NSG 340 Nursing Leadership - Exam 1 per Study Guide, Nursing Leadership Exam 1

This decision making style offers the staff the ability to make a decision after information has been shared and without the active involvement of the manager.

Informed

3 phases comprise processing complaints

Investigation, conciliation, and litigation.

Transactional Leadership means what?

Leadership that motivates subordinates by rewarding them for high performance and reprimanding them for low performance.

Leadership vs. Management

Leadership: using individual traits/abilities in relationship with others and the ability to interpret the environment/context where a situation is emerging and enter that situation *without the use of a pre-designed plan.* Management: the ability to plan, direct, control, and evaluate others in situations where the outcomes are known or *pre-established*, where one or more ways of performing have been agreed on based on evidence.

This often occurs when faced with two ethical principles that compete.

Moral distress

Main characteristics of non-profit organizations

Not publicly traded Excess revenue over expenses is put back into the org Exempt from paying taxes Provide a community service

Shared Governance Model

Nurses involved in care are part of the decision-making process and communication flow within an organization. Main principles are partnership, equity, accountability and ownership.

This is the reflection of the norms or traditions of the organization and is exemplified by behaviors that illustrate values and beliefs.

Organizational culture Examples: rituals and customary forms of practice, such as celebrations of promotions, degree attainment, professional performance,weddings, and retirements.

Beyond formal manners, how else is organizational culture expressed?

Organizational culture is also represented in the day-to-day experience of staff and patients. To many, it is the lived experience that reflects the true organizational culture.

How is organizational culture typically expressed in the nursing environment?

Organizational culture is typically expressed in a formal manner via written mission, vision, and philosophy statements; job descriptions; and policies and procedures.

This law protects one's right to be left alone.

Privacy

This is a decision making style that is made through interactive, deliberate process where the staff and manager express and discuss options and preferences.

Shared decision model

Recognizing that each person brings his or her own unique strengths and that diversity of styles helps the team adapt to changes and challenges is the hallmark of this type of leadership.

Shared leadership

Main characteristic of for-profit organizations

Specific intent to earn a profit

4 agreements of personal leadership

1) Be impeccable with your word 2) Don't take anything personally 3) Don't make assumptions 4) Always do your best

3 components of case management

1) Case manager 2) Critical paths/critical pathways 3) Unit-based managed care.

4 purposes of the code of ethics

1) Inform the public of the minimum standards of conduct 2) Outline major ethical considerations 3) Provide guidelines to its member 4) Serve as a guide for self-regulation

This is a decision making style in which managers decide what is best for their team.

Autocratic or Paternalistic Appropriate for rapid, crisis situations.

The basic obligation to assist others and promote good.

Beneficence

Coaching a patient on how to be more assertive with a physician who is reluctant to answer the patient's questions is another form of: A. Networking B. Negotiating C. Empowerment D. Care coordination

C. Empowerment

Which of the following represents outcomes of transformational leadership? A. Deadlines are met. B. Work is completed according to the rules. C. Increased job satisfaction D. Pay tends to be higher.

C. Increased job satisfaction People tend to have higher satisfaction when they are motivated and intellectually stimulated, as are hallmarks of the transformational leader. Regimented, deadline-oriented leadership does not tend to promote higher job satisfaction.

A model of delivering patient care based on patient outcomes and cost containment.

Case Management Model

This process is a personal approach in which the manager and the employee interact on a frequent/regular basis with the ultimate outcome that the employee performs at an optimal level.

Coaching

The right to privacy of health records is an example of what?

Confidentiality

Problem solving and decision making revolve around what quality?

Critical thinking

Non-maleficence means what?

Do no harm

This is authority or power given to someone to do something or the process of becoming stronger and more confident, especially in controlling one's life and claiming one's rights.

Empowerment

Gardner's Tasks of Leadership

Envisioning goals Affirming values Motivating Managing Achieving workable unity Developing trust Explaining Serving as a symbol Representing the group Renewing

A body of patient advocates that explore ethical principles and theories.

Ethics commitee

Types of power

Expert: (based on one's credibility or expertise) Position: (based on a formal position) Information: (possession of info needed by others) Connection: (gained through association/networking) Referent: (via association w/ someone in a position of power) Coercive: (stems from fear) Reward: (based on ability to provide rewards/favors) Persuasion: (based on ability to influence) Empowerment: (based on ability to give power to others)

True or False: Leader-follower relationship should foster an environment of dictatorship.

False. Leaders trust followers to make decisions and speak up about concerns. Followers trust leaders to actively listen and provide guidance and open communication.

True or False: Typically, vision statements are long, in depth and broad statements that reflects the policies of the hospital.

False. They are brief (consisting of only one or two phrases or sentences) that reflect the image of how the organization will meet its mission in the future in harmony with its core values and beliefs reflected in the philosophy.

Formal vs. Informal leadership

Formal: Positional (CEO, Director, etc.) Informal: Influential (leads via motivation)

Case Management

Honestly, just read about it. p. 202-205 (7th edition - hard copy) p. 371-373 (7th edition - electronic version)

Since recruitment and retention of nurses is one of the most important functions that a nurse manager performs, how can they optimize the process?

Include staff in the interview process for recruitment. This will help select nurses that are a good fit.

What is the purpose of a vision statement?

They serve to unify all subsequent statements toward the view of the future and to convey the core message of the mission statement.

True or False: Coaching can be individual or may involve a team approach.

True

True or False: Privacy law extends to the protection of the patient's reputation.

True

These are statements that are future-oriented, purposeful statements designed to identify the desired future of an organization.

Vision statements

Why is it important for staff recruitment to be congruent with work culture?

When a lack of congruity exists between the expressed culture during recruitment and the actual experienced culture, confusion, frustration, and poor morale often result. Basically, are the words used in recruitment ads simply empty promises with little evidence to back them up? This will end up in poor morale.

The unit is shifting from primary nursing to a team model in an effort to contain costs. Staff members are upset about the change and ask for a meeting to discuss the new model. After hearing their concerns related to reduction in professional autonomy, what is the initial response by the manager to address the concerns? a. Acknowledge the loss. b. Explain the reasons for change, emphasizing the need to reduce costs. c. Repeat the information several times, giving detailed budget overviews. d. Adjourn the meeting and provide explanation through e-mail.

a. Acknowledge the loss *** Visioning involves engaging with others to assess the current reality, specify the end point, and then strategize to reduce differences. This requires trusting relationships that acknowledge the differences in values and ideas. When done well, the nurse manager and the nurses within a unit experience creative tension that inspires working in concert to achieve desired goals.

Which of the following would not be a characteristic of an effective team nurse leader? a. An autocratic perspective b. Excellent communication skills c. Awareness of everyone's abilities d. A genuine interest in team members

a. An autocratic perspective *** In ineffective teams, leadership tends to be autocratic and rigid, and the team's communication style may be overly stiff and formal. Members tend to be uncomfortable with conflict or disagreement, avoiding and suppressing it rather than using it as a catalyst for change. When criticism is offered, it may be destructive, personal, and hurtful rather than constructive and problem-centered. Team members may begin to hide their feelings of resentment or disagreement, sensing that they are "dangerous." This creates the potential for later eruptions and discord.

As a nurse manager and the leader of the unit, you are aware of multiple avenues for learning leadership traits. Which avenues would you pursue for learning leadership traits? (Select all that apply.) a. Attending professional conferences b. Reading books on leadership c. Joining professional organizations d. Connecting with other leaders in the organization e. Experiences from new nurses

a. Attending professional conferences b. Reading books on leadership c. Joining professional organizations d. Connecting with other leaders in the organization *** We can learn leadership through multiple avenues. For example, attending professional association meetings, reading, and connecting with others at a local, state, or national level allow us to learn from others about their development as a leader.

The nurse manager is working with a group of new nurses. The new nurses ask questions about leadership and the role of a manager in leading nursing. The manager shares the desire to have engaged staff nurses who participate in a team environment. What is the manager describing? a. Effective follower b. Effective leader c. Ineffective follower d. Ineffective leader

a. Effective follower *** The manger has described the role of an effective follower on the unit. The effective follower identifies and engages and participates as member of the team to work to achieve the team goals.

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.

High levels of work-related stress affect all but which of the following? (Select all that apply.) a. Job satisfaction b. Absenteeism and turnover c. Nurses' health d. Client welfare

a. Job satisfaction b. Absenteeism and turnover c. Nurses' health d. Client welfare *** Many writers and researchers have found that these work-related areas are adversely affected by stress.

A staff nurse is taking leadership classes in an advanced degree program with a goal to become a nurse manager. The nurse is studying the leader-follower relationship. What has the nurse discovered as accurate part of the leader-follower relationship? a. Leaders are also followers. b. Followers need hierarchical structures. c. Followers are submissive in nature. d. Leaders should dictate to the group.

a. Leaders are also followers. *** In the leader-follower relationship, it is important to be aware the leaders are also followers. In reality, a core part of leadership is being an effective follower as well. There is no linear structure any longer and followers have as much input in decision making as is needed based on the topic. The older days of dictatorship as leadership are antiquated and no longer valid in true leader-follower relationships.

The manager calls the staff together to assess a situation in which the family of a seriously ill patient is anxious and is absorbing a great deal of staff time in consultation, discussion, and questioning of treatment decisions. Staff members are becoming distanced from the family. After inviting the concerns of staff, the manager explains that the organization values patient-centered care and that evidence supports that acting as an advocate and a listener is helpful to families. The manager asks the staff for ideas and strategies that are effectively patient-centered in dealing with families in similar situations. What is the role of the nurse manager in this situation? a. Leadership b. Management c. Follower d. Visionary

a. Leadership *** As a leader, the manager is providing and communicating vision and direction based on evidence and experience. The manager is engaging others in decision making that moves them toward the vision with a reasonable level of risk taking.

A family is keeping vigil at a critically ill patient's bedside. Distant family members call the unit continuously asking for updates and expressing concern. The nurse speaks with the distant family members and states she is referring them to the hospital social worker, whose role is to work with family in this situation. What role is the nurse assuming through this action? a. Manager b. Leader c. Follower d. Laissez-fair

a. Manager *** As a manager, you are concerned with managing and coordinating resources to achieve outcomes in accordance with established clinical processes. Referral to a social worker alleviates demand on staff time and is consistent with hospital procedures.

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 has 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.

A client requires an appendectomy. The surgeon explains the procedure and asks the client to sign the consent. The patient speaks very little English and looks worried. What is the appropriate action by the nurse? a. Suggest that an interpreter explain the procedure to the client and answer any questions. b. Ask the client if he has any questions. c. Draw a picture to show the incision. d. Not intervene.

a. Suggest that an interpreter explain the procedure to the client and answer any questions. *** The Five Steps to Safer Patient Care identifies that encouraging patients to ask questions when there are doubts and concerns and ensuring understanding before surgery is performed are ways in which nurses can support patients in having greater influence in their own care. In this situation, asking an interpreter to help enables access to information for the patient and active assessment of his understanding.

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: a. accountable. b. responsible. c. authoritative and liable. d. responsible and task-oriented.

a. accountable. *** When a registered nurse delegates care to a UNP, responsibility is transferred; however, accountabilityfor 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).

Mr. T. Jones and Mr. R. Smith are both going to become residents in Sunny Haven Lodge. Mr. Jones views it as an opportunity to socialize and meet new friends. Mr. Smith views this as abandonment by his family and is worried that the care will be inadequate. Each senior perceives the situation differently. This is a good example of stress that is: a. both a positive stressor and a negative stressor. b. occurring only because of age. c. positive in both cases. d. harmful in both cases.

a. both a positive stressor and a negative stressor. *** Some researchers have determined that stress is a person-environment process in which the person appraises the situation as taxing or not. Appraisal is an important concept that explains why two people react in different ways to the same situation. Stress can be viewed as positive (eustress) or negative (distress).

"Stress-buffering" behaviors can be elicited to reduce stress. All of the following behavioral coping responses can be used by nurse managers to reduce and manage stress except: a. distancing oneself from work. b. using cognitive reframing to change irrational thoughts. c. refusing a request to sit on a committee to evaluate scheduling software. d. exercising regularly.

a. distancing oneself from work. *** Achieving balance between work and leisure is a useful strategy for stress reduction. Distancing, however, can be a sign of depersonalization that includes negative attitudes as well and is a characteristic of burnout.

The risk manager wants to evaluate the reasons for an increased number of falls on the rehab unit. The risk manager devises a fishbone diagram. A fishbone diagram is a useful tool to: a. identify the root causes of problems. b. list possible solutions to problems. c. help leaders select the best options. d. evaluate the outcomes of decisions made.

a. identify the root causes of problems. *** A fishbone diagram, also known as a cause-and-effect diagram, is useful for determining the reasons (causes) for an effect (falls).

A mediator suggested that the nurse manager and staff members decide on a method to resolve conflicts. It is important to have agreements about how team members will work together because: a. if there are no agreements, each member will make up rules about how to handle disagreements and relationships. b. people are naturally difficult and will not work well together without such agreements. c. people will naturally ask for agreements about how to be together. d. a way to eliminate nonproductive team members must be available.

a. if there are no agreements, each member will make up rules about how to handle disagreements and relationships. *** People must agree on the goals and mission with which they are involved. They have to reach some understanding of how they will exist together. Tenets or agreements such as "I will respectfully speak promptly with any team member with whom I have a problem" go a long way to avoid gossiping, backbiting, bickering, and misinterpreting others. Without agreement, people have implicit permission to behave in any manner they choose toward one another, including angry, hostile, hurtful, and acting-out behavior.

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

a. teaching self-catheterization to a patient with paraplegia who has limited English. b. basic care for a patient with a head injury who is rapidly deteriorating. d. 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.

Which of the following indicates safe delegation? a. 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. b. 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. c. 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. d. 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.

b. 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 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.

The manager of a unit is finding it difficult to work with a new graduate nurse. The new nurse has many ideas; however, his manner of presenting them irritates the manager. After reflection and discussion with others, the manager recognizes that she feels threatened by his behavior. She comes to understand that the new nurse is trying to establish his own role on the unit; is not trying to challenge her; and needs guidance, coaching, and affirmation. What is the nurse manager demonstrating in this situation? a. A positive self-concept b. Deepening self-awareness c. Leadership d. Acquiescence

b. Deepening self-awareness *** Stepping outside oneself to envision the situation while assuming ownership is a component of emotional intelligence. This is an example of self-awareness to identify the resolve to self-conflict in this situation.

A nurse manager of a 20-bed medical unit finds that 80% of the patients are older adults. She is asked to assess and adapt the unit to better meet the unique needs of the older adult patient. Using complexity principles, what would be the best approach to take for implementation of this change? a. Leverage the hierarchical management position to get unit staff involved in assessment and planning. b. Engage involved staff at all levels in the decision-making process. c. Focus the assessment on the unit and omit the hospital and community environment. d. Hire a geriatric specialist to oversee and control the project.

b. Engage involved staff at all levels in the decision-making process. Rationale: Complexity theory suggests that systems interact and adapt and that decision making occurs throughout the systems, as opposed to being held in a hierarchy. In complexity theory, every voice counts, and therefore, all levels of staff would be involved in decision making.

You overhear a new graduate RN telling a nurse colleague that leadership and management belong to the unit manager, not to her. As a nursing colleague, what do you know to be true in regard to the statement? a. The statement is correct. Leadership is not the role of the staff nurse. b. The new graduate would benefit from further understanding of her role as a professional, whose influence may affect the decision making of patients, colleagues, and other professionals. c. The new graduate has been influenced by nurse leaders and managers who leave for other positions. d. The general perception is that nurse leaders and managers are not satisfied in their jobs.

b. The new graduate would benefit from further understanding of her role as a professional, whose influence may affect the decision making of patients, colleagues, and other professionals. *** Care coordination that involves the intersection of individual, family, and community-based needs requires that nurses have self-confidence, knowledge of organizations and health systems, and an inner desire to lead and manage. There is often a view that leadership is isolated to those holding managerial positions, and that a direct care nurse is subject to following by adhering to the direction of others. Such views fail to acknowledge that to be a nurse requires each licensed individual to lead, manage, and follow when practicing at the point-of-care and beyond.

Decision making is described by the nursing educator as the process one uses to: a. solve a problem. b. choose between alternatives. c. reflect on a certain situation. d. generate ideas.

b. choose between alternatives. *** The hallmark of decision making is choosing among options. Generating options is one phase of decision making, and solving a problem refers to problem solving, which is problem centered. Decision making does not always begin with problems, but rather is defined as a purposeful, goal-directed effort that uses a systematic process to choose among options.

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.

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.

With delegation, responsibility and accountability remain with the: a. physician. b. professional who delegates. c. individual who receives the delegation. d. individual who previously performed the task.

b. 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.

An example of role stress occurs when: a. the director of the ICU and the manager of the surgical unit wish to hire the same new employee. b. two part-time staff members are hired to work in a unit, but the job expectations for them are not clear, and the head nurse expresses disappointment in their performance. c. the nurse manager for the ICU wants to advocate for more staff and finds it difficult to find data to substantiate his proposal. d. line managers believe that support staff use their technical knowledge to intrude on their authority.

b. two part-time staff members are hired to work in a unit, but the job expectations for them are not clear, and the head nurse expresses disappointment in their performance. *** Role stress is an additional stressor for nurses. Viewed as the incongruence between perceived role expectations and achievement, role stress is particularly acute for new graduates. Failure to comply with expectations can lead to role conflict. Role conflict and role ambiguity are major sources of conflict for nurses.

An outpatient surgery manager is evaluating new infusion pumps for purchase to use in the operating room. The manager should: a. select the least expensive brand. b. use a decision-making tool to evaluate brands. c. ask the nursing staff which brand they prefer. d. select the vendor the institution usually buys from.

b. use a decision-making tool to evaluate brands. *** Decision-making tools such as decision grids and SWOT analyses are most appropriate when information is available and options are known.

As a unit manager, you chair the unit meetings. For each meeting, you consider and establish the purpose of the meeting. Second, you prepare an agenda. Arrange the following steps in an order that would make the meetings productive and successful. 1. Distribute an agenda. 2. Distribute minutes. 3. Select team members. 4. Start on time. 5. Keep the meeting focused and directed toward accomplishing the set objectives. Select the correct order from the following options: a. 1, 2, 4, 5, 3 b. 4, 1, 2, 5, 3 c. 3, 1, 4, 5, 2 d. 3, 4, 2, 1, 5

c. 3, 1, 4, 5, 2 *** Planning, organizing, and keeping the group on task are critical in ensuring that meetings are productive and that time is managed well.

A staff nurse has been recently promoted to unit manager. During the time on the unit, the nurse formed a strong social network among staff, has promoted the development of relationships between staff and workers in other areas of the organization, and has formed relationships that generate ideas from patient organizations and the local nursing education program. According to complexity theory, what principle is being engaged? a. Empowerment b. Systematic thinking c. Development of networks d. Bottom-up interactions

c. Development of networks *** According to complexity theory, social networks evolve around areas of common interest and are able to respond to problems in creative and novel ways.

****************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.

Mary, an 85-year-old patient with cognitive impairment and gross instability, wanders continuously. Lately, she has fallen twice, and the family demands that she be restrained. As the unit manager, you have initiated a least restraint practice. What is an appropriate action in this situation? a. Setting up a nursing team meeting to review practices b. Calling the family to inform them of the practice c. Initiating a multidisciplinary and family meeting to focus on Mary's needs d. Restraining Mary to satisfy the family's wishes

c. Initiating a multidisciplinary and family meeting to focus on Mary's needs *** Crossing the Quality Chasm emphasizes the importance of rendering care with the client (client-centered) rather than to the client. In this situation, the patient includes family in transparent discussions about quality needs and takes a team approach that involves healthcare professionals, the family, Mary's needs, and evidence associated with safe practice.

The charge nurse walks into Mr. Smith's room and finds him yelling at the LPN. He is obviously very upset. The charge nurse determines that he has not slept for three nights because of unrelieved pain levels. The LPN is very upset and calls Mr. Smith an "ugly, old man." The charge nurse acknowledges the LPN's feelings and concerns and then suggests that Mr. Smith's behavior was aggressive but was related to lack of sleep and to pain. The charge nurse asks, "Can you, together with Mr. Smith, determine triggers for the pain and effective approaches to controlling his pain?" This situation is an example of what? a. Lack of empathy and understanding for Miss Jones b. Concern with placating Mr. Smith c. Leadership behavior d. Management behavior

c. Leadership behavior *** The situation between Mr. Smith and Miss Jones is a complex situation involving unrelieved patient symptoms and aggressiveness toward a staff member. Providing engaged, collaborative guidance and decision making in a complex situation where there is no standardized solution reflects leadership.

Kala, a unit manager, in discussing a role the CEO would like her to perform, makes the following statement, "I will sit on the hospital task force on improving morale if you send me to the hospital's leadership training classes next week, so I can further develop my skills and thus be more effective." Which of the following conflict management styles is Kala using? a. Collaborating b. Avoiding c. Negotiating d. Accommodating

c. Negotiating *** Negotiation involves an exchange of concessions (membership on a committee in return for attendance at a workshop) or trading. This strategy supports a balance of power.

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 principle of paternalism allows one person to make partial decisions for another and is most frequently deemed to be a negative or undesirable principle. Paternalism, however, may be used to assist persons to make decisions when they do not have sufficient data or expertise. Paternalism becomes undesirable when the entire decision is taken away from the employee.

To solve a problem, the nurse manager understands that the most important problem-solving step is: a. the implementation phase. b. identification of numerous solutions. c. accurate identification of the problem. d. evaluation of the effectiveness of problem resolution.

c. accurate identification of the problem. *** To proceed effectively, it is important to determine if a problem exists and to accurately identify a problem. Failure to resolve problems is most often linked to improper identification of the problem.

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: a. passive delegation. b. passive accountability. c. active delegation. d. active responsibility.

c. 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.

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.

From the information supplied in this chapter, which statement best defines critical thinking? Critical thinking is a: a. high-level cognitive process. b. process that helps to develop reflective criticism for the purpose of reaching a conclusion. c. high-level cognitive process that includes creativity, problem solving, and decision making. d. discussion that guides the nursing process.

c. high-level cognitive process that includes creativity, problem solving, and decision making. *** It is generally accepted by many authors and researchers that this statement best defines critical thinking.

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: a. acknowledging the arrival of the second UNP on the unit. b. providing clear directions to both UNPs. c. matching tasks with qualified persons. d. receiving reports from the prior shift.

c. 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.

*************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.

Which one of the following statements has been proven to be true? a. Recent research has found that women do not have a unique physiologic response to stress. b. Both men and women interpret the same stressor in the same manner without regard to past experiences. c. Stress influences the immune system in one complex manner. d. Stressors that are identical do not necessarily have similar effects on each individual.

d. Stressors that are identical do not necessarily have similar effects on each individual. *** Stressors may be unique to certain environments, situations, and persons or groups, and individuals may respond to the same stressor in different ways.

The nurse manager has been asked to implement an evidence-based approach to teach ostomy patients self-management skills postoperatively. The program is to be implemented across the entire facility. What illustrates effective leadership in this situation? a. The training modules are left in the staff room for times when staff are available. b. The current approach is continued because it is also evidence-based and is more familiar to staff. c. You decide to implement the approach at a later date because of feedback from the RNs that the new approach takes too much time. d. An RN who is already familiar with the new approach of volunteers to take the lead in mentoring and teaching others how to implement it.

d. An RN who is already familiar with the new approach of volunteers to take the lead in mentoring and teaching others how to implement it. *** Followership occurs when there is acquiescence to a peer who is leading in a setting where a team has gathered to ensure the best clinical decision making, and actions are taken to achieve clinical or organizational outcomes. Followership promotes good clinical decisions and use of clinical resources.

A new graduate nurse has accepted a position in an intensive care unit. The nurse is assigned a preceptor with several years of experience. The new nurse also notices the other staff seek this nurse out for answers to questions and as a resource to the unit. What does the new nurse consider the role of the mentor nurse? a. A formal leader b. A positional leader c. An official leader d. An informal leader

d. An informal leader *** Formal leaders, positional leaders, and official leaders hold positions of leadership or titles. In this scenario, the nurse is the formal leader of the unit. The nurse is noted to be an informal leader is one who does not hold an actual leadership title, but leads from an informal position based on experience and behavior.

The unit manager was addressing nursing students in the lounge area and was discussing team leadership and team effectiveness. She stated, "One can agree to disagree with another team member's perspective even when one doesn't necessarily see that perspective as being the correct one." In being creative, what did she mean? a. Championing one's own opinion b. Being compassionate c. Being flexible d. Committing to resolution

d. Committing to resolution *** Caregivers must listen to the other person's perspective, listen to the message accurately, identify differences, and creatively seek resolutions.

After several months of heavy patient loads in the Emergency Department and inability to secure sufficient and experienced staff, the department is especially taxed by a train accident that brings in many seriously injured individuals. You observe that Rama ignores the requests of several of the injured, even when time is available to care for them and is rude to two older adult patients. You are concerned that Rama is evidencing which state? a. Hardiness b. Depression c. Role ambiguity d. Depersonalization

d. Depersonalization *** A characteristic of burnout is depersonalization, a state characterized by distancing oneself from the work itself and developing negative attitudes toward work in general (Greenglass et al., 2001). Depersonalization is commonly described as a feeling of being outside one's body, feeling as if one is a machine or robot, an "unreal" feeling that one is in a dream or that one "is on automatic pilot." Generally, subjective symptoms of unreality make the nurse uneasy and anxious. Nurses pushed to do too much in too little time may distance themselves from patients as a means of dealing with emotional exhaustion.

As a nurse manager on the West Surgery Unit, you are interested in increasing patient safety and reducing morbidity and mortality on your unit. What recommendations would be consistent with the IOM The Future of Nursing report? a. Careful screening of nursing staff for substance use and abuse b. Increased RN staffing on the unit c. Salary and benefits that reflect nursing accountabilities d. Increase in the percentage of baccalaureate-prepared nurses to 80%

d. Increase in the percentage of baccalaureate-prepared nurses to 80% *** The Future of Nursing advocates for having 80% of the nursing population at a baccalaureate-prepared level. This recommendation reflects research that suggests that improved mortality and morbidity rates occur with a better educated work force.

A client has severe pain and bladder distention related to urinary retention and possible obstruction. An experienced unlicensed assistive personnel (UAP) states that she received training in indwelling catheter insertion at the previous job. What task can be delegated to this UAP? a. Assessing the bladder distention and the pain associated with urinary retention. b. Inserting the indwelling catheter after verifying her knowledge of sterile technique. c. Evaluating the relief of pain and bladder distention after the catheter is inserted. d. Measuring the urine output after the catheter is inserted and obtaining a specimen.

d. Measuring the urine output after the catheter is inserted and obtaining a specimen. *** Measuring output and obtaining a specimen are within the scope of practice of the UAP. Insertion of the indwelling catheter in this client should be done by an experienced RN because clients with obstruction and retention are usually very difficult to catheterize, and the nurse must evaluate the pain response during the procedure. The UAP's knowledge of sterile technique or catheter insertion is not the issue.

The definition of follower has historically referred to a person who is subservient and submissive. The new principles of followership offer a different perspective. What is NOT considered an attribute of followership in nursing? a. Independent decision making b. Critical thinking c. Patient advocate d. No influence over leaders

d. No influence over leaders *** A followership in nursing does have influence over the leaders in an organization. The followers are an integral part of the healthcare team in nursing and provide support, patient care, critical thinking, and decision-making skills.

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 *** Nonmaleficence refers to "doing no harm." For a nurse manager following this principle, performance evaluation should emphasize an employee's good qualities and give positive direction for growth. Destroying the employee's self-esteem and self-worth would be considered doing harm under this principle.

What would be the primary emphasis in designing and implementing a quality, safe healthcare environment? a. Evidence-based practice b. Informatics c. Staffing d. The patient

d. The patient *** Focusing on the patient moves care from concern about who controls care to a focus on what care is provided to and with patients, which was an aim identified in the IOM report Crossing the Quality Chasm.

In trying to achieve Magnet® status, the chief nursing officer establishes a shared governance model to help nurses experience job satisfaction. However, some nurses who have enjoyed working with less autonomy resist this change and begin to criticize and make rude comments about managers who embrace this model, as well as colleagues who support it. The comments are largely ignored because those who are making them are well established nurses who are often vocal about their displeasure with the organization. Organizational conflict is arising from which of the following? a. Staffing practices b. Increased participation in decision making c. Allocation of resources d. Tolerance of incivility

d. Tolerance of incivility *** Organizational conflict arises from discord related to policies and procedures (such as staffing policies and practices and allocation of resources), personnel codes or conduct or accepted norms of behavior (such as incivility), and patterns of communication. A major source conflict in organizations stems from strategies that promote more participation and autonomy of staff nurses.

As the head of a nursing program, you consistently invite the ideas of your team about innovations in teaching, community partnerships, and curriculum design and invite participation in decisions. Many of these ideas have been implemented successfully, and your staff members are keen to try on other ideas. What is the leadership you are employing? a. Situational b. Trait-based c. Contingency-based d. Transformational

d. Transformational *** Transformational leadership involves attending to the needs and motives of followers, which results in creativity, improvement, and employee development.

The team is providing emergency care to a client who recieved an excessive dose of opioid pain medication. Which task is best to assign to the LPN.LVN? a. calling the health care provider (HCP) to report SBAR b. giving naloxone and evaluating response to therapy c. monitoring the respiratory status for the first 30 minutes d. applying oxygen per nasal cannula as ordered

d. applying oxygen per nasal cannula as ordered *** The LPN/LVN is well trained to administer oxygen per nasal cannula. This client is considered unstable: thereforee, the RN should take responsibiltiy for administering drugs and monistoring the response to therapy, which includes the effects on the respiratory system. The RN should also take responsibility to communicate with the HCP for ongoing treatment and therapy.

After the nurses who work on an adolescent psychiatric unit have had a brainstorming session, they are ready to resolve the problem of unmanageable teenage patients. To maximize group effectiveness in decision making and problem solving, the nurse manager has: a. prevented conflict. b. formed highly cohesive groups. c. used majority rule to arrive at decisions. d. encouraged equal participation among members.

d. encouraged equal participation among members. *** Groups are more likely to be effective if members are involved, the group is cohesive, communication is encouraged, and members demonstrate some understanding of the group process. The nurse leader or manager should provide a nonthreatening and positive environment in which group members are encouraged to participate actively.

A staff nurse approaches the unit manager and indicates to her that because of her father's death in the previous month, she is now finding it very difficult to do her work effectively. This would be considered a(n) ________ stress. a. internal source b. familial c. burnout d. external

d. external *** External stress is outside and removed from the work setting, but it is considered work-related stress because of the impact it has on the worker.

In helping nurse managers to manage their time, the chief nursing officer suggests that they: a. maintain a perfectionistic attitude. b. set up a complaint list. c. have good negotiation skills. d. have good information literacy skills.

d. have good information literacy skills. *** Time can be saved by using information technology effectively, as it assists with effective data retrieval and information gathering and with communication related to a variety of needs in the management setting.

??????????????????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.

Empowerment emphasizes the notion that power grows when ___________.

shared.