Leadership Test 2

The chief nursing office continues to seek ways to improve healthcare services to clients and to save the hospital money. However, with the federal guidelines of paying agencies based on capitation, the chief nursing officer faces a challenge. Capitation provides incentives for healthcare providers to control costs by: a.Providing fewer services to fewer clients. b.Using fewer services per client. c.Using high-technology treatments. d.Requiring second opinions

b.Using fewer services per client.

What is Team Nursing?

RN has a group of patients and a "team" to work with

Best way to ensure proper performance appraisal for staff?

Staff evaluation - completed at least annually -performance should be assessed regularly -if low performance level, consult immediately Evaluation includes -Positive and negative qualities -future plans and goals -signed document and copies

An example of an initiative that may reduce total healthcare costs would be: a.Offering nurse practitioner-led clinics that educate parents about nonpharmacologic strategies for managing ear infections. b.Educating seniors about the comparative costs of medications that are prescribed to them. c.Lowering copayments for prescription drugs for seniors. d.Advocating for more readily available MRI services to ensure early diagnosis.

a.Offering nurse practitioner-led clinics that educate parents about nonpharmacologic strategies for managing ear infections.

When interviewing an applicant for a position, the nurse manager describes the unit's care delivery system as one in which each nursing assistant is cross-trained to perform specific tasks, and the RNs do all treatment, medication administration, and discharge teaching. The nurse applicant knows this nursing care delivery strategy to be: a. The case method. b. Functional nursing. c. Primary nursing. d. Nurse case management.

b. Functional nursing.

When interviewing a candidate for a nursing position who has an Aboriginal background, you recognize that the candidate' s lack of eye contact reflects the ethnicity. You are exhibiting: a. Acculturation. b. cultural sensitivity. c. ethnocentrism. d. transculturalism.

b. cultural sensitivity. -Cultural sensitivity refers to the affective capacity to feel, convey, or react to ideas, habits, customs, or traditions unique to a group of people. In this situation, acknowledgement of the candidate's background in relation to eye contact demonstrates cultural sensitivity.

What does HPPD stand for?

Hours per productive day

What does PDSA stand for?

Plan, Do, Study, Act

A nurse manager discovers that the actual number of visits per patient in a home health service is 3.8 visits per day when the standard is 5 visits per day. Based on this information, the nurse manager: a.Concludes that the complexity of care in each visit has arisen. b.Concludes that patient volume has been decreased. c.Decides that more information is needed before a conclusion can be reached. d.Initiates a training session regarding the importance of ensuring that visits are made

c.Decides that more information is needed before a conclusion can be reached.

John notes that the next section is specific to the organizational philosophy and has a 4-point ordinal scale that describes performance from "always meets expectations" to "does not meet expectations." This type of evaluation is most commonly known as: u. a behavior-anchored rating scale. v. management by objectives/learning goals. w. the forced distribution scale. x. a graphic rating scale.

x. a graphic rating scale. -Graphic rating scales are commonly used in evaluation and reflect generalizations rather than specific behaviors.

The difference between a nurse practitioner's charge of $45 for an office visit and the insurance company's payment of $34 is: a. contractual allowance. b.A profit. c.A flat rate. d.Revenue.

a. contractual allowance.

Managers responsibility regarding chemical dependence or emotional problems with employees?

-May see poor judgement, increased errors, increased absenteeism, decreased productivity, negative attitude -Refer to professional help (EAP) -Substance use: affects staff morale (pickup on heavy workload) -Report before -State rehab

What is primary nursing?

-RN is patients primary nurse throughout hospital stay -Accountable for pt care 24 hours/day (may have other nurses to help care for patient when primary nurse is gone) - ex is hospice -disadvantage - costly, 24 hours responsibility

What is Functional Nursing?

-each team member performs tasks within their scope of practice - RN does IV care, LPN does PO meds, CNA does VS - disadvantage - patients unaware who their nurse is (fragmented care)

What is negligence?

conduct lacking in care from non-professionals (UAPs)

In an acute care unit, the nurse manager utilizes the functional nursing method as the care delivery model. The nurse manager's main responsibility is the needs of the: a. Department. b. Unit. c. Staff. d. Patient.

d. Patient.

What is Malpractice?

failure to act in reasonable and prudent manner with professional obligation (RNs)

How does absenteeism affect culture of the unit?

-Affects patient care -Replacement staff is not the same -Co-workers become resentful -cannot be completely eliminated -may indicate poor work satisfaction, try non-punitive discipline

What is EMTALA?

-Emergency Medical Treatment and Active Labor Act -Provide emergency care to patients regardless of their ability to pay

malpractice issues for nurse managers?

Failure to correctly: -Assign -Delegate -Supervise -Orient -Educate -Evaluate - Warn -Staff

Which of the following is NOT a factor in patient- and/or family-generated violence in healthcare settings? a. Feelings of vulnerability b. Anxiety about treatments or diagnoses c. Feelings of powerlessness or loss of control d. Staff rudeness

d. Staff rudeness

How is basic clinical competence determined?

skills checklist

What type of employee is considered fixed FTE? Variable FTE?

-Fixed- Educators, managers, scheduling staff, etc -variable- pt care nurses (hours fluctuate based on workload)

What is OSHA?

-Occupational Safety and health administration -Part of the health and labor requiring and evaluating workplace safety

What is total patient care/Case Method of Delivery Nursing?

-One nurse provides total care for 1 patient -ICU, Hospice, nursing students -Benefits - holistic, comprehensive, continuous, patient centered -Disadvantage - Expensive

Causes of disparities in health care?

-poor education -poor health behaviors -inadequate financial resources -environmental factors

Progressive discipline

1. Counsel employee regarding problem 2. Reprimand the employee with verbal/written documentation 3. Suspend the employee without pay 4. Allow employee to return to work on agreement 5. Terminate if problem recurs

Which of the following factors is not implicated in rising healthcare costs? a.Rising expectations of consumers for cure and care b.Unintentional injuries c.Socioeconomic conditions d.Rising Medicare costs

d.Rising Medicare costs

The unit manager discusses absenteeism with the unit clerk. She indicates that it is a serious problem on the unit. Which of the following points would they have likely discussed? i. Employee morale is at a high level. j. Patient care will be jeopardized and possibility below standards. k. Existing staff have experienced little effect from the absenteeism. l. Cost for the unit remains the same when new staff are hired.

j. Patient care will be jeopardized and possibility below standards. -Absenteeism puts a strain on staff, produces morale problems, can jeopardize patient safety, and increases unit costs.

Complex care of acutely ill patients is required on a surgical unit, which utilizes differentiated nursing practice as its model of care delivery. On what is the concept of differentiated nursing practice is based? i. Licensure status j. Experience in the agency k. Leadership capabilities l. Education and expertise

l. Education and expertise -Differentiated nursing practice models are models of clinical nursing practice that are defined or differentiated by level of education, expected clinical skills or competencies, job descriptions, pay scales, and participation in decision making.

To prepare staffing schedules, a nurse manager needs to calculate paid non-productive time. When calculating paid non-productive time, the nurse manager considers: m. work time, educational time, and holiday time. n. paid hours minus worked hours. o. vacation time, holiday time, and sick time. p. paid hours minus meeting time.

o. vacation time, holiday time, and sick time. -Non-productive hours are hours of benefit time and include vacation, holiday, and personal or sick time.

What is Capitation?

rate based on designated services/designated time (payment over 1 year)

You are a member of a team assigned to care for 15 general medical/surgical clients. You have all worked well together in the past in this same type of care. If you are assigned to coordinate this team's work, your best strategy, based on the Hersey model, would be to: q. have a list of tasks to be accomplished and tell each member of the team what he or she must do. r. encourage people to discuss their frustrations in providing this care. s. ignore them—they've done it before. t. provide minimal direction and let them come to you with questions.

t. provide minimal direction and let them come to you with questions. -According to the Hersey model, when ability (skills, job knowledge) and willingness are strong, the role of the delegator is less ("delegating behavior").

Which of the following might best conclude an interview? u. "Thank you for your interest. Someone will be in touch with you soon." v. "Before you go, we will make sure that we have your contact information. Thank you for coming." w. "I will be in contact with all candidates by telephone by next Friday. It has been a pleasure to meet you." x. "We have several excellent candidates so I am not sure about the outcome of the interview, but I will let you know. Thank you for coming."

w. "I will be in contact with all candidates by telephone by next Friday. It has been a pleasure to meet you." -An employment interview should always conclude with information as to how and when follow-up to the interview will occur.

John is an older adult patient who comes regularly to the multigroup practice in which you are a nurse practitioner. He says that he doesn't understand what he is supposed to be doing about his medications, because every time he comes to the clinic, he sees a different provider. John's experience represents what aspect of the current consumer experience? x. Nurses are well-trusted members of the healthcare team. y. Fragmentation of care results in lack of respect and trust. z. Care providers often have conflicting ideas about care. aa. The public does not trust care providers other than nurses.

y. Fragmentation of care results in lack of respect and trust. -When consumers visit a multigroup practice, they do not have the option of selecting a specific healthcare provider, and thus, there is less opportunity to build a trusting relationship with a provider.

In designing a program for young adults regarding safe sexual practices, which of the following might reach the greatest number in the target group? y. Web-based applications z. Print-based media such as newspapers aa.Television advertisements bb.Brochures in kiosks in malls

y. Web-based applications -Mobile technology is changing the digital divide, with young adults, minorities, those with no college experience, and those with lower household incomes being more likely to indicate that phones are their main source of Internet access.

The nurse manager analyzes the data from the patient satisfaction surveys. What can a nurse manager do to strengthen service recovery and improve consumer relationships? y. Post comparisons of patient satisfaction scores with those of other units monthly. z. Involve the staff in resolving consumer issues quickly and effectively. aa.Ensure that staff members apologize to patients when they complain about services. bb. Ask that patients with complaints about services place them in a written format.

z. Involve the staff in resolving consumer issues quickly and effectively. -Consumers need to be treated with fairness, given explanation, and provided with information about how errors will be prevented in the future. Staff can be assisted to respond to patient concerns through scripting, support, and an atmosphere that places an emphasis on learning and solutions rather than on blaming.

Changes of nursing care to ensure it is person-centered?

-Decrease complaints -Improve length of stay -Involve patients in their care plan -Better compliance post discharge -Teach patients to self-manage their chronic conditions -Reduce readmissions

Need to prove malpractice?

-Duty owed, Breach of duty, Foreseeability, Causation, Injury, damages

What is delegation?

-RN accountable for patient care -Able to share work with UAP through responsibility -UAPs receive delegated activities -Responsibility is transferred to the UAP but accountability stays with the RN

5 rights of delegation

-Right task -Right circumstances -Right person -Right direction/communication -Right Supervision

What is case management? Who utilizes it?

-The process of coordinating health care by planning, facilitation, and evaluating interventions across levels of care to achieve measurable cost and quality outcomes -Manage complex patients, shorten LOS, prevent readmissions, appropriate referrals, use critical paths

What is Managed Health Care?

-health plan that includes both service and finance -decreases unnecessary services, thereby decreasing cost

4 principles of person-centered care

-treat people with dignity, compassion, and respect -coordination of care -personalization of care -support of people to develop their strengths and abilities

Best practice for termination

1. Manager must be confident everything possible has been done to help employee correct the problem 2. Manager must know that if this employee stays, it will affect the entire unit. 3. Employee needs to be fully aware of the problem and steps to correct it 4. Manager must check with human resources before proceeding

You are involved in designing a clinic for women in an inner-city neighborhood. A goal of this clinic might be: y. development of services that are identified in various studies as important for this target group. z. partnership with area city councilors and health professionals to provide services that are consistent with their vision and funding sources. aa.provision of immunization and addictions services and health screening services for women in the area. Bb. development of services that have been identified by the women and neighborhood advocates as necessary for their health care.

Bb. development of services that have been identified by the women and neighborhood advocates as necessary for their health care. -Involvement of persons in their own health care is a cornerstone of healthcare reform and is important for improving health outcomes and patient experiences. While studies and partnership with key informants are important sources of information in the design of services, engagement of the women through their neighborhood advocates may increase activation and resulting behavior. Patient activation refers to patients' willingness and ability to take independent actions to manage their health and care.

In the Emergency Department waiting room, you notice a patient sitting, with his head in his hands, who has been waiting for about 5 hours for relief of his headache. When you approach him to ask him how he is doing, he says, "I can't believe that I have to wait this long for help! Do you know what it is like to be in pain for 10 hours?" Your response to him would be: a. "It is frustrating to wait when you are in pain and when you are expecting to receive relief right away." b. "Don't talk to me. If you are going to be rude, then you will not receive treatment here." c. "We are very busy and don't have enough staff to deal with problems such as yours." d. "Perhaps you should go elsewhere. We do not have time for you here, as many more sick patients are waiting."

a. "It is frustrating to wait when you are in pain and when you are expecting to receive relief right away."

You need to terminate Gregory, who has had a long-standing history of conflict with you and the staff, and who recently was charged with theft of patient belongings. You consult Human Resources, and together, you develop a plan, which includes: a. A private meeting with Gregory, a Human Resources representative, and you to deliver the news and deliver the termination notice and all other documents that are related. b. Planning an opportunity for Gregory to return and be recognized at a staff farewell. c. Calling Gregory at home to tell him that he is fired and that his paperwork will be sent to him at a future date. d. Calling him into a meeting in your office on the ward, where assistance is available, should he become upset or agitated.

a. A private meeting with Gregory, a Human Resources representative, and you to deliver the news and deliver the termination notice and all other documents that are related.

At 3 AM, a man walks into your emergency department. He paces back and forth in the waiting area before he approaches staff to ask if he can see his wife, who is a patient on another floor. He speaks rapidly, his face is flushed, he glances around often, and he keeps his hand in his jacket pocket. A best initial response would be to: a. Assess your situation and your surroundings. b. Ask two or three staff to assist in confronting the individual. c. Ask what floor his wife is on and remind him that visiting hours are closed. d. Remain calm as there is no potential for violence here.

a. Assess your situation and your surroundings.

A patient is admitted to a medical unit with pulmonary edema. His primary nurse admits him and then provides a written plan of care. What type of educational preparation best fits the role of primary nurse? a. Baccalaureate b. Associate c. Diploma d. LPN/LVN

a. Baccalaureate

Becky, RN, works as a staff nurse in mental health; Sharon works as a data entry clerk in Admissions; Sarah is an emergency room physician; and Donna is a housekeeper in geriatrics. Which of these four is most at risk for violence and aggression? a. Becky b. Sarah c. Sharon d. Donna

a. Becky

Three gravely ill patients are candidates for the only available bed in the ICU. As the supervisor, you assign the bed to the patient with the best chance of recovery. This decision reflects which of the following ethical principles? a. Beneficence b. Autonomy c. Veracity d. Nonmaleficence

a. Beneficence -Beneficence refers to doing what's good for the patient; in this situation, doing what's good means providing care to the patient with the best likelihood of recovery.

In comparing team and functional models of care, a nurse manager favors the team model. In particular, she finds that the team model: a. Can be effective in recognizing individual strengths and backgrounds of staff. b. Promotes autonomy and independence for the RN. c. Avoids conflict because of role clarity. d. Is efficient in delivering care to a large group of patients, utilizing a staffing mix.

a. Can be effective in recognizing individual strengths and backgrounds of staff

During times of nursing shortages and increased nursing costs in health care, which of the following nursing care delivery models might come under greatest scrutiny? a. Case method - its expensive b. Team nursing c. Functional nursing d. Nurse case management

a. Case method - its expensive

The relief charge nurse has assigned a newly licensed baccalaureate-prepared nurse to be one of the team leaders for the 3-11 shift. In making this decision, the charge nurse has overlooked this nurse's: a. Clinical expertise. b. Leadership ability. c. Communication style. d. Conflict-resolution skills.

a. Clinical expertise.

In designing a new healthcare facility, it is particularly important to pay close attention to safety elements related to violence and aggression in which of the following settings? (Select all that apply.) a. Emergency b. Psychiatry c. Gerontology d. Maternal-child

a. Emergency b. Psychiatry c. Gerontology

Your organization has made a decision to implement TCAB in your hospital. As a manager, what strategies would you use to implement TCAB? (Select all that apply.) a. Encourage recognition among staff of their knowledge of the patient-care environment. b. With staff, select small changes for consideration. c. Select only projects that have widespread impact. d. Secure external advisors to evaluate innovation. e. Present ideas based on best practices and ask staff for advice on implementation.

a. Encourage recognition among staff of their knowledge of the patient-care environment. b. With staff, select small changes for consideration. e. Present ideas based on best practices and ask staff for advice on implementation.

Joe and Carol, two of the RNs on Unit 22, are discussing recent incidents on the unit that have involved patients and visitors uttering threats or making demeaning remarks to staff during evening hours. Joe observes that unless someone shoots at him, he is not concerned because "words can't hurt you." Joe's remarks: a. Illustrate common misperceptions about the nature of violence. b. Accurately depict the difference between violence and aggression. c. Are partially correct because verbal remarks do not cause injury. d. Reveal possible issues that Joe relates to violence in his personal life.

a. Illustrate common misperceptions about the nature of violence.

A conflict develops between an associate nurse and a primary nurse over the assessment of a patient with pulmonary edema. Based on her assessment of the patient, the associate nurse insists that it is her role to change the care plan because she is the one who has made the assessment. As the nurse manager, you clarify that: a. It is the role of the primary nurse to make alterations based on assessment data and input. b. The associate nurse is accountable and responsible while the primary nurse is off duty and therefore is able to alter the care plan. c. Neither the primary nor the associate should make changes without first consulting you as the manager. d. It really does not matter who alters the nursing care plan as it depends on situation and time to do so.

a. It is the role of the primary nurse to make alterations based on assessment data and input.

An individual in a wheelchair is applying for the position of receptionist in an outpatient clinic. What does the nurse manager understand based on The Americans with Disabilities Act of 1990 requirements for employers? a. Make reasonable accommodations for persons who are disabled. b. Allow modified job expectations for persons recovering from alcoholism. c. Hire disabled individuals before hiring other qualified, non-disabled persons. d. Treat, for purposes of employment, homosexuals and bisexuals as disabled

a. Make reasonable accommodations for persons who are disabled. -The purposes of the ADA are to eliminate discrimination against persons with disabilities and to provide consistent, enforceable standards to address discrimination in the workplace.

Case managed care may enhance profit in a for-profit health organization by: a. Minimizing costs in high resource consumption areas. b. Combining licensed and non-licensed care providers in delivering patient care. c. Increasing reimbursement from third-party payers. d. Reducing the amount of technology used to support clinical decision making.

a. Minimizing costs in high resource consumption areas.

A staff nurse, who was fired for reporting patient abuse to the appropriate state agency, files a whistleblower lawsuit against the former employer. What reason would the court provide to uphold a valid whistleblower suit claiming retaliation by the nurse? a. Previously reported the complaint, in writing, to hospital administration. b. Threatened to give full details of the patient abuse to local media sources. c. Was discharged after three unsuccessful attempts at progressive discipline had failed. d. Had organized, before filing the complaint, a work stoppage action by fellow employees.

a. Previously reported the complaint, in writing, to hospital administration. -An employer is unable to fire an employee who, in good faith, reports what is believed to be a violation of a law, rule, or state or federal law.

As a charge nurse, you counsel your RN staff member that they have their duty of care by notifying a child's physician regarding concerns about deterioration in the child's status at 0330 hours. The physician does not come in to assess the child and does not provide additional orders. The child dies at 0630 hours. As the charge nurse, you could be held liable for what? a. Professional negligence b. Assault c.Avoidance d. Murder

a. Professional negligence -Professional negligence can be asserted when there is failure to do what a reasonable and prudent nurse would do in the same situation. In this situation, the charge nurse might have advocated further for the patient in light of the evident seriousness of the child's condition.

For a nurse manager in the functional nursing model, an approach that will assist in maintaining staff satisfaction in this specific model is: a. Rotation of task assignments. b. Frequent opportunities for in-service education. c. Orientation to job responsibilities and performance expectations. d. Team social events in off hours.

a. Rotation of task assignments.

You are part of a multidisciplinary team that is charged with designing a workplace safety plan for your healthcare organization. This team has been established in response to increases in reports of violence and aggression. You begin by: a. Surveying staff about levels of satisfaction with the workplace and management, collegial, and patient relations. b. Offering training sessions in self-defense. c. Developing a policy that outlines zero tolerance for bullying. d. Offering education sessions on recognizing behaviors with potential for violence.

a. Surveying staff about levels of satisfaction with the workplace and management, collegial, and patient relations

Physicians in a small urban hospital are reluctant to discharge older adult patients because many of the patients lack private insurance and the resources to travel distances for follow-up care. The hospital administration pressures the physicians to discharge patients sooner and to be more consistent with the number of hospitalization days specified within the DRGs. Which of the following would most likely prompt the action of administrators? a. The hospital is incurring a deficit related to a gap between the PPS and the DRGs and costs of care. b. Local home care services are expressing concern about the increased acuity of patients being discharged into their care. c. The resource-based relative scale for physicians does not account for the increased length of stay. d. Acute care patients are being denied entry to the hospital because of the increased stay of patients.

a. The hospital is incurring a deficit related to a gap between the PPS and the DRGs and costs of care.

One of your staff nurses asks for your advice because a patient refuses to sign a consent for surgery. The patient says that he won't sign because he doesn't understand the nature of the surgery. You advise that: (Select all that apply.) a. consent must not be coerced. b. the patient has a right to choose not to consent. c. the patient must sign the consent because the doctor wants him to sign. d. witnessing a consent is related only to the voluntary nature of the signature.

a. consent must not be coerced. b. the patient has a right to choose not to consent. d. witnessing a consent is related only to the voluntary nature of the signature. -Consent must be voluntary and not coerced; the patient must understand what he is signing, must have legal capacity, and must understand the consequences of refusal. Witnessing a consent means attesting to the voluntary nature of the patient's signature.

During the performance appraisal session, the manager should: (Select all that apply.) a. maintain a relaxed and professional manner. b. inquire about the employee's personal life and how it is affecting performance. c. allow the employee to express opinions orally and in writing. d. plan to give specific examples only for poor performance.

a. maintain a relaxed and professional manner. c. allow the employee to express opinions orally and in writing. -During a performance appraisal, it is important to provide examples of both strong and problematic performance and to provide opportunities to express opinions. The supervisor needs to maintain a relaxed professional manner.

With regard to nursing practice, nurse managers are held responsible for: (Select all that apply.) a. practicing within legal guidelines established under state law and nurse practice acts. b. ensuring that nursing staff under their supervision are currently licensed to practice. c. referring all errors in nursing judgment to state discipline boards. d. ensuring that physicians are properly licensed to provide care on patient care units.

a. practicing within legal guidelines established under state law and nurse practice acts. b. ensuring that nursing staff under their supervision are currently licensed to practice. -Nurses are responsible for knowing and practicing under state law and nurse practice acts. Managers are responsible for monitoring staff practice and ensuring that staff hold current, valid licensure.

A colleague asks you to give her your password access so that she can view her partner's healthcare record without using her login. This request violates the patient's right to: a. privacy. b. confidentiality. c. undue authorization of treatment. d. protection against slander.

a. privacy -Privacy refers to the right to protection against unreasonable and unwarranted interference with the patient's solitude. Privacy standards limit how personal health information may be used or shared and mandate safeguards for the protection of health information. Institutions can reduce potential liability in this area by allowing access to patient data, either written or oral, only to those with a "need to know." Persons with a need to know include physicians and nurses caring for the patient, technicians, unit clerks, therapists, social service workers, and patient advocates. Others wishing to access patient data must first ask the patient for permission to review a record.

Mr. M. complains to you that one of your staff asked him details about his sexual relationships and financial affairs. He says that these questions were probing and unnecessary to his care, but he felt that if he refused to answer, the nurse would be angry with him and would not provide him with good care. Mr. M.'s statements reflect concern with: a. privacy. b. confidentiality. c. veracity. d. informed consent.

a. privacy. -Privacy protection includes protection against unwarranted intrusion into the patient's affairs.

The difference between staffing and scheduling is that staffing? a. puts the right person in the right position b. puts the right person in the right time and place c. refers to the number of nursing hours per patient per day d. looks after interpretation of benefits and compensation

a. puts the right person in the right position

You have hired Chelsea as a new staff member on your unit. Although she is an experienced ICU nurse, this is her first educator role. A month into her new position, she confides that she feels really incompetent in her new position and bursts into tears. Your response is based on application of your understanding of: a. role acquisition. b. role conflict. c. role complexity. d. performance appraisal.

a. role acquisition. -Acquisition of a role is time dependent and involves application of life experiences to each role and interpretation of the role within one's own value system. As roles become more complex, an individual may take longer to assimilate the components of each role.

Because of the complexity of reimbursement systems and its implications for the services available to patients, the nurse has a key role in: a.Advocacy for patients with regard to services required and services utilized. b.Increasing the volume of services and decreasing the number of patients served. c.Accomplishing more with each visit and decreasing the volume of services used. d.Decreasing the volume of services used and the number of return visits.

a.Advocacy for patients with regard to services required and services utilized.

A patient is admitted to a medical unit with pulmonary edema. His primary nurse admits him and then provides a written plan of care. What type of educational preparation best fits the role of primary nurse? a.Baccalaureate b. Associate c. Diploma d. LPN/LVN

a.Baccalaureate -Because of the breadth of nursing knowledge required, baccalaureate education is preferred for primary nurses.

During the budgeting process, nurse managers are typically responsible for which of the following (select all that apply)? a.Calculating workload b.Developing unit operation objectives c.Justifying capital equipment requests d.Predicting cash flow e.Calculating patient load

a.Calculating workload b.Developing unit operation objectives c.Justifying capital equipment requests

The rising cost of health care in the United States is stimulated by which of the following (select all that apply)? a.Consumers' attitudes b.Population demographics c.Managed care d.Medical treatment patterns e.Attitudes of healthcare staff

a.Consumers' attitudes b.Population demographics d.Medical treatment patterns

After a major flu vaccination campaign, an agency bills a private insurance company for allowable costs for administration of each vaccination according to the schedule established by the insurance company for reimbursement. This is an example of which major payment method? a.Cost-based reimbursement b.Charges c.Contractual allowance d.Prospective reimbursement

a.Cost-based reimbursement

A nurse on your inpatient psychiatric unit is found to have made sexually explicit remarks toward a patient with a previous history of sexual abuse. The patient sues, claiming malpractice. What conditions do not apply in this situation and do not support malpractice? a.Injury b. Causation c. Breach of duty d. Breach of duty of care owed

a.Injury -By virtue of employment, the nurse owes a duty of care to the patient; this care has been breached by a nurse, who would be expected to know that this behavior violates usual standards of care. The resultant injury, the fifth malpractice element, must be physical, not merely psychological or transient. In other words, some physical harm must be incurred by the patient before malpractice will be found against the healthcare provider, which is not evident in this situation where the action did not involve physical harm.

Of the following, which is the most effective strategy that a nurse manager could employ to reduce unnecessary costs in specific healthcare settings? a.Training nurses on accurate documentation of supplies used for patient care b.Reducing the number of overtime hours worked by staff c.Reducing the number of staff on a unit d.Making decisions for patients about which care is important to their health

a.Training nurses on accurate documentation of supplies used for patient care

To maintain patient safety, studies suggest that scheduling should avoid: a.rotating shifts. b. weekends. c. 8-hour shifts. d. mandatory overtime.

a.rotating shifts. -Rotating shifts and overtime past 12 hours (mandatory or not) are being shown to increase nurse error and jeopardize patient safety.

A nurse is admitted to a psychiatric unit. The staff expresses frustration with her because they have explained her medication regimen several times, and yet, when she leaves the unit with a pass, she fails to follow it. The staff believe that, as a nurse, she should be able to understand what is expected. The nurse's failure to follow the regimen indicates: y. early cognitive impairment. z. lack of motivation. aa. lack of health literacy. bb.worsening health state.

aa. lack of health literacy. -What is evident from the response is that she lacks health literacy or the capacity to obtain, process, and understand basic health information and services. Using a Health Literate Care Model involves weaving health literacy strategies into care by assuming that patients do not understand their health conditions or what to do about them, and then, subsequently assessing patients' understanding. For example, a nurse who is an expert clinician in a specialty practice area, when diagnosed with a serious chronic illness, may not have the appropriate background to make informed healthcare decisions.

As part of performance appraisal, the nurse manager designs strategies to acknowledge staff members. What practices by the nurse manager best acknowledge staff accountability and contribution? y. Providing new and varied learning experiences for staff members z. Fostering group cohesiveness through standardization of unit activities aa.Allowing professionals greater influence over their practices bb. Giving recognition for success and support for failure to staff members

aa.Allowing professionals greater influence over their practices -Facilitating greater control over practices implies trust and acknowledges expertise and performance.

In writing the patient satisfaction survey, the nurse manager is aware of the education levels of the families. What is the most critical element in the concept of health literacy? y. Providing instructional materials at appropriate reading levels z. Facilitating access to translators for persons with language barriers aa.Obtaining, processing, and understanding basic health information so appropriate decisions can be made bb. Knowing that most people have limited health literacy skills

aa.Obtaining, processing, and understanding basic health information so appropriate decisions can be made -The definition of health literacy used by the federal government is "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions" (U.S. Department of Health and Human Services, 2010).

A staff nurse regularly works two 12-hour shifts each week and one 8-hour shift every other week. How many FTEs is this position? a. 0.6 b. 0.7 c. 0.8 d. 1

b. 0.7

A small rural hospital has been designated as a critical access hospital. It has 40 beds and an average occupancy of 34 beds. To prepare the staffing, the chief nursing officer computes the occupancy as being: a.90%. b. 85%. c. 75%. d. 60%.

b. 85%. -A way to assess a unit's activity level is to calculate the percentage of occupancy. Formula: daily patient census (rounded) divided by the number of beds in the unit The occupancy level is calculated as 34/40, or 85%.

The day shift nurse asks an LPN/LVN to complete a task for a patient. The day shift nurse is engaging in what function? a. Delegating b. Assigning c. Sharing d. Authorizing

b. Assigning -Delegation refers to transfer of responsibility for work; the day shift nurse retains accountability for the outcomes of patient care therefore is using assigning of the task rather than delegation.

Sarah is involved in intervening when a patient attempts to harm herself on the unit. During the interaction, the patient slaps Sarah across the face. As a head nurse, it is important that you: a. Offer Sarah immediate education and training in self-defense. b. Assist with follow-up documentation and offer access to counseling. c. Provide access to a lawyer. d. Encourage Sarah to see the incident as a normal part of care.

b. Assist with follow-up documentation and offer access to counseling.

Which ethical principle is primarily involved in informed consent? a.Veracity b. Autonomy c. Beneficence d. Nonmaleficence

b. Autonomy -Autonomy refers to the right to choose freely, which is inherent in informed consent.

Delaney, one of your staff nurses, confides that Marjorie, another nurse, has been actively telling others that you are incompetent and do not know what you are doing in relation to patient care, and that you lie to the staff about attempts to get more staffing. Delaney says that Marjorie is derogatory towards her in front of others and tells her "that she better shape up." Through telephone calls and conversations during breaks, she is recruiting other staff to her position. Delaney confides that most of the staff find you fair, honest, and knowledgeable. Marjorie's behavior can best be characterized as: a. Political action. b. Bullying. c. Building alliances. d. Disgruntlement.

b. Bullying.

A patient who has a history of involvement with drugs and weapons comes up to you in the hallway and asks you a question regarding directions in treatment. When you respond, he moves closer in to you and puts both hands up on either side of your neck. No one else is in the hallway. Your best response at this point is to: a. Yell at him to stop. b. Calmly ask the patient to remove his hands. c. Hit the patient in the midsection. d. Use pepper spray.

b. Calmly ask the patient to remove his hands.

The nurse manager at a cardiac rehabilitation unit was asked to select a care delivery model. Which of the following methods would be the most cost-effective? a. Functional method b. Case management method c. Primary care method d. Team method

b. Case management method

In hiring nurses during the transition from team nursing to a primary nursing model, Benner's work would suggest that you give priority to nurses who are at least at which level of competency? a. Advanced beginner b. Competent c. Proficient d. Novice

b. Competent

In transitioning to a primary nursing model, it is important for a nurse manager who enjoys a high level of control over patient care to understand that his or her decision making at the patient care level: a. Is increased. b. Is decreased. c. Is relinquished. d. Remains the same.

b. Is decreased.

Caroline asks family members to leave while she cares for the 16-year-old victim of a recent car accident. The father screams at her and tells her that she has no right to ask his family to leave, and that if she continues to do so, he will "throw her out of the room." Caroline is shaken and tells her head nurse, who tells her that this kind of thing is just part of the job. The guidance of the head nurse: a. Is reasonable. No physical violence was involved. b. Is related to why statistics on violence in health care are likely underreported. c. Acknowledges the deep distress and fear of the family. d. Acknowledges the concern of the nurse.

b. Is related to why statistics on violence in health care are likely underreported.

In a telehealth organization, a nurse who is licensed in New York and Pennsylvania provides teaching to a patient who resides in Pennsylvania. The patient charges that the teaching failed to provide significant information about a potential side effect, which led to delay in seeking treatment and untoward harm. Under which state nurse practice act and standards would this situation be considered? a. New York b. Pennsylvania c. Neither New York nor Pennsylvania d. Both New York and Pennsylvania

b. Pennsylvania -Under the law, the state in which the patient resides and not the state where the nurse holds his or her license determines the state nurse practice act that is considered.

As a nurse manager, you have to be effective in managing a culturally diverse staff. Which of the following nurse manager attributes would assist you in addressing the cultural needs of your staff? (Select all that apply.) a. Stereotyping of others b. Respecting others c. Understanding the importance of language d. Encouragement of potential in all staff e. Age bias f. Disrespect for others

b. Respecting others c. Understanding the importance of language d. Encouragement of potential in all staff -Cultural competence involves knowledge of diverse cultural and ethnic groups, including knowledge of staff members and respect for others and their cultural differences.

You are considering putting forward a proposal to move the model of care from team nursing to a primary nursing hybrid: patient-focused care model. In considering this proposal, you recognize that significant costs specific to operationalizing this model are related to: a. Implementation of an all-RN staff complement. b. Significant changes in the physical structure of units. c. Orientation of staff to new roles and responsibilities. d. Testing and piloting technology at the bedside.

b. Significant changes in the physical structure of units.

Your healthcare organization places a high value on workplace safety and integrates this into all aspects of administrative and patient care processes. As a unit manager, you thoroughly endorse this direction, and during the selection and hiring of new staff, you consistently: a. Refuse to hire applicants who are pushy during interviews. b. Thoroughly follow up with all references before offering a position. c. Ask applicants during the interview if drug or alcohol abuse is a problem. d. Refuse to interview applicants with sporadic work histories

b. Thoroughly follow up with all references before offering a position.

The parents of a toddler who dies after being brought to the ER launch a lawsuit, claiming that the failure of nurses to pursue concerns related to their son's deteriorating condition contributed to his death. How is senior nurse executive named in the suit? a. As a global respondent b. Under the doctrine of respondeat superior c. As a frivolous action d. Under the element of causation

b. Under the doctrine of respondeat superior -Known as vicarious liability, the doctrine of respondeat superior makes employers accountable for the negligence of their employees, using the rationale that the employee could not have been in a position to have caused the wrongdoing unless hired by the employer.

One means of ensuring that the nurses floated to other patient care areas in healthcare organizations are qualified to work in the areas they are floated is: a. employing additional staff to assist with orientation processes. b. cross-educating staff members to other areas of the institution. c. transferring patients to units where the staffing pattern is optimal. d. orienting staff members to all patient care areas as part of their general orientation to the institution.

b. cross-educating staff members to other areas of the institution. -Nurses should be floated to units as similar as possible to their own to decrease the potential for liability. Negotiating cross-training, a proactive approach to temporary staffing problems, reduces the potential for liability.

While walking past a patient's room, you overhear one of the RN staff telling a patient that the patient has no right to refuse chemotherapy treatment because the family and the doctor think the treatment is the best option for the patient. This patient is 40 years of age and alert. When you meet later to discuss what you heard with the RN, it is important to: a. discuss how statute law enforces the right of the doctor, but not of families, to ensure that patients comply with recommended treatment plans. b. discuss that statute law provides for patient autonomy and refusal of treatment. c. remind the nurse to provide clearer explanations to aid in the patient's comprehension of the treatment and compliance. d. acknowledge the nurse's role in ensuring that she does not fail in her duty of care for the patient.

b. discuss that statute law provides for patient autonomy and refusal of treatment. -Statute law states that the patient must be given sufficient information, in terms he or she can reasonably be expected to comprehend, to make an informed choice. Inherent in the doctrine of informed consent is the right of the patient to informed refusal. Patients must clearly understand the possible consequences of their refusal.

To reduce the incidence of falls in a skilled nursing unit, the nurse manager contacts the risk manager. Risk management is a process that attempts to identify potential hazards and: a. compensate for previous injuries. b. eliminate these risks before anyone else is harmed. c. supersede the need for staff members to file incident reports. d. discipline staff members who have been involved in previous incident reports

b. eliminate these risks before anyone else is harmed. -Risk management involves taking proactive steps to identify and eliminate risks and liability.

A member of a patient's family calls the nurse manager of the palliative care unit to express concern that a member of the family, who died on the weekend, had requested analgesics from the RNs on duty. An RN came with the analgesic nearly 45 minutes later, just after the patient had died. The manager is aware that the unit was especially busy that weekend because many patients were seriously ill, staff had called in ill, and the staffing manager was unable to completely replace staff who were absent. The manager is deeply troubled that the family member had to die in pain because it violates what she knows should have been done. This manager is experiencing: a. compromised agency. b. moral distress. c. moral sensitivity. d. moral dilemma.

b. moral distress. -Moral distress is experienced when nurses cannot provide what they perceive to be best for a given patient. Examples of moral distress include constraints caused by financial pressures, limited patient care resources, disagreements among family members regarding patient interventions, and/or limitations imposed by primary healthcare providers.

The chief nursing officer establishes a shared governance model to help empower the nursing staff, thus empowering the organization. Common characteristics of empowered organizations are: a. shared values, high salaries, and a human focus. b. shared values, flexibility, and a human-capital focus. c. commitment to communication, high salaries, and flexibility for evaluations. d. creation of community and of effective stress management in the midst of divergent goals.

b. shared values, flexibility, and a human-capital focus.

Within a healthcare environment, where the gap between revenues and costs can mean the difference between sustainability of an organization and non sustainability of an organization or services, it is critical for nurse managers to: a.Maintain a clear vision of how to trim healthcare costs. b.Balance value-added services against costs and revenues. c.Consistently delete programs that are of high cost. d.Implement programs that bring in additional revenues.

b.Balance value-added services against costs and revenues.

After reviewing her monthly budget report, the nurse manager sees that she has a negative variance, which prompts her to change the staffing schedule. A negative or unfavorable variance in a monthly expense report may result from: a. Overestimation of inflation. b.Higher than expected client acuity. c.Net revenue exceeding net expenses. d.Not replacing staff who called in sick

b.Higher than expected client acuity.

The chief nursing officer of a Magnet™ hospital has conducted a study of ways to improve healthcare services. Healthcare services that add value for clients: a.Accomplish healthcare goals. b.Minimize costs. c.Decrease the number of services used. d.Use high-technology treatments.

b.Minimize costs.

In a nurse managers' meeting, the chief nursing officer encourages the managers to brainstorm ways to reduce costs. Nurse managers have the greatest impact on reducing costs by managing: a.Supplies. b.Staffing. C. Fixed costs. D. Medication costs.

b.Staffing.

As an experienced nurse manager who is new to an organization, it would be important to: a.Know the difference between operating and capital budgets. b.Understand the budget timetable and level of involvement expected of individual managers in budget preparation. c.Know why a budget is essential to the well-being of an organization. d.Understand what factors drive up healthcare costs in the healthcare system.

b.Understand the budget timetable and level of involvement expected of individual managers in budget preparation.

The unit manager on 4E is concerned about the performance of Jean, a staff nurse. She is not involved directly with Jean, so she has not been able to determine whether the problem is one of motivation, ability, or both. If Jean lacks ability, which of the following strategies might the head nurse use? aa.Dismiss or transfer Jean. bb. Document all problem areas and then discuss them with Jean. cc.Develop appropriate solutions and make recommendations to human resources. dd. Smooth over the problems if they are minor in nature.

bb. Document all problem areas and then discuss them with Jean. -For the employee to change and grow, specific corrective measures need to be taken. Consultation with the employee is necessary, and documentation is key to determining the issues.

Ellen is a novice nurse on your unit. Even though she has come to you highly recommended, as her supervisor, you have noticed some knowledge and skill deficiencies. These deficiencies have been noticed by her peers as well, who cover for her because she is new and they like her. Which of the following is likely to be the greatest asset to Ellen in improving her performance? y. Ignore Ellen's errors until she has more experience. z. Instruct staff to avoid working with Ellen until she learns to how do things herself. aa. Ask Ellen to complete a self-assessment, using a standard skills checklist. bb. Encourage staff to report every behavior of Ellen's that is different from theirs.

bb. Encourage staff to report every behavior of Ellen's that is different from theirs. -When other employees are engaged in enabling behavior by covering for the mistakes of one of their peers, the nurse leader may be surprised to discover that the employee does not know or cannot do what is expected of him or her. The nurse leader must remind employees that part of professional responsibility is to maintain quality care and thus they are obligated to report instances of clinical incompetence, even when it means reporting a co-worker. Ignoring violations of a safety rule or poor practice is unprofessional and cannot be tolerated. The employee may be asked to do a self-assessment of the listed skills or competencies and then have performance of the skills validated by a peer or co-worker. This is a very effective method for the leader to assess the skill level of employees and to determine whether additional education and training may be necessary.

The chief nursing officer decides to establish a client advocacy position in an oncology unit. Advocacy is best represented by: y. establishing private and professional networking systems. z. asking social services to handle clients' concerns. aa.identifying community support groups. bb. empowering others by promoting self-determination.

bb. empowering others by promoting self-determination. -Advocacy involves empowering and promoting self-determination in others

The nursing director calls a meeting with one of the new unit managers. She is very concerned about a report of substance abuse on the manager's unit, and she reviews the procedures involved in dealing with chemically dependent staff. Which of the following statements would NOT be included in the discussion? "As a manager, you: y. need to be aware of ADA issues." z. should check with human resources regarding chemically dependent employees and employment practices." aa.check the nurse practice acts for the state in which the nurse resides." bb. should realize that the nurse is a professional embarrassment and should be kept out of sight of other staff."

bb. should realize that the nurse is a professional embarrassment and should be kept out of sight of other staff." -As a manager, you need to be familiar with state and professional regulatory and reporting requirements regarding chemical use and abuse, as well with human resource practices and guidelines.

Which of the following exemplifies a service orientation for a facility? y. Staff members on the unit are encouraged to chart details about family support networks. z. Chart audit reveals that details related to assessment of family history are missing. aa. The palliative care unit organizes a "tree of light" fundraiser each year to highlight the importance of palliative care. bb.A children's preoperative holding area is implemented in response to requests from families and staff nurses for development of an area.

bb.A children's preoperative holding area is implemented in response to requests from families and staff nurses for development of an area. -A service orientation needs to translate caring into appropriate, timely action that meets the needs of patients. Activities such as documentation of details or promotion of services may remain at the technical or conceptual level without a commitment to caring interactions. The institution of a holding area where families can be with children represents a caring action that arises out of interactions and knowledge of patient needs and thus, is service oriented.

All of the following are grounds for immediate dismissal except: bb.failing to pursue further medical help for a patient; patient dies. cc.selling narcotics obtained from the unit supply of narcotics. dd. restraining a patient in bed for 7 hours, unsupervised, as punishment for hitting a staff member. ee.grabbing the unit manager and threatening further physical harm after a poor performance appraisal.

bb.failing to pursue further medical help for a patient; patient dies. -Situations that may warrant immediate dismissal include theft, violence in the workplace, willful abuse of the patient, harassment, and chemical abuse

The nurse manager on a pediatric intensive care unit wants to evaluate patient satisfaction. The nurse manager understands that ultimately, positive relationships with consumers of care are evaluated by the: y. cultural sensitivity of staff. z. cost-effectiveness of care delivery. aa.economic value of service. bb.outcomes for clients and their perceptions of care.

bb.outcomes for clients and their perceptions of care. -Trend-setting organizations such as Magnet® organizations need to demonstrate excellence in outcome data such as patient satisfaction. Patient satisfaction and perception of the quality of care are affected by the quality of the nurse-patient relationship. Valid measurement of patient satisfaction is an evolving science; nurses do not always accurately gauge what factors are most important to patients. Satisfaction measures are often skewed in a positive direction with scores clustered at the top of the scale.

A patient refuses a simple procedure that you believe is in the patient's best interest. What two ethical principles are in conflict in this situation? a. Fidelity and justice b. Veracity and fidelity c. Autonomy and beneficence d. Paternalism and respect for others

c. Autonomy and beneficence

In keeping with standards of The Joint Commission (TJC), the nurse manager organizes an orientation for new staff members. As part of the orientation, the nurse manager reviews the employee handbook. What is the basis that binds employers to statements in the employee handbook? a. Under the doctrine of apparent agency b. Under the doctrine of respondent agency c. Based on the employee's or the employer's expectations d. Based on the theory that the handbook creates an explicit contract

c. Based on the employee's or the employer's expectations -The handbook is an implied contract and frames the employment contract. This contract binds the employer to meeting the handbook statements.

To effectively delegate in a team nursing environment, the RN team leader must be familiar with the legal and organizational roles of each group of personnel and must: a. Be able to effectively communicate with patients. b. Build relationships with physicians. c. Be able to adapt to daily changes in staffing. d. Adapt in communicating information to her supervisor.

c. Be able to adapt to daily changes in staffing.

In which of the following situations would you, as the head nurse, be concerned about potential safety issues? a. Jordan comes to your office to complain about inadequate staffing on the unit. He says that he is concerned because he attributes a recent incident to the staffing levels. b. Henry, a long-standing RN on the unit, has begun to miss work regularly. He calls in but is vague about his reasons for the absences. c. Carla, RN, has just ended an abusive relationship with Jake, RN, and he will not leave her alone. You are meeting with Jake today because colleagues on nights have reported that Jake seems to have been intoxicated last night and the previous night. d. Sarah is very quiet and says almost nothing in team meetings. Lately, she has been much more animated since becoming friendly with a couple of other RNs on the unit.

c. Carla, RN, has just ended an abusive relationship with Jake, RN, and he will not leave her alone. You are meeting with Jake today because colleagues on nights have reported that Jake seems to have been intoxicated last night and the previous night.

You note that Unit 64 has had a high turnover rate of staff during the past year. In selecting the appropriate action, it is important that: a. All documentation is reviewed. b. Usual processes for discipline are followed. c. Confidentiality is assured. d. An incident report is filed.

c. Confidentiality is assured.

A nurse manager questions the true difference between primary nursing and total patient care. After careful consideration of both models, the nurse manager concludes that primary nursing differs significantly from total patient care in: a. Breadth of nursing knowledge and expertise required. b. Intention to provide holistic nursing. c. Degree of task orientation. d. Levels and types of assessment.

c. Degree of task orientation.

You note that Unit 64 has had a high turnover rate of staff during the past year. In investigating this situation, an important source of data might include: a. Employee evaluations. b. Level of experience of staff. c. Exit interviews with staff. d. Selection processes and decisions.

c. Exit interviews with staff.

The principle that requires nurses to uphold a professional code of ethics, to practice within the code of ethics, and to remain competent is which of the following? a. Veracity b. Autonomy c. Fidelity d. Honesty

c. Fidelity -Fidelity refers to promise keeping or upholding one's promise to practice as a reasonable and prudent nurse would do and in an ethically competent manner.

in considering whether or not to accept a job offer as a nurse manager at a Magnet™ hospital, you look at an environment that you might encounter as a head nurse at the hospital. You determine that you could expect to: a. Find it difficult to recruit new staff. b. See rapid turnover of staff on your unit. c. Find nurses who exemplify interest in quality care. d. Find limited interest in excellence in the nursing environment.

c. Find nurses who exemplify interest in quality care

A patient complains to you that she has no idea who "her nurse" is on any given day. "I ask one nurse for my pills and she says, 'That's not my job.' I ask the pill nurse about my lab tests and she says that I should ask another nurse." The nursing care delivery model most likely employed in this situation is: a. Differentiated practice. b. Team nursing. c. Functional nursing. d. Case management.

c. Functional nursing.

During coffee and other breaks, Rosalie, the new RN, is shut out of conversations with the other staff. When she approaches other staff on the unit to ask questions, they turn and walk off in the other direction. The behavior of the staff is characteristic of: a. Dislike. b. Lack of trust in Rosalie's abilities. c. Horizontal violence. d. Cultural incompetence.

c. Horizontal violence.

As a manager, you are responsible for two separate units: a CCU and a cardiac step-down unit. The organization and relationships on these units are distinct and very different from one another. Your decision has been to support the uniqueness of these units because each is effective in different ways in providing patient care. This approach is consistent with which principle? a. Transculturalism b. Cross-culturalism c. Multiculturalism d. Acculturation

c. Multiculturalism -Multiculturalism refers to maintaining several different cultures, such as the uniqueness of different work units. Cross-culturalism means mediating between/among cultures, and transculturalism denotes bridging significant differences in cultural practices.

A nurse manager approves two staff nurses to attend a national conference. When reviewing the budget, the nurse manager looks at which line item? a. Cash budget b. Capital budget c. Operating budget d. Supply and expense budget

c. Operating budget

A staff nurse in the area that you manage has excelled in the delivery of patient education. You are considering implementing a new job description that would broaden her opportunity to teach patients and orient new staff members to the value of patient education. What ethical principle is being reinforced? a. Justice b. Fidelity c. Paternalism d. Respect for others

c. Paternalism

The case method of care delivery could be best justified in which of the following scenarios? a. Stable patient population with long-term care and family needs b. Acute care surgical unit with predictable postsurgical outcomes and many technical procedures c. Pediatric intensive care unit that heavily involves families as well as patients d. Home healthcare environment with patients at varying levels of acuity

c. Pediatric intensive care unit that heavily involves families as well as patients

While working with an aggressive patient, it is important for the nurse to: a. Speak firmly. b. Call the individual by name. c. Place herself between the patient and the door. d. Ignore threats against her.

c. Place herself between the patient and the door.

In a small rural nursing home, a director of nursing decides, because of a shortage of nurses, to implement a partnership model to help with basic tasks that comply with state rules regarding delegation. What type of design constitutes a partnership care delivery model? a. RN and LPN/LVN b. RN and RN c. RN and medication assistants d. RN and certified nurses' aides

c. RN and medication assistants

As a nurse manager, you realize that your unit has become a toxic environment in which horizontal violence and incivility has become common. In addressing the problem, you decide to implement which of the following? a. Increased education in clinical skills b. Follow-up of all reports of violence c. Training in conflict resolution and team-building d. Posting of the institutional policy on violence at the nursing station

c. Training in conflict resolution and team-building

Jenny tells you that she is always able to tell when others are about to become violent because they yell. Your response to Jenny is based on your understanding that: a. Her perception is accurate. b. Yelling is more likely associated with aggression. c. Violence is signaled by a variety of behaviors. d. She is mostly accurate in her thinking.

c. Violence is signaled by a variety of behaviors.

Mary joins 5W nursing unit. Mary is a new graduate who is anxious to fit in. She soon learns that some of her "book learning" is being criticized by her colleagues, so she adapts her practice to what others on the unit are doing. She is demonstrating: e. cultural awareness. f. cultural sensitivity. c. acculturation. d. cultural marginality.

c. acculturation. -In accepting the practices of the dominant group on the unit, Mary is demonstrating acculturation.

County Hospital has position descriptions for all staff, including RN Team Leaders. Sarah, a team leader on the rehab unit, assesses the needs of the patients in her area, assesses the skills and backgrounds of each of the individuals on her team, and then assigns and delegates the appropriate care provider to each patient and task. Sarah provides Colleen, her RN colleague with details regarding the patients to whom Colleen has been assigned on the day shift. This is an example of: a. accountability. b. responsibility. c. assignment. d. delegation.

c. assignment. -When an RN assigns care to another RN, it is termed an assignment and not delegation, because both accountability and responsibility are transferred.

You volunteer at a free community clinic. A 13-year-old girl presents with chlamydia. The team leader at the clinic advises that: a. the state-defined age of legal consent is 18; therefore, no treatment can be delivered. b. the teen is underage and should be referred to the family general practitioner. c. care can be provided as long as consent is voluntary and information about treatment and options is provided. d. treatment is provided as long as telephone consent is obtained from a parent or legal guardian.

c. care can be provided as long as consent is voluntary and information about treatment and options is provided. -All states have a legal age for consent; generally, this age is 18. However, emancipated minors, minors seeking treatment for substance abuse, and minors seeking treatment for communicable diseases can provide their own consent.

A new graduate RN joins your unit. After a few weeks, she complains about some of her peers on the unit and compares their practices negatively to what she learned in her nursing program. She also is vocal about how she has learned so much here that she did not learn in her program. She is best described as: a. having cultural sensitivity. b. experiencing cultural diversity. c. experiencing cultural marginality. d. experiencing acculturation.

c. experiencing cultural marginality. -The new graduate is caught between two cultures at this point—work and education—and expresses feelings of belonging to neither.

On your nursing unit, you employ LPNs, RNs, and advanced practice nurses. You will need to be familiar with at least: a. two nursing practice acts. b. two nursing practice acts in most states. c. one nursing practice act. d. one nursing practice act and a medical act.

c. one nursing practice act. -In all states, you will need to be familiar with at least one nursing practice act. In some states, there may be two nursing practice acts if RNs and LPNs/LVNs come under different licensing boards.

In caring for a patient from an East Indian culture, the staff expresses frustration that many people are in the room at any one time, which interferes with care. As the nurse manager, you provide leadership in understanding that this behavior of the family and friend network reflects: a. lack of understanding of the seriousness of the patient's illness. b. lack of communication between family members. c. the social organization of friendships and family networks in East Indian culture. d. lack of caring about the hospital environment by the friends and family.

c. the social organization of friendships and family networks in East Indian culture. -The Giger and Davidhizar Transcultural Model identifies six phenomena to assess provision of care for patients who are from different cultures, including social organizations, which include how relationships are formed and expressed in different cultures.

In preparing a budget, the nurse manager needs to anticipate the cost of benefits (e.g., health, life insurance, pension and retirement plans). Based on the usual cost of benefits, how much should a nurse manager include for a total full-time salary cost of $312,000? a.$78,000-$93,600 b.$62,400-$78,000 c.$46,800-$62,400 d.$31,200-$46,800

c.$46,800-$62,400

In preparing her budget, a nurse manager determines that she needs to budget for six FTE RN positions in the upcoming year. Based on a 40-hour week, this means that the nurse manager has determined that the budget will provide for _____ hours. a.12,480 productive b.10,820 productive c.12,480 paid d.10,800 patient care

c.12,480 paid

An older adult couple with limited means and on Medicare is considering options after the hospitalization of Mrs. A. with a fractured hip. Mrs. A. is stable but requires assistance with bathing, transfer, and mobility, and this will present stress for Mr. A., who was hospitalized with a mild myocardial infarction last year. Considering their means and health concerns, which of the following might be the best option? a.Hospice care b.Custodial nursing home care[ c.Home care d.Hospital care

c.Home care

Nurses generally experience difficulty in identifying behaviors and actions that could signal chemical dependency in a co-worker. Which of the following is not a behavioral change that occurs with chemical dependency? aa.Personality and behavioral changes bb. Job performance changes cc.Changes in educational involvement and pursuit dd. Absenteeism

cc.Changes in educational involvement and pursuit -A manager needs to be alerted when suspicions of chemical dependency are raised by behavioral changes in the employee. These include mood swings, changes in hygiene and appearance, heightened interest in the pain control of patients, frequent changes in shifts, increases in absenteeism, and increases

Nathan has been on the cardiac unit for 6 months and has found it difficult to adjust to the expectations of his team. Which of the following behaviors would mostlikely signal that Nathan is intending to resign from his position on the unit? cc.Increased absenteeism over the past month ddIncreased attempts to discuss his concerns with his colleagues ee.Testing of workplace guidelines ff. Frequent defensiveness

cc.Increased absenteeism over the past month -Many employees increase their absenteeism just before submitting their resignation. If the healthcare worker is experiencing some form of role stress, it might be manifested through absenteeism. Role strain may be reflected by (1) withdrawal from interaction; (2) reduced involvement with colleagues and the organization; (3) decreased commitment to the mission and the team; and (4) job dissatisfaction. Testing of workplace guidelines and defensiveness are associated with immaturity.

During unit staff meetings, you observe that Marg rolls her eyes and snorts whenever Julia makes a comment. Your first response as a unit manager is to: cc.discuss what you have observed with Marg. dd. file immediate documentation in Marg's personnel file. ee. ask Julie to monitor Marg's behavior during meetings. ff. ignore the behavior, as Marg is one of your strongest nurses.

cc.discuss what you have observed with Marg. -Incivility must be addressed. The initial step in addressing it is discussion with Marg, and if the behavior continues, then written documentation should be filed in Marg's personnel file. Monitoring and follow-up are your responsibility as the unit manager.

A nurse makes a medication error that is not serious and does not cause harm to the patient. As the charge nurse, your best action would be to: z. call attention to it by posting the critical incidents report at the nursing station. aa.include the mistake on the nurse's performance appraisal. bb. apologize to the patient for the error and indicate that discipline has occurred. cc.educate the nurse on how to provide an apology to the patient.

cc.educate the nurse on how to provide an apology to the patient. -Service recovery ensures responsiveness to the patient, and as part of service recovery, it is important to address an error in the most productive way, which also includes the nurse who made the error offering an apology to the patient.

In keeping with guidelines of the organization, the nurse manager documents staff problems. Documentation of disciplinary problems should: cc.include a plan to correct them and to prevent future occurrences. Dd. state a detailed history of past problems that are related to the current one. ee. be written at the convenience of the manager. ff. not be discussed until the formal performance evaluation.

cc.include a plan to correct them and to prevent future occurrences. -In documenting staff problems, it is important to identify the incident with an objective statement of facts and record actions taken to correct/prevent future problems.

When progressive discipline is used, the steps are followed progressively only for repeated infractions of the same rule. On some occasions, rules that are broken are so serious that the employee is: cc.transferred to another unit. dd. suspended indefinitely. ee.asked to attend a union grievance meeting. ff. terminated after the first infraction.

cc.transferred to another unit -Behaviors that include violence, theft, and purposeful abuse of a client are sufficiently serious to warrant immediate dismissal with the first incident.

A patient complains to you that she has no idea who "her nurse" is on any given day. "I ask one nurse for my pills and she says, 'That's not my job.' I ask the pill nurse about my lab tests and she says that I should ask another nurse." This nursing care delivery model employed in this situation might be particularly effective in: a. Promoting communication among diverse team members. b. Facilitating multiple perspectives on the total care of a patient. c. Avoiding patient-provider conflict. d. Developing competence and confidence in unskilled workers.

d. Developing competence and confidence in unskilled workers

Which of the following healthcare employees is MOST at risk for violence? a. Becky, working in a well-lit area with stable psychiatric patients and other staff members nearby. b. Sarah, who works in a busy emergency room. Access to the emergency patient units is allowed by security staff and alarm systems are in place in patient units. c. Sharon, who works evening shifts. Workstation is behind a shatterproof glass, and an alarm can be reached easily from her computer. d. Donna, who works the evening shift, cleans rooms each night in the administrative wing and business offices, which are largely empty. The wing is near an outside access door.

d. Donna, who works the evening shift, cleans rooms each night in the administrative wing and business offices, which are largely empty. The wing is near an outside access door.

Complex care of acutely ill patients is required on a surgical unit, which utilizes differentiated nursing practice as its model of care delivery. The concept of differentiated nursing practice is based on: a. Licensure status. b. Experience in the agency. c. Leadership capabilities. d. Education and expertise.

d. Education and expertise.

Residents in a new long-term care facility attend a large dining hall for meals. In reviewing reports of aggression and violence, you note that behaviors such as hitting, or attempting, to hit staff are increasing. Further investigation suggests that this behavior occurs most often at mealtimes. A possible intervention would be to: a. Seat residents with the highest potential for violence next to those with the lowest potential for aggression. b. Feed residents earlier in the day. c. Restrain residents who are violent or aggressive during mealtimes. d. Establish a smaller dining area that is away from the main area that is for residents who have potential for aggression/violence.

d. Establish a smaller dining area that is away from the main area that is for residents who have potential for aggression/violence.

A safety and security plan is important to a healthcare organization because it: a. Lays out preventive measures in relation to violence. b. Provides direction as to changes in facilities that protect staff. c. Establishes expectations in relation to behavior and tolerance of violence. d. Establishes policies and practices that guide prevention of violence and expectations in the workplace.

d. Establishes policies and practices that guide prevention of violence and expectations in the workplace.

When hiring a case manager for a rehabilitation setting, you would most likely consider a. Registered nurse with a master's degree. b. Physiotherapist with a background in stroke rehabilitation. c. Social worker with a background in counseling. d. Health professional with advanced background who is client and outcome focused.

d. Health professional with advanced background who is client and outcome focused.

When comparing functional nursing and primary nursing, a nurse manager, after evaluating particular models of nursing care for potential adoption, determines that patient and nurse satisfaction in primary nursing are: a. Similar to those in functional nursing. b. Not of significance in either model. c. Low by comparison with functional nursing. d. High when compared with functional nursing.

d. High when compared with functional nursing.

The manager in the coronary care unit believes an important ethical consideration in performance evaluations is to include the employee's good qualities and give positive direction for professional growth. What ethical principle does this represent? a. Justice b. Fidelity c. Beneficence d. Nonmaleficence

d. Nonmaleficence

The nurse case manager is working with a client admitted for end-stage renal disease. The case manager's major goal during this hospitalization is to: a. Implement the care pathway on admission. b. Provide direct nursing care throughout the hospitalization. c. Supervise the nursing staff members who implement the care map. d. Prevent additional hospitalizations resulting from complications of the client's disease

d. Prevent additional hospitalizations resulting from complications of the client's disease

Linda, a staff nurse on nights, yells at Ali, another RN, and tells Ali that she is stupid and can't get anything right. In responding to this situation as head nurse, it is critical that you: a. Require that Linda attend anger management classes. b. Investigate to see if Ali did anything to aggravate Linda. c. Call both immediately into the office to discuss the situation. d. Respond to Linda in a way that is consistent with organizational processes and with similar situations

d. Respond to Linda in a way that is consistent with organizational processes and with similar situations

Sarah, one of your RNs, tells you that she can't understand why Jim, an Aboriginal patient, wants to do a smudge. Sarah's response is based on her: a. cultural marginality. b. circle of familiarity. c. cultural understanding. d. acculturation.

d. acculturation. -The "circle of familiarity" refers to constrained interpretation based on one's values, attitudes, and beliefs.

When interviewing a candidate for a nursing position who has an Aboriginal background, you recognize that the candidate' s lack of eye contact reflects the candidate's: e. lack of confidence. f. professional behavior. g. cultural sensitivity. d. ethnicity.

d. ethnicity. -Ethnicity refers to groups of people who are classified according to common racial, tribal, religious, linguistic, or cultural backgrounds.

During a staff shortage, you hire an RN from a temporary agency. The RN administers a wrong IV medication that results in cardiac arrest and a difficult recovery for the patient. Liability in this situation: a. is limited to the temporary agency. b. is restricted to the RN. c. could include the RN, the agency, and your institution. d. may depend on the patient's belief regarding the employment relationship.

d. may depend on the patient's belief regarding the employment relationship. -Apparent agency may apply here because your liability and that of your institution could be established if it can be shown that the patient believes that the RN was an employee of yours and of your institution.

In an acute care unit, the nurse manager utilizes the functional nursing method as the care delivery model. The nurse manager's main responsibility is the needs of the: a. Department. b. unit. c. staff. d. patient.

d. patient. -In a functional nursing model, where other team members are focused on performing specific tasks, the nurse manager assumes primary responsibility for patient outcomes.

To satisfy duty of care to a patient, a nurse manager is legally responsible for all of the following except: a. notifying staff of changes to policies related to medication administration. b. scheduling and staffing to ensure safe care. c. delegating in accordance with practice acts. d. supervising the practice of the physician.

d. supervising the practice of the physician. -Legally, the nurse manager is accountable to nursing practice standards, standards for nurse administrators, and hospital policies and procedures

A nurse manager is planning to request three new infusion pumps at a cost of approximately $1500 each. This item would typically be included in which budget? a.Operating b.Strategic c.Unit of service d.Capital

d.Capital

The primary reason for calculating productive hours paid instead of simply calculating work paid per year is that productive hours enable the manager to: a.Anticipate total costs for patient care. b.Know how much time staff will likely be unavailable because of illness. c.Determine when orientation needs to occur for new staff. d.Determine the number of hours available for patient care.

d.Determine the number of hours available for patient care.

The chief nursing officer works with her nurse managers by helping them understand how to develop and implement a budget. A nurse manager can best describe a budget as a: a.Day-to-day plan for operations. b.Unit of service. c.Statement of revenues and services. d.Financial plan.

d.Financial plan.

Nurse Stacey is a self-admitted drug addict and has been a heavy abuser of codeine. Stacey and the unit manager decide that changes have to occur. Stacey enrolls in an addiction program, and the manager has her transferred to a drug-free area. What other strategies might be appropriate? cc. The manager could refer Stacey to the human resources department. dd. The manager could assist in monitoring Stacey's progress. ee. The manager could counsel Stacey if Stacey has formed a trusting relationship with her. ff. Stacey needs to be asked not to involve her family in the recovery program because this is a work-related situation.

dd. The manager could assist in monitoring Stacey's progress. -Effective management demands that the organization take an active role in helping employees with special needs. Humanistic strategies that counsel and assist employees are cost-effective and necessary.

Before terminating an employee, a nurse manager must: cc. be an expert in all legal aspects of termination and discipline practices. dd. follow the organization's specific policies for addressing disciplinary problems and termination. ee.function as a counselor for problem employees. ff. do everything to assist and protect the employee by adjusting standards and policies.

dd. follow the organization's specific policies for addressing disciplinary problems and termination. -It is important to know the policies of the organization to address disciplinary issues fairly and equitably, as well as to know the model that is employed to address employee problems. Human resource departments and legal departments are important sources for consultation, advice, and support.

A nurse manager understands that the second step in handling an employee with a disciplinary problem is to document the incident. Which of the following is best for documentation of personnel problems? cc. Use of the performance appraisal on an annual basis dd.Notes made immediately after an incident that include a description of the incident, actions taken, plans, and follow-up ee. A tally sheet of medication errors and other specific problems that will be used at annual review ff. Copies of reports, placed in his or her file, of all unusual occurrences involving the employee

dd.Notes made immediately after an incident that include a description of the incident, actions taken, plans, and follow-up -In documenting staff problems, it is important to specifically indicate what rules were broken or violated, consequences if behavior is not altered, employee's explanation of the incidents, and the plan of action to achieve and to reach new goals.

A 66-year-old native Chinese patient, hospitalized for a myocardial infarction, asks the nurse manager about seeing his "acupuncture doctor" for treatment of his migraine headache. The best response to this patient would be: e. "How long have you been using acupuncture treatment?" f. "Do you think acupuncture relieves your pain satisfactorily?" g. "What have you told your heart specialist about your migraines and treatment?" h. "Have you tried nonprescription pain medication or been given a prescription drug for your headaches?"

e. "How long have you been using acupuncture treatment?" -Acknowledging the patient's use of acupuncture demonstrates cultural sensitivity through acknowledgement of treatments that would be consistent with the patient's cultural interpretation of illness and responses to it. The other responses indicate lack of cultural sensitivity as well as cultural imposition, in that the nurse diverts the line of inquiry toward interventions that would be common to the nurse's experience of health care in Western cultures.

During managers' meetings, Lindsay is surprised by the forthrightness of male managers. She finds that, during discussions, she would be more likely to say: e. "I wonder if we should consider changing our policy on performance appraisals? What do you think?" f. "Sean, your approach to appraisal is completely off track and does not reflect available evidence." g. "The system that has been developed needs to be implemented. We have already spent enough time in discussion." h. "Forget about change in this policy. It is fine as it is."

e. "I wonder if we should consider changing our policy on performance appraisals? What do you think?" -Males and females in the workplace are likely to have different management styles, and although not all males are authoritative or females more participatory, women are likely to use more participatory and inclusive methods.

As a nurse manager, you have hired two new staff members who have recently come to the United States from other countries. Which of the following strategies might indicate your efforts to assist these staff members with acculturation to your unit? e. Analyze a recent situation with them in which an order with a physician was not clarified and explore their beliefs about nurse-physician relationships. f. Expect them to behave in ways that are expected of staff who have grown up and been educated in the United States. g. Stress to these new staff that your unit is a "family" and that staff members take pride in saying that they are from Unit 4. h. Recognize that culture develops over time and leave them alone to figure out differences between their culture and that of the unit.

e. Analyze a recent situation with them in which an order with a physician was not clarified and explore their beliefs about nurse-physician relationships. -Acculturation refers to adapting to a particular culture. Assimilation occurs when individuals now define themselves as members of the dominant culture and is evidenced by when individuals say they are from where they live and practice. When individuals grow up within a culture and take on the characteristics of that culture, it is referred to as socialization. Assisting the staff to recognize differences in the relationships between physicians and nurses on the unit and those in their country of origin is assisting adaptation or acculturation and is promoting positive patient outcomes

Because an increasing number of Hispanic patients are being admitted, a nurse manager designs a staff-development program to help her staff understand the Hispanic culture. A nurse should understand that culture is determined by which of the following? e. Behavior f. Love for people g. Shared vision h. Genetic predisposition

e. Behavior -Culture is determined by behaviors and beliefs and develops slowly.

Which of the following activities would represent a customer-friendly approach in a healthcare setting? (Select all that apply.) e. Using a local anesthetic before inserting a needle into a child's arm f. Repeating patient history information to the admitting clerk, the admitting nurse, and the ultrasound technician g. Ensuring that birthing preferences are on file and available in a laboring mother's chart h. Providing support to families when a family member is brought into trauma

e. Using a local anesthetic before inserting a needle into a child's arm g. Ensuring that birthing preferences are on file and available in a laboring mother's chart h. Providing support to families when a family member is brought into trauma -A service orientation means delivering services in a manner that is least disruptive. When possible, services should come to the patient and should be as easy, comfortable, pleasant, and effective as

The nurse manager for a unit's culturally diverse staff creates a staff-development program so the professional nursing staff members can enhance their understanding of cultures on the basis of published literature. The literature reveals that the following characteristic is inherent in a culture. It: e. develops over time. f. maintains a strong work ethic. g. changes easily. h. develops quickly.

e. develops over time. -Culture is a patterned behavioral response that evolves slowly as times change. The culture may or may not maintain a strong work ethic.

In designing programs through your institution to address the health needs of Hispanics in your community, you most likely would develop programs related to: e. diabetes. f. cardiovascular disease. g. cancer. h. asthma.

e. diabetes. -Hispanics with diabetes are twice as likely to die from diabetes as non-Hispanics

Case managed care may enhance profit in a for-profit health organization by: e. minimizing costs in high resource consumption areas. f. combining licensed and non-licensed care providers in delivering patient care. g. increasing reimbursement from third-party payers. h. reducing the amount of technology used to support clinical decision making.

e. minimizing costs in high resource consumption areas. -Case managed care is not revenue generating but rather revenue protecting in that better coordination of care enables efficient achievement of patient outcomes, can result in shorter length of stay, and can prevent readmission.

Incivility is a disruptive behavior or communication that creates a negative environment and interferes with quality patient care and safety. The manager can implement the following steps that help to alleviate uncivil behavior on a unit. (A) Suspending the staff member from work (B) Providing written admonishment that is discussed and placed in the employee's file (C) Providing verbal admonishment (D) Terminating the staff member cc. A, B, C, D dd.B, A, C, D ee. C, B, A, D ff. C, A, B, D

ee. C, B, A, D -The steps in progressive discipline are followed from the least severe (counseling the employee) to the most severe (termination). Studies have shown that following this sequence provides a fair and effective plan for discipline and remediation.

The nurse manager places a staff member on probation because of reports of chemical dependency. The nurse manager should be aware that which of the following statements is true regarding chemical dependency? cc. The chemically dependent employee usually hides any changes in behavior. dd.When confronted with the issue, the affected employee is usually relieved to have someone to talk to about the problem. ee. The chemically impaired nurse affects the entire healthcare organization. ff. Hospital policy, state laws, and nurse practice acts address procedures for the chemically dependent employee in the most general terms.

ee. The chemically impaired nurse affects the entire healthcare organization. -A chemically impaired nurse jeopardizes patient care through impaired skills and judgment. She or he also compromises teamwork and continuity as peers attempt to cover deficiencies in work performance for their impaired team member.

A nurse manager must be familiar with the agency's policies regarding termination. Termination procedures include which of the following? cc.Following specific procedures from other organizations dd. Having an attorney present at the termination meeting ee.Having adequate written documentation to support the action ff. Having a friend present during the termination meeting

ee.Having adequate written documentation to support the action -All steps should be followed, including full appropriate detailed documentation and following the procedures of the organization.

The most important approach that a nurse manager can take with an emotionally troubled employee is to: cc. act as a therapist for the employee. dd.adjust the standard of care to assist the employee. ee.assist the employee in obtaining professional help. ff. adjust the employee's work schedule to decrease stress.

ee.assist the employee in obtaining professional help. -Emotional difficulties are usually beyond the scope of skills that a nurse manager would normally employ. A referral needs to be made to a professional who is specifically prepared to deal with this kind of difficulty.

A nurse manager understands that the typical first step in handling an employee with a disciplinary problem is a: cc.verbal reprimand. dd.written reprimand. ee.reminder of employment standards. ff. day off without pay.

ee.reminder of employment standards. -The progressive model of discipline advocates that the first step of the disciplinary process is the informal reprimand or verbal admonishment. The nonpunitive discipline model advocates reminding the employee of the employment policies and procedures of the agency.

The education consultant for the hospital is presenting a workshop titled "Documentation: A Manager's Responsibility." Which of the following points would she not include in her PowerPoint presentation? Documentation: dd. cannot be left to memory. A notation must be placed in the personnel file. ee.should avoid discussion of the problem. ff. should include what was done about the problem when it occurred. gg. needs to include date, time, and place.

ee.should avoid discussion of the problem. -Documentation of personnel problems is one of the most important aspects of the nursing manager's role. Through carefully detailed and timely documentation of the problem and plan, the manager decreases the burdensome problems that can ensue from improper or inadequate documentation.

One of the staff nurses on your unit makes the comment, "All this time I thought Mary was black. She says she is Jamaican." The best response would be to say: e. "Who cares what she is?" f. "What did you think when you learned she was Jamaican?" g. "Why did you assume she was black?" h. "We have never had a Jamaican on this unit."

f. "What did you think when you learned she was Jamaican?" -The response of the nurse manager invites cultural awareness, which involves self-examination and in-depth exploration of one's own biases, prejudices, and assumptions.

In hiring nurses during the transition from team nursing to a primary nursing model, Benner's work would suggest that you give priority to nurses who are at least at which level of competency? e. Advanced beginner f. Competent g. Proficient h. Novice

f. Competent -Nurses who have less than 2 or 3 years' experience in primary nursing and/or less than 2 or 3 years of nursing experience will likely require more assistance than other nurses, which will put a greater demand on the unit during a time of transition.

During performance appraisal, you praise Xia for her attention and care to nursing details. You suggest that her care would be further enhanced by greater acknowledgment of patients' feelings. Xia bursts into tears and leaves the office. Later, you learn that criticism is perceived as akin to failure in Xia's culture. You reflect on how you could modify your approach in the future to acknowledge different cultural interpretations of feedback. Your response is indicative of: e. bias. f. cultural awareness. g. cultural diversity. h. ethnocentricity.

f. cultural awareness. -Cultural awareness involves self-examination and in-depth exploration of one's own cultural and professional background, including biases, prejudices, and assumptions, including assumptions about thinking modes and decision making.

Sarah, RN, complains to you that a male nurse from a different culture sits very close during charting and leans toward her when speaking. In responding to Sarah, you consider that differences across cultures that are relevant to this situation include: e. eye contact. f. personal space. g. harassment. h. expressions of feeling.

f. personal space. -Body movements, eye contact, gestures, verbal tone, and physical closeness when communicating are all part of a person's culture. For the nurse manager, understanding these cultural behaviors is critical in accomplishing effective communication within the diverse work force population.

Within the deaf culture, there is considerable disagreement about the use of SEE (Signed Exact English) and ASL (American Sign Language). This is indicative of: e. dominant versus nondominant behaviors. f. the need to recognize diversity within groups. g. the impact of cross-culturalism. h. how language separates subgroups.

f. the need to recognize diversity within groups. -When working with various cultural groups and diversity, it is important to recognize that diversity also exists within groups. Cultural differences among groups should not be taken in the context that all members of a certain group or subgroup are indistinguishable.

At Health Center XYZ, staff members on the rehabilitation unit have a head nurse who is intolerant of error and publicly chides anyone who makes a mistake. Over time, the rules on the unit dictate that mistakes are hidden and that areas of concern related to the functioning of the unit are discussed in tub rooms and are never openly discussed during periodic meetings. New staff members are quickly made to realize that silence is expected. The situation described is an example of: a. ethnicity. e. work environment. f. work culture. d. marginalization.

f. work culture. -Culture develops over time, is essential to survival, is learned and shared by members, and changes with difficulty.

According to Leininger, "cultural imposition" is a major concern in nursing because nurses have a tendency to impose their values, beliefs, and practices on patients of other cultures. The discussion topic most likely to be without cultural imposition would be: e. abortion. f. wound management. g. blood transfusion. h. advance directives.

f. wound management. -Abortion, blood transfusion, and advance directives are heavily imbued with values, beliefs, and practices that may be different between patients and nurses.

Incivility is a disruptive behavior or communication that creates a negative environment and interferes with quality patient care and safety. The manager can implement steps that help to alleviate uncivil behavior on a unit. Which of the following would not be an appropriate first step? cc.Suspending the staff member from work dd. Providing written admonishment that is discussed and placed in the employee's file ee.Providing verbal admonishment ff. Terminating the staff member

ff. Terminating the staff member -Dismissal does not enable the present organization to attempt remediation of the behavior and is not consistent with first steps in progressive discipline.

The chief nursing officer understands that clinical incompetence is best prevented by a(n): cc.flexible protocol for evaluating competency skills. Dd. standardized clinical skills checklist. ee.administration of personality tests and competency assessments at point of hire. ff. formalized competency program with established standards for practice.

ff. formalized competency program with established standards for practice. -The competency program with established standards of practice outlines what the nurse must do to achieve desired competencies in her current position. Competency assessment and goal-setting should help the nurse identify how to excel and which competencies the nurse wants to achieve in the future.

The chief nursing officer reviews the policy about "progressive discipline process." The progressive discipline process includes which of the following? The manager: cc. acts as a counselor and friend to the employee. dd.should reprimand and suspend the employee as a last resort. ee.should rehire the employee after a reasonable length of time. ff. should terminate the employee if the problem persists.

ff. should terminate the employee if the problem persists. -Termination can be defined as the discharge of an employee who is performing at an unsatisfactory level or who is not a good match for the organization. Termination is always considered the last resort when dealing with poor performance.

The nurse manager knows that the most serious effect that absenteeism has on the nursing unit is that: cc.using replacement personnel with new ideas may be beneficial. dd. salary costs are lower because personnel are fewer, and outcome is favorable. ee.absence on the part of the rest of the staff is decreased. ff. unacceptable patient care may result.

ff. unacceptable patient care may result. -Reduced staffing adversely affects patient care. Employee morale suffers, care standards may be lowered, and additional stress is placed on working staff.

Maintaining a culturally diverse staff and working with a culturally diverse patient population is an important function of a nurse manager who works in the hospital of a large medical center. On your palliative care unit, you have recently received complaints from families about ineffective pain management for their family members and you determine this occurs primarily when certain nurses are working. What approach might you take to resolve the concerns of the families, patients, and potentially, the staff? e. Reinforce to staff that practice guidelines support as-needed analgesia for the terminally ill. f. Ask staff input on the development of stricter guidelines to ensure that all terminally patients are given sufficient analgesia. g. Encourage conversation with patients and among staff that facilitates learning about cultural beliefs and priorities in dying. h. Advise families that the administration of analgesia is based on the expert clinical judgment of nurses who are familiar with care of patients in palliative care.

g. Encourage conversation with patients and among staff that facilitates learning about cultural beliefs and priorities in dying. -The cultural and religious backgrounds of nurses influence their perceptions of dignity-conserving care. For example, foreign-born Catholic nurses stated the dying experience should not be altered by analgesics to relieve suffering or by attempts to hasten death by forgoing curative therapy or by other means. Approaches to working with differences in the diverse cultural and religious backgrounds of patients, families, and nurses alike include taking time to have conversational chats with patients in end-of-life and with colleagues that will facilitate learning about each other and provide care that fits with the patient's cultural beliefs about dying.

Your organization has made a decision to implement TCAB in your hospital. As a manager, what strategies would you use to implement TCAB? (Select all that apply.) g. Encourage recognition among staff of their knowledge of the patient-care environment. h. With staff, select small changes for consideration. i. Select only projects that have widespread impact. j. Secure external advisors to evaluate innovation. k. Present ideas based on best practices and ask staff for advice on implementation.

g. Encourage recognition among staff of their knowledge of the patient-care environment. h. With staff, select small changes for consideration. k. Present ideas based on best practices and ask staff for advice on implementation. -Transforming care at the bedside (TCAB) relies on active involvement of staff in the generation of innovative ideas to improve patient care. Staff are actively engaged in selecting innovation, planning, and evaluation of the innovations. Critical to practice changes, rapid cycle change is a process that encourages testing creative change on a small scale while determining potential impact.

Cultural diversity is the term used to describe a vast range of cultural differences. Events have symbolic meanings for the nurse manager and the staff. The event that would be most likely to provide symbolic meaning to a nurse manager and staff is a: e. task force formed to commemorate a New Year's celebration in the Western tradition. f. project to provide Christmas gifts to the children in a daycare program. g. celebration of National Nurses Week with the focus on cultural care. h. task force to develop a poster for the unit depicting religions of the world.

g. celebration of National Nurses Week with the focus on cultural care. -Human cultures have material items or symbols such as artifacts, objects, dress, and actions that have special meaning in a culture. National Nurses Week, with a focus on nursing interests, reflects the culture of nursing.

In considering whether or not to accept a job offer as a nurse manager at a Magnet® hospital, you look at an environment that you might encounter as a head nurse at the hospital. You determine that you could expect to: e. find it difficult to recruit new staff. f. see rapid turnover of staff on your unit. g. find nurses who exemplify interest in quality care. h. find limited interest in excellence in the nursing environment.

g. find nurses who exemplify interest in quality care. -Magnet® hospitals exemplify hospitals whose focus processes attract and retain nurses who value and promote quality care and excellence in nursing environments.

In comparing team and functional models of care, a nurse manager favors the team model. In particular, she finds that the team model: h. can be effective in recognizing individual strengths and backgrounds of staff. i. promotes autonomy and independence for the RN. j. avoids conflict because of role clarity. k. is efficient in delivering care to a large group of patients, utilizing a staffing mix.

h. can be effective in recognizing individual strengths and backgrounds of staff. -Team nursing delivers care to a small group of patients, using a mix of licensed and unlicensed personnel. Team nursing uses the strengths of each caregiver.

The nurse manager of a unit is asked by a family member of a dying Native American patient if it is possible to have the patient's eight-member family recite the rosary by the bedside. The manager responds affirmatively. The nurse manager is most likely exhibiting behavior related to: e. acculturation. f. ethnocentricity. g. cultural diversity. h. cultural sensitivity.

h. cultural sensitivity. -Cultural sensitivity involves the capacity to feel or react to ideas, customs, and traditions unique to a group of people.

An example of a factor that would impede a patient's learning is: e. poverty. f. limited health insurance. g. being an older adult. h. heavy sedation.

h. heavy sedation. -Nurses need to be sensitive to the teaching needs of those at risk for disparities in health care: persons of a different race or ethnic group, women, children, older adults, rural residents, and those with limited or no health insurance, low health literacy, and/or low socioeconomic status. It is important that lower expectations for persons who are disadvantaged, have a low literacy level, or have limited English proficiency are not unintentionally communicated.

As a nurse manager, you notice that Maria, a Hispanic nurse aide, is visibly upset. When you ask her if something is wrong, she becomes tearful and says, "Why is it that when John and I work together in giving patients care, he jokes about my being "a little fat Mexican"? The nurse manager's best response is, "Do you think he: e. is sensitive to your culture?" f. wants to learn more about you?" g. has been hurt and wants to hurt others?" h. is stereotyping you without thinking?"

h. is stereotyping you without thinking?" -Prejudices enable us to predict behaviors and make sense of situations but constrain our understanding and development of new insights.

Individuals living with asthma, who also live in poverty, are much less likely to seek early care and are more likely to go to emergency rooms for assistance. This example reflects: e. stereotyping. f. cultural diversity. g. ethnocentricity. h. transcultural care.

h. transcultural care. -Transcultural care involves consideration of health beliefs and practices between genders among races, ethnic groups, and those with different socioeconomic status.

Clinical incompetence is one of the more serious problems facing a nurse manager. Joyce, the nurse manager, is not aware of the problems of Sarah, a novice nurse. After she investigates, it is obvious that Sarah's peers are covering for her. Which of the following might Joyce include in her meeting with the nurses? (Select all that apply.) i. "It is a nurse's professional responsibility to maintain quality control." j. "All instances of clinical incompetence are to be reported." k. "It is not considered being disloyal when one nurse reports another for poor care." l. "Patient care is the number one concern. Meeting standards is mandatory and necessary."

i. "It is a nurse's professional responsibility to maintain quality control." j. "All instances of clinical incompetence are to be reported." k. "It is not considered being disloyal when one nurse reports another for poor care." l. "Patient care is the number one concern. Meeting standards is mandatory and necessary." -The nurse leader must remind employees that professional responsibility is to maintain quality care, and thus they are obligated to report instances of clinical incompetence, even when it means reporting a co-worker. Ignoring safety violations or poor practice is unprofessional and jeopardizes patient care.

During times of nursing shortages and increased nursing costs in health care, which of the following nursing care delivery models might come under greatest scrutiny? i. Case method j. Team nursing k. Functional nursing l. Nurse case management

i. Case method -The case method may involve total patient care provided by a registered nurse, which, in today's costly healthcare economy, is very expensive. In times of nursing shortages, there may not be enough resources or nurses to use this model.

To effectively delegate in a team nursing environment, the RN team leader must be familiar with the legal and organizational roles of each group of personnel and must: g. be able to effectively communicate with patients. h. build relationships with physicians. i. be able to adapt to daily changes in staffing. j. adapt in communicating information to her supervisor.

i. be able to adapt to daily changes in staffing. -A particular challenge in team nursing is that staff mixes and staff may change daily because of individual schedules and shortages.

The relief charge nurse has assigned a newly licensed baccalaureate-prepared nurse to be one of the team leaders for the 3-11 shift. In making this decision, the charge nurse has overlooked this nurse's: i. clinical expertise. j. leadership ability. k. communication style. l. conflict-resolution skills.

i. clinical expertise. -Because the basic education of baccalaureate-prepared RNs emphasizes critical-thinking, clinical reasoning, and leadership concepts, they are likely candidates for such roles. Benner (2001), however, identified five stages of clinical competence for nurses: novice, advanced beginner, competent, proficient, and expert. She suggests that competence is typified by a nurse who has been on the job in the same or similar situation 2 to 3 years. Nurses who are at the novice or advanced beginner stage would be less likely than their more experienced counterparts to implement any type of delivery model effectively and thus, this assignment overlooks the nurse's level of clinical expertise and leadership experience.

A nurse manager questions the true difference between primary nursing and total patient care. After careful consideration of both models, the nurse manager concludes that primary nursing differs significantly from total patient care in: g. breadth of nursing knowledge and expertise required. h. intention to provide holistic nursing. i. degree of task orientation. j. levels and types of assessment.

i. degree of task orientation. -Significant overlap can be seen between primary nursing and total patient care in terms of breadth of assessment and knowledge required to provide holistic care. A primary difference is that nurses in the total care model assume accountability while on shift, whereas primary nurses assume responsibility from time of admission to discharge and 24 hours a day.

A conflict develops between an associate nurse and a primary nurse over the assessment of a patient with pulmonary edema. Based on her assessment of the patient, the associate nurse insists that it is her role to change the care plan because she is the one who has made the assessment. As the nurse manager, you clarify that: i. it is the role of the primary nurse to make alterations based on assessment data and input. j. the associate nurse is accountable and responsible while the primary nurse is off duty and therefore is able to alter the care plan. k. neither the primary nor the associate should make changes without first consulting you as the manager. l. it really does not matter who alters the nursing care plan as it depends on situation and time to do so.

i. it is the role of the primary nurse to make alterations based on assessment data and input. -The primary nursing model assumes that the primary nurse is accountable for patient care, even while off duty. The primary nurse is responsible for establishing the patient plan of care and therefore for altering it with the input of an associate. The associate is responsible for implementation of the established care plan when the primary nurse is off duty.

For a nurse manager in the functional nursing model, an approach that will assist in maintaining staff satisfaction in this specific model is: i. rotation of task assignments. j. frequent opportunities for in-service education. k. orientation to job responsibilities and performance expectations. l. team social events in off hours.

i. rotation of task assignments. -Although repetition of tasks increases confidence and competence, it can also lead to boredom. Rotation of tasks can assist specifically in this model to reduce the boredom that is a potential disadvantage of this model.

To project staffing needs and to avoid understaffing, it is important that nurse managers consider which of the following? i. Maximum productive hours j. Average non-productive hours k. Minimum benefit hours l. Maximum vacation time

j. Average non-productive hours -To avoid understaffing, average non-productive or benefit hours need to be taken into account, so the unit is properly staffed when staff members are off.

The nurse manager at a cardiac rehabilitation unit was asked to select a care delivery model. Which of the following methods would be the most cost-effective? i. Functional method j. Case management method k. Primary care method l. Team method

j. Case management method -Team nursing, functional nursing, and case management are all considered efficient, cost-effective methods of care delivery because they enable utilization of various types of healthcare providers (rather than baccalaureate nurses in direct care, which is the primary nursing method). Case management is considered particularly cost-effective in patient care settings because it maintains quality care while streamlining costs for high-risk, high-volume, high-cost patient populations and seeks the active involvement of the patient, the family, and diverse healthcare professionals.

When interviewing an applicant for an RN position, the nurse manager describes the unit's care delivery system as one in which the nursing assistants are cross-trained to perform specific tasks and the RNs complete all treatment, medication administration, and discharge teaching. The nurse applicant knows this nursing care delivery strategy to be: i. the case method. j. functional nursing. k. primary nursing. l. nurse case management.

j. functional nursing. -The functional model of nursing is a method of providing patient care by which each licensed and unlicensed staff member performs specific tasks for a large group of patients.

In transitioning to a primary nursing model, it is important for a nurse manager who enjoys a high level of control over patient care to understand that his or her decision making at the patient care level: i. is increased. j. is decreased. k. is relinquished. l. remains the same.

j. is decreased. -The nurse manager who is considering movement to primary nursing needs to consider how the role of the manager changes, as well as the roles of the staff. The role of decision making at the patient care level is relinquished to the primary nurse, and the role of manager becomes that of facilitator, coach, mentor, role model, and clinical resource.

You are considering putting forward a proposal to move the model of care from team nursing to a primary nursing hybrid: patient-focused care model. In considering this proposal, you recognize that significant costs specific to operationalizing this model are related to: i. implementation of an all-RN staff complement. j. significant changes in the physical structure of units. k. orientation of staff to new roles and responsibilities. l. testing and piloting technology at the bedside.

j. significant changes in the physical structure of units. -This particular model includes a focus on patient care that includes multidisciplinary teams and assistants at the bedside. Services, including laboratories and pharmacies, are decentralized to bring them closer to where care is delivered.

The case method of care delivery could be best justified in which of the following scenarios? i. Stable patient population with long-term care and family needs j. Acute care surgical unit with predictable postsurgical outcomes and many technical procedures k. Pediatric intensive care unit that heavily involves families as well as patients l. Home healthcare environment with patients at varying levels of acuity

k. Pediatric intensive care unit that heavily involves families as well as patients -This model is especially useful in the care of complex patients who need active symptom management provided by an RN, such as the care of the patient in a hospice setting or an intensive care unit. This method would be justifiable delivery in the pediatric intensive care unit, where the status of patients can change rapidly and where complex functions of care involve both patients and families.

In a small rural nursing home, a director of nursing decides, because of a shortage of nurses, to implement a partnership model to help with basic tasks that comply with state rules regarding delegation. What type of design constitutes a partnership care delivery model? i. RN and LPN/LVN j. RN and RN k. RN and medication assistants l. RN and certified nurses' aides

k. RN and medication assistants -The partnership care delivery model is a variation of primary nursing in which an RN works with a consistent assistant, who performs basic nursing functions consistent with state delegation rules.

You are the nurse manager of a nursing service organization that provides around-the-clock care to clients in their homes. To achieve maximum reimbursement for a client who is recovering from a hip replacement, the nursing staff most likely will follow the nursing care guidelines presented in the: i. nursing care plan. j. physician's orders. k. critical pathway. l. clinical practice guidelines.

k. critical pathway. -A critical pathway outlines outcomes, clinical standards, and interventions for a patient in each phase of treatment. The goal of critical pathways is effective coordination of care across various staff and levels of care

A patient complains to the charge nurse that she has no idea who "her nurse" is on any given day. "I ask one nurse for my pills and she says, 'That's not my job.' I ask the pill nurse about my lab tests and she says that I should ask another nurse." The nursing care delivery model most likely employed in this situation is: i. differentiated practice. j. team nursing. k. functional nursing. l. case management.

k. functional nursing. -Functional team nursing involves licensed and unlicensed personnel who perform specific tasks for a large number of patients. A disadvantage of functional team nursing is the fragmentation of care. The physical and technical aspects of care may be met, but the psychological and spiritual needs may be overlooked. Patients become confused with so many different care providers per shift. These different staff members may be so busy with their assigned tasks that they may not have time to communicate with each other about the patient's progress.

The American Nurses Association has advocated for the Registered Nurse Safe Staffing Act. This legislation is based on ANA Safe Staffing Principles and takes what factors into consideration for planning staffing on a nursing unit? i. Patient acuity and complexity j. Education and training of the nurses k. Technology available and use on the unit l. All factors listed are to be considered

l. All factors listed are to be considered -ANA has opted to support the nurse staffing committee as the approach to ensure safe staffing. For the last decade, the ANA has advocated for a Registered Nurse Safe Staffing Act. The legislation is based upon the ANA Safe Staffing Principles (Box 13-2) and considers the following: RN educational preparation, professional certification, and level of clinical experience The number and capacity of available healthcare personnel Geography of the unit Available technology Intensity, complexity, and stability of patients

In reviewing the job description of a nurse manager, the staff becomes aware that a nurse manager's role is complex. Which of the following duties are required of a nurse manager? (Select all that apply.) l. Ensure unit productivity reports. m.Develop policy and legislation to protect nurses' well-being. n. Plan staffing of UNPs only. o. Prepare a unit budget that reflects unit staffing needs. p. Monitor nurse-sensitive indicators such as falls and incidence of infections.

l. Ensure unit productivity reports. o. Prepare a unit budget that reflects unit staffing needs. p. Monitor nurse-sensitive indicators such as falls and incidence of infections. -A nurse manager manages financial resources by developing business and staffing plans.

When hiring a case manager for a rehabilitation setting, you would most likely consider a: i. registered nurse with a master's degree. j. physiotherapist with a background in stroke rehabilitation. k. social worker with a background in counseling. l. health professional with advanced background who is client and outcome focused.

l. health professional with advanced background who is client and outcome focused. -Case managers can come from a variety of disciplines but should have advanced preparation with the particular at-risk population being served, be comfortable in an advocate role, and be outcome and patient focused.

The nurse manager is comparing functional nursing and primary nursing for potential adoption. The nurse manager determines that patient and nurse satisfaction in primary nursing are: i. similar to those in functional nursing. j. not of significance in either model. k. low by comparison with functional nursing. l. high when compared with functional nursing.

l. high when compared with functional nursing. -Although some studies suggest there is little difference between functional nursing and primary nursing, primary nursing tends to be more satisfying for RNs, who enjoy a high level of accountability and autonomy in decision making. Patient satisfaction is also high, as patients form close therapeutic relationships with the nurse because of the continuity of the relationship. Functional nursing is criticized for low patient satisfaction and potential staff dissatisfaction related to boredom and an autocratic approach to management.

The nurse case manager is working with a client admitted for end-stage renal disease. The case manager's major goal during this hospitalization for this patient is to: i. implement the care pathway on admission. j. provide direct nursing care throughout the hospitalization. k. supervise the nursing staff members who implement the care map. l. prevent additional hospitalizations resulting from complications of the client's disease.

l. prevent additional hospitalizations resulting from complications of the client's disease. -The goals and outcomes established in a critical pathway are designed to support the aims of case management, which are shortened hospital stays and prevention of hospital readmissions.

Your healthcare organization has a decentralized system for scheduling. As part of this process, after you have developed a draft schedule, you may need to: i. seek budgetary approval. j. balance personal schedules against institutional needs. k. negotiate the schedule with unit staff. l. submit the schedule to a centralized staffing office for review.

l. submit the schedule to a centralized staffing office for review. -In a decentralized model, you may be completely responsible for approving all schedule changes and for development of the schedule, or you may need to submit a draft to a centralized office for review and determination of supplemental staff. Balancing personal schedules and negotiation describes staff self-scheduling models.

The difference between staffing and scheduling is that staffing: m. puts the right person in the right position. n. puts the right person in the right time and place. o. refers to the number of nursing hours per patient per day. p. looks after interpretation of benefits and compensation.

m. puts the right person in the right position. -Nursing staffing involves planning for hiring and deploying qualified human resources to meet the needs of a group of patients. Scheduling, on the other hand, is a function of implementing the staffing plan by assigning unit personnel to work specific hours and days of the week.

A busy neurologic ICU and step-down unit most likely would use which patient-classification system? m.Factor evaluation n. Prototype evaluation o. Hybrid system p. AHRQ system

m.Factor evaluation -A factor evaluation system is considered more objective than a prototype evaluation system. It gives each task, thought process, and patient care activity a time or rating. Some patient types with a single healthcare focus, such as maternal deliveries or outpatient surgical patients, would be appropriately classified with a prototype system. Patients with more complex care needs and a less predictable disease course, such as those with pneumonia or stroke, are more appropriately evaluated with a factor system.

A particular classification system assigns revenue according to the functional capacity of patients and the progression of patients during their stay in rehabilitation units. More independent patient activities, such as prompted voiding, require higher staff utilization than dependent activities but do not result in increased staff resources. This is an example of: l. bureaucracy. m.concern related to the validity of classification systems. n. inadequate reliability of classification systems. o. inappropriate subjectivity in making judgments about staffing.

m.concern related to the validity of classification systems. -Validity of categories and implications for staffing levels are in question in this situation because staffing levels are not reflective of the levels of activity required for patient care.

To reduce reliance on overtime hours, an organization develops a strategy for floating nurses during staff shortages. To maximize patient safety and reduce costs, the healthcare organization: m.develops a centralized pool of float nurses. n. assigns nurses from less busy units to ones with increased acuity levels. o. floats nurses only between units on which the nurses have been cross-trained. p. assigns float nurses to basic care only.

m.develops a centralized pool of float nurses. -A centralized pool usually includes experienced nurses who maintain a broad range of competencies. Other approaches are less satisfying for nurses, are less efficient, and may be less safe.

As the unit manager, you post the staffing plan and compliance reports. This initiative is aimed at: m.maintaining unit morale. n. complying with national requirements. o. demonstrating patient outcomes. p. inviting staff participation in decision making.

m.maintaining unit morale. -Hospitals are responsible for monitoring the extent to which actual staffing matches the staffing plans, making revisions as necessary. The Joint Commission accreditation reviews staffing plans against any obvious staffing deficiencies and patient care concerns. Posting of the staffing plan is required in some states so that staff may view it. Adequate staffing, as demonstrated through a staffing plan, and compliance reports contribute to staff morale.

A nurse manager must also consider a number of internal variables that will affect staffing patterns. An internal variable to be considered is: m.organizational staffing policies. n. state licensing standards. o. American Nurses Association. p. consumer expectations.

m.organizational staffing policies. -State licensing standards outline what a nurse can do. Internal policies determine what a nurse may do in a particular setting as well as the amount of flexibility that is allowed to manage times of high and low volumes, as well as changes in acuity. Organizational policies can put the nurse manager in a situation where patient safety cannot be maintained or financial obligations met.

A nurse manager uses many sources of data when planning the unit's workload for the year. Which of the following data must be considered in the planning? m.Hours of operation of the unit n. Trends in acuity on the unit o. Maximum work stretch for each employee p. Weekend requirements

n. Trends in acuity on the unit -Acuity levels are determined through classification systems, which determine the nursing resources required.

A strategy to increase RN staff retention at Valley Hospital includes: k. better compensation and benefits. l. clearer position descriptions. m. lay-offs of nursing assistants. n. adequate staffing to meet acuity levels.

n. adequate staffing to meet acuity levels. -Over the past decade, a significant amount of research has been done in the United States to evaluate links among nursing staffing, workloads, skills mix, and patient outcomes. An analysis of this research demonstrates that ensuring adequate staffing levels has been shown, among other things, to improve nurse retention and job satisfaction.

In the past year, you have noticed an increase in patient falls on your unit. In reading studies related to staffing and patient outcomes, you realize that you will need to plan for: k. higher patient care hours. l. safer facilities. m.institution of a patient-classification system. n. an increased number of RN positions.

n. an increased number of RN positions. -Lower fall rates are shown to be related to higher total nursing hours and a higher percentage of nursing hours supplied by RNs.

Staff members on your unit raise concern that there is rising acuity on the unit and lack of responsiveness in addressing these needs through appropriate staffing. They point to increased incidences of adverse and sentinel events on the unit. To address this concern, your hospital organization would do best to: m.implement a patient-classification system immediately. n. participate in databases that compare the outcomes and staffing levels versus those of similar institutions. o. provide increased numbers of staff to the unit. p. ignore such concerns because acuity is variable.

n. participate in databases that compare the outcomes and staffing levels versus those of similar institutions. -Staff morale suffers both when acuity models indicate a gap between staffing and acuity and when there is no model but perceived acuity that is not being addressed. A truer approach is to monitor patient outcomes and participate in national databases that measure staffing levels through comparison with like institutions.

A nurse staffing plan takes into account: m.specific nurse-to-patient ratios per shift. n. participation of nurses in projecting staffing needs. o. compensation and benefits for each level of staff. p. the occupancy load of a unit.

n. participation of nurses in projecting staffing needs. -Nurse staffing plans employ nursing judgment and flexibility that is based on acuity, nurse experience, and unit configuration rather than set nurse-to-patient ratios. The American Nurses Association has opted to support the nurse staffing committee as the approach to ensure safe staffing. In 2013, national legislation was introduced that requires all acute care hospitals to establish a committee made up of 55% direct care RNs.

Functions such as "delegates tasks to assistive personnel" that are outlined in a position description for an RN Team Leader would be considered: m.active delegation. n. passive delegation. o. passive accountability. p. active responsibility.

n. passive delegation. -Delegation of functions that are normally considered part of or an essential part of the practice of a licensed person through a position description is considered passive delegation.

In a job interview for a staff position, which of the following indicates your knowledge of patient safety? m. "Will I be able to get overtime hours on your unit?" n. "If there is an opportunity to work extra shifts, I would really like that." o. "Is there a strategy in place to reduce the number of overtime hours on the unit?" p. "I see no reason why I wouldn't be able to work overtime."

o. "Is there a strategy in place to reduce the number of overtime hours on the unit?" -Overtime, whether voluntary or mandatory, to fill staff vacancies is seen as a risk to both patients and nurses because it is more likely to lead to compromised decision making and technical skills because of fatigue.

Which of the following would be most in line with Hersey model and concepts? o. The team of caregivers on day shift are familiar with their roles and with the patients. The nurse manager decides to work on the unit budget in her office. p. After a year of working on the unit, Shari, an LPN, is still hesitant about many policies and procedures. The charge nurse decides to challenge Shari with more difficult patients. q. The nursing supervisor asks one of her charge nurses to lead a technology integration project. The supervisor continuously demands involvement in decisions that the charge nurse is making in the project. r. Team members complain that Alysha, an RN, is unmotivated, and that she refuses assignments that are complex or difficult. The charge nurse suggests that Alysha is relatively new and that she needs time to adjust.

o. The team of caregivers on day shift are familiar with their roles and with the patients. The nurse manager decides to work on the unit budget in her office. -The Hersey model/framework suggests that when ability (skills, job knowledge) and willingness are strong, the involvement of the delegator is less.

Scheduling is a function of implementing the staffing plan by assigning unit personnel to work specific hours and specific days of the week. To retain nursing staff, the nurse manager must incorporate into the schedule plan: m. all weekends off. n. all holidays off. o. a variety of scheduling options. p. rotating shifts.

o. a variety of scheduling options. -Creating a flexible schedule with a variety of scheduling options that leads to work schedule stability for each employee is one mechanism likely to retain staff, which is within the control of nurse managers.

County Hospital has position descriptions for all staff, including RN Team Leaders. Sarah, a team leader on the rehab unit, assesses the needs of the patients in her area, assesses the skills and backgrounds of each of the individuals on her team, and then assigns and delegates the appropriate care provider to each patient and task. Sarah's activity in the example described is termed: m.passive delegation. n. passive accountability. o. active delegation. p. active responsibility.

o. active delegation. -When a position description contains functions that are considered to be the normal practice of the person in that role, then it is considered a passive delegation act. When Sarah decides what is best for the patients in her care in terms of who should perform the care and then holds the person accountable, she is engaging in active delegation.

A factor evaluation system: m.utilizes financial data to determine number of staff-to-patient ratios. n. utilizes DRGs to determine acuity on a unit. o. combines interventions and time required for interventions to determine levels of care required. p. combines financial resources and nursing interventions to determine patient contact hours.

o. combines interventions and time required for interventions to determine levels of care required. -A factor evaluation system considers tasks, thought processes, and patient care activities and gives them a time or rating. These are then used to determine the number of patient care hours required.

In evaluating weekend mortality rates, the head nurse on the cardiac unit is surprised to find that they are higher than on weekdays. In exploring the reasons for this apparent anomaly, the head nurse focuses on: m.availability of diagnostic personnel. n. availability of physicians. o. communication with on-call providers. p. acuity level of patients.

o. communication with on-call providers. -Studies to date of off-peak hours (weekends and nights) are limited, but those that have been done indicate increased mortality during weekends and nights, when staff work with fewer and often less experienced staff and when there may be strained communication among on-call healthcare providers.

An important aspect of managing the costs on a unit is to plan accurately for staffing needs. Nurse managers use staffing plans to: m.assign staff on the unit on a daily basis. n. ensure that days off are planned for the staff. o. outline the number of individuals by classification on a per-shift basis. p. predict the numbers and classifications of float staff needed to augment regular staff.

o. outline the number of individuals by classification on a per-shift basis. -A nurse manager needs to manage financial resources by developing staffing plans. Staffing plans plan for minimum number of professional nurses required on a unit at a given time or to the amount of minimum staffing in an extended-care facility or prison, based on regulatory guidelines.

A nurse manager must consider a number of external variables when preparing the personnel budget and projecting the unit's staffing needs. An external variable to be considered is: m.organizational staffing policies. n. staffing models. o. changes in services that will be offered. p. department of Health licensing standards.

p. department of Health licensing standards. -Licensing regulations of the state can determine staffing models. Staffing regulations can dictate the number of professional nurses required on a unit at any given time.

The number of adverse events such as falls and pressure ulcers on the unit is increasing. An ideal staffing plan to address this issue would include which of the following? Increasing the: m. total number of staff on the unit. n. staff and RN hours per patient. o. total number of staff and implementing 12-hour shifts. p. number of RNs and number of RNs with experience on the unit.

p. number of RNs and number of RNs with experience on the unit. -number of studies have identified that adverse events such as falls and pressure ulcers can be reduced by increasing the number of RNs on a unit (relative to other personnel) and utilizing experienced RNs. Overtime and 12-hour shifts are linked to greater incidence of errors.

Leslie, a UNP, transfers a patient while using improper technique. The patient is injured, and as a result, a suit is launched in which both Sarah (the delegator) and Leslie (the delegatee) are named. Sarah is named in the suit because she: m.retains accountability for the care of the patient. n. worked the same shift as Leslie. o. has passive accountability for delegation. p. retains accountability for the outcomes of care for the patient.

p. retains accountability for the outcomes of care for the patient. -Whenever care is provided by someone other than a registered nurse, accountability for care remains with the manager/delegator even though others provide aspects of care.

Which of the following indicates safe delegation? p. The nurse supervisor for a large urban acute care department asks the unit manager to accept two new acutely ill patients, which the manager does. The unit is short two staff, and the replacement is inexperienced. q. A unit manager agrees to release a staff from her unit to Unit B. The staff member she agrees to release is experienced on Unit B and is agreeable to the change. The unit manager's unit is fully staffed and patients are stable. r. The nurse supervisor asks the head nurse for Unit A to make do without a replacement for an ill staff member because Unit A was originally overstaffed anyway. Patient acuity levels are very high on Unit A and two staff are orientating. s. The nurse supervisor asks the charge nurse on Unit B to cover Unit F, which is two floors up, because the charge nurse for Unit F is ill. The charge nurse for Unit B is an experienced manager but has no experience with the nursing care required on Unit F.

q. A unit manager agrees to release a staff from her unit to Unit B. The staff member she agrees to release is experienced on Unit B and is agreeable to the change. The unit manager's unit is fully staffed and patients are stable. -When span of control (number of individuals for whom a manager is responsible) is compromised by geographic factors such as lack of proximity, instability in patients' conditions, or lack of experience, the span of control that is being delegated may lead to unsafe care.

The nurse on the 7-7 shift is assigning a specific component of care to an unlicensed nursing personnel (UNP) employee. The night nurse would remain: q. accountable. r. responsible. s. authoritative and liable. t. responsible and task-oriented.

q. accountable. -When a registered nurse delegates care to a UNP, responsibility is transferred; however, accountability for patient care is not transferred. Thus, "accountability rests within the decision to delegate while responsibility rests within the performance of the task" (Anthony and Vidal, 2010, p. 3).

An example of a nursing care activity that would not be delegated by an RN to a UNP is: (Select all that apply.) q. teaching self-catheterization to a patient with paraplegia who has limited English. r. basic care for a patient with a head injury who is rapidly deteriorating. s. one-to-one observation with a suicidal patient. t. assessment of patients being admitted through the Emergency Department. u. basic hygienic care for a patient who is post MI and stable.

q. teaching self-catheterization to a patient with paraplegia who has limited English. r. basic care for a patient with a head injury who is rapidly deteriorating. t. assessment of patients being admitted through the Emergency Department. -Functions such as assessment, diagnosis, planning, and evaluation cannot be delegated. In addition, stability, critical thinking, time, and safety are factors that are considered in assessing whether or not to delegate care to a UNP. Teaching self-catheterization to a patient with limited English requires critical thinking; basic care for a patient who is rapidly deteriorating exemplifies concern with stability; and assessment of patients through Emergency is related to the factor of time. An exception to safety and stability in which patients may be delegated to UNPs is when patients are placed on suicide precautions.

In delegating to a UNP in a home health setting, which of the following represents the most appropriate delegation communication? o. "You will be taking care of Mrs. S., who needs assistance with her bath." p. "You will need to help Mrs. S. get into and out of her shower. Ensure that you check the condition of her feet, and let me know if you have any concerns when you check in." q. "I am not sure that you know how to do this, but I am giving you Mrs. S. She is quite obese and needs skin care." r. "Mrs. S. needs help to get into and out of her bathtub. Her bath will need to be completed by 10:00. When you are helping her to dry, please check between her toes and toenails, and phone me by 10:30 if you notice nail discoloration or redness."

r. "Mrs. S. needs help to get into and out of her bathtub. Her bath will need to be completed by 10:00. When you are helping her to dry, please check between her toes and toenails, and phone me by 10:30 if you notice nail discoloration or redness." -Delegation communication includes what is being delegated (and what is not), outcomes, specific deadlines (if applicable), specific reporting guidelines (what, when), and who may be consulted. Communication also includes conveying recognition of the authority to do what is expected.

Which of the following strategies might be effective in empowering staff? q. Communication book in which new information on policies and processes is communicated and mistakes are highlighted. r. Monthly staff meetings during which a portion of the agenda is devoted to sharing ideas and presentations on best practices for implementation on the unit. s. Once-yearly summative evaluations based on what the manager best likes about the individual. t. Focus on discussion of errors in care with direction as to how errors are to be prevented in the future.

r. Monthly staff meetings during which a portion of the agenda is devoted to sharing ideas and presentations on best practices for implementation on the unit -Empowerment is a process that acknowledges the values and judgments of others and trusts their decisions. It allows freedom for making decisions while retaining accountability and provides an environment that is safe in which to explore.

You ask Evelyn, a new UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. Before assigning Evelyn to Mrs. N.'s care, the most appropriate action of the care coordinator would have been to: q. determine Evelyn's educational background and preparation for this role. r. ask Evelyn if she has worked with inhalers before and to describe what she knows about them. s. advise that if Evelyn has any questions about what to do with the inhaler, she should come to the coordinator. t. advise Evelyn that working the inhaler is not really complicated and that she should ask the patient how to check medication levels in the inhaler.

r. ask Evelyn if she has worked with inhalers before and to describe what she knows about them. -When delegating tasks, in addition to specifying the task to be completed, outcomes, priorities, time lines, deviations, report time frames, monitoring, and resources, asking the delegatee to give examples of each is helpful in ensuring that communication is clear and has been understood. Preparation of UNPs lacks consistency; therefore, the safest practice is to determine the knowledge and skill level of the UNP in relation to the skill and the patient before delegating.

You ask Evelyn, a new UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. Determination of Evelyn's educational preparation and certification is related to the concept of: q. accountability. r. authority. s. role performance. t. assignment.

r. authority. -Authority refers to the right to do and may be designated by law, educational preparation, or job description.

You ask Evelyn, a new UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. This incident is an example of: q. incompetence of the UNP. r. failure to follow-through. s. skills but no motivation. t. lack of accountability.

r. failure to follow-through. -The nurse should maintain open lines of communication and seek information, and the UNP should know how, when, and what to report. Communication of delegation of tasks includes specific information about what is being delegated, expected outcomes, and deviations (which includes what immediate action needs to be taken). This 2-way communication and follow-through allows patient care to be altered, if necessary, in a timely manner.

With delegation, responsibility and accountability remain with the: q. physician. r. professional who delegates. s. individual who receives the delegation. t. individual who previously performed the task.

r. professional who delegates. -Even though the delegatee (the one who receives the delegation) receives direction from the professional who delegates a task and must have the authority to complete it, the delegator retains accountability for the overall outcome and completion of the activity. The delegatee has responsibility (obligation to engage in the task) and authority for the task.

Joanne, a new nurse manager, writes certain assumptions regarding the organization's objectives into her budget. Her supervisor tells her that the objectives implied in her assumptions are not entirely consistent with the organization, and that she needs to clarify these objectives with her supervisor. Joanne apologizes and says she had more latitude with the budget where she previously worked. This is an example of: q. role complexity. r. role ambiguity. s. role conflict. t. time-dependent roles.

r. role ambiguity. -Role ambiguity in the workplace creates an environment for misunderstanding and hinders effective communication. Without clear expectations of performance, missteps in performance can occur.

The chief nursing officer establishes a shared governance model to help empower the nursing staff, thus empowering the organization. Common characteristics of empowered organizations are: q. shared values, high salaries, and a human focus. r. shared values, flexibility, and a human-capital focus. s. commitment to communication, high salaries, and flexibility for evaluations. t. creation of community and of effective stress management in the midst of divergent goals.

r. shared values, flexibility, and a human-capital focus. -Shared governance involves valuing the contributions of each member of the team, releasing the need to control, and understanding that accountability rests with members of the team.

During staff-development programs, staff nurses verbalize their frustration about their workloads and having to delegate so many tasks to others. One of the main reasons that delegation has emerged as an issue is because of: q. the amount of paperwork required to complete care. r. the complexity of care required by patients. s. earlier discharge practices. t. the numbers of other disciplines present on a given unit.

r. the complexity of care required by patients. -Complexity of client care, a multilevel nursing model (registered nurses, mixed with LPNs/LVNs, and UNPs), and community-based care provide many challenges in determining the care required and outcomes desired and/or mandated, and in matching needs with various abilities and authority of regulated and unregulated healthcare providers. The nurse manager should ensure that staff is clinically competent and trained in their roles in patient safety.

During a fire drill, the nurse manager becomes very assertive and directive in her communications with staff. This type of situational leadership depends on: q. supportive behavior by the leader and immature followers. r. the development level of the followers and the behavior based on the situation. s. well-developed followers combined with a strong leader who acts quickly. t. the leader's ability to evaluate personnel and communicate that evaluation.

r. the development level of the followers and the behavior based on the situation. -When abilities, relationships, and/or time is limited (as in a crisis situation), the leader assumes a bigger role in guiding and in making decisions, or "telling" behavior. Leaders need to behavior differently and use different leadership styles in different situations.

What is assignment?

routine care/procedures within scope, distribution of work

An RN colleague, who is a long-standing and collaborative member of your team, is performing a complex dressing with new orders written for the first time for the assigned patient. Which of the following would be the most appropriate communication with her? q. "How do you usually do this kind of dressing?" r. "The dressing needs to be done today and tomorrow with the supplies on this cart." s. "Here is what you need for the dressing, and I will show you what needs to be done." t. "I know you know what you are doing. Let me know if you have any problems."

s. "Here is what you need for the dressing, and I will show you what needs to be done." -If a situation involves a new task and the relationship is ongoing (two individuals who will usually continue to work together), the delegator explains what to do and how to do it. Hersey described the leader's behavior as explaining or persuading, which, is characterized as "selling." The RN who is assigned to the patient is an experienced nurse and team member, but is new to this specific situation. In situations where the nurse is experienced but the task is new, explain (and demonstrate) what needs to be done.

The charge nurse is making patient assignments for the next shift on the unit. There is one critical patient on the unit, who is going to require more care than the other patients. Before delegating this patient in an assignment, what is the appropriate action by the charge nurse? q. Delegate the admission assessment to the LPN. r. Review the employee's performance assessment for the most recent period. s. Assess the amount of guidance and support needed for the nursing care of the patient. t. Create a task analysis of critical behaviors for the individual.

s. Assess the amount of guidance and support needed for the nursing care of the patient. -To delegate effectively, the charge nurse must assess the abilities required in the situation and the abilities that staff have to anticipate the amount of direction, monitoring, explanation, and independence that can be assumed.

The unit manager is working in a large metropolitan facility and is told that two UNPs are to be assigned to work with her. Delegation begins with: q. acknowledging the arrival of the second UNP on the unit. r. providing clear directions to both UNPs. s. matching tasks with qualified persons. t. receiving reports from the prior shift.

s. matching tasks with qualified persons -In delegating to the UNPs, the nurse must consider what cannot be delegated, as well as the factors of safety, time, critical thinking, and stability of patients.

Which of the following exemplifies accountability? Karen, the nurse manager on 5E: q. consistently submits her budgets on time. r. gets along well with her staff and with other managers. s. outlines her rationale for reduction of RN coverage on nights to the Nursing Practice Committee after serious patient injury. t. actively solicits ideas regarding scheduling from her staff.

s. outlines her rationale for reduction of RN coverage on nights to the Nursing Practice Committee after serious patient injury. -Reliability, dependability, and obligation to fulfill the roles and responsibilities of the nurse manager are consistent with responsibility. Accountability refers to being answerable for actions and results.

Sally is an experienced nurse on the unit and is very experienced with ICP monitoring. She is assigned David, a patient who has been admitted with a severe head injury. In communicating with Sally, what is an appropriate action by the charge nurse? q. Provide a detailed explanation of what she needs to do with ICP monitoring. r. Tell her when she needs to provide an update about David's status. s. Ask her to tell you what she knows about ICP monitoring and share expectations about reporting. t. Advise her that you are available if she needs you.

t. Advise her that you are available if she needs you. -The charge nurse and Sally have a well-established relationship and Sally has the expertise to work effectively with David; therefore, the charge nurse would need to provide little guidance but would need to communicate that they are available if needed. Hersey refers to this leader behavior as "delegating."

The night nurse understands that certain factors need to be considered before delegating tasks to others. These factors include the: q. complexity of the task and the age of the delegatee. r. potential for benefit and the complexity of the task. s. potential for benefit and the number of staff. t. complexity of the task and the potential for harm.

t. complexity of the task and the potential for harm. -In delegating tasks to others, the nurse considers factors such as stability of the patient, safety of the situation and of the patient, time and intensity involved, and level of critical thinking required to achieve desired outcomes.

The validity of comments and ratings related to performance is enhanced by: t. maintenance of anecdotal notes over the entire evaluation period. u. quantity of information gathered for appraisal purposes. v. agreement of the employee with the ratings and comments. w. whether or not other individuals have contributed to the observations.

t. maintenance of anecdotal notes over the entire evaluation period. -Anecdotal notes compiled consistently over the entire rating period are a much more equitable method of providing an accurate summary of the employee's performance.

You are working in a home health service and have three unlicensed nursing personnel (UNPs) assigned to your team. You have worked with two of them for 2 years; the third is new. The two experienced UNPs have patients with complex illnesses for whom they provide basic care. The third member of the team has been assigned to patients with less complex illnesses. Your best approach to supervising their care is to: q. remain in the office and ask each UNP to check in with you upon arrival at their first patient care site. r. ask another RN to supervise the two experienced assistants so you can be with the new person full time. s. meet the new staff member at the first patient care site and ask the others to call if anything is unusual. t. meet the new staff member at the first patient care site and call the others with questions to determine whether anything is unusual.

t. meet the new staff member at the first patient care site and call the others with questions to determine whether anything is unusual. -When ability and willingness are strong, the involvement of the delegator is needed less.

A key advantage that a charge nurse has in terms of delegating is that: q. clients receive less attention because too many staff make it difficult to coordinate care. r. nurses report less pressure to perform necessary tasks themselves. s. administration can predict overtime more accurately. t. team skills can be used more effectively.

t. team skills can be used more effectively. -The use of multilevel healthcare providers enables healthcare organizations and nursing to provide patient-centered care, with a focus on abilities and skills that can be employed to perform "what is needed now." As tasks become more complicated, delegating skills to others enables the nurse to effectively deliver a complex level of care.

As a manager, you are interested in developing behavioral questions for an interview. Knowing that there is team conflict at times on your unit, which of the following questions would satisfy your interest in behavioral questions? u. "Tell me about a time you were involved in a conflict related to a project. What was your role in the conflict? In the resolution of the conflict?" v. "If you were to employ one strategy for managing conflict, what would it be?" w. "What is your preferred style of conflict resolution?" x. "How effective are you in working in a group? In dealing with conflict?"

u. "Tell me about a time you were involved in a conflict related to a project. What was your role in the conflict? In the resolution of the conflict?" -Behavioral questions seek demonstrated examples of behavior from the candidate's past experiences; behavioral-based interviewing can be a strong predictor of a future employee.

The biggest challenge in the recruitment of staff is: u. finding well-qualified candidates who can function well within your particular work culture. v. recruiting individuals with the appropriate qualifications and experience. w. screening out candidates who are unable to function well within a team. x. determining if candidates have had previous negative experiences in a work environment.

u. finding well-qualified candidates who can function well within your particular work culture. -Choosing the right individual is the challenge for managers and involves finding qualified candidates who will work well within your culture.

The nurse manager schedules evaluations of staff members using a newly developed performance appraisal tool. The development of a performance appraisal tool should include: u. organizational mission, philosophy, and position requirements. v. a generalized overview of the duties of a position. w. a skills checklist and accreditation requirements. x. an ordinal scale that ranks all employees.

u. organizational mission, philosophy, and position requirements. -Performance appraisal tools and processes should reflect the organizational mission and philosophy, as well as position requirements.

An outpatient clinic advertised for RN positions. Before authorizing an open position, the nurse manager should: u. review the position description and performance expectations for the opening. v. place an ad in the local newspaper and on the telephone job line. w. review all current applications on file. x. look for employees within the system who might best fill the position

u. review the position description and performance expectations for the opening. -The position description provides the basis for this position within the organization and communicates expectations for the role. When applying for a position, researching the facility and position description will help an applicant gain insight into the organization; therefore, the position description should be current and communicate expectations.

On your unit, despite efforts to build a strong sense of team, conflict between some of the staff is ongoing. Nonetheless, you want to proceed with developing a systematic and effective performance appraisal system. Which of the following approaches would be most appropriate for you to implement? u. Peer review v. A combination of tools w. Anecdotal notes x. Rating scale

v. A combination of tools -A combination of tools is likely superior to any one method in any situation.

You have hired a new RN to replace a well-respected and experienced nurse in your outpatient department. The new RN recently graduated and is nervous about stepping into a role that was previously filled by someone who was so competent. You recognize anxiety and set up regular, frequent meetings during which you explore how she is dealing with her anxiety, provide feedback, and discuss strategies/ideas that will enhance her performance. What development approach are you using? s. Performance appraisal t. Counseling u. Empowerment v. Coaching

v. Coaching -The overall evaluative process can be enhanced if the manager employs the technique of coaching. Coaching is a process that involves the development of individuals within an organization. This coaching process is a personal approach in which the manager and the employee interact on a frequent and regular basis with the ultimate outcome that the employee performs at an optimal level.

Sue, a nurse manager, discusses her concerns about the hospital's employee appraisal system with her work group, noting that it includes only one rating scale and that it means nothing unless the manager has effective relationship skills. Sue's concerns reflect which best practices associated with performance appraisal? u. Rating scales are too generalized to be considered valid or reliable. v. The effectiveness of appraisal is enhanced by a combination of methods and effective communication skills. w. BARS is considered superior to simple rating scales in terms of performance appraisal. x. Rating scales need to be designed by users to be well accepted.

v. The effectiveness of appraisal is enhanced by a combination of methods and effective communication skills. -A combination of several methods is probably superior to any one method. The primary success of any performance appraisal lies in the skills and communication abilities of the manager.

John's performance was satisfactory during the first month, but after that time, he was found to be very inconsistent in the provision of nursing care. One month before the end of the rating period, he cared for a very wealthy and influential client, who is best friends with the clinical manager. This client donated new furniture for the staff lounge in John's name to show appreciation for his care. John's subsequent performance appraisal resulted in outstanding ratings in all areas. This is an example of: u. a performance rating based on justifiable evidence. v. a bias related to recent events. w. the impact of personality on the appraisal of performance. x. the effective use of a behaviorally anchored rating scale.

v. a bias related to recent events. -To gain and to provide an accurate evaluation of performance over time, anecdotal notes need to be maintained throughout the evaluation period. This process assists in avoiding bias related to recent or sensational events that make a particularly strong impression.

A nurse manager in the ICU works with his staff to develop an appraisal instrument that includes quantitative data and respects standards for an RN working on that unit. This type of appraisal is a: s. rating scale. t. collaboratively based appraisal system. u. narrative instrument. v. behaviorally anchored rating scale.

v. behaviorally anchored rating scale. -Behaviorally anchored rating scales (BARSs) describe performance quantitatively and qualitatively.

Anecdotal notes: u. should be completed only when there are performance concerns. v. can be used to support and justify fairness in termination discussions. w. are unnecessary if the evaluation instrument is thorough. x. need to be completed at the end of a performance period.

v. can be used to support and justify fairness in termination discussions. -Anecdotal notes should be kept consistently throughout the evaluation period and should reflect both negative and positive behaviors if they are to provide an accurate assessment of performance. Anecdotal notes provide documentation to support rating scales and narrative evaluation summaries.

A survey of staff satisfaction is conducted. The survey indicates that staff members are satisfied, are loyal to the organization, and feel that they have reasonable control in their individual responsibilities. The findings best exemplify: v. clarity in roles and valuing of contributions. w. satisfaction but not empowerment. x. effective coaching of new staff. y. role attachment.

v. clarity in roles and valuing of contributions. -Commitment, a sense of control, and satisfaction are linked to clear role expectations and a feeling that contributions are valued.

John, a new graduate, reviews the employee evaluation for his new position. The first section requires that he list his own specific objectives to be accomplished. This is an example of: u. the traditional rating scale. v. learning goals, or management by objectives. w. a forced distribution scale. x. a behavior-anchored rating scale.

v. learning goals, or management by objectives. -In management by objectives, the employer and the employee jointly establish clear and measurable objectives for the next performance period.

Technology is integral to a cardiac ICU. Sue, the nurse manager, implements a patient-centered approach that focuses on the meaning of the experience for the patient and family, primary nursing, and a health literacy approach. Sue is: u. using high-tech-low-touch approaches. v. using high-tech-high-touch approaches. w. providing products. x. providing tangible products of satisfaction.

v. using high-tech-high-touch approaches. -The provision of humanistic care within a high-tech environment is characteristic of high tech-high-touch approaches and reflects the idea that the more that high-tech is used, the more patients also desire high-touch.

During a performance appraisal, Joanne, the nurse manager, indicates that Alysha has difficulty mentoring students on the unit. Alysha responds that this is not her responsibility. In responding to Alysha, Joanne needs to consider: u. Alysha's level of confidence. v. whether mentoring is included in the position description. w. whether mentoring is an essential component of the position description. x. whether mentoring can be accurately observed and measured.

v. whether mentoring is included in the position description. -Employees must have clear role expectations, clearly understand what is expected of their performance, and understand the ramifications of not meeting those expectations. Position descriptions provide written guidelines detailing the roles and responsibilities of a specific position within the organizational context.

In determining the fit of a candidate with the culture on your unit, which of the following interview questions might be asked? u. "Could you review your résumé for us, highlighting your certifications and experience?" v. "If we were to ask your references, what would they list as your strengths? Weaknesses?" w. "We have a number of older adult patients on this unit. If you noticed another staff member addressing one of these patients impatiently, how would you respond?" x. "Tell us about your work and academic experiences and qualifications."

w. "We have a number of older adult patients on this unit. If you noticed another staff member addressing one of these patients impatiently, how would you respond?" -The nurse manager wants the most qualified individual for the position who also fits the culture of the organization. Asking behavioral questions in the interview allows you to assess how a candidate may function in real-life situations and to assess if this behavior is compatible with the culture on the unit.

Which of the following actions best exemplifies advocacy? u. Developing a list of agencies that will provide free services for the homeless v. Working in a needle exchange program for individuals in an inner-city environment w. Acting on behalf of a patient to promote end-of-life wishes to an ethics committee x. Working in a free clinic for immigrant workers

w. Acting on behalf of a patient to promote end-of-life wishes to an ethics committee -Advocacy means making known and defending and protecting the rights and interests of others, as well as ensuring the dignity and respect due to others. Simply being employed in an environment where this might be a focus of practice does not necessarily ensure that advocacy is occurring.

During review of a patient's progress, the healthcare team determines that a patient requires treatment that is generally accepted at that time in the usual illness trajectory of a patient. The patient is unable to pay. As the head nurse, you persist in ensuring that this patient receives the treatment. You are: u. empowering the patient. v. avoiding litigation. w. advocating for the patient. x. supporting the clinical pathway.

w. advocating for the patient. -Advocacy means defending the rights and interests of others and, in this situation, the right of a patient to receive care, as determined by standards utilized in a critical pathway.

The final section of a performance appraisal is a rating scale. This scale is very detailed and relates to competency standards specific to surgical clients. The scale is a summary of performance directly observed or documentation reviewed and is specific to client care situations in which the employee has been involved. This type of evaluation is most commonly known as: u. a traditional rating scale. v. management by objectives/learning goals. w. a forced distribution scale. x. a behaviorally anchored rating scale.

x. a behaviorally anchored rating scale. -BARS contain both quantitative (rating scales) and qualitative data. They are specific to situations and positions.

The turnover rate for RNs in the ICU is high. You discuss this situation with existing staff and you find out that because of the rapid turnover, new staff are frequently required to assume full responsibilities soon into the position and before training is completed. In considering approaches that will reduce turnover rates, the staff and you decide to implement: u. an employee recognition program. v. coaching for new staff. w. a new performance appraisal system. x. a committed orientation and training program.

x. a committed orientation and training program. -Retention of new nursing personnel begins on the day of their hire. This includes an effective, appropriate orientation and training program, which has a measurable impact on reducing turnover.

As part of orientation to your unit, you decide to administer Kolb Learning Style Inventory (LSI) to new staff. The most likely reason for your decision is that the use of Kolb LSI: u. reduces the cost of orientation. v. determines if there is fit between learner and organizational values. w. develops the strengths of the new staff member. x. enables individualization of learning to the learner's needs.

x. enables individualization of learning to the learner's needs. -Administration of Kolb LSI enables identification of the learning styles of new employees, which assists in focusing the implementation of orientation goals and in individualizing learning to the needs and learning style of the employee.

Based on data from the patient satisfaction survey, the nurse manager decides that a change should be made in communication with family members. What would be important for a nurse manager to consider when instituting a change to improve customer service? y. Assess the perceptions of the nursing staff regarding the specific service problem. z. Include community representatives on a planning committee to address the change. aa.Involve physicians, other healthcare professionals, and ancillary staff. bb. Review all patient complaints with the nursing staff.

y. Assess the perceptions of the nursing staff regarding the specific service problem. -Nurses are the healthcare providers who spend the most time with the consumer and are in an opportune position to understand the issues, structures, and processes that affect patients. The nurse acts as the primary person to be alert to circumstances that may prevent a successful outcome for the patient and to intervene on the patient's behalf. As a nurse manager, it is important to support staff in their use of power to be in control and to make decisions at the consumer-staff level of interaction.

The chief nursing officer is pleased with the nurse manager's strategy of improving patient satisfaction in the pediatric intensive care unit. She decides to implement these changes throughout the hospital. What would be important to consider in implementing a new program focused on improving relationships with consumers? y. Recognition of the nursing staff for excellence in promoting consumer relationships z. Holding the staff accountable for resolving patient complaints aa.Selecting a staff nurse leader to implement the program bb. Identifying key staff members who have already demonstrated excellence in consumer relationships

y. Recognition of the nursing staff for excellence in promoting consumer relationships -The nurse leader should allow professionals more influence over their practice; give staff opportunities to learn new and varied skills; give recognition and reward for success and support and consolation for lack of success; and foster motivation and belief in the importance of each individual and the value of his or her contribution.

The complexity of the healthcare environment for consumers is increased by: w. falling levels of education among the public. x. increased levels of poverty. y. complex compensatory systems and a variety of delivery systems. z. increased numbers of uninsured or underinsured.

y. complex compensatory systems and a variety of delivery systems. -The complexity of options in health care and the processes and policies involved in funding health services for patients, as well as fragmented relationships with a growing variety of healthcare providers, contribute to the complexity of the system for patients, especially for those who might need it most, such as the poor, uninsured or underinsured, and homeless.

As a nurse manager, you see an opportunity for patients to be well serviced through the medical home concept. You recognize that the concept of medical homes: y. currently does not include nurses in its vision of multifaceted primary care. z. includes nurses as part of an interdisciplinary and multidisciplinary team. aa.restricts nurses to services related to direct care and procedures. bb. cannot encompass nurses within this framework.

y. currently does not include nurses in its vision of multifaceted primary care. -The concept of medical homes encompasses the idea of multifaceted medical homes that provide a usual source of health care. Current discussions have focused on physician-directed care even though nurses in advanced practice are well suited to lead teams in this model.

Susan, a new graduate, is upset that so many staff have been absent lately from the unit. She declares to you that all absenteeism could be eliminated with proper management. Your response is based on understanding that: y. not all absenteeism is voluntary. z. high personal control contributes to absenteeism. aa.direct discussions with employees who have high levels of absenteeism are not recommended. bb. all absenteeism is related to personal issues and needs.

y. not all absenteeism is voluntary. -Not all absenteeism is voluntary or preventable, which means that absenteeism can never be fully eliminated. Absenteeism can result from personal issues and needs, work dissatisfaction, and involuntary reasons such as jury duty.

In orienting new staff nurses to a pediatric intensive care unit, the nurse manager asks the staff nurses to answer the following question: "What is an important consideration in providing information to parents of a critically ill child?" y. Making sure that they receive complete information during each encounter with a member of the nursing staff z. Assessing parents' preferences regarding the amount of information provided aa.Allowing parents to observe key aspects of their child's nursing care bb. Making sure that patient education brochures explaining ICU protocols are readily available

z. Assessing parents' preferences regarding the amount of information provided -Consultation with the parents regarding the amount of information that they desire reflects a service orientation, in which preferences and needs of the consumer are placed first. The other answers reflect nurse-directed decisions in which the nurse decides what information and how much information is needed and how it is to be delivered.

As a head nurse, you are concerned about the service orientation on your unit. Which of the following findings and approaches might provide useful information for you? y. Patients find nurses friendly and accessible; data are aggregated for the institution as a whole. z. Data indicate that nurses are responsive to requests for assistance; data are available for the unit and the institution. aa.Specific questions related to management of comfort are included for the institution as a whole. bb. The survey asks for a range of responses for the unit and the organization, with a focus on facilities, such as cleanliness and responsiveness of administrative services.

z. Data indicate that nurses are responsive to requests for assistance; data are available for the unit and the institution. -The National Database of Nursing Quality Indicators (NDNQI) is a national repository for unit-based quality data that can be used by organizations to benchmark the outcomes of care against those of other institutions (ANA, n.d.). Unit-based quality indicators, including satisfaction with nursing care, are a key feature of the NDNQI®. In addition to hospitals being provided with their own and comparison data, researchers are able to access de-identified data in order to answer important questions about nursing care quality. Pain management, the discharge process, and post-discharge patient callbacks are specific areas where nurses can make significant improvement in patient satisfaction. Because patients and nurses may differ in what they see as factors that produce satisfaction, total reliance on nursing perceptions of patient satisfaction may not provide a complete picture.

The nurse manager must develop a patient satisfaction survey. What is one of the critical elements in selecting a patient satisfaction instrument? y. Being able to use the same instrument for all clinical units z. Including items that are important from the patient's perspective aa.Being able to administer the instrument before a patient's discharge from the hospital bb. Being sure that the reading level is no higher than third grade

z. Including items that are important from the patient's perspective -Because satisfaction is a measure of service and service is a measure of perception of what matters to the patient, to measure satisfaction, surveys must include items that reflect the perspective of the patient. The quality of human contacts becomes the measure by which the consumer forms perceptions and judgments about nursing and the health agency. Consumers may not be able to evaluate the quality of interventions, but they always can evaluate the quality of the relationship with the person delivering the service.

A 27-year-old woman is admitted to your ICU in a coma, following an accident. The family of the patient, who is a Native American, places a medicine pouch in the bed with the young woman. As the nurse in this situation, it is important to: y. explain to the family that the medicine pouch may contain herbs that may bother other patients. z. ask the family about the significance of the medicine pouch for them. aa.remove the pouch when the family is not present. bb.put the medicine pouch on the shelf beside the bed.

z. ask the family about the significance of the medicine pouch for them. -Diversity encompasses more than differences in nationality or ethnicity and may include a variety of ways that patients are different from their healthcare providers. Nurses need to recognize the culture of their work setting, realizing that it may differ markedly from the culture of the consumer, and move beyond ethnocentrism to provide culturally competent care. This competence includes cultural knowledge, which involves actively learning about a community; cultural sensitivity, which entails valuing and respecting beliefs, norms, and practices of the people being served; and collaboration within a community. In this instance, it is important to understand the meaning of the pouch for the family; removal from the bed without discussion does not demonstrate respect for the values and beliefs of this family.

Corrine, a student nurse, often hears that nurses are gatekeepers and wonders what that term means. As a nurse leader, you explain that this is a reference to the: w. assessment and admission of patients into care. x. orientation of patients to services once they are admitted. y. function of controlling which patients see the physician and which do not. z. coordination of care, services, advocacy, and access for patients within the healthcare system.

z. coordination of care, services, advocacy, and access for patients within the healthcare system. -As gatekeepers to the system, nurses advocate for and coordinate care, services, and access for patients across all providers, settings, and levels of care.