for-profit organization dedicated to improving health care quality. The NCQA Accreditation for Health Plans division accredits health insurance programs. Incorrect: TJC The Joint Commission (TJC) is responsible for ensuring a minimum standard of structures, processes, and outcomes for patient care. It does not accredit insurance plans. RWJF The Robert Wood Johnson Foundation (RWJF) promotes and supports standards of care in nursing. It does not accredit insurance plans. ANCC The American Nurses Credentialing Center's (ANCC's) Magnet Recognition Program recognizes health care organizations that provide the very best in nursing care and uphold the tradition of professional nursing practice. It does not accredit insurance plans.

A nursing student in her final year is looking for assistance in finding a registered nurse position after graduation. Which organization would be beneficial for this individual to join now? American Nurses Association (ANA) International Council of Nurses (ICN) National Student Nurses' Association (NSNA) Sigma Theta Tau International (The Honor Society of Nursing)

National Student Nurses' Association (NSNA) The NSNA provides leadership and networking opportunities for nursing students and new graduates. It also publishes a magazine with information on job opportunities.

The preceptor is explaining the benefits of joining professional nursing organizations with a cohort of recent nurse graduates. Which items does the leader include in the discussion? Select all that apply. Network with other nurses Influence patient-to-nurse ratios Become certified in specialty areas Participate in health care policy activities Strengthen workplace security for all health care roles

Network with other nurses Participating in professional nursing organizations allows nurses to network with other colleagues across the world. Influence patient-to-nurse ratios Participating in professional nursing organizations enables nurses to have a voice on issues affecting the nursing profession. Patient-to-nurse ratios would affect nurses. Become certified in specialty areas Participating in professional nursing organizations allows nurses to pursue continuing education and certification opportunities. Participate in health care policy activities Participating in professional nursing organizations allows nurses to influence health care policy locally and globally.

Mary wishes to continue the success of the patient services leadership team with other units. The team agrees to create a new position to assist other patient units in working with each other, the patient, and the family. What is the best title for this new position? Head nurse Nurse manager Nurse facilitator Nurse practitioner

Nurse facilitator: The nurse facilitator can help to advocate for both patients and staff members, and provide extra support as needed. Incorrect: Nurse practitioner A nurse practitioner provides direct patient care, including performing health histories and physical exams, and is also able to order diagnostic testing and medical treatments as needed. This is not the most appropriate person to take on this role. Head nurse The head nurse assists the nurse manager in managing the clinical team. This is not the best position to take on this role. Nurse manager A nurse manager is usually assigned to managing staff and the other business functions of the unit. This is not the best position to take on this new role.

How can a nurse plan emergency self-defense measures for the workplace? Select all that apply. Participate in unit safety drills Remain aware of surroundings Carry a can of mace during patient care View patients and visitors with suspicion Learn techniques to recognize and disrupt the violence cycle

Participate in unit safety drills Participation in unit drills helps a nurse plan emergency self-defense measures by allowing the nurse to practice how to prevent escalation. Remain aware of surroundings Remaining aware of surroundings is correct, as the nurse should know what is going on, how to access help, and how to leave the premises if needed. Learn techniques to recognize and disrupt the violence cycle Self-defense through violence prevention includes learning to recognize and disrupt the violence cycle.

Nurse Jameson is an Adult ICU nurse. She has been assigned to care for a patient admitted to the ICU 8 days ago. During the afternoon assessment, Nurse Jameson notes the following vital signs: HR 98, RR 13, BP 132/74, temperature 101.3° F, and lung sounds clear bilaterally. Upon further assessment, Nurse Jameson finds that the patient has an indwelling urinary catheter draining a cloudy fluid with a foul smelling odor. The catheter was placed in the emergency department prior to the patient being admitted to the ICU. Which type of nursing-sensitive quality indicator may Nurse Jameson be breaching? Patient-centered Nursing-centered System-centered Community-centered

Patient-centered: The prevalence of catheter-associated urinary tract infections is a patient-centered nursing-sensitive quality indicator that can be affected by how Foley catheters are placed in patients and by how long they remain in place. Incorrect: Nursing-centered Nursing-centered quality indicators focus primarily on counseling provided. The prevalence of catheter-associated urinary tract infections is not a nursing-centered quality indicator. System-centered System-centered quality indicators focus on the makeup of the organization, including the type and skill set of the staff. The prevalence of catheter-associated urinary tract infections is not a system-centered quality indicator. Community-centered Community-centered is not a type of nursing-sensitive quality indicator.

How have current trends in health care led to increased patient-centered care and patient safety initiatives? SATA Patients have become more assertive about their own health care. Patients have become more knowledgeable about diseases that affect them. The Internet and the media teach patients about Health Insurance Portability and Accountability Act (HIPAA) laws and health care policies. Remote patient monitoring contributes to patients becoming more involved in their own care. The TeamSTEPPS evidence-based team approach has led to increased patient safety and involvement of patients in their own care. Concerns about quality health care have resulted in the development of programs, policies, and guidelines focused on safety.

Patients have become more assertive about their own health care.Patients used to just do what the health care practitioner told them to do and did not question it. Patients now ask more questions and are assertive about their care, which has led to patient-centered care such as bedside reporting. Patients have become more knowledgeable about diseases that affect them.The Internet and the media have helped patients learn more about diseases, which helps them know which questions to ask. This inclusion in their care has increased the patient-centered care approach. The Internet and the media teach patients about Health Insurance Portability and Accountability Act (HIPAA) laws and health care policies.Patients are savvier about their privacy rights and general health care policies. More patients know to complain to administration if their rights are violated or if they receive subpar care. Concerns about quality health care have resulted in the development of programs, policies, and guidelines focused on safety.Patient safety initiatives have been created in response to quality care concerns and monitoring. This has created more focus on patient safety and structure in health care.

A.J. is a 47-year-old woman who was recently diagnosed with stage III breast cancer. She had a double mastectomy last week and is being admitted to the cancer care center to begin radiation and chemotherapy treatment. She has appointments scheduled with the dietician, oncologist, radiation therapist, and physical therapist in the morning. While performing the initial assessment, the nurse notes that A.J. appears teary and states that she is overwhelmed and scared. Using therapeutic communication, the nurse learns that A.J. is very worried about her treatment and how she will manage to remember everything. Which component of collaboration is A.J. missing that might help her feel more secure? Consultant Process access Resource manager Point of continuing contact

Point of continuing contact: A point of continuing contact helps to coordinate all of the medical care performed by all health care providers. This can be instrumental in helping A.J. manage her care and remember all that needs to be done.

A nurse is developing an interprofessional collaborative team for the health care unit. It is important for the nurse to provide which information to the other team members? SATA The goals of the team and criteria for success The major financial benefactors of the health care facility Potential barriers to the creation of the collaborative team The process of the task and the most responsible person to perform it Information about the professional expertise of the other members of the team

Potential barriers to the creation of the collaborative team: Understanding the barriers to the creation and working of the collaborative team is important because it gives the team an opportunity to respond to and address those barriers upfront. The process of the task and the most responsible person to perform it: The process for approaching each task, as well as who will be responsible for that task is crucial information that must be provided to the team. Without clear direction, the team may find it difficult to meet their goals. Information about the professional expertise of the other members of the team: Understanding and respecting the knowledge, expertise, and professional role of other members of the team is one of the most important components of collaboration. This information should be provided to other members of the health care team. The goals of the team and criteria for success The team should understand the goals of the team and how success or failure of those goals will be measured. This information helps the team focus their collaborative efforts.

A nurse has learned that a patient has been referred to another facility. Which intervention should the nurse anticipate performing? Plan for rehabilitative care Write the back referral information Prepare the referral documentation Locate a medical transport company

Prepare the referral documentation: When preparing a patient for a referral to another facility, the nurse must document all of the care provided to the patient so the receiving facility can provide continuity of care. Incorrect: Plan for rehabilitative care The receiving facility makes arrangements for post-referral and rehabilitative care. This is not the responsibility of the initiating facility. Write the back referral information The back referral is prepared by the receiving facility to inform the initiating provider of the care provided after the referral. The nurse at the initiating facility does not need to provide the back referral form. Locate a medical transport company Protocols for using a medical transportation company should already be established. The nurse should not need to make such arrangements at this point in the patient's care.

The nurse manager is concerned that charting is not being completed correctly by the nurses. The nurse manager should use which audit tool to evaluate this problem? Peer audits Process audits Concurrent audits Retrospective audits

Process audits: A process audit can be used to evaluate charting procedures. A process audit will evaluate how accurately steps related to specific health care actions are accomplished.

Which statement correctly describes nurses' membership in professional associations? Professional membership is encouraged among nurses. Professional membership is a legal obligation of the nurse leader. Professional membership requirements are determined by each state. Professional membership expectations are outlined in the Nurse Practice Act.

Professional membership is encouraged among nurses. The nursing profession encourages nurses to belong to professional associations and provide leadership in improving communities. However, it is not a legal requirement.

A nursing committee is creating protocols to prevent physical violence in their hospital system. What environmental controls should they include? SATA Require written policies Provide adequate lighting Provide code locks to interior doors Encourage violence prevention activities Require badge access to the nursing stations

Provide adequate lighting Adequate lighting is an example of an environmental-level control that may prevent physical violence. Provide code locks to interior doors Restricting access is an environmental-level control to prevent physical violence in the workplace. Require badge access to the nursing stations Requiring badge access to the nursing stations is an example of an environmental-level control that can prevent physical violence.

The nurse manager in the Urgent Care clinic should use which interventions to reduce workplace bullying and intimidation? Select all that apply. Ensure safe staffing ratios Avoid hiring foreign trained nurses Mandate one-on-one conflict resolution Provide confidential reporting opportunities Include culture of safety training in orientation

Provide confidential reporting opportunities Include culture of safety training in orientation Ensure safe staffing ratios

Which are benefits that come from an effective referral system? SATA Less expensive care Better living facilities Greater family support Provision of optimal care Appropriate use of the hospital

Provision of optimal care Use of the referral system helps patients receive optimal care at facilities that are able to care for them. Appropriate use of the hospital Appropriate use of the hospital and primary care system are benefits of the referral system because patients are able to access the correct level of care that is needed. Incorrect: Less expensive care Referring a patient to another facility does not guarantee that the medical care will be less expensive. Better living facilities Patients are not referred to other facilities because of better living arrangements. This may or may not be a benefit of the referral, depending on the health care provider. Greater family support Greater family support is not a benefit to the medical referral system in this situation.

The orthopedic unit has had an increase in medication errors in the past year. As a result, the clinical nurse manager and director have been terminated, and more experienced candidates have filled their roles. Which model of health care quality does this situation exemplify? Lean Six Sigma Quality assurance Clinical microsystems

Quality assurance: Quality assurance is a model for monitoring health care quality that takes a retrospective approach to problem-solving and places blame on individuals for quality issues. Incorrect: Lean Lean is a model of quality improvement that focuses on improving processes, not on identifying fault and taking action as a means to improve health care quality. Six Sigma Six Sigma is a model of quality improvement that focuses on using statistical analyses to measure performance, practices, and systems, not on identifying fault and taking action as a means to improve health care quality. Clinical microsystems Clinical microsystems refers to a unit of an organization in which members work together for a common goal, not to a model of health care quality that identifies fault and takes action as a means to improve health care quality.

The nurse manager is having problems recruiting and hiring an adequate number of qualified nurses on the unit. Which actions indicate the nurse manager has a good grasp on various factors that can have an adverse effect on recruiting efforts? SATA Quickly addressing any concerns or complaints among staff members Fostering a relationship of mutual respect and trust with employees Offering higher salary to offset a negative reputation of the organization Interacting closely with employees to build a good reputation in the community Ignoring gossip on the unit, as it is unethical to engage in or consider such conversation

Quickly addressing any concerns or complaints among staff members: The experience of staff nurses speaks loudly of the reputation of an organization. The reputation of the unit or facility can be adversely affected when dissatisfied nurses talk to other nurses about negative experiences. Maintaining good communication with subordinates is imperative for effective nurse leaders. Fostering a relationship of mutual respect and trust with employees: Nurses who have a high level of respect for their managers and feel they are empowered readily spread this information when networking with other employable nurses. Interacting closely with employees to build a good reputation in the community Nurses interact frequently in the community via continuing education seminars, personal contacts, and more. This is an important factor when it comes to setting the tone for satisfied employees who can speak well of the institution.

Example of a standard used in benchmarking

Reducing medication errors in hospitalized patients to an acceptable rate determined by Medicare Standards are derived from laws, professional organizations, and accrediting bodies.

The nurse manager is analyzing patient outcomes after knee replacement surgeries, so the nurse manager collects data on all patients who have had knee replacement surgery five years after discharge. Which type of audit is the nurse manager conducting? Process audit Concurrent audit Peer review audit Retrospective audit

Retrospective audit Retrospective audits are done after a patient is discharged and involve the comparison of many discharged patients who have received the same or similar care. Incorrect: Process audit Process audits are related to how care is carried out. For example, a process audit can be performed on the implementation of nursing procedures or teaching. This nurse manager is not collecting data on a process. Concurrent audit Concurrent audits are conducted while the patient is receiving care. This nurse manager is collecting this information after the patients have been discharged. Peer review audit Peer review audits look at nursing performance and standards of care; they are not done to review patient outcomes.

Which strategy for collecting data should the nurse apply when evaluating nursing outcomes? Evaluating the skill mix on the unit during each shift Assessing the departmental turnover rate in the last quarter Observing the number of patients who are in restraints for more than 24 hours Reviewing the number of patients with heart failure who have quit smoking after receiving counseling

Reviewing the number of patients with heart failure who have quit smoking after receiving counseling: Reviewing the number of patients with heart failure who have quit smoking after counseling is a strategy that can be used to evaluate nursing outcomes.

A health care provider takes steps to reduce medical errors during patient care. This is an example of which National Academy of Medicine goal to enhance the quality of health care? Safety . Efficiency Effectiveness Patient-centered care

Safety The NAM identified safety, or preventing adverse outcomes from care intended to help patients, as a primary goal for improving the quality of the United States health care system.

Which statement describes the importance of the Patient Safety and Quality Improvement Act of 2005? Safety violations are identified more readily due to secure reporting practices. The impact of nursing care on patient outcomes can be quantified and recorded. Data can be used to monitor outcomes of care and to test specific improvement methods. Nurse leaders are provided with a framework for implementing procedural changes to enhance patient safety

Safety violations are identified more readily due to secure reporting practices.: The Patient Safety and Quality Improvement Act of 2005 enabled health care providers to contract voluntarily with certified patient safety organizations to help identify and analyze threats to patient safety without fear of reprisal.

What are the six goals proposed in 2001 by the report titled Crossing the Quality Chasm, the National Academy of Medicine (formerly called the Institute of Medicine) to enhance the U.S. health care system by addressing the quality of patient care (Nelson & Staggers, 2014)?

Safety: Preventing injury or other adverse outcomes from care intended to help patients Effectiveness: Ensuring that evidence-based interventions are used, with patients always receiving the treatments most likely to be beneficial Patient-Centered Care: Ensuring that patient preferences, needs, and values are prioritized in the process of clinical decision-making Timeliness: Delivering care when needed and without harmful delays Efficiency: Preventing the waste of valuable human and material resources Equitability: Providing safe care to all individuals without regard for ethnic, racial, socioeconomic, or other personal characteristics

Which statements correctly describe specialty nursing organizations? Specialty nursing organizations support minority nursing groups. Specialty nursing organizations support role-focused nursing groups. Specialty nursing organizations only invite outstanding nurse leaders. Specialty nursing organizations mostly recognize academic excellence. Specialty nursing organizations provide support to clinical specialty nursing groups.

Specialty nursing organizations provide support to clinical specialty nursing groups. Specialty nursing organizations are groups that represent nurses in specific areas of the nursing profession, including clinical specialties such as Pediatrics. Specialty nursing organizations support minority nursing groups. Specialty nursing organizations are groups that represent nurses in specific areas of the nursing profession, including minority nurse groups and male nurse groups. Specialty nursing organizations support role-focused nursing groups. Specialty nursing organizations are groups that represent nurses in specific areas of the nursing profession, including a role focus such as Clinical Nurse Specialists.

A new nurse manager is assigned a patient care unit with very poor staff retention. The nurse manager knows that which factor may be most useful in assessing nurse retention rates and patient outcomes? Staffing levels Collaborative environment Transformational leadership style Shared governance within the nursing unit

Staffing levels Adequate staffing levels may be the most indicative of nursing staff retention and patient outcomes. The new nurse manager should start by looking at the staffing levels and ensuring that each shift is appropriately staffed.

Which statement indicates that the nurse leader understands the significance of implementing successful recruitment strategies? Successfully recruiting quality nurses is achieved through the hospital's marketing strategy. Successfully recruiting nurses is the primary job of the facility recruiter in the HR department. Successfully recruiting qualified nurses who plan to stay on the job long-term will save money. Successfully recruiting and retaining nursing staff does not have an impact on patient safety and quality outcomes.

Successfully recruiting qualified nurses who plan to stay on the job long-term will save money. Successful recruiting involves hiring nurses who plan to stay in their jobs long-term. This saves money in terms of not having to pay temporary staff or overtime pay.

The nurse is monitoring a post-operative patient and is concerned by periods of high blood pressure that seem to occur during certain periods of the day. Describe the next steps.

Take steps to minimize patient stress during the hours of variation. Determine what is different with the patient's environment during the hours of variation so interventions can be planned. Measure the patient's blood pressure hourly to pinpoint the exact time of variation. Identify the goal of determining the cause of variation in blood pressure. Use run charts to identify that the variation has previously occurred between the hours of 12 and 3 PM *Once a performance variation is identified using charting tools, the nurse should implement the Model for Improvement to address the variation. The Model for Improvement starts with identifying the goal, which, in this case, would be determining the cause of variation. The next steps are reviewing existing data and determining how to measure change (measuring blood pressure hourly). Finally, the changes that will make improvements must be determined (identifying and manipulating the changes in the patient's environment during times of variation). Once changes are identified, the nurse should take the next step in the quality improvement process, which would be an implementation of the changes, including minimizing stress during the hours of variation..

Which is true of the baby boomer generation's influence on the health care environment? The aging baby boomer population creates a need for fall reduction interventions. The aging baby boomer generation comprises 78 million people that Medicare may need to absorb. The aging baby boomer generation creates a need for increased government agency involvement in health care. The aging baby boomer generation creates a need for the Centers for Medicare & Medicaid Services (CMS) to develop a no-pay policy for "never events."

The aging baby boomer generation comprises 78 million people that Medicare may need to absorb. There is increased concern about how the Medicare system will absorb the 78 million baby boomers and how this will affect health care policies.

How have perspectives of managing health care quality evolved over time? The approach has become more proactive. The focus has shifted to a more traditional means of error reporting. The burden of monitoring quality has shifted from the group to the leader. The focus has shifted to comparing care against a predetermined standard.

The approach has become more proactive.: Traditionally, health care quality was monitored using the quality assurance approach, which took a retrospective approach by analyzing "what went wrong." Newer models focus on quality improvement and attempt to identify and address problems before they occur.

Steps of the QI Process

The steps of the QI process include assessing and analyzing goals, developing interventions, and testing and implementing those interventions.

A medical-surgical unit has a steady nursing-staff-to-patient ratio. Which actions or findings indicate the nurse manager may be utilizing the strategies used by magnet-designated hospitals? Select all that apply. The unit has fewer cases of patient falls. The unit has a reduced rate of nursing staff turnover. The unit has high levels of patient satisfaction regarding care. The unit passes inspection by The Joint Commission for hospital accreditation. The unit, under the direction of the nurse manager, implements a new staffing strategy called "Forces of Magnetism."

The unit has fewer cases of patient falls. Since this unit is well staffed, fewer incidences of patient falls are expected. Adequate staffing and improved patient outcomes are characteristics associated with magnet-designated hospitals, and this finding suggests the nurse manager is utilizing effective strategies. The unit has a reduced rate of nursing staff turnover. Being well-staffed and having a reduced rate of staff turnovers are characteristics associated with magnet-designated hospitals, and this finding suggests the nurse manager is utilizing effective strategies. The unit has high levels of patient satisfaction regarding care. Being well-staffed and having high levels of patient satisfaction are characteristics associated with magnet-designated hospitals, and this finding suggests the nurse manager is utilizing effective strategies.

What are nurse manager's goals in using financial controllership in the health care environment? To identify and report costs To support a culture of financial honesty To ensure the accuracy of financial reporting To ensure adequate long-term financial resources to deliver quality care

To ensure adequate long-term financial resources to deliver quality care The financial principle of controllership's goal is to adequately use resources to deliver high-quality care. This would include identifying long-term financial needs and managing debts, assets, and contracts to acquire adequate resources to meet those needs and deliver quality care.

How is a check sheet used when making organizational improvement decisions? To record raw data To evaluate performance To weigh multiple options . To compare a single dataset

To record raw data: A check sheet is used to collect and classify raw data.

Which scenario is an example of how benchmarking can improve patient care? To reduce the number of teenagers who smoke, nurses go to 50% of high schools and show a lung affected by cancer. To reduce the risk of injury from car accidents for children older than 10 years, the school nurse creates a brochure about the benefits of seatbelts. To reduce the readmission rate of patients with heart failure, nurses educate patients to weigh themselves daily and call their health care provider if they have a 2 lb weight gain in a 24-hour period. To reduce the risk of pneumonia in patients older than 50 years, nurses ensure that 90% of patients receive the pneumonia vaccine. The team monitors patient records to determine if this goal is met.

To reduce the risk of pneumonia in patients older than 50 years, nurses ensure that 90% of patients receive the pneumonia vaccine. The team monitors patient records to determine if this goal is met. Benchmarking consists of an aim (reducing the risk of pneumonia in patients older than 50 years), a goal (administration of the pneumonia vaccine), a measure (90%), and a data collection plan (monitoring patient records).

Scenario describes the use of core measures for benchmarking

Training more nurses to review discharge instructions for patients with congestive heart failure to decrease the readmission rate of these patients Congestive heart failure readmission rate is a core measure identified by the Joint Commission for benchmarking.

The nurse observes that a visitor in the waiting room appears very agitated. He knocks a chair over and yells at the nurse, "I'm tired of waiting here! I demand to see the manager right now!" The nurse should use which communication technique? Use a mild, but firm tone to retain authority over the situation. Allow the visitor to continue to vent until he's done, then respond calmly. Slowly approach the visitor, using gentle touch, and ask him to calm down. Speak loudly and in a strong tone, so the visitor can clearly hear the nurse over his yelling.

Use a mild, but firm tone to retain authority over the situation. Even if the nurse is not feeling in control of the situation, the nurse's response should be calm and confident, allowing him/her to have control over the escalated scenario.

Which historical themes in health care finance influence the rise in health care costs? SATA Using advanced medical technology Focusing on illness rather than prevention Focusing on evidence-based practice guidelines Keeping care decisions in the hands of the financial provider Encouraging unnecessary tests and treatments due to economic incentives Expanding health care coverage because of the Patient Protection and Affordable Care Act (PPACA)

Using advanced medical technology The increase in the sophistication of technology historically increased the costs of medical tests and procedures. Examples include advances in imaging technology or blood testing equipment. Focusing on illness rather than prevention The historical illness-focused approach created the need for treatments that may have been avoided with prevention. Diet and exercise might prevent diabetes, eliminating the cost of insulin and blood sugar monitoring equipment. Keeping care decisions in the hands of the financial provider In the past the primary care provider had the "if it might help let's do it" approach to treatment. The patient was rarely informed of the cost of treatment or a test until the bill was sent. This increased health care costs as a result of unnecessary testing and treatments. Encouraging unnecessary tests and treatments due to economic incentives Economic incentives given for tests and procedures ordered increased the unnecessary use of those treatments. This is a historical approach that increased health care costs. Other considerations: Health care emphasized illness rather than prevention. (For example, emphasis was on insulin use and blood sugar monitoring, rather than prevention through exercise and diet.) Decisions about care and costs of that care were made by primary health care providers. The "if it might help do it" attitude stimulated the need for evidence-based practice guidelines. Medical resources were not always well allocated. (For example, providers utilized the highest level of technology available, even though it may not have been necessary.) Costs have increased as technology (e.g., better imaging or blood testing) has become more sophisticated. Economic incentives have encouraged the overuse of unnecessary tests or treatments.

A newly hired nurse manager is unsure of how to address conflicting issues with subordinates, many of whom are older than the nurse manager and who seem to be opinionated and sometimes aggressive. Which action should the nurse manager take? Ignore the conflict and let the issue work itself out Work with the staff to identify the source of conflict and come to a resolution and earn their respect Consider putting in a resignation notice and seeking out a job on a unit with younger, less experienced nurses Ask a staff member to discuss the issue with the other nurses on the unit and inform the charge nurse of the results of the conversation

Work with the staff to identify the source of conflict and come to a resolution and earn their respect Quickly addressing the problem by discussing issues with the staff members will show that the nurse leader is confident and cares about the staff. This will lead to an increase in the level of respect the new nurse leader receives.