Leadership exam 3 part 2 (ch. 10, 15, 21)

Which statement concerning a budget is true? a. A budget's reliability decreases if it is prepared significantly in advance of the funding period. b. Budgets should be created as far in advance is possible. c. A budget is revised every 3 months during a fiscal year. d. Budgets are reliable only when expenses are fixed

: A Feedback: A budget that is predicted too far in advance has greater probability for error. For this reason, it is not desirable to create a budget too far in advance

A client belongs to an HMO that is a preferred provider organization (PPO). When requiring health care, this client will most likely: a. prove that he or she has received preventive care from a provider at some point. b. pay out of pocket for care and then submit for reimbursement. c. be assessed by a nurse before being referred to a physician. d. choose between the health-care providers that are in the PPO

D Feedback: A PPO provides financial incentives to consumers to use a select group of preferred providers and pay less for services. Clients do not normally have to pay out of pocket, and there is no obligation to demonstrate preventative care or to be assessed by a nurse before seeing a physician.

An applicant has accepted a position in the health-care organization and has begun the indoctrination process. This process should include what activities? Select all that apply. a. Educating the employee about the policies and procedures b. Orienting the employee to the specifics of the job role c. Socializing the employee to the workplace culture d. Scheduling the employee's continuing education activities e. Verifying the employee's references and credentials

: A, B, C Feedback: Indoctrination includes orientation and socialization of employees. During orientation, the employee is informed of the organization's policies and procedures. Normally, continuing education offerings are addressed after the employee has completed orientation and indoctrination. The employee's credentials and references should be verified before an offer of employment is made

The manager is using a decision package to set funding priorities for a hospital unit. What type of budgeting is the manager most likely using? a. Flexible b. Operating c. Capital d. Zero based

: D Feedback: Managers must rejustify their program or needs every budgeting cycle in zero-based budgeting. Using a decision package to set funding priorities is a key feature of only zero-based budgeting, not flexible, operating, or capital budgets

A nurse is preparing for a job interview. The nurse should prepare responses to what types of interview questions because they are difficult to respond to without advance thought? Select all that apply. a. Personal philosophy of nursing b. Professional organizations membership c. Individual strengths and weaknesses d. Career goals e. Days and times of availability

A, C, D Feedback: It is difficult to spontaneously answer interview questions about a personal philosophy of nursing, individual strengths and weaknesses, and career goals without giving them advance thought. Question about availability and professional organizations are less open-ended and likely require less forethought and preparation

Determine the nursing care hours per client day (NCH/PPD) if the following staffing existed for a 24-hour period (unit census = 10): 12 midnight to 12 noon, 1 registered nurse, 1 licensed vocational nurse 12 noon to 12 midnight, 1 registered nurse, 1 licensed vocational nurse, 1 unit clerk (8 hours only) a. 5.6 NCH/PPD b. 4.8 NCH/PPD c. 5.0 NCH/PPD d. 6.2 NCH/PPD

A Feedback: A total of 56 hours of nursing was worked in 24 hours (unit clerks are counted in NCH/PPD) and the census was 10 clients. Dividing the total number of nursing care hours by the census (56 divided by 10) yields an NCH/PPD calculation of 5.6 NCH/PPD.

A nurse-manager is working in the context of an accountable care organization (ACO). What task will this manager most likely perform? a. Coordinating care for Medicare clients b. Providing community-based illness prevention c. Health promotion d. Determining whether clients' care plans are justified

A Feedback: ACOs exist to better coordinate care for Medicare patients across care settings. Health promotion and illness prevention would be lesser concerns. In this particular context, justifying clients' care plans would not be the nurse's major task.

Which interview questions would be considered illegal? Select all that apply. a. "What is your current marital status?" b. "Which languages are you able to speak or write?" c. "What university did you attend?" d. "What city do you live in?" e. "In what year were you born?"

A, E Feedback: Asking applicants about their marital status or age is unlawful. None of the other options are considered illegal areas of questioning.

A nurse-manager has proposed an expansion of the organization's indoctrination program to the organization's board of directors. What potential advantage of expanding the indoctrination program should the manager describe? a. Enhanced retention rates b. More efficient recruitment c. Higher proportion of internal applicants d. Reduced burden on unit managers

A Feedback: An extensive and effective indoctrination program has the potential to reduce staff turnover of new employees and increase retention. The program may have an effect on recruitment but its effects are more likely to be experienced by new employees in the organization. Such programs will likely have a lesser effect on internal employees who are already familiar with the organization. Despite being beneficial, indoctrination does have the potential to be burdensome for managers because of the time and effort it requires

The nurse-manager at a long-term care facility is participating in fiscal planning for the first time. What is fiscal planning? a. A learned skill that improves with practice b. A job role of the facility business manager c. Part of the organizing phase of the management process d. Reactive, based on political, social, and economic forces

A Feedback: Fiscal planning is a learned skill and must include nursing management input. It should be proactive, not reactive, and it is part of the planning process of management.

An organization is considering the adoption of flexible budgeting. What advantage will this type of budgeting provide to the organization? a. Increased ability to adapt to changing circumstances throughout the year b. Increased reimbursement from state and federal agencies c. Longer budget cycles d. Increased opportunities for staff to participate in the budget process

A Feedback: Flexible budgeting allows for adjustments throughout the year based on volume. Flexible budgets do not necessarily involve longer budget cycles or more participation by staff. Flexible budgeting has no effect on reimbursement policies.

The nurse-manager of a community health clinic is participating in budget planning for the next year. The manager will most likely assign the most money to what expenditure category. a. The personnel budget b. Short-term capital acquisitions c. The operating budget d. Supplies and equipment

A Feedback: Health care is labor-intensive; therefore, the personnel budget makes up the largest expense. In most circumstances, the other options represent lower expenditures.

When do nursing shortages historically occur? a. When the economy is on an upswing b. When the economy is in recession c. When nursing salaries decline d. When client acuity increases

A Feedback: Historically, nursing shortages occur when the economy is on the upswing and decline when the economy recedes. Historically, salaries were not a causative factor in existing nursing shortages. Client acuity is not identified as a factor that directly contributes to nursing shortages.

A nurse-manager is required to make decisions about the proper placement of employees within the organization. What practice should the manager follow? a. Attempting to place employees in units where they have the greatest chance of success b. Avoiding overemphasizing the match between the employee and the unit in order to prevent discrimination suits c. Placing new employees on units that have the greatest need for new staff d. Helping employees modify their personal values and beliefs to coincide with that of the unit on which they are placed

A Feedback: If employees are placed where they have the greatest chance of success, employee morale and retention will be positively affected. It is unrealistic to expect employees to fundamentally change their beliefs and values. A match between the employee and the unit should be sought; this practice is not grounds for a discrimination suit. The employees' strengths and skills should be considered in placement, not solely the needs of the unit

A health-care organization has advertised a position that requires a doctoral degree and several years of experience. These high standards for education and experience may have what unintended consequence? a. The position may remain unfilled for longer than desired. b. Applicants may lack applicable skills. c. Applicants' credentials may be difficult to verify. d. Applicants may find it difficult to collaborate with subordinates.

A Feedback: If requirements for a position are too rigid, the job may remain unfilled for some time. There is no reason why these high standards would be associated with a lack of skills or difficulty verifying credentials. High standards do not correlate with an inability to collaborate

A nurse is in a conflict with a colleague, but both nurses are committed to collaboration. To promote collaboration, the nurses should: a. identify a common goal that is important to both of them. b. possess the ability to negotiate without having emotion get involved. c. have a relationship that existed before the conflict. d. ask a neutral third party to mediate in the conflict.

A Feedback: In collaboration, all parties set aside their original goals and work together to establish a supraordinate or priority common goal. This does not necessarily require the preexistence of a relationship or mediation. Collaboration is still possible even if the conflict has an emotional element

A nurse-manager is preparing to interview an applicant for a position. What is the most appropriate strategy for planning, conducting, and controlling the interview? a. If the applicant clearly lacks qualifications for the position, the manager should promptly and tactfully tell this to the applicant. b. Personal questions should be asked early the interview so rapport can be established between the manager and the applicant. c. The manager should develop questions that can be answered with a yes or no answer. d. The manager should assess an applicant's perceptive skills by sending nonverbal cues to the applicant during his or her responses.

A Feedback: In situations in which the interviewee is not qualified for the position, the interviewer must inform the interviewee of this early and tactfully. The manager should include job-related questions only, not personal questions. Open-ended questions elicit more information than yes-no questions. Nonverbal communications is highly subjective and is not included as reliable and valid interview data.

Which statement describes the induction phase of employee indoctrination? a. It occurs after hiring but before performing the role. b. It includes the activities performed by the personnel department. c. It relates to the information included in the employee's handbook. d. It is the responsibility of the staff development department

A Feedback: Induction, the first phase of indoctrination, includes all activities that educate the new employee about the organization and personnel policies and procedures before actually assuming nursing responsibilities. It does not denote the roles of the personnel department. The manager has partial responsibility for induction and it is not the exclusive responsibility of a staff development department. An employee is often provided with a handbook during induction, but the process is not limited to information in a handbook

Which client would be most likely to qualify for Medicaid? a. An adult client who earns $750.00 per month b. A veteran who sustained injuries in combat c. A Native American client who lives on a reservation d. A child who requires physical therapy to recover from traumatic injuries

A Feedback: Low income is the primary criterion for Medicaid. Veterans do not automatically qualify, nor do Native American clients. Some individuals with long-term disabilities qualify, but recovery from acute injuries would not normally cause an individual to qualify.

When evaluating the risk of a nursing shortage, the nurse-manager should prioritize which of the following variables? a. The economy b. Infectious disease prevalence c. Continuing education offerings d. Political climate

A Feedback: Nursing shortages are multifactorial. However, it is generally agreed that the state of the economy is among the most salient variables.

A negotiating session has just concluded with a compromise agreement. What is the manager's best action? a. Clearly restate the terms of the compromise to all involved before dispersing. b. Give feedback to the members of the other negotiating team on their behavior and performance. c. Evaluate the fairness of the compromise to all involved parties. d. Restate each party's original bottom line

A Feedback: Once a compromise has been reached, restate it so that everyone is clear about what has been agreed on. Giving feedback to others after negotiation is not a usual practice. The fairness of the compromise would be considered as it was negotiated, not after the fact. There is no benefit to stating the original bottom lines

What was the primary reason for the development of the prospective payment system? a. Skyrocketing health-care costs following the advent of Medicare and Medicaid b. The passage of the Health Maintenance Act of 1973 c. The introduction of the Health Security Act to Congress d. A coalition held by the three largest private insurers in 1975

A Feedback: Prospective payment systems were the result of skyrocketing medical costs in the United States. They are not generally attributed to the Health Maintenance Act, the Health Security Act, or a coalition of insurers.

What is an implication of responsibility accounting for a nurse who manages a hospital unit? a. The manager is accountable for the way that resources on used on the unit. b. The manager has a responsibility to submit the unit budget on time each year. c. The organization's financial officer works with manager regarding budget approval. d. The budgeting process must be transparent and data must be made publicly available

A Feedback: Responsibility accounting requires that someone must be responsible for all revenue, expenses, assets, and liabilities. As a result, the leader-manager may be held accountable for the financial results of the operating unit. Collaboration and timeliness are characteristics of prudent budgeting, but these are not implications of the principle of responsibility accounting. For most organizations, the budgeting processing is not revealed to the public.

A nurse-manager has accepted a new position on a hospital unit. An experienced nurse on the unit tells the manager, "We all work really well with each other. There's never any conflict." How should the manager interpret this statement? a. The unit may be lacking in growth and new ideas. b. There is a need for the manager to introduce conflict. c. The manager needs to ensure that this characteristic continues. d. There is likely conflict that the nurse is not recognizing or acknowledging

A Feedback: Some level of conflict in an organization appears to be desirable because it appears to prevent organizational stagnation. Despite this, it would normally be inappropriate for the manager to deliberately introduce conflict for the purpose of promoting growth. There is no reason to believe that the nurse's statement is untrue

A small health-care organization has had a static group of employees for almost 2 years. The manager should identify what potential advantage of having some staff turnover in the organization? a. Fresh ideas b. Younger staff c. Cost containment d. Increased groupthink

A Feedback: Some turnover is normal and, in fact, desirable. Turnover infuses the organization with fresh ideas. It also reduces the probability of groupthink, in which everyone shares similar thought processes, values, and goals. Staff turnover is not guaranteed to result in a younger staff; as well, this may or may not be a desirable goal. Turnover nearly always comes with a cost because recruitment and indoctrination are expensive.

What aspect of a client's care is most likely to be influenced by the Patient Protection and Affordable Care Act (PPACA)? a. The number of health insurance plans that the client can choose between b. The likelihood that the client will have to seek out-of-state treatment c. The client's ability to act as the "gatekeeper" of his or her own care d. The client's ability to qualify for Medicaid

A Feedback: The Affordable Care Act was aimed at increasing consumers' options for obtaining health insurance. It did not alter the criteria for Medicaid. In most forms of managed care, the client does not act as the "gatekeeper" for his or her own care. Out-of-state treatment was not a focus of the PPACA

The nurse-manager has learned that two employees are in conflict. The manager's fact gathering reveals that the conflict exists because each employee misunderstands the job description and role of the other employee. What conflict management strategy should the manager implement first? a. Responsibility charting b. Confrontation c. Behavior change d. Third party consultation

A Feedback: When a supervisor delineates job duties to persons in conflict, it is called responsibility charting. This attempt at clearing up the misunderstanding should be attempted before resorting to other strategies

An employee has come to the manager with a long list of complaints about a coworker, all of which are attributable to personality factors rather than unsafe practice. What is the manager's best initial action? a. Encourage the employee to speak directly with the coworker. b. Ask the employee to e-mail or text message the complaints to the coworker. c. Arrange for third-party mediation. d. Acknowledge and document the employee's complaints

A Feedback: When team members inappropriately expect the manager to solve their interpersonal conflicts, managers can urge subordinates to attempt to handle their own problems by using face-to-face communication to resolve conflicts. This basic approach should be attempted before mediation. E-mails and text messages are too impersonal for interpersonal conflicts that can have significant conflict aftermath. Acknowledging and documenting the complaints offers no course of action to the employee

Health disparities in the client care population are likely to occur when the health-care workforce lacks diversity in which areas? Select all that apply. a. Age b. Gender c. Ethnicity d. Education e. Personality type

A, B, C Feedback: The workforce should also reflect the gender, culture, ethnicity, age, and language diversity of the communities that the organization serves. The lack of ethnic, gender, and generational diversity in the workforce has been linked to health disparities in the populations served. Heterogeneity of educational levels and types will exist in every health-care organization and issues related to a lack of diversity in this area are rare. It is normally impractical to make hiring decisions on the basis of personality type, and a lack of diversity in this area has not been identified as being problematic.

Which statements regarding fiscal planning are true? Select all that apply. a. Social influences affect fiscal planning. b. A successful fiscal planner must be creative. c. An understanding of economic forces is necessary to perform fiscal planning. d. Practical experience is a key to being a good fiscal planner. e. Subordinates should be excluded from fiscal planning

A, B, C, D Feedback: Fiscal planning is not intuitive; it is a learned skill that improves with practice. Fiscal planning also requires vision, creativity, and a thorough knowledge of the political, social, and economic forces that shape health care. Subordinates should be included in the process

The manager may be greatly or minimally involved with recruiting, interviewing, and selecting personnel. What factors can determine to the extent of the manager's involvement? Select all that apply. a. Size of the institution b. Existence of a separate personnel department c. Presence of a nurse recruiter within the organization d. Centralization or decentralization of nursing management in the organization e. The preferences of subordinates

A, B, C, D Feedback: The manager may be greatly or minimally involved with recruiting, interviewing, and selecting personnel depending on (a) the size of the institution, (b) the existence of a separate personnel department, (c) the presence of a nurse recruiter within the organization, and (d) the use of centralized or decentralized nursing management. The preferences of subordinates would not normally determine the extent of the manager's involvement in personnel decisions

Which of the following behaviors should the nurse-manager identify as workplace violence, incivility, or bullying? Select all that apply. a. A group of nurses consistently refuse to help a nurse when that nurse has a heavy workload, despite having time to do so. b. Staff members assign an unwanted nickname to a colleague. c. A nurse's specific vacation request is denied by the manager for 2 years in a row. d. A nurse asks a colleague to assess a known verbally abusive client without warning to see how the colleague will respond. e. A nurse tells a nursing student to rush to room 311, knowing that the unit has no room 311

A, B, D, E Feedback: Workplace incivility can take many forms, including name-calling, refusing help, setting up a colleague for failure, or playing pranks. Vacation denials can happen for many reasons and would not necessarily constitute an uncivil act

An applicant has disclosed a criminal record during an interview. When considering the implications of this disclosure on the hiring decision, the manager should consider what factors? Select all that apply. a. The time that has elapsed since the offense b. The geographic location where the offense occurred c. The severity or gravity of the criminal offense d. The relationship of the offense to the job duties e. The applicant's collaboration with other persons during the offense

A, C, D Feedback: Any decision not to hire on the basis of criminal history must be job related and consistent with business necessity and must take into account factors such as the nature and gravity of the criminal offense, the amount of time since the conviction, and the relevance of the offense to the job being sought. In most cases, the location of the offense and applicant's collaboration with other criminals are not central considerations and are unlikely to affect the applicant's ability to perform the job role.

When participating in fiscal planning, a leader should perform what role? a. Monitoring aspects of budget control b. Accurately assessing personnel needs using agreed-on standards or an established client classification system c. Documenting the need for resources on a unit d. Being visionary in identifying short- and long-term unit fiscal needs

D Feedback: Leaders are visionary; the other roles of assessing needs, monitoring budget control, and documenting needs are management-related.

Two groups in the health-care organization have been unable to reach an agreement after prolonged negotiation. The groups have agreed to arbitration. What will happen during this process? a. A neutral party will facilitate new negotiations, starting from the beginning. b. A neutral party will listen to both groups and then present a binding recommendation. c. A neutral third party will act as a "go between" in the negotiations. d. Negotiations will continue in a court setting, and a lawyer will mediate between the groups.

B Feedback: Arbitration is a binding conflict resolution process in which the facts of the case are heard by an individual who makes a final decision for the parties in conflict. It does not involve repeating the negotiations and does not take place in a court setting.

A nurse-manager has made a selection to fill a staff opening. When finalizing this selection, the manager should: a. identify the successful applicant's long-term career goals. b. inform the unsuccessful applicants that the position has been filled. c. negotiate the successful applicant's salary. d. inform the successful applicant about when he or she will be given promotions.

B Feedback: Candidates not offered a position should be notified of this as soon as possible. The applicant's career goals and salary expectations should be ascertained well before a selection is made. It would be premature to tell the successful applicant when he or she may expect promotions.

A nurse-manager is attempting to help a group of staff members reach a consensus on a sensitive issue. What is a consequence of using a consensus-based approach? a. One group will be perceived as the "winner" and one group as the "loser." b. It is likely that neither group will achieve their desired "ideal" outcome. c. A solution that is ideal to both groups will be selected. d. There is an increased risk for similar conflict in the future.

B Feedback: Consensus means that negotiating parties reach an agreement that all parties can support, even if it does not represent everyone's first priorities. Consensus decision making does not provide complete satisfaction for everyone involved, and the solution is unlikely to be described as "ideal" by anyone involved. Reaching a consensus does not involve an increased risk for future conflict

A recent switch to a new laundry provider at a long-term care facility has been described as "cost-effective." What does this imply about the change in laundry service? a. It is the least expensive service available. b. It is worth the cost. c. It is reimbursable. d. The cost was anticipated.

B Feedback: Cost-effective does not necessarily imply the cheapest, but it requires that the expenditure be worth the cost. The other options are not characteristic of the term cost-effective.

During the budgetary process, a nurse-manager and the other members of the fiscal planning team are considering factors that may affect the accuracy of the budget. What factor should the team prioritize? a. Legislation regarding client safety b. Possible changes in reimbursement policies c. Depreciation of capital equipment d. Establishment of new HMOs in the region

B Feedback: Historically, there have been significant changes in reimbursement policies that have happened quickly. These changes threaten the accuracy of budgeting. Depreciation is more predictable and changes in client safety regulations usually do not have such significant effects on the budget proocess. The emergence of an HMO would not be expected to affect an organization's budget.

A charge nurse has assisted two employees to resolve their conflict, with the outcome being that the two opposing goals were discarded and new goals were adopted. What is this an example of? a. Smoothing of conflict by the leader b. Facilitating collaboration c. A majority rule approach d. A good lesson in compromising

B Feedback: In collaboration, all parties set aside their original goals and work together to establish a common goal. In promoting collaboration, the charge nurse has not simply smoothed over the conflict. The formation of new goals differentiates between collaboration and compromise. There is no evidence that a majority rule approach has been taken because there are two parties involved.

Interviews at a large health-care organization are conducted by various individuals and groups, due to the high number of positions and applicants. What action will best ensure interrater reliability when different individuals are conducting interviews? a. Use a semistructured format and have interviewers practice with one another. b. Create a structured interview format and adhere to it closely. c. Have at least two, but not more than four, interviewers conduct each interview. d. Use yes-no questions whenever possible, rather than open-ended questions

B Feedback: Interrater reliability is better if the interview is structured and the same format is used by different interviewers. Unstructured and semistructured interviews are more subjective and less reliable. A team approach enhances validity but cannot guarantee reliability among interviewers who work independently of one another. Open-ended questions yield more meaningful information than yes or no questions and are always preferred.

The managers of an HMO have argued against a proposed decrease in deductibles, citing a risk of moral hazard. What phenomenon would show that the managers' concerns were justified? a. Members of the HMO adopt high-risk behaviors because they know that treatment is available. b. Members of the HMO use more health-care services because of the reduced cost. c. Members are reluctant to comply with the HMO regulations. d. Members leave the HMO for other HMOs that have more favorable terms.

B Feedback: Moral hazard is the risk that the insured will overuse services just because the insurance will pay the costs. This does not denote an increase in high-risk behavior, noncompliance with regulations, or abandonment of the HMO by consumers.

Which personal characteristics will best help meet the psychological needs of conflict negotiation? a. Perseverance and assertiveness b. Calmness and self-assuredness c. Compassion and reflectiveness d. Organization and self-reflection

B Feedback: Negotiation is psychological and verbal. The effective negotiator always appears calm and self-assured. The other options are not as impactful when considering the psychological aspects of the negotiation process.

What is the relationship between the national and local economy and an organization's ability to maintain an adequate workforce? a. When the economy is on an upswing, many unemployed nurses return to work and recruitment becomes easier. b. When a recession occurs, it causes many part-time nurses to return to full-time employment and others to delay their retirement. c. Although the economy tends to affect the size of the blue-collar workforce, professions such as nursing remain fairly stable regardless of economic changes. d. When there is an economic downturn, many nurses reduce their work hours from full time to part time.

B Feedback: Nursing shortages occur when the economy is on the upswing and decline when the economy recedes because many unemployed nurses return to the workforce and part-time employees return to full-time employment. The nurse workforce is highly variable and is subject to changes in the economy

The nurse-manager responsible for personnel is checking the references of an applicant. The reference offers unsolicited information about the applicant's personal history. What should the nurse-manager do with this information? a. Contact the applicant to disclose this violation of confidentiality. b. Disregard the information unless it has a direct bearing on the applicant's ability to do the job. c. Document the information and note the fact that it was offered unsolicited. d. Corroborate the information with the applicant without mentioning the source of the information.

B Feedback: Occasionally, reference calls will reveal unsolicited information about the applicant. Information obtained by any method may not be used to reject an applicant unless a justifiable reason for disqualification exists. There is not normally an obligation for the manager to contact the applicant to disclose this, and corroborating it would constitute an inappropriate interview question. Unless the personal information has a direct bearing on the applicant's ability to do the job, the information should not be entered into the personnel record

A nurse-manager is engaged in a negotiation with staff representatives when the discussion becomes controlled by a particularly aggressive member. Which action will the nurse-manager take to assure that the process is successful? a. Ask that the aggressive individual recognize the rights of all the other members. b. State, "I need to have time to think over all that we have discussed." c. Halt any discussion until new representatives can be appointed. d. Share with the members that aggressiveness negatively impacts the negotiationS

B Feedback: Some people win in negotiation simply by rapidly and aggressively taking over and controlling the negotiation before other members realize what is happening. If managers believe that this may be happening, they should call a halt to the negotiations before decisions are made. Saying simply, "I need to have time to think this over" is a good method of stopping an aggressive takeover. The other options are much less effective and may even lead to increased aggressiveness among team members

A nurse-manager is implementing strategies to maintain adequate staff in the health-care organization. What action by the manager will best achieve this goal? a. Proactively plan to hire two RNs for each unit each year. b. Use knowledge of turnover rates on their units for planning and hiring. c. Look at staff-to-client ratios at other health-care organizations in the area. d. Hire consultants to study national turnover rates to determine recruitment needs

B Feedback: Staffing needs are unique to each institution and should be determined by looking at client census, client health-care needs, the type of client care management used, and budget. Specifying the number of new hires each year does not respond to changing needs. The manager should focus on the organization where he or she works, not in other organizations. Local and regional needs may not be reflected in larger, national trends.

A nurse-manager was involved in conflict where the other individual adopted a competing approach. This approach is evident in what circumstances? a. When fair play is important to all involved parties b. When one party wins at the expense of the others c. When managers need to control a volatile situation d. When an appropriate political strategy is necessary

B Feedback: The competing approach is used when one party pursues what it wants at the expense of the others. Because only one party typically wins, the competing party seeks to win regardless of the cost to others. Neither manager control nor political strategy is necessarily associated with the competing approach to resolving conflict

A nurse-manager is participating in the budgeting process. What task should the manager perform first? a. Creating a spending plan b. Determining what needs to be covered in the budget c. Identifying the organization's strengths and weaknesses d. Determining how to maximize cost-effectiveness

B Feedback: The first step in the budgetary process involves assessment. That is, the manager must assess what needs to be covered in the budget. Creating a plan and maximizing cost-effectiveness occur after the assessment. Identifying the organization's larger strengths and weaknesses is not an explicit part of the budgetary assessment

What changed the structure of Medicare payments from a retrospectively adjusted cost reimbursement system to a prospective, risk-based one? a. Zero-based budgets b. Diagnosis-related groupings c. Prospective payment system d. Incremental budgets

B Feedback: The impetus of diagnosis-related groupings changed the structure of Medicare payments from a retrospectively adjusted cost reimbursement system to a prospective, risk-based one. None of the other options were involved in the change

What statement about conflict most closely reflects the interactionist theories of organizational conflict? a. "The most important response to conflict is to deal with it immediately." b. "Conflict can actually be a good thing and can help us to grow." c. "The presence of conflict in our workplace shows that there is bad management." d. "The best organizations are places where there is no conflict."

B Feedback: The interactionist movement encouraged organizations to promote conflict as a means of producing growth. Interactionist did not see conflict as evidence of bad management or dysfunction. Interactionists did not particularly emphasize the need to deal with conflict immediately.

The manager has learned that some of the more experienced nurses on the unit have been playing pranks on a newly hired nurse and delegating their most challenging tasks to the nurse. What is the manager's best response after confirming that these events took place? a. Offer support and encouragement to the newly hired nurse. b. Confront the more experienced nurses directly about their behavior. c. Implement a structure change so the experienced nurses no longer work at the same time as the new nurse. d. Arrange for third-party consultation involving the more experienced nurses, the manager and the new nurse.

B Feedback: The manager must address bullying directly and promptly. The nurse should also offer support to the bullied nurse, but the priority is addressing the behaviors. Separating the group from the individual or having mediation may eventually be necessary, but the manager would first confront the behavior

A nurse-manager is participating in negotiations around the allocation of resources in the organization. During the negotiations, the manager should: a. try to speak the same amount or slightly more than the other party. b. use open-ended questions rather than yes or no questions. c. declare his or her bottom line at the start of negotiations. d. ensure that the negotiations proceed at a rapid pace.

B Feedback: The manager should encourage the other negotiator to talk by asking lots of open-ended questions that cannot be answered with a simple "yes" or "no." It is not beneficial to openly declare the bottom line before negotiations have even begun. The manager should listen 70% of the time and talk only 30% of the time. Speed is not a goal during negotiation and can lead to hasty decision

The leader-manager of several inpatient units is participating in fiscal planning. During this process, the leader-manager should: a. assume primary responsibility for the organization's budgetary planning goals. b. monitor and evaluate all aspects of the unit's budget control. c. encourage broad participation of subordinates in the budgetary process. d. control unpredictable census variations that may undermine the personnel budget.

B Feedback: The manager's responsibility is to monitor all aspects of the unit's budget in the unit under his or her leadership. However, the leader-manager does not have primary responsibility for budgeting, which usually lies with a chief financial officer. There is often minimal participation by subordinates in fiscal planning, and it is often not possible to control variations in the census.

The nurse is caring for a client who has health insurance that is a form of managed care. What are likely characteristics of this client's health-care plan? Select all that apply. a. Clients as gatekeepers of their health-care services b. A focus on prevention of illness c. Decreased emphasis on inpatient hospital care d. Capitation e. Unlimited choice of health-care providers

B, C, D Feedback: Key principles of managed care include the use of primary care providers as gatekeepers, a focus on prevention, a decreased emphasis on inpatient hospital care, the use of clinical practice guidelines for providers, selective contracting, capitation, utilization review, the use of formularies to manage pharmacy care, and continuous quality monitoring and improvement. The client's choice of health-care providers is often limited

Which statements regarding a budget are true? Select all that apply. a. Personnel costs are normally considered to be an uncontrollable expense. b. A budget contains an estimate of both expenses and income for a fixed period. c. It allows for an institution to plan for the effective use of its resources. d. The cost of supplies is an example of a variable expense. e. A mortgage is an example of a fixed expense.

B, C, D, E Feedback: A budget is a financial plan that includes estimated expenses as well as income for a period of time. Accuracy dictates the worth of a budget; the more accurate the budget blueprint, the better the institution can plan the most efficient use of its resources. Examples of fixed expenses might be a building's mortgage payment or a manager's salary; variable expenses might include the payroll of hourly wage employees and the cost of supplies. Personnel costs are usually considered to be a controllable expense, not an uncontrollable expense.

A team of nurse-managers are attempting to make accurate predictions about variables that will impact future staffing decisions. What pieces of data should the team seek to identify? Select all that apply. a. Client satisfaction levels b. When staff resignations historically occur c. How long new hires usually stay employed d. Education of current nursing staff members e. Third-party insurer reimbursement levels

B, C, D, E Feedback: Accurately predicting staffing needs is a crucial management skill because it enables the manager to avoid staffing crises. Managers should know the usual length of employment of newly hired staff and peak staff resignation periods. In addition, managers must consider the education and knowledge level of needed staff and have a fairly sophisticated understanding of third-party insurer reimbursement because this has a significant impact on staffing in contemporary health-care organizations. It is important to assess and review client satisfaction levels, but this factor does not normally have a direct effect on staffing needs unless low satisfaction is directly linked to staffing issues

The unit manager is calculating the NCH/PPD for a 24-hour period. The manager will need what data to calculate this? Select all that apply. a. The acuity level of the clients on the unit b. The total number of hours worked by nursing personnel c. The average hourly wage of the nurses on the unit d. The complexity of nursing care that was provided on a particular unit in a 24-hour time span e. The unit census

B, E Feedback: NCH/PPD by dividing the number of nursing care hours worked in 24 hours by the client census. It is not necessary to know the acuity level, the nurses' wages or the complexity of care provided, even though these variables affect budgeting

Which statement about the role of unit managers in recruitment and selection is accurate? a. The more centralized nursing management is and the more complex the personnel department, the greater the involvement of the unit manager. b. Unit managers should always leave such decisions to a centralized personnel department so consistency can be maintained. c. Regardless of the extent of their involvement, all managers must be aware of recruitment and selection constraints within their organization. d. Unit managers should assume total responsibility for recruitment and selection of personnel on their units.

C Feedback: Although some institutions have personnel departments and nurse recruiters to carry out most of the hiring responsibilities, the nurse-manager must understand how recruitment and selection are accomplished within the organization. Generally speaking, the more decentralized nursing management and the less complex the personnel department is, the greater the involvement of lower level managers in selecting personnel for individual units or departments. Nurse-manager may not have the ability to defer decision making to a personnel department. In most cases, the manager collaborates with other staff in the organization and does not hold total responsibility for personnel matters.

What type of interview is the best predictor of job performance and overall effectiveness? a. Unstructured b. Semistructured c. Structured d. Informal

C Feedback: As a predictor of job performance and overall effectiveness, the structured interview is much more reliable than the unstructured, semistructured, or informal interviews

Which statement best defines conflict? a. It involves an internal struggle resulting from value-related discord. b. Its basis is the violation of personal rights or values. c. It centers on either internal discord or external discord between individuals. d. It is the outcome of a visible struggle between individualS

C Feedback: Conflict is generally defined as the internal or external discord that results from differences in ideas, values, or feelings between two or more people. The remaining options describe only limited aspects of conflict

Which is a true statement about destructive negotiation tactics? a. Ridicule often takes the form of ambiguous or inappropriate questioning and is a diversionary tactic. b. Most managers successfully resist the helplessness tactic because of their nursing preparation. c. Negotiation tactics can sometimes be manipulative; thus, managers must be cognizant of the other party's motives. d. Nurses are known to be particularly vulnerable to the tactic of flattery

C Feedback: Destructive negotiation tactics are never a part of a successful collaborative conflict resolution. An astute nurse-manager must stay cognizant of the other party's motives and behaviors in order to identify manipulative tactics. Ridicule is a separate tactic from ambiguous and inappropriate questioning. Nurses can be particularly vulnerable to the helplessness tactic because nurses are educated and inclined to help others. Nurses are not noted to be exceptionally vulnerable to flattery, however

What is the name for a provision of health care in an organized system to subscribing members in a geographical area with an agreed-on set of basic and preventive supplemental health maintenance and treatment services for a fixed, prepaid charge? a. Preferred provider organizations (PPOs) b. A traditional third-party payer indemnity plan c. A health maintenance organization (HMO) d. Diagnosis-related groupings (DRGs)

C Feedback: HMOs provide health care in an organized system to subscribing members in a geographical area with an agreed-on set of basic and preventive supplemental health maintenance and treatment services for a fixed, prepaid charge. That definition does not apply to the other options.

What factor contributed significantly to the beginning of the acute RN shortage that originated in the late 1990s? a. Closing of nursing programs b. Lack of interest in nursing c. Hospital downsizing d. Poor nursing salaries

C Feedback: Hospital downsizing and shortsightedness regarding recruitment and retention contributed to the beginning of an acute shortage of RNs in many health-care settings by the late 1990s. None of the other options were significant contributors to the nursing shortage that began in the late 1990s

An employee who is involved in a dispute has sought the assistance of the organization's ombudsperson. What role will the ombudsperson play in resolving the employee's conflict? a. Providing expert testimony in conflict cases b. Providing psychosocial support to employees in distress c. Investigating the employee's grievance against the other party d. Monitoring the implementation of the terms of a conflict's compromise

C Feedback: Ombudspersons investigate grievances filed by one party against another and ensure that individuals involved in conflicts understand their rights as well as the process that should be used to report and resolve the conflict. They do not normally provide expert testimony, psychosocial support, or monitor implementation of a solution

A disease outbreak in the local community caused an unprecedented increase in staffing costs. In what category of expenses should the nurse-manager place these costs? a. Controllable b. Fixed c. Capital budget d. Noncontrollable

D Feedback: Noncontrollable costs include equipment depreciation, the number and type of supplies needed by clients, or overtime that occurs in response to an emergency. This would not be a fixed cost. Personnel costs are not capital expenditures

A team of nurse-managers have finished interviewing qualified candidates for a position and have now begun the selection process. During this process, the managers should: a. review the results of the applicants' physical examinations. b. schedule times for induction and orientation. c. carefully verifying the chosen applicant's references and credentials. d. reflect on the overall efficiency of the hiring process.

C Feedback: Positions should never be offered until information on the application has been verified and references have been checked. Physical examinations should be performed after a position has been offered to a particular applicant. It would normally be impractical to schedule induction and orientation until an applicant has been offered the position. Evaluation is normally focused at the end of the hiring process.

The personnel department at a health-care organization has recently mandated preemployment personality testing for all applicants. How should a nurse-manager best interpret the results of this testing when making hiring decisions? a. Testing results should be disregarded until their legal status becomes more clear. b. Testing results should be prioritized over subjective data such as interviews and references. c. Testing results should be considered alongside interview results and reference checking. d. The applicant should be invited to review the results of the testing with the interviewers

C Feedback: Preemployment testing is not a stand-alone selection tool, but it can, when coupled with interviewing and reference checking, provide additional information about candidates to make a selection decision. There have been legal challenges (lawsuits) regarding this testing but this does not necessarily mean that results should be disregarded if they are in fact mandated in an organization. It is atypical for applicants to have the opportunity to discuss the results of these tests with interviewers.

What should selectors do when processing employment applications? a. Reject applicants who have a criminal record. b. Require a physical examination before making a hiring decision. c. Always follow up on references and verify employment history. d. Use unsolicited personal information about an applicant in the decision-making process.

C Feedback: Some managers prefer to verify credentials and references before the interview; others do it after the interview. Either way, doing a comprehensive check of credentials and references is of absolute importance. A physical examination (if required) should be performed after a hiring decision is made. Categorical rejection of all applicants with a criminal record is unnecessary and refusing to hire someone with a criminal record could constitute illegal discrimination in some circumstances. Unsolicited information should not be used to make hiring decisions because this could constitute discrimination

Which statement about American health-care budget spending is correct? a. A large health-care budget equals quality health-care outcomes. b. America spends less than any other industrialized country on health care. c. Outcomes related to low-birth-weight infants are worse than many other industrialized countries. d. The scarcity of resources is the biggest factor in the failure to reach outcomes

C Feedback: Spending more does not always equate to higher quality health outcomes. The United States spends more per capita on health care than does any other industrialized country, and yet outcomes in terms of teenage pregnancy rates, low-birth-weight infants, and access to care are worse than many countries that spend significantly less

The nurse-manager is negotiating for the funds necessary to purchase several new isolettes for the facility's newborn nursery. The chief financial officer (CFO) states, "I've always been curious about that piece of equipment; how does it actually work?" What negotiation action has the CFO engaged in? a. Collaborating b. Smoothing c. A diversionary tactic d. Appropriate fact finding

C Feedback: The CFO was consciously or unconsciously using a diversionary tactic that deflects from the issue at hand. There is no evidence of collaboration with this question, and it is unnecessary information. Smoothing is an approach to conflict, not negotiation

Which of the following workplace situations would be categorized as latent conflict? a. A nurse expresses frustration to a colleague who did not perform some tasks that were clearly delegated. b. A nurse expresses anger to the manager, accusing the manager of preferential treatment toward other nurses. c. The most experienced nurses on a unit are allowed to self-schedule, but less experienced nurse are not. d. Two nurses were in conflict about inequities in their work assignment but were able to resolve the conflict

C Feedback: The first stage in the conflict process, latent conflict, implies the existence of antecedent conditions such as inequities in staffing. In this stage, conditions are ripe for conflict, although no conflict has actually yet occurred. In each of the other examples, the conflict has progressed beyond this antecedent stage.

A recent graduate has begun working at a health center and finds the behaviors of colleagues stressful and intimidating. The nurse's colleagues whisper when she is around, roll their eyes at her, and laugh when she asks for assistance or clarification. What is this recent graduate's best action? a. Organize a meeting to confront the colleagues about their behavior. b. Avoid the offending colleagues whenever possible. c. Report these behaviors to the nurse-manager. d. Seek assistance from the organization's ombudsperson.

C Feedback: The nurse-manager should be made aware of this behavior so that action can be taken. It is unrealistic to expect a new graduate to organize a staff meeting to confront a group of more experienced colleagues about their behavior. Ombudspersons generally deal with disputes and grievances, not the immediate management of workplace violence. The nurse may be tempted to simply avoid these colleagues, but this is not sustainable and does not address this unacceptable behavior.

A hospital unit is in a major transition from a nursing model that was exclusively RNs to one that involves a mix of RNs, LPNs, and NAPs. The transition has resulted in several conflicts between staff. What conflict resolution strategy will the manager most likely need to use? a. Third-party consultation b. Behavior change c. Responsibility charting d. Structure change

C Feedback: The transition from a homogenous workforce to a highly diverse one with a complex skills mix is likely to cause conflict around roles and jurisdictions. This type of conflict can be addressed by reviewing and reinforcing the responsibilities of each team member. Each of the other listed strategies may be necessary for some conflicts on the unit, but the most likely strategy is the one that directly addresses roles and responsibilities.

Several RNs on the unit want to address the possibility of initiating flextime on the unit because they state that the current scheduling system is unfair. What is the manager's best initial response? a. Assuring the RNs that every effort is being made to streamline the current scheduling system b. Asking the RNs to circulate a partition to be signed by employees who support the change c. Arranging for the RNs to air their views at the next staff meeting d. Sharing with the RNs that they need to address the issue with upper management

C Feedback: This manager should plan to let employees air their views at the next staff meeting. Nursing managers can no longer afford to respond to conflict traditionally (to avoid, deflect, or suppress conflict) because this is nonproductive. Putting off the nurses be providing false reassurance or referring them elsewhere is not a direct and respectful response to conflict.

A client is a member of an HMO and has chronic shoulder pain from an old injury. The client has decided to pursue shoulder surgery and the HMO has required a utilization review. What will this review focus on? a. The circumstances surrounding the client's original injury b. The client's baseline level of functioning c. The costs and benefits of the proposed surgery d. The profit to be made from the surgery

C Feedback: Utilization review is a process used by insurance companies to assess the need for medical care and to assure that payment will be provided for the care. Utilization review typically includes precertification or preauthorization for elective treatments, concurrent review, and, if necessary, retrospective review for emergency cases. Profits are always a relevant consideration, but many other variables would be considered. The client's baseline functioning and the circumstances of the original injury are not the primary focuses of a utilization review

A nurse-manager has been required to justify each item of the following year's proposed budget. The manager has been instructed that referring to the previous year's expenditures is not a sufficient justification. What type of budgeting is being used in this facility? a. Incremental budgeting b. Perpetual budgeting c. Zero-based budgeting d. Managed care

C Feedback: Zero-based budgeting begins each year with zero and requires rejustification. This is not true of the other options.

What action most directly addresses the projected nursing shortage? a. Increasing the number of unlicensed assistive personnel b. Increasing the number of nursing internships for recent graduates c. Expanding the nursing scope of practice d. Creating incentives for nurses to enter faculty roles

D Feedback: A shortage of nursing faculty is known to contribute significantly to the pending nursing shortage. Because so many qualified applicants are being turned away from schools of nursing, there is a pressing need to increase numbers of nursing educators. Internships and scope of practice have a significant effect on the nursing profession, but a faculty shortage is seen as even more significant. Increasing the numbers of UAPs does not necessarily relieve a nursing shortage

A client has a managed care program that is organized on the basis of capitation. What is a characteristic of this client's health care? a. Health-care providers earn a bonus if the client remains free of disease for a predetermined length of time. b. The client pays a fixed percentage of the cost of any health care, usually between 10% and 20%. c. The program uses a "gatekeeper" to ensure appropriate utilization of services. d. The client's providers are paid the same amount each month, regardless of the client's use of services.

D Feedback: Capitation is a predetermined, negotiated payment to providers, per client, regardless of whether services are used. Providers earn more if clients use fewer services, but this is not characterized in the form of a "bonus." Capitation does not denote the payment of a fixed percentage of health-care costs. Many forms of managed care involve a gatekeeper of sorts, but this is not particular to capitation

An older adult client has been admitted to the hospital with pneumonia and has been placed on a critical pathway. This tool will allow the care team to: a. minimize the client's out-of-pocket expenses for care. b. decrease the amount of paperwork required for reimbursement. c. minimize administrative costs. d. standardize the client's care

D Feedback: Critical pathways are one means of standardizing care for clients with similar diagnoses. Pathways do not necessarily reduce the client's costs. Care is standardized, but this does not mean that administrative costs and documentation are always reduced.

A nurse-manager will be participating in negotiations around the skills mix in the organization. Before these negotiations begin, the manager should perform what action first? a. Identify the ideal skills mix for the organization. b. Choose an appropriate negotiation strategy. c. Interact with the other party to identify any hidden agendas. d. Learn as much as possible about the issue

D Feedback: For managers to be successful, they must systematically prepare for the negotiation. As the negotiator, the manager begins by gathering as much information as possible regarding the issue to be negotiated. This data-gathering phase should precede the other listed actions.

What should a nurse-manager do to reduce the potential for bias when interviewing candidates? a. Conduct single, rather than multiple, interviews. b. Trust his or her first impressions of an applicant. c. Avoid taking notes during the interview d. Have at least one other colleague join in the interview.

D Feedback: Having more than one person interview the job applicant reduces individual bias. Multiple interviews are recommended, and limiting the process to one interview does not reduce bias. First impressions should be recognized but reflected upon and appraised critically. Note taking enhances the interviewer's recall of the interviewee's statements; avoiding it does not reduce bias.

Which nurse is experiencing intrapersonal conflict? a. A manager who has received a negative performance appraisal and who wishes to dispute the findings b. A manager who has to confront a nurse who made a medication error but did not follow up with documentation c. A manager who is in conflict with a long-standing employee who often ignores the manager's directives d. A manager who perceives a dilemma between loyalty to staff and loyalty to the organization in a particular situation

D Feedback: Intrapersonal conflict occurs within the person. Each of the other examples constitutes interpersonal conflict

Which question asked during an interview is acceptable? a. "Are you married?" b. "Have you ever been arrested?" c. "What is your religious preference?" d. "What professional organizations do you belong to?

D Feedback: It is lawful for an interviewer to ask about professional organizations, but the interviewer cannot ask the interviewee to produce a list of all memberships. It is not permissible to ask about an applicant's marital status, religion, or arrest record

Which of the following factors is most likely to benefit a health-care organization's recruitment and retention efforts? a. Being located in a rural area distant from major urban centers b. Dedicating several weeks to induction for new employees c. Offering incentives to employees with more than 10 years of service d. Ensuring high levels of employee engagement and satisfaction

D Feedback: One of the best ways to maintain an adequate employee pool is by word of mouth; the recommendation of the organization's own satisfied and happy staff. Work groups with high employee engagement have a far lower turnover rate than those with low engagement. In general, rural areas have historically had more difficulty recruiting employees. Prolonged induction is likely to be attractive to applicants but will not normally have as large an effect as a satisfied work force. Incentives that take a decade to accrue may not have an appreciable effect on newer employees or potential applicants.

Two nurses in a small community are in conflict because the first nurse's son committed a violent assault on the second nurse's son. In recent weeks, workplace interactions between the two have become increasingly tense. What is the nurse-manager's best strategy for resolving this conflict? a. Confrontation b. Soothing c. Responsibility charting d. Structure change

D Feedback: The manager does not have the ability to mitigate the realities of these nurses' relationship, and it may be unrealistic to expect them to set aside this significant event. As a result, it may be necessary for one of the nurses to change work locations. This issue has nothing to do with roles or responsibilities, so responsibility charting is irrelevant. Soothing is always a temporary solution. Confrontation has the potential to exacerbate this particular conflict because there is no solution that changes the facts of their circumstances

The nurse-manager is mediating a conflict between two nurses on the unit. What goal should the manager prioritize when addressing this conflict? a. A solution is chosen that minimizing the effect on other employees. b. The nurses emerge from the resolution with a close personal relationship. c. A solution is identified that can be easily and quickly implemented. d. The nurses agree to a solution that is mutually beneficial.

D Feedback: The optimal goal in resolving conflict is creating a win-win solution for all involved. Speed and ease of implementation are not priority goals and may in fact lead to a simplistic or hasty solution. It may be necessary for other employees to be affected by a fair and desirable solution. A win-win solution does not necessarily lead to the development of a close relationship between the parties.

1. The nurse-manager is preparing for negotiations. When negotiating, what is the manager's most appropriate action? a. Be willing to win at any cost. b. Communicate only when asked direct questions. c. Compromise only as a last resort. d. Begin with a high but realistic expectations.

D Feedback: The selected starting point in negotiations should be at the upper limits of the negotiator's expectations, within reason. However, negotiators must realize they may have to come down to a lesser goal. Winning at any cost is counterproductive, and the manager should expect to compromise. Plentiful and accurate communication is necessary at all stages of negotiation

The nurse-manager is participating in negotiations that have become confrontational and unproductive. As a result, both parties have agreed to mediation. This mechanism for dispute resolution will have what characteristics? Select all that apply. a. The mediator will be a respected person from within the organization. b. Both parties are required to accept the mediator's decision. c. The mediator addresses the process but not the issues. d. The mediator meets with each group separately as well as meeting with them together. e. The mediator is an individual who has no vested interest in the outcome

D, E Feedback: A mediator is a neutral third party who has no conflict of interest and who is from outside the organization. The mediator's decision is not binding, unlike arbitration. The mediator has a broad role that can address process as well as the issues in dispute

A registered nurse reports to the nurse-manager that the team's nursing assistant regularly fails to complete assigned tasks. The nurse-manager responds that it is the nurse's initial responsibility to talk with the nursing assistant about this problem. The manager is engaged in what aspect of conflict? a. Conflict avoidance b. Conflict smoothing c. Encouraging competitive conflict resolution d. Facilitating conflict resolution

D. Feedback: Managers should not intervene in every conflict but should urge subordinates to handle their own problems. This is an example of supporting conflict resolution. In most circumstances, this approach should be implemented before the manager becomes directly involved. The manager's deference does not indicate conflict avoidance or conflict smoothing.