MNGMT CH. 5

A nurse manager is faced with the task of introducing an unpopular change to a staff that includes several nurses who have acted as rejecters to previous changes. The manager expects resistance but hopes to identify these rejecters early in the process. The manager should be particularly alert to which statements? Select all that apply. 1. "I don't care what they say; I'm not giving care that way." 2. "I don't think this is going to work, but I'll probably come around to it sooner or later." 3. "I'm not crazy about this idea, but we do need to change how we are providing care." 4. "I bet I can make it very difficult for this change to occur." 5. "It won't be so bad. I like change."

1. "I don't care what they say; I'm not giving care that way." 4. "I bet I can make it very difficult for this change to occur."

A nursing administrator overhears nurses conversing during a break in a seminar on change. The administrator would interpret which statement as meaning that the nurse who made it is ready to become a change agent? Select all that apply. 1. "I know that suggesting this change may backfire on me." 2. "I don't expect too much conflict or resistance to this change." 3. "I see an opportunity to make a difference in the way this facility provides nursing care." 4. "I think the status quo is just fine for now." 5. "This change is certainly going to be a challenge, but that's okay."

1. "I know that suggesting this change may backfire on me." 3. "I see an opportunity to make a difference in the way this facility provides nursing care." 5. "This change is certainly going to be a challenge, but that's okay."

Which statements by a hospital executive reflect power-coercive strategies to implement change? Select all that apply. 1. "We must follow the federal guidelines in the way we bill for our services." 2. "If we don't reduce our nosocomial infection rate, Medicare won't reimburse us." 3. "Administration has to make this change or our accreditation status will be at risk." 4. "This change is the only logical action we can take." 5. "All our sister institutions in the association have already made this change."

1. "We must follow the federal guidelines in the way we bill for our services." 2. "If we don't reduce our nosocomial infection rate, Medicare won't reimburse us." 3. "Administration has to make this change or our accreditation status will be at risk."

A nursing supervisor would like the nurse manager to serve as change agent for a needed revision to unit policy. Which statements would alert the supervisor that this manager is not the best choice for this assignment? Select all that apply. 1. "Well, we don't want to rock the boat too much." 2. "Do you think we can get enough support from the nurses to make this change?" 3. "We tried making a change like this before and it didn't work out well." 4. "To make this big change, we need to start making smaller changes now." 5. "There is going to be resistance, but I think it can be overcome."

1. "Well, we don't want to rock the boat too much." 2. "Do you think we can get enough support from the nurses to make this change?" 3. "We tried making a change like this before and it didn't work out well."

The healthcare facility has elected to make a significant change in organization strategy. The change has been thoroughly researched and all levels of leadership have been included in the decision. Which roles are commonly undertaken by the nurse manager when such a change is necessary? Select all that apply. 1. Disciplinarian 2. Resister 3. Fact manager 4. Liaison 5. Support person 6. Discussion leader

1. Disciplinarian 3. Fact manager 4. Liaison 5. Support person 6. Discussion leader

A major change has occurred in the governance of the hospital. How can the nurse manager help staff cope with this change? Select all that apply. 1. Disperse information about the change as quickly as possible. 2. Discourage any negative discussion about the change. 3. Remind staff that change is part of the healthcare environment. 4. Talk about the change in positive terms. 5. Withdraw slightly from those who oppose the change.

1. Disperse information about the change as quickly as possible. 3. Remind staff that change is part of the healthcare environment. 4. Talk about the change in positive terms.

The Institute of Medicine (IOM), has made recommendations for the nursing profession in its report "The future of nursing: Leading change, advancing health." Which recommendations will help nurses lead change? Select all that apply. 1. Engage in lifelong learning 2. Remove scope of Practice barriers 3. Implement nurse residency programs 4. Change the structure of the organization 5. Lead change to advance health

1. Engage in lifelong learning 2. Remove scope of Practice barriers 3. Implement nurse residency programs 5. Lead change to advance health

A nursing supervisor has introduced a needed change in policy to the nurse managers. The managers have met maximum resistance when attempting to gain support for the change. Which options reflect valid strategies for the nurse managers? Select all that apply. 1. Meet with the supervisor and discuss modifications of the proposed change. 2. Slow down the change process. 3. Meet with the supervisor and suggest abandoning the change. 4. Work together to identify strategies to overcome resistance. 5. Proceed with the change.

1. Meet with the supervisor and discuss modifications of the proposed change. 2. Slow down the change process. 4. Work together to identify strategies to overcome resistance. 5. Proceed with the change.

The nurse administrator has been asked to work with other administrators to make a change in a long-standing hospital policy. What should be the nurse's first action? 1. Research the options that will work best for the nursing staff and the hospital. 2. Speak positively of the change to ensure the most "buy-in" from the nurses. 3. Encourage the other administrators to choose the option that is easiest for the nurses. 4. Ensure that each nurse is aware of the change and why it is necessary.

1. Research the options that will work best for the nursing staff and the hospital.

The nurse manager is facilitating change to a new documentation system in the unit. If the manager wants to use the most common method to overcome resistance to the change, which strategy would be chosen? 1. The manager distributes a handout explaining the new system and how to use it. 2. The manager creates a "quick tip" sheet about how to use the system and schedules practice sessions for each nurse. 3. The manager identifies a key supporter of the change and has that nurse act as mentor to the remaining staff. 4. The manager threatens to transfer anyone who resists the change.

1. The manager distributes a handout explaining the new system and how to use it.

The nursing supervisor identifies ineffective communication as a problem among the managers. According to Lippitt's phases of change, which action by the supervisor reflects the final stage of improving this issue? 1. The supervisor uses outcome data to evaluate the amount of change that has occurred. 2. The supervisor has gradually withdrawn from the role of change agent. 3. The supervisor has developed strategies to maintain the change. 4. The supervisor has determined if anyone in the group is sabotaging change efforts.

2. The supervisor has gradually withdrawn from the role of change agent.

The nurse manager has determined that changes are necessary in the way holiday shifts are assigned. When assessing the political climate surrounding this potential change, the nurse manager would ask which questions? Select all that apply. 1. Who is in control of the way holiday shifts are being assigned? 2. What communication technology is available to distribute information about the change in holiday shift assignments? 3. Who will lose when holiday shift assignments are changed? 4. Will changing holiday shift assignments affect the budget? 5. Who is benefiting the most from the way holiday shifts are currently assigned?

1. Who is in control of the way holiday shifts are being assigned? 3. Who will lose when holiday shift assignments are changed? 5. Who is benefiting the most from the way holiday shifts are currently assigned?

The nurse is working on a committee tasked with making a major organizational change. Which comments by the nurse would help to advance the work of this committee? Select all that apply. 1. "I would like to focus on completing this process so we can move on." 2. "Have we looked at all available data in order to make an informed decision?" 3. "What are the obstacles to implementing this change within the organization?" 4. "Are we including the opinions of all stakeholders in this decision?" 5. "I think it does not really matter when we institute this change, as long as it is over quickly."

2. "Have we looked at all available data in order to make an informed decision?" 3. "What are the obstacles to implementing this change within the organization?" 4. "Are we including the opinions of all stakeholders in this decision?"

Hospital administrators are considering changing from the traditional method of creating work schedules to a system in which the nurses will choose their own workdays. Choices will be made according to seniority. Which change strategy would likely be best for this endeavor? 1. A power-coercive strategy 2. A normative-reeducative strategy 3. An empirical-rational model 4. A driving force

2. A normative-reeducative strategy

The nurse manager feels that changing the unit's method of assigning break times would benefit the flow of client care. What should be the manager's first action associated with this idea? 1. Tell the staff that a change is coming, but that it is positive and they should not be worried. 2. Collect and analyze information about how the current system is working. 3. Mention in a staff meeting that the current system is causing a lot of trouble. 4. Identify how the manager would know if the change is benefiting the unit.

2. Collect and analyze information about how the current system is working.

The new chairperson of the nursing department has determined that the faculty's teaching is stagnant and outmoded. The chairperson would like to encourage the faculty to adopt more innovative teaching strategies. According to Lewin, what is the first step in initiating this plan? 1. Bring an expert on innovative teaching strategies to campus for a meeting with faculty. 2. Include the staff in identifying problems related to teaching strategies. 3. Ask staff to assist in the development of a plan for implementing new teaching strategies. 4. Implement interventions to improve the teaching strategies currently used.

2. Include the staff in identifying problems related to teaching strategies.

A proposed change in a healthcare organization is controversial and will require cooperation from all parties involved. Which change strategy should the change agent use? 1. Empirical-rational 2. Normative-reeducative 3. Power-coercive 4. Empirical-reeducative

2. Normative-reeducative

The staff is transitioning to a major change in the provision of nursing care in a large hospital. Which behaviors should the nurse manager watch for that would indicate possible problems? Select all that apply. 1. Nurses are discussing the change at breaks and meals. 2. Nurses are doing both the old work and the new work. 3. A nurse says, "I guess everything we've done for years is wrong." 4. The provision of care with the new system takes longer than expected. 5. Nurses are doing parts of the old procedure and parts of the new procedure.

2. Nurses are doing both the old work and the new work. 3. A nurse says, "I guess everything we've done for years is wrong." 5. Nurses are doing parts of the old procedure and parts of the new procedure.

The nurse manager is planning to initiate new policies in the department and is reviewing several change theories. Which step of Havelock's model will the nurse find most closely resembles Lewin's moving stage? 1. Self-renewal occurs among all participants. 2. Solutions are identified to create change. 3. Resources are acquired to facilitate change. 4. Relationships are formed among all participants.

2. Solutions are identified to create change.

A nurse leader is contemplating change on the unit. Which is the first step in the change process? 1. Defining costs/benefits 2. The problem has been clearly defined 3. Identify driving and restraining forces 4. Select and analyze data 5. Develop a plan for change

2. The problem has been clearly defined

Computerized charting will be initiated on select units of the hospital. Orientation to this new system will be provided to each nurse by a team of nurses educated in nursing informatics. This is an example of which type of change strategy? 1. Normative-reeducative strategies 2. Lippitt's phases 3. Empirical-rational model 4. Power-coercive strategies

3. Empirical-rational model

The CEO of the hospital approaches the chief nurse with a request that the nurse act as the primary change agent in the implementation of a new hospital-wide policy. Why would the nurse be a good choice for this assignment? 1. Nurses thrive on transition and work best in such circumstances. 2. Nurses are role models for reacting positively to change. 3. Nurses routinely interact with multiple disciplines. 4. Nurses are always acting in the client's best interest.

3. Nurses routinely interact with multiple disciplines.

The nurse manager knows that maximum power will be needed to achieve a desired change and has identified a key person on the organizational chart who will be affected by the change. What is important for the nurse manager to do? 1. Try to minimize the impact of the change when talking to this person. 2. Bypass this person and talk to the administrator who supervises him or her. 3. Pay attention to the people above and below this person on the organizational chart. 4. Try to find some information against this person to use as leverage.

3. Pay attention to the people above and below this person on the organizational chart.

The nurse manager is facing resistance to change from many staff nurses. Why should the manager work hard to address this resistance? 1. Resistance will keep the change from occurring at all. 2. Resistance from the late majority can keep others from accepting the change. 3. Resistance can negatively impact future client care. 4. Resistance allows others to take power from managers.

3. Resistance can negatively impact future client care.

Hospital administration is working with a university school of nursing to establish a nursing residency program. Why is this a desired action? 1. A residency program eliminates the hospital's liability if a novice nurse makes an error. 2. A residency program is established to make nursing education more like physician education. 3. The Institute of Medicine (IOM) has proposed residency programs for nurses. 4. A residency program ensures that nurses participate in lifelong learning.

3. The Institute of Medicine (IOM) has proposed residency programs for nurses.

When faced with the prospect of change, the nurse states, "We have always done it this way and never had any problems." A few weeks later, the same nurse remarks, "This new way seems to work better than the old way did." This statement is characteristic of which type of change response? 1. Laggards 2. Early adopters 3. Early majority 4. Innovators

3. early majority

A new IV pump has just been purchased by the facility. Which statement by the nurse manager reflects Rogers' first step in making the change to this new equipment? 1. "The nursing staff will have the final decision on whether to change to this IV pump." 2. "Before we make the final decision, we will do a three-month 'test run' of the equipment to make sure we like it." 3. "I have looked at the pump and I like it." 4. "I have information to share with you about the new IV pump we are considering for the unit."

4. "I have information to share with you about the new IV pump we are considering for the unit."

The novice nurse manager is acting in the role of change agent for the unit. Which statement indicates that this manager needs further training in regard to change? 1. "I must not get so bogged down in details that I lose focus on the ultimate goal." 2. "As we go through this process, I think I need to be flexible but persistent." 3. "Those who are resistant will probably accept it sooner or later with my support." 4. "I think the implementation will go much better if I stay available the whole time."

4. "I think the implementation will go much better if I stay available the whole time."

Which statements by the nurse manager would demonstrate effective change management? Select all that apply. 1. "If this approach doesn't work, at least we can say we've tried." 2. "Let's wait until the administration has completed their reorganization before we implement change." 3. "In order for this plan to work, everyone must agree to participate." 4. "We cannot lose sight of the mission and values of our institution as we begin to integrate these changes." 5. "Although this task is going to be difficult, we have the full support of our hospital administration."

4. "We cannot lose sight of the mission and values of our institution as we begin to integrate these changes." 5. "Although this task is going to be difficult, we have the full support of our hospital administration."

Which factor best represents a driving force in the process of change? 1. An ineffective nurse manager 2. An administration composed of long-term employees 3. A staff composed of long-term employees 4. A financial deficit of millions of dollars

4. A financial deficit of millions of dollars

Which action will have the greatest impact on the successful implementation of a planned change? 1. Disciplining individuals who continue to be resisters to the change 2. Ensuring there are no remaining pockets of disagreement when the change occurs 3. Continually rewarding those working toward the change and ignoring those who are not 4. Creating a supportive environment for those undergoing the change

4. Creating a supportive environment for those undergoing the change

The nursing committee is planning a change in the unit's organization. Which statement reflects the priority expected outcome of these change agents' work? 1. The nurses involved will demonstrate management skills. 2. The nurses will agree with the change and present a united front for its adoption. 3. The change will guide nursing practice on the unit. 4. The change will lead to improved client care on the unit.

4. The change will lead to improved client care on the unit.

Refusing to work with a staff member who dresses unprofessionally most closely represents which change strategy? A) Power-coercive B) Normative-reeducative C) Rational-empirical D) Resistance-withdrawal

A. power-coercive

It is appropriate to make a change for which reason? SATA a. to solve an existing problem b. to increase staff efficiency c. to reduce unnecessary workload d. to improve staff productivity

All of them

Which force is the driving change in today's heal-care environment? SATA a. increased cost of health-care services b. decrease in health-care professionals and providers c. decreased third-party reimburse of health-care services d. increased need to update health-care related technologies

All of them

What is required to successfully implement the chaos of theory change? a. most stakeholders accepting the need for change b. finding solutions to resistance to change c. changing attitudes more than increasing knowledge d. finding underlying order in random data

D. Finding underlying order in random data

Which action would be a normal and expected behavioral response during the unfreezing phase of change? A. anger B. withdrawal and acceptance c. open acceptance d. active collaboration

a. anger

Which action is reflective of the leadership role necessary for a successful planned change to occur? a. demonstrates flexibility in goal setting b. recognizing the need for a planned change c. identifying the resources that are available to support a change d. support the staff during the implementation of a planned change

a. demonstrates flexibility in goal setting

In planning strategies to prevent stagnation and promote renewal, which action would most likely result in the desired outcome? a. developing a program for recruitment of young talent b. rewarding employees by promoting from within c. having set pay increases mandated annually d. using longevity to determine committee selection

a. developing a program for recruitment of young talent

What is the basic argument for the use of rational-empirical change strategies? a. information supports change b. peer influence brings about change c. reward-based incentives influence change d. punishment supports the acceptance of change

a. information supports change

Which change is easier to make? A) Personal behavior B) Group behavior C) Group knowledge D) Personal attitudes

a. personal behavior

Which statement is true regarding planned change? SATA a. resistance to change should be expected as a natural part of the change process b. change should be viewed as a chance to do something innovative c. technical changes are more resisted by staff than social changes are d. change affects the homeostasis of a group

a. resistance to change should be expected as a natural part of the change process b. change should be viewed as a chance to do something innovative d. change affects the homeostasis of a group

Which statement is true concerning the refreezing phase of the change process? SATA a. the focus of this phase is to integrate the change into the status quo b. stabilization of change requires a 6- to 9-month period of time c. if refreezing is incomplete, prechange behavior will be resumed d. the change agent must remain involved until the refreeze stage is complete

a. the focus of this phase is to integrate the change into the status quo c. if refreezing is incomplete, prechange behavior will be resumed d. the change agent must remain involved until the refreeze stage is complete

Which behavior/attitude makes it likely that a planned change will be unsuccessful? a. the suggested change is brought forward after the plan has been formalized b. individuals affected by the change are involved in planning for the change c. the change agent is aware of the organization's internal and external environment d. an assessment of resources to carry out the plan is completed before unfreezing

a. the suggested change is brought forward after the plan has been formalized

Distributing flyers that charge arbitrary action on the part of an employer in an effort to garner interest in employee unionization would be a part of what phase of planned change? A) Unfreezing B) Movement C) Refreezing D) Resistance

a. unfreezing

Historically, many of the changes that have occurred in nursing or have affected the profession are the result of what type of change? a. planned b. change by drift c. rational-empirical d. normative-reeducative

b. change by drift

Which statement reflects an important factor to consider when implementing a planned change? a. change should be implemented suddenly b. change should be implemented gradually c. change should be implemented arbitrarily d. change should be implemented sporadically

b. change should be implemented gradually

What characteristic is associated with organizational groups assigned to manage the change process? a. both formulate and implement the change b. have representation from all key stakeholders c. are made up of quality circles d. are teams of resistance breakers

b. have representation from all key stakeholders

Which factor is the greatest contributor to the resistance encountered with organizational change? a. poor organizational leadership b. presence of employee mistrust c. ineffective organizational management d. insufficient staff involvement in the process

b. presence of employee mistrust

Which characteristics are associated with change by drift changes? SATA a. they are planned b. they are accidental c. they are unplanned d. they are a result of a threat

b. they are accidental c. they are unplanned

Which situation is associated with an aging organization? a. retired staff is replaced with new graduate nurses b. state-of-the-art cardiac monitoring equipment is placed in the ICU c. the unit functions with strict adheres to institutional rules and policies d. a suggestion committee composed of staff and management meets monthly

c. the unit functions with strict adheres to institutional rules and policies

Which description best describes the theory behind nonlinear change? a. it occurs in organized steps b. it must have a logical sequence c. it results in equilibrium d. it has unpredictable outcomes

d. it has unpredictable outcomes

Which activity does a change agent make a commitment to in order to best assure a successful implementation of a change? a. helping followers arrive at total consensus regarding the change b. encouraging subgroup opposition to change so many viewpoints can be heard c. using change by drift if the resistance to change is too strong d. being available to support those affected by a change until the change is complete

d. being available to support those affected by a change until the change is complete

Which statement is true regarding the philosophy of nonlinear change theories? a. change occurs in sequential steps b. change is predictable c. change success relies on policies and hierarchies d. change is necessary because organizational stability is brief

d. change is necessary because organizational stability is brief

Which activity is associated with the movement stage of the development of a plan? a. gather data b. accurately diagnose the problem c. decide if change is needed d. develop a plan

d. develop a plan

Which action represents a management function in planned change? a. inspiring group members to be involved in planned change b. visionary forecasting c. role modeling high-level interpersonal communication skills in providing support for individuals and undergoing rapid or difficult change d. recognizing the need for planned change and identifying the options and resources available to implement

d. recognizing the need for planned change and identifying the options and resources available to implement change

Which activity associated with the unfreezing state of change will have the greatest impact on the success of the movement stage of the change process? a. accurate identification of the problem requiring change b. effective information gathering concerning the problem c. key personnel voicing they opinions regarding the need for change d. the need for change is perceived by all those affected by the problem

d. the need for change is perceived by all those affected by the problem