Zerwekh: Chapter 10: Challenges of Nursing Management and Leadership

The nurse manager is giving a presentation on the disadvantages of democratic leadership in group functioning. Which statement shows an understanding of this type of leadership? a. "Requires more time and effort to make decisions and accomplish goals" b. "Discourages participation from quieter members of the group" c. "Increases the possibility of 'scapegoating' or argumentative behavior" d. "Is difficult to control the outcomes and decisions of the group"

a. "Requires more time and effort to make decisions and accomplish goals" Because of the encouragement of participation in decision making and the democratic leadership's emphasis on group function, decision making becomes more involved with consensus and is less timely. Democratic leadership encourages group participation and works to reduce any type of scapegoating behavior among members because everyone has equal voice. The group democratically makes decisions and determines outcomes that are not controlled by management

A nurse manager has an adequate understanding of this nursing role when making which of the following statements? a. "A manager selects or assumes a role." b. "I have the same function as a floor nurse." c. "I have the same authority as the director of the hospital." d. "I was appointed to my role."

d. "I was appointed to my role." Although a manager is assigned or appointed to a role, a leader selects or assumes a role. The nurse manager functions differently from a floor nurse, and although the nurse manager has some authority, it is less than the director of the hospital.

Which of the following actions is consistent with a manager? (Select all that apply.) a. Planning the agenda for a staff meeting b. Directing nurse assistants to divide up patient-care assignments c. Organizing a group of nurses to present a topic at a staff meeting d. Giving blood at the local hospital blood drive as an example to others e. Assume control of the guidelines for how hourly rounding will work on the unit

a. Planning the agenda for a staff meeting b. Directing nurse assistants to divide up patient-care assignments c. Organizing a group of nurses to present a topic at a staff meeting e. Assume control of the guidelines for how hourly rounding will work on the unit Managers plan, direct, organize, and control activities designated to their staff. Giving blood at the local hospital would not be an action that is consistent with a nurse manager role.

Which of the following actions by the nurse manager would indicate an autocratic management style? a. Allows staff members to make most of the decisions b. Makes most of the decisions without input from the staff members c. Exerts little control over staff d. Emphasizes effective group functioning

b. Makes most of the decisions without input from the staff members The autocratic manager uses an authoritarian approach to direct the activities of others. This manager would make most of the decisions without input from the staff members. Allowing staff members to make most of the decisions and exerting little control over staff is a laissez-faire management style. Emphasizing effective group functioning is common for a democratic management style.

If many complaints arise about a newly developed procedure, what is the best way to handle them? a. Discontinue the change because it is not working. b. Persuade a few friends to talk positively about it. c. Consider the complaints as indications that change is being resisted. d. Analyze the complaints and alter the plan as needed

d. Analyze the complaints and alter the plan as needed In handling complaints about a new procedure, consideration should be given to bringing in a person with expert power or back to the group with the complainers' input and returning to the moving phase for analysis and adjustment of the procedure if needed. Because a complaint occurs does not mean that the change is being resisted. Refreezing cannot occur if the change is abandoned. Until the complaint is investigated, the change should continue; it should not be discontinued until the issue is fully determined and resolved about the newly developed procedure.

A nurse is respected by peers for clinical skills and effective interpersonal relationships. The nurse has studied diabetic patient educational needs and consults with several units. What type of power does this nurse possess? a. Informational b. Legitimate c. Reward d. Expert

d. Expert Expert power is based on specialized knowledge, skills, or abilities that are recognized and respected by others. Those who have information that others need to perform their duties have informational power. Legitimate power is based on the person's position within an organization. Reward power occurs when an individual has the power to give or withhold rewards.

A nurse manager has received a report that indicates the infection rate on the unit has gone up by 25% in the past month. What action by the manager is best? a. Post the report for staff to read. b. Pull a couple of the nurses aside and discuss the issue with them. c. Require staff to attend an infection prevention conference. d. Provide a mandatory hand hygiene in-service to all staff.

d. Provide a mandatory hand hygiene in-service to all staff. The nurse manager has a duty to implement and mandate interventions to reduce infection rates for the unit. Providing a mandatory hand hygiene in-service to all staff is the best way to do this and to ensure that every staff member is competent. The other options may be used in the process for the nurse manager to set up or reinforce the hand hygiene in-service program.

Which of the following describe the reward power used by the nurse manager? (Select all that apply.) a. A nurse manager who allows employees to initiate schedule changes b. A nurse manager who uses salary increases to motivate staff c. A nurse manager who is perceived as an expert due to specialized knowledge d. A nurse manager who is well liked by the majority of staff e. A nurse manager who has information that others need to perform their jobs

a. A nurse manager who allows employees to initiate schedule changes b. A nurse manager who uses salary increases to motivate staff Reward power occurs when nurse managers provide or withhold rewards. A nurse manager who is perceived as an expert has expert power. A nurse manager who is well liked by the majority of the staff has referent power. A nurse manager who has information needed by others to perform their jobs has informative power. The nurse manager who uses fear of consequences is using coercive power.

Which of the following actions is consistent with a nurse leader? a. A nurse who encourages staff to give excellent patient care b. A nurse who performs chart audits on the staff c. A nurse who writes yearly staff evaluations d. A nurse who always gives medication on time

a. A nurse who encourages staff to give excellent patient care A nurse leader is someone who influences others, such as a nurse who encourages staff to give excellent patient care. A nurse who performs and writes staff evaluations is functioning as a nurse manager. Giving medications is a function of the staff or bedside nurse.

The nurse manager on a surgical unit receives notification that multiple victims of a plane crash will arrive at the hospital momentarily. What is the most appropriate leadership style to adopt in this situation? a. Autocratic b. Democratic c. Laissez-faire d. Eclectic

a. Autocratic The authoritarian or autocratic style of management has its emphasis on the tasks, which would be effective during an emergency or disaster situation; hence, the autocratic manager may be most effective in a crisis situation. The laissez-faire manager maintains a permissive climate with little direction or control exerted. This manager allows staff members to make and implement decisions independently and relinquishes most of his or her power and responsibility to them. The democratic manager is people oriented and emphasizes effective group functioning. The environment is open, communication is both ways, and staff members are encouraged to participate in decision making. Eclectic is not a specific leadership management style.

The nurse manager is beginning the process of problem solving. Which action should be taken first? a. Define the problem b. Gather information c. Analyze the information. d. Consider the alternatives.

a. Define the problem The good manager will guide the process of defining or identifying the problem by asking the what, when, and where of the problem. Before the manager can perform any of the other steps of problem solving, the problem must be identified. Importance is placed on management's ability to differentiate between facts and opinions and to attempt to break down the information to its simplest terms.

The nursing staff in a busy unit enjoys autonomy and needs minimal direction for patient care. Which leadership style would be most effective in this unit? a. Democratic b. Authoritarian c. Laissez-faire d. Bureaucratic

a. Democratic The democratic manager is people oriented and emphasizes effective group functioning. The decisions when staff participation is not necessary. An authoritarian leader makes decisions environment is open, communication is both ways, and staff members are encouraged to participate in decision making. The manager is also willing to take responsibility to make without the input of others. The laissez-faire manager maintains a permissive environment. The bureaucratic leader follows a close set of standards to maintain order.

A nurse manager is in the planning phase in a new job. Which actions show this? (Select all that apply) a. Developing goals that reflect the mission and vision of the organization b. Defining strategies to meet the mission and vision of the organization c. Providing direction for staff to perform the work of the organization d. Retaining accountability for all work completed by the staff e. Planning for contingencies that may interfere with the work of the organization

a. Developing goals that reflect the mission and vision of the organization b. Defining strategies to meet the mission and vision of the organization e. Planning for contingencies that may interfere with the work of the organization In the planning phase, the nurse manager will develop goals, define strategies, and plan for contingencies that may interfere with the work. The next phase of management is providing direction to staff and retaining accountability for all work completed by the staff.

Which of the following statements by the nurse reflect transformational leaders? (Select all that apply.) a. Lifelong learners b. Courageous change agents c. Slow to change d. Value-driven visionaries e. Hesitant to follow

a. Lifelong learners b. Courageous change agents d. Value-driven visionaries Transformational leaders are lifelong learners, courageous change agents, and value-driven visionaries. They are not slow to change or hesitant to follow.

What types of changes in management can be anticipated with the introduction of generations X and Y to the nursing workforce? a. More flexible work time and increased personal responsibility for work outcomes b. Increased loyalty to the institution and the need for a well-defined work environment c. Increased interest in the goals and needs of the institution d. Increased structure within the nursing environment to more effectively predict outcomes

a. More flexible work time and increased personal responsibility for work outcomes Members of Generations X and Y are more independent and place a higher value on personal time. They are not characteristically team players, but they are very creative and want to be responsible for their work outcomes. Baby Boomers are focused on building careers and are invested in organizational loyalty. The silent or veteran generation places a high value on loyalty, discipline, teamwork, and respect for authority.

What do the responsibilities of the nurse manager include? abirb.com/test a. Planning and organizing how nursing care can most effectively be delivered b. Establishing the nursing care standards to be implemented on the unit. c. Developing educational programs to assist staff to meet licensure requirements d. Assisting staff to adhere to organizational policies and procedures

a. Planning and organizing how nursing care can most effectively be delivered Managers must be attentive to both dimensions of their job: the mission and goals of the organization and planning with the staff to meet the nursing care goals of the unit within the overall goals of the institution. Both levels must be addressed—the organization as well as the needs of the individuals. Other options are not as comprehensive and could be included within the first option.

Which action by the nurse indicates placement in the unfreezing phase of Lewin's ChangeTheory? a. The nurse reconsiders if he or she is resistant to change. b. The nurse begins the process of implementing change. c. The change has become routine. d. The change is permanent.

a. The nurse reconsiders if he or she is resistant to change. Lewin's Change Theory consists of three phases: unfreezing, moving, and refreezing. In the unfreezing phase, the nurse reconsiders what has caused him or her to be resistant to change. In the moving phase, the nurse begins the process of implementing change. In the refreezing phase, the change has become a permanent, routine part of the nurse's life

Which statement by the staff nurse shows an adequate understanding of the nurse manager role? The nurse manager a. "is given information and power through an official position." b. "coordinates group activities toward a common goal." c. "is responsible for developing goals to be accomplished." d. "selects and assumes a role among a group of peers."

b. "coordinates group activities toward a common goal." The manager coordinates the activities of the group to maintain balance and direction. There are generally four functions the manager performs: planning (what is to be done), organizing (how it is to be done), directing (who is to do it), and controlling (when and how it is done). Although it is correct to state the manager is given information and power through an official position, this is too narrow in scope to be the best answer. Goals may be developed by the manager, the group, or the organization. Leaders select their role.

A nurse is unhappy about the way medications are being administered on the unit. What does the nurse need to do first to facilitate a change in the process? a. Initiate a new method starting with assigned patients b. Discuss concerns with fellow nurses to determine interest in changing. c. Develop a better method to administer the medications. d. Inform the charge nurse of how it can be done better.

b. Discuss concerns with fellow nurses to determine interest in changing. For the nurse to be successful the initial step is to consider all the factors that might cause resistance to change and to involve those who might be willing to help champion a change. Once this has been done, the team can design strategies to improve the process. The nurse cannot just start using a new process for individual patients. Developing a better method is needed, but only after some work has been done to identify support. Without a plan to create the change, informing the charge nurse of how this can be done better is likely to fail.

The nurse understands that having a stand-up meeting versus the traditional (sitting at a conference table) meeting takes less time to come to a decision based on which of the following ideas? a. Contingency-style leadership b. Evidence-based management protocols c. Autocratic management style d. Presence of a clinical nurse leader (CNL)

b. Evidence-based management protocols Nurses are expected to practice using evidence-based protocols and interventions for clinical decision making, and managers are expected to use those management practices that are not simply based on conventional wisdom but on demonstrated outcomes. Evidence indicates that stand-up meetings took 34% less time to make decisions. Using this model could save an organization many hours a year that could be put to another productive use or could be eliminated from the payroll. Autocratic management style is authoritative. Contingency leadership style is a style of leading that is flexible to adapt to the situation.

Which statement best describes effective leadership by the nurse manager? a. Directs a staff nurse to modify his/her communication skills b. Fosters behavior changes in one staff member that have positive effects on the others c. Encourages behavior changes through the annual evaluation process d. Uses the group process to determine what behavior is distressing to staff

b. Fosters behavior changes in one staff member that have positive effects on the others Leadership in established groups should be democratic and leave members feeling positive about being part of the group. This is seen in a group where one member can have a positive influence on the other members' feelings and actions. Democratic leaders do not have to be directive unless a situation arises where one person must take charge. Waiting until the annual review process to encourage positive growth is too long. Using the group process to determine distressing behavior is not conducive to democratic leadership.

The nurse manager identifies which of the following as the most critical step in problem solving? a. Brainstorm all the possible solutions b. Identify the problem c. Evaluate possible solutions. d. Choose a solution.

b. Identify the problem The most critical step in the problem-solving process is to identify the problem. Brainstorming solutions, evaluating possible solutions, and choosing a solution occur after the problem have been identified.

What is the most consistent concern of the nurse as a manager? a. To develop long-range career goals b. To coordinate patient care while meeting the agency goals c. To maintain harmony within the agency d. To organize the subordinates to meet agency goals

b. To coordinate patient care while meeting the agency goals The role of the nurse as manager has evolved into a complex one that includes organizing patient care, directing personnel to achieve agency goals, and allocating resources. The most consistent concern of the nurse as a manager is not to develop long-range career goals, maintain harmony within the agency, or organize subordinates to meet agency goals. Although having long-range career goals is a good idea for the nurse manager, it is not a day-to-day concern. Organizing subordinates is not a role of the nurse manager, but instead, it is directing or supervising them to achieve patient-care needs.

The nurse manager oversees a busy unit that has experienced several major changes recently. The manager notes the staff comply with the changes but seem depressed and lack energy. What action by the manager is the best? a. Remind them that the changes were for the best b. Explain why the changes were needed. c. Allow nurses to move at their own paces. d. Give weekly pep talks and bring treats

c. Allow nurses to move at their own paces. These nurses are in a state of resignation. While they continue to comply with the changes, their energy is low. The manager needs to let them work at their own pace, and since they are complying, no reminders of why the changes were needed or pep talks with treats are necessary. Eventually, the changes will become ingrained and the energy level will rebound.

The nurse manager tells the patient that he must eat his breakfast before getting out of bed. What type of power is the nurse manager using? a. Legitimate power b. Expert power c. Coercive power d. Referent power

c. Coercive power Coercive power is power derived from the fear of consequences. Expert power is based on specialized knowledge, skills, or abilities that are recognized and respected by others. Reward power is closely linked with legitimate power in that it comes about because the individual has the power to provide or withhold rewards. Legitimate power is power connected to a position of authority. Referent power is the power that a person has because others closely identify with that person's personal characteristics; the person is liked and admired by others.

What action would be an appropriate first step for the nurse to take toward becoming an effective manager? a. Learn how to effect and direct the change process. b. Assess individuals' sources of power. c. Develop communication and interpersonal skills. d. Implement effective nursing care plans.

c. Develop communication and interpersonal skills. Effective managers have a balanced mix of management skills and leadership qualities. There are generally four functions the manager performs: planning (what is to be done), organizing (how it is to be done), directing (who is to do it), and controlling (when and how it is done). To be effective in performing these functions, a manager must develop communication and interpersonal skills.

A nurse wants to implement a change in the work environment. Which of the following actions would be the most important thing to do? a. Ask for suggestions from peers working in other institutions. b. Explain to coworkers how a different plan would work better. c. Seek input from coworkers from the beginning. d. Incorporate all suggestions into the plan before implementing.

c. Seek input from coworkers from the beginning. Seeing the input from coworkers from the beginning is an important component of initiating change in the work environment. In the unfreezing phase, all of the factors that may cause resistance to change are considered. Others who may be affected by the change are sought out to determine whether they recognize that a change is needed and to determine their interest in participating in the process. It will be important to determine whether the environment of the institution is receptive to change and then convince others to work with the group initiating the change.

A nurse is using the decision-making process. Which action should be taken first? a. Evaluate the outcome. b. Identify and evaluate options. c. Set the objective. d. Implement the options.

c. Set the objective. Decision making requires the definition of a clear objective to guide the process. The nurse must set the objective before proceeding to the other steps in the decision-making process. The second step is to identify and evaluate alternate decisions. The third step is to make the decision and implement, and the last step is to evaluate the outcome.

A nurse is interested in moving into a management position. Which action would assist with accomplishing this? a. Use of reward power b. Use of coercive power c. Use of expert power d. Use of legitimate power

c. Use of expert power An expert refers to someone who is knowledgeable, experienced, and respected in his or her area of nursing. This type of expert power would assist the nurse to advance to higher positions in nursing. Reward power is closely linked with legitimate power in that it comes about because the individual has the power to provide or withhold rewards. Legitimate power is power connected to a position of authority. Coercive power is power derived from the fear of consequences.

Which statement by the nurse shows understanding of the primary advantage in using the group process in decision making? "The process a. increases the time spent discussing alternatives." b. eliminates opposition to decisions by administrators." c. allows additional time for the planning process." d. promotes acceptance of the decision by the group."

d. promotes acceptance of the decision by the group." When the group has input in the decision-making process, there is more acceptance of the group's decision. Groups can be beneficial to the decision-making process. Groups generally offer the benefits of a broader knowledge base for defining objectives and more creativity in identifying alternatives. The effectiveness of the group decision-making process is dependent on the dynamics of the group. When a group is involved in the decision-making process, there may be additional time spent discussing alternatives, and more time may be allowed for planning; however, this is not a specific advantage. It may not necessarily eliminate opposition to the decision by the administration, but when the group makes a decision, it may be easier to deal with administrative opposition.