Chapter 4 - Leading, Managing, Following

The nurse manager consistently refocuses the staff on achieving outcomes and directly involves the staff in decision making to achieve those outcomes. How would this style of leadership be described? 1. Quantum 2. Transactional 3. Contingency 4. Transformational

*Answer: 1* *Explanation:* 1. Quantum leadership is based on the concepts of chaos theory, with the focus on outcomes. 2. Transactional leadership is based on the principles of social exchange theory. 3. Contingency theory suggests that managers adapt their leadership styles in relation to changing situations. 4. Transformational leadership emphasizes the importance of interpersonal relationships to inspire and motivate followers.

What is the most common skill shared by effective nurse leaders in leadership theories or models? 1. Critical care experience 2. Political knowledge 3. Communication 4. Informal power

*Answer: 3* *Explanation:* 1. Critical care experience is not necessary for effective leadership. 2. A leader may or may not have political knowledge but should have knowledge of and involvement in the community. 3. Regardless of the type of leader or the type of unit a nurse manages, communication skills are the key to effective leadership. 4. An effective leader may have formal power only.

Which leadership activities exemplify a quantum leadership style?Select all that apply. 1. The leader reports how outcomes were achieved. 2. The leader brings cookies and coffee to every early morning meeting. 3. The leader is accepting of change. 4. The leader encourages staff nurses to help clients access internet sites about their disease process. 5. The leader often talks about the "vision" of the organization.

Answer: 3, 4 Explanation: 1. In quantum leadership, the outcome is more important than how it was achieved. 2. This social emphasis is more likely to occur with a leader who is transactional. 3. Change is expected by the quantum leader. 4. Informational power is shared by the quantum leader. 5. Focus on vision is an attribute of a transformational leader.

The nurse has been asked to assume a first-level management role on the nursing unit. Which statement indicates that this nurse will need further mentoring in the new role? 1. "I won't be able to increase my team's motivation. That has to come from within them." 2. "As a manager, I will be available for my team if problems with clients arise." 3. "One of my roles will be to make sure assignments are clear and understandable." 4. "I will still be responsible for the care being provided even if I am off the unit during the day to attend meetings."

*Answer: 1* *Explanation:* 1. Managers can affect motivation by developing strategies and possible incentives. The other options are true management functions. 2. Being available for consultation or help with assignments is one of the roles of the first-level manager. 3. First-level managers are responsible for supervising the work of non-managerial personnel and the day-to-day activities of a specific work unit or units. Clarity of assignment is part of this supervision. 4. First-level managers are responsible for attending meetings and may be away from the unit while retaining responsibility for the care being provided.

The nurse manager is working on a committee whose task is to review and revise job descriptions for nursing employees. In which job description would the committee most likely include the phrase "Management responsibilities include shift-by-shift coordination and promotion of quality client care"? 1. Charge nurse 2. Staff nurse 3. Clinical nurse leader 4. Nurse executive

*Answer: 1* *Explanation:* 1. The charge nurse is unique to the healthcare setting and assists with shift-by-shift coordination and promotion of quality client care as well as efficient use of resources. 2. The staff nurse is not formally a manager. This nurse is responsible for promotion of quality care for the shift worked. 3. The clinical nurse leader is not a manager but rather works as a resource to those providing direct care. This nurse may coordinate care at the bedside and works to integrate care. 4. The nurse executive is an upper-level manager and is responsible for quality care across the institution.

The vice-president for nursing services of a large teaching hospital has been aware that many of the problems in the nursing staff result from poor management at the unit level. What are reasons that nurse managers are sometimes ineffective in their role? Select all that apply. 1. There is little training available for nurse management positions. 2. Entry-level educational programs for nurses do not contain sufficient managerial content. 3. Management techniques are often learned "on the job." 4. Nurses are not good managers. 5. Nurses often experience poor supervision in their own careers.

*Answer: 1, 2, 3, 5* *Explanation:* 1. Few nurses have the training necessary to be managers. 2. Entry-level education programs are designed to produce generalists, and most content is focused on bedside nursing skills. 3. Many managers depend on their own experience with former supervisors. 4. Nurses work as managers of their own practice and can become very good managers when sufficient education and support are provided. 5. Nurses may manage as they were managed and perpetuate poor management techniques.

The nurse manager is listening to new nurses discussing nurses as managers and overhears one state, "I don't care how long I am a nurse; I will never be a manager." In which ways do nurses manage regardless of their official role Select all that apply. 1. Deciding on priorities 2. Being a liaison 3. Coordination of client care 4. Developing the unit budget 5. Delegation responsibilities

*Answer: 1, 2, 3, 5* *Explanation:* 1. Staff nurses are responsible for prioritizing care for the clients for whom they provide care. 2. Staff nurses act as liaisons between clients and other healthcare professionals. 3. Staff nurses work to coordinate care provided by other healthcare professionals. 4. Staff nurses may have input into budget development but do not have direct responsibility for the process. 5. Staff nurses have the responsibility of delegating tasks to nonprofessional staff.

Which topic would likely appear on the agenda for a staff meeting chaired by a nurse manager who follows transactional leadership theory? Select all that apply. 1. Progress on request to increase personal day benefits 2. Review of policy and procedure for unit evacuation 3. The value of teamwork 4. Being empathetic with clients 5. Standardized first of shift assessments

*Answer: 1, 2, 3, 5* *Explanation:* 1. Transactional leadership uses personal reward as a method of maintaining the status quo. 2. Transactional leaders value policy and procedure. 3. Interpersonal dependence is valued by transactional leaders. 4. An emphasis on empathy, awareness, and persuasion is more characteristic of servant leadership. 5. Transactional leaders value standardization.

According to the behavioral view of leadership, how are leaders formed? Select all that apply. 1. By being educated 2. From inborn traits 3. With training 4. Through life experiences 5. Through abilities

*Answer: 1, 3, 4* *Explanation:* 1. Behavioralists believe leaders are made, not born. Leaders become good at leading through formal education, experience in leadership roles, and training in leadership seminars. 2. Some researchers believe leaders are born with personality traits that make them successful in leadership. This is not part of behavioral theory. 3. Behavioralists believe leaders are made, not born. Leaders become good at leading through formal education, experience in leadership roles, and training in leadership seminars. 4. Behavioralists believe leaders are made, not born. Leaders become good at leading through formal education, experience in leadership roles, and training in leadership seminars. 5. Abilities may develop in a variety of ways. This is not a part of behavioral theory.

The nurse executive wishes to hire nurse managers who embody the service leadership mission of the organization. Which specific attributes should this nurse look for in applicants? Select all that apply. 1. The ability to be empathetic to clients and staff 2. Ability to sustain high energy for long periods of time 3. Awareness of the needs of clients and the organization 4. Use of persuasion as a leadership technique 5. Long history of leadership success

*Answer: 1, 3, 4* *Explanation:* 1. Empathy is a characteristic of a servant leader. 2. The ability to sustain high energy is common in many leaders and is not particular to a servant leader. 3. An awareness of others and their needs is a characteristic of the servant leader. 4. The use of persuasion is characteristic of the servant leader. 5. A long history of leadership success is not unique to a servant leader.

A nursing committee has been organized to help plan a new intensive care service at the hospital. Which questions are essential for this committee to consider? Select all that apply. 1. Where will the service be housed? 2. Why were the nurses asked to participate? 3. When will the service begin? 4. Who will provide the services? 5. How will money for the project be raised?

*Answer: 1, 3, 4* *Explanation:* 1. Where is an important question in planning. 2. Although it is important to ask "why" when planning, the correct "why" in this case is "Why are we providing this service?" 3. When is an important aspect of planning. The timeline for implementation is critical. 4. There are numerous possibilities for answering this question. It is important to consider when planning. 5. This question is not as essential for this committee. Finding money for the project would not be a nursing function.

The nurse is focusing on becoming a leader. What skills should the nurse continually develop? Select all that apply. 1. Empowerment 2. Participation 3. Facilitation 4. Reflection 5. Communication

*Answer: 1, 3, 4, 5* *Explanation:* 1. Empowerment is a skill that should be developed for leadership. 2. Participation is not a skill developed for leadership. 3. Facilitation is a skill that should be developed for leadership. 4. Reflection is a skill that should be developed for leadership. 5. Communication is a skill that should be developed for leadership.

A staff nurse tells the manager, "I don't want to be promoted. I am a much better follower than I am a leader." How should the manager interpret this remark? 1. Leadership takes more energy than followership, so this nurse is taking the easy way out. 2. Followership is a valuable skill in nurses. 3. A nurse who is not willing to work to master the skills of leadership should not be retained on the unit. 4. Most people have difficulty developing leadership skills.

*Answer: 2* *Explanation:* 1. Active following takes skill, self-direction, and energy. There is no evidence that it is easier than leading. 2. In any situation where people must work together, followership is a valuable skill. 3. There is no indication that this nurse is not effective in the followership role and may be a valuable employee without leadership skills. 4. Leadership skills can be learned.

The nurse manager makes an error that results in the unit being $20,000 short on operating budget for the fiscal year. When asked about the error, the nurse takes full responsibility This statement reflects which component of emotional intelligence? 1. Initiative 2. Transparency 3. Empathy 4. Conflict management

*Answer: 2* *Explanation:* 1. Initiative is the readiness to act and seize opportunities. 2. Transparency is displaying honesty and integrity. 3. Empathy is sensing others' emotions and understanding their perspective. 4. Conflict management is the ability to resolve disagreements.

The healthcare organization's monthly newsletter has a headline reading "Nurse Promoted to Leader of Specialty Care Units." What is the error inherent in this headline? 1. One person cannot be the leader of all the specialty care units in an organization. 2. A person cannot be promoted to the role of leader. 3. Leaders have to be hired from outside the organization. 4. Nurses cannot serve as leaders over other nurses.

*Answer: 2* *Explanation:* 1. Leadership is not unit specific. 2. The organization cannot promote someone to the position of leader. A leader uses interpersonal skills to influence others to accomplish a specific goal. The organization can promote a person who may become a leader. 3. A leader cannot be "hired." 4. Nurses often develop strong leadership over other healthcare providers, including other nurses.

Which nurse has legitimate leadership authority in the organization? Select all that apply. 1. Staff nurse 2. Nurse manager 3. Case manager 4. Quality improvement coordinator 5. Education specialist

*Answer: 2, 3* *Explanation:* 1. Staff nurses are not seen as having legitimate leadership authority. Staff nursing is not a management or leadership role. 2. Nurse managers have legitimate authority conferred by the organization and described in job descriptions. 3. Case managers have legitimate authority conferred by the organization and described in job descriptions. 4. The leadership of the quality improvement coordinator is informal and stems from the nurse's knowledge. 5. The leadership of the education specialist is informal and stems from the nurse's knowledge.

Shared leadership is based on partnership, empowerment, and understanding boundaries. Which examples exemplify shared leadership in nursing? Select all that apply. 1. Empowered scheduling 2. Self-directed work teams 3. Shared governance 4. Co-leadership 5. Autonomous participation

*Answer: 2, 3, 4* *Explanation:* 1. Empowered scheduling is fictitious and is not an example of shared leadership. 2. Self-directed work teams are an example of shared leadership. 3. Shared governance is an example of shared leadership. 4. Co-leadership is an example of shared leadership. 5. Autonomous participation is fictitious and is not an example of shared leadership.

The nurse manager is conducting a nurse's annual performance review. Which events from the previous year would be evidence that this nurse is a successful follower? Select all that apply. 1. The nurse attended more than 80%of staff meetings but offered little input into discussion. 2. The nurse participated in testing a new charting system before it was installed on the unit. 3. In a private meeting with the nurse manager, the nurse critiqued the manager's decision to change the unit's method of client assignment. 4. After attending an in-service presentation on a new intravenous (IV) access catheter, the nurse used one of the devices the next time an IV was ordered. 5. When asked for an opinion on an issue dividing the unit, the nurse replies, "I don't know. What do you think?"

*Answer: 2, 3, 4* *Explanation:* 1. Merely attending staff meetings is not a sign of good followership. 2. Active, positive participation shows good followership. 3. As long as the critique is private, this demonstrates that the nurse is engaged and thinking about the processes. 4. Taking the initiative to try out changes is considered good followership. 5. This is an example of dependent thinking, which is not good followership.

Staff nurses have been asked to comment on the work of a nurse manager as part of the manager's performance review. Which comments by the staff nurses would indicate to the supervisor that the manager is also a leader? Select all that apply. 1. "The manager helped me to understand the structure of the hospital's organization." 2. "I hope to be as good a manager." 3. "The manager negotiated a pay increase for the RNs on the unit." 4. "The manager's example has encouraged me to get to know people in other departments in the hospital." 5. "The manager's assignments are always fair and appropriate for the client census."

*Answer: 2, 4* *Explanation:* 1. Clarification of organizational structure is part of the manager's job. 2. A leader uses interpersonal skills to influence others to accomplish a specific goal. 3. Negotiating pay is a role of the manager. 4. Leaders help to forge links among the organization's members. 5. Making assignments is a part of the manager's role.

The nurse manager has been assigned the task of developing and implementing a new staffing system for the emergency department. The nurse has reached the "directing" phase of this project. On which activities would the nurse focus at this point? Select all that apply. 1. Deciding on the skill mix necessary for direct client care 2. Selling the new system to the current emergency department staff 3. Comparing the actual results of the new system to the projected results 4. Telling staff what to do 5. Coaching the staff through the implementation of a new schedule

*Answer: 2, 5* *Explanation:* 1. Deciding on the skill mix would be part of organizing the project. 2. Convincing or "selling" the new idea is part of the directing phase. 3. This comparison is part of the controlling phase. 4. In today's environment, the directing phase consists of guidance rather than telling the staff what to do. 5. Coaching and counseling are two major roles in the directing phase.

A newly promoted nurse manager is fearful that previous coworkers will undermine her efforts to succeed in this new position. The new manager does not share information with these coworkers even though they may need the information to understand changes that are going to occur in the organization. Which emotional intelligence self-management competency is this nurse most clearly violating? 1. Adaptability 2. Initiative 3. Transparency 4. Optimism

*Answer: 3* *Explanation:* 1. Adaptability is flexibility in adapting to changing situations or overcoming obstacles. 2. Initiative is readiness to act and seize opportunities. 3. Transparency is displaying honesty, integrity, and trustworthiness. This nurse is not displaying these traits. 4. Optimism is seeing the up side in events.

In a leadership training class, which statement by a student indicates learning has been successful? 1. "If I am to be successful in leadership, I should make sure no followers are friends." 2. "Most people would not be able to tell if I only pretend to be interested in them." 3. "Relationship building is essential to successful leadership." 4. "Leadership means I can delegate tasks I do not want to do."

*Answer: 3* *Explanation:* 1. Although the leader can show no favoritism, leaders can have friends among the group of followers. 2. The caring demonstrated in the leadership-followership relationship must be authentic. 3. Authentic caring in relationships is an important method of improving respect and competence as a leader. 4. Authentic leaders are willing to take risks and are not afraid to do any task.

A successful nurse manager is mentoring a newly promoted nurse manager. Which comment by the mentor reflects the most important consideration of all nurse managers? 1. "You must work to develop your staff's competencies." 2. "Take your role on the strategic planning committee very seriously." 3. "Your most important role is to ensure client care accountability." 4. "Fiscal resource management is the most important aspect of your job."

*Answer: 3* *Explanation:* 1. Developing staff competencies is very important but not the most important consideration. 2. Strategic planning is very important but not the most important consideration. 3. Although the nurse manager has a variety of roles and tasks, the most important role is assuring quality client care. The nurse manager is accountable for quality care. 4. Managing fiscal resources is a very important task of the nurse manager but not the most important consideration.

During a discussion of how to proceed on a project, a team member says, "I don't care how we do it. Just tell me what to do and I will get it done." What kind of followership is this nurse exhibiting? 1. Passive 2. Active 3. Dependent 4. Independent

*Answer: 3* *Explanation:* 1. The nurse is not passively participating. There is an indication that the work will be done. 2. The active follower would express ideas on how to achieve the goal. 3. This dependent "you make the decision and I'll do it" statement is characteristic of an ineffective follower. 4. An independent follower would express constructive criticism of plans.

As a result of retirements, resignations, and reorganization, a nurse became nurse manager of a high-acuity unit three months after being licensed. The manager struggles with the responsibilities of the position and is often unable to make decisions. Which component of the AONE management competencies does this nurse probably lack? 1. Foundational thinking skills 2. Personal and professional accountability 3. Clinical practice knowledge 4. Effective communication skills

*Answer: 3* *Explanation:* 1. There is no evidence that this nurse lacks foundational thinking skills. 2. There is no evidence that this nurse lacks personal and professional accountability. 3. To effectively manage a high-acuity unit, the nurse must have sufficient experience to develop clinical practice knowledge. Three months is not long enough for that to occur. 4. There is no evidence that this nurse does not have effective communication skills.

A nurse is working in a unit with several less-experienced nurses. Which attribute displayed by the senior nurse would make the leadership of the less-experienced nurses most effective? 1. Strong belief that the leader is accountable for actions taken by those working on the unit 2. Authority to carry out actions necessary to move the work of unit staff forward 3. Efficiency in actions and in words 4. Ability to inspire the others to commit to the team's goals

*Answer: 4* *Explanation:* 1. A leader may have no formal accountability or authority. The manager has that authority. 2. The unit manager has the authority. The experienced nurse in this scenario may or may not be the unit manager. 3. A leader is not necessarily a good manager and may not be efficient. 4. A nursing leader must be a visionary in order to empower others to make needed changes for the good of the group. This leader may or may not be the formal leader of the group.

A community hospital has been purchased by a large healthcare conglomerate. Nursing administration has the task of changing the nursing practice model that has been followed for 50 years. To best achieve this change, administration should appoint a nurse executive whose leadership style follows which theory? 1. Contingency theory 2. Quantum leadership 3. Transactional leadership 4. Transformational leadership

*Answer: 4* *Explanation:* 1. According to contingency theory, the manager adapts leadership styles in relation to changing situations; these styles range from authoritarian to permissive. This is not the best choice for this situation. 2. Quantum leadership focuses on outcomes, and employees are directly involved in decision making. This is not the best choice for this situation. 3. Transactional leadership is based on the premise that individuals engage in social interactions expecting to give and receive rewards. This is not the best choice for this situation. 4. Transformational leadership is concerned with effecting revolutionary change in organizations and human service, not with the status quo.

The nurse has set a goal of becoming a clinical nurse leader (CNL). What actions should this nurse plan to reach this goal? 1. Obtain experience as a nurse manager. 2. Learn as much as possible about the hospital's organization. 3. Take a class in hospital administration. 4. Return to school to obtain a master's degree.

*Answer: 4* *Explanation:* 1. Experience as a nurse manager is not essential to the CNL role. 2. The CNL role is a unit-based role. 3. The CNL role is to coordinate care at the bedside and supervise the healthcare team. 4. CNLs are educated at the master's level.

The mother of a staff nurse is critically ill and the nurse must miss several shifts of work. If the leadership style of the nursing manager is transactional, which approach to covering these shifts is most likely? 1. "I have made out a schedule of who will work to cover these shifts." 2. "I can work an extra shift tomorrow night. Who can cover tonight?" 3. "How can we work together to cover these shifts to help our coworker?" 4. "If you work overtime tonight I will authorize double your hourly pay rate."

*Answer: 4* *Explanation:* 1. Making out a schedule with no input from nursing is authoritative leadership. 2. Transformational leaders appeal to individuals' better selves rather than their self-interests. 3. Transformational leaders appeal to individuals' better selves rather than their self-interests. 4. Transactional leadership is based on the principles of social exchange theory. The primary premise is that individuals act in their own best interest.

An accreditation visitor observes the following situations in a healthcare organization. Which situation would this visitor interpret and document as evidence of the shared governance type of shared leadership? 1. Nurses working in groups and managing themselves 2. Nursing leadership originating from a desire to serve and share 3. Two nurses sharing the management role 4. Nurses formally organized to make decisions regarding practice standards

*Answer: 4* *Explanation:* 1. Nurses working in groups managing themselves are an example of self-directed work teams rather than shared governance. 2. Servant leadership arises from a desire to serve and share. This leadership may or may not be shared. 3. Two nurses sharing the management role are an example of co-leadership. 4. Shared governance is a formal process. Decision making is done by designated nurse representatives.

To address the problem of increasing costs of staffing agencies, a hospital has developed a plan for an internal float pool of nurses to be used when scheduled staff nurses call in sick. What type of planning has the administrative staff done? 1. Strategic 2. Organizational 3. Directive 4. Contingency

*Answer: 4* *Explanation:* 1. Strategic planning is prioritizing long-term goals. 2. Organizing is related to planning to get the work done. 3. Directing is related to planning to get the work done. 4. Contingency planning is a proactive response to problems that may interfere with getting work done.