Leadership exam 2 part 1 (ch. 7,8, 12,13 HALF)

A team has been formed to consider a change in medication delivery. How can the team leaders best promote a successful change? a. Implement the change as rapidly as possible in order to diffuse resistance. b. When planning, involve as many people who will be affected by the change as possible. c. Bring in outside experts to implement the change. d. Enforce compliance with the change fairly and consistently

: B Feedback: Whenever possible, all those who may be affected by a change should be involved in planning for that change. Making a change too quickly can result in poor outcomes because rigor is compromised. Outsiders are often resisted more than internal change agents. A collaborative approach is preferred to "enforcement," even though fairness and consistency are appropriate goals during a change process.

Frequent turnover in leadership at a health-care organization has meant that change has often occurred by drift. What are characteristics of this mode of change? Select all that apply. a. Changes are planned by teams. b. Changes occur accidentally. c. Changes take place even though they are unplanned. d. Changes take place only as the result of threats. e. Change takes place democratically.

: B, C Feedback: Change by drift is unplanned or accidental. Change by drift is not necessarily the result of a threat. Even though change by drift happens "organically," this does not mean that it is necessarily a democratic process.

Which employee of a health-care organization would likely be considered a middle-level manager? a. An experienced primary care nurse who mentors other nurses b. The team leader of the hospital's wound care specialists c. The charge nurse who oversees day shifts on a medical unit d. The hospital's nursing supervisor

: D Feedback: Nursing supervisors are middle-level managers. All the other listed nurses are first-level managers.

After starting a new job, a nurse-manager has been surprised at the amount of grapevine communication that happens. The manager should recognize what characteristic of this type of communication? a. It is difficult to control or stop. b. It always involves verbal, face-to-face communication. c. It consists of negative and subversive messages. d. Strong organizations have policies that prohibit it

A Feedback: "Grapevine" communication is informal and is difficult to control or stop. Consequently, policies that aim to ban it are unrealistic. This type of communication can involve all types of content, not just negative messages. The spread of easy, instant electronic communication means that it is not always verbal.

What is the primary influence that shapes a person's response to authority? a. Power figures in the family unit b. Work experiences in each job held c. Administrative figures in the workplace d. Experiences in the spiritual dimension of life

A Feedback: A person's response to authority is conditioned early through authority figures and experiences in the family unit. Although the other options may influence an individual, none are the primary influence

A nurse-manager recognizes the role that individual values play on decision making. How should the manager best address this fact during a period of organizational planning? a. The manager should carefully reflect on his or her most important values. b. The manager should make every attempt to set aside his or her values when making decisions. c. The manager should seek individuals who have similar values when creating a decision-making team. d. The manager should seek individuals who claim to have flexible values when creating a decision-making team.

A Feedback: All people should carefully examine their value system and recognize the role that it plays in how they make decisions and resolve conflicts and even how they perceive things. Therefore, the nurse-leader must be self-aware and provide subordinates with learning opportunities or experiences that foster increased self-awareness. In most cases, teams are not chosen on the basis of their personal values. It is unrealistic for a person to expect that he or she can set aside values or alter them when making decision

A nurse-manager is chairing a workplace committee. What should the manager prioritize in this role? a. Keeping members on task and promoting productivity b. Promoting members' career development c. Resolving interpersonal conflicts and preventing groupthink d. Providing information on each agenda item

A Feedback: Although all the items may be something the chairperson does, the primary responsibility is to keep members on task so that committee work gets completed. This is prioritized because it best reflects the main purpose of a committee, which is to collectively address specific tasks and challenges in the workplace

A nurse-manager is implementing proactive political strategies. What activity by the nurse is most consistent with this type of strategy? a. Assuming authority to do something if it is not expressly prohibited b. Using competitive approaches to the decision-making process c. Attempting to appear as a victim so future gains can be made d. Verbalizing discontent with the politics of an organization

A Feedback: Assuming authority to do something that is not prohibited allows the individual to accomplish goals for the organization, which will lead to greater empowerment. Proactive strategies do not include overt competition, adopting a position of victimhood or explicitly verbalizing discontent

Which strategy should the manager adopt when attempting to empower staff? a. Role model the characteristics of an empowered nurse. b. Follow a rigid but consistent rule enforcement policy. c. Arrange for all employees to get an annual cost-of-living raise. d. Encourage staff to establish a strong unit culture.

A Feedback: By serving as a role model of an empowered nurse, the manager encourages others to become empowered. Rule enforcement produces order but may not foster empowerment. Similarly, increased salaries would be welcomed but may not cause empowerment. Encouraging a strong unit culture may not give staff the empowerment to accomplish this task.

A health-care organization utilizes decentralized decision making. What will most likely happen when there is need for decisions to be made in the organization? a. A decision can be made at the lowest practical managerial level. b. The decision will be made by top-level managers. c. There is a potential that the decision will be made too quickly. d. It will be unclear who is ultimately accountable for the decision.

A Feedback: Decentralized organizational structure allows decision making to be made at the level at which problems occur. Decision making by top managers is more likely when decision making is centralized. Decentralized decision making does not necessarily lead to rash decisions or unclear accountability.

The leader-manager has successfully implemented a change and is now entering the refreezing stage of the change process. During this stage, the leader-manager should prioritize: a. restoring stability to the workplace. b. rewarding the employees who embraced the change early. c. communicating the specific benefits of the change. d. addressing the concerns of resistors.

A Feedback: During the refreezing phase, the change agent assists in stabilizing the system change so that it becomes integrated into the status quo. The distribution of rewards is not a high priority in this phase, although this may help reinforce the change. Communicating the benefits and addressing concerns should take place in the early stages of the change process

Many nurses at an ambulatory clinic have expressed frustration about the low quality of care that clients have been receiving. How should a manager best interpret this situation? a. The nurses may be in the unfreezing phase of change. b. The clinic is likely an aged organization. c. The movement phase of change will be difficult to initiate. d. There is a need for the manager to demonstrate power-coercive strategies.

A Feedback: During the unfreezing stage, people become discontented, and even angry, with the status quo. This is a necessary precursor to the movement phase of change. This is a positive development and does not indicate a need for power-coercive strategies. Similarly, this does not demonstrate that this is an aged organization.

Which characteristic of a planned change is most likely to threaten its success? a. The suggested change is introduced to staff after the plan has been formalized. b. Individuals affected by the change are involved in planning for the change. c. The change agent is aware of the organization's internal and external environment. d. An assessment of resources to carry out the plan is completed before unfreezing.

A Feedback: Employees should be involved in the change process. When information and decision making are shared early in the process, subordinates will be more accepting of the change. Awareness of the environment and assessment of resources support successful change

A nurse-manager is working with a committee that is showing evidence of groupthink. What characteristic of the committee would show evidence of this phenomenon? a. Members of the committee are unwilling to take risks with new ideas. b. The committee prefers to make decisions by consensus. c. The committee members want to take turns chairing the meetings. d. Membership in the committee is frequently changing

A Feedback: Groupthink occurs when group members fail to take adequate risks by disagreeing, being challenged, or assessing discussion carefully. A preference for a rotating meeting chair does not necessarily indicate groupthink, nor does a preference for working by consensus. Unstable membership is not a desirable characteristic of a committee, but this does not directly indicate groupthink.

A new nurse on the unit has been criticized for deviated from the accepted model of end-of-shift report, even though there is no written policy about the content or format for report. Which term is used for this type of policy? a. Implied policies b. Expressed policies c. Understood precedents d. The organizational culture

A Feedback: Implied policies are neither written nor stated verbally and have developed over time. The other options fail to meet this description

The nurse is working on a unit whose culture has become firmly entrenched? What solution should the nurses on the unit best propose? a. New leadership b. A decrease in workload c. Collaboration with a unit that is not entrenched d. Increased administration support

A Feedback: It is extremely difficult to change a unit culture without new leadership. A change in administrative support or even a reduction in workload will not necessarily challenge the established culture. Collaboration with a unit that is not entrenched may be beneficial, but new leadership is likely the most effective solution

What is one of the most politically serious errors one can make? a. Dispensing untrue information b. Promoting the advancement of subordinates c. Withholding or refusing to divulge information d. Delaying decision making until there is additional information

A Feedback: Lying to others is a serious political error. The other options represent appropriate behaviors.

A nurse-manager can best expand political resources by: a. networking with individuals who are politically influential. b. making decisions proactively. c. initiating discussions about political power while at work. d. delegating decisions as much as possible.

A Feedback: Nurses often can increase their power and influence by forming coalitions and alliances (networking) with other groups, be they peers, sponsors, or subordinates, especially when these alliances are with peers outside the organization. Proactive decision making is beneficial but does not necessarily expand the manager's political influence. In the same way, delegating and talking about political realities at work will not necessarily expand the manager's influence

Which statement is an example of a process objective? a. "Every nurse will screen newly admitted clients for alcohol abuse." b. "The falls rate on the unit will decrease by 50% compared with 2016 rates." c. "The health-care facility will achieve accreditation within the next 24 months." d. "The new bowel care protocol will be fully implemented by the end of the calendar year."

A Feedback: Objectives can focus on either the desired process or the desired result. Process objectives are written in terms of the method to be used, whereas result-focused objectives specify the desired outcome. The statement "Every nurse will screen newly admitted clients for alcohol abuse" states how (i.e., the process) each client will be screened. Each of the other listed statements focuses on results or outcomes.

A nurse-manager is reviewing the organizational chart of a health-care facility before accepting a job offer. When reviewing the organizational chart, the nurse should: a. be aware that the informal structure of the organization cannot be discerned from the chart. b. confirm the accuracy of the chart with the human resources department. c. try to meet with the people at the top of the chart, if possible. d. review the qualifications of each person on the chart.

A Feedback: Organizational charts convey the formal structure of an organization, but they do not include informal structures. It is impractical and unnecessary to review every individual's qualifications. Unless there are reasons to doubt the accuracy of the chart, it is unnecessary to confirm with the human resources department. Unless the manager is applying for a top-level position, it is often unnecessary and impossible to meet with the people at the top of the chart.

A change in the skills mix has been proposed at a care facility. What action by the nurse-manager would best support a rational-empirical change strategy? a. Presenting the research evidence that supports the change b. Publicizing the change to generate enthusiasm c. Appointing "champions" to ensure communication throughout the change process d. Ensuring that employees know the consequences of resisting

A Feedback: Rational-empirical change strategies assume that resistance to change comes from a lack of knowledge and that humans are rational beings who will change when given factual information documenting the need for change. Actions to create awareness and enthusiasm are more consistent with normative-reeducative strategies. A punitive approach would be more consistent with a power-coercive strategy

A nurse-manager has introduced a proposed change to the operations of an ambulatory clinic and has been met with resistance. How should the manager best interpret this resistance? a. Resistance is an expected component of a proposed change. b. Resistance confirms that the proposed change is necessary. c. The presence of resistance suggests that the change may be unsuccessful. d. The presence of resistance indicates a need to implement power-coercive strategies.

A Feedback: Resistance is an expected component of a change process and it does not suggest that change will be unsuccessful. However, the presence of resistance does not necessarily validate that the change was necessary. A manager should interpret the presence of resistance as indicated a need to implement power-coercive change strategies.

A nursing supervisor has been given the responsibility for increasing the frequency and thoroughness of nursing assessments on a hospital unit. However, the supervisor does not have the authority to enforce new guidelines for assessment or assign consequences for noncompliance. What is the most likely outcome of this scenario? a. The desired outcome will not be achieved. b. The assessments will improve, but the nurses will be resentful. c. The supervisor will need to use unauthorized enforcement. d. The assessments will improve as a result of collaboration

A Feedback: Responsibility without authority often causes role confusion and makes it difficult for a manager to enforce a necessary change. This is likely to cause the failure of the initiative. Without binding incentives and disincentives, it is unlikely that change will occur. Spontaneous collaboration is possible, but role confusion is more likely. The use of unauthorized enforcement could be problematic for the manager and would be most likely avoided due to the associated risk.

In planning strategies to prevent stagnation and promote renewal, which action would most likely result in the desired outcome? a. Developing a program for recruitment of young talent b. Rewarding employees by promoting from within c. Having set pay increases mandated annually d. Using length-of-service to determine committee selection

A Feedback: The constant influx of young talent brings new ideas to the organization. Each of the other listed strategies may promote stagnation and inhibit the promotion of renewal.

A manager has been experiencing challenges during a planning process and must implement strategies to overcome barriers that impede planning. What is the manager's best action? a. Reevaluate whether the goals and objectives are appropriate and achievable. b. Establish a fixed goal that is unaffected by changes in the organization. c. Limit membership in the planning team to administrators, leaders, and executives. d. Make the goals of the plan more general so that they can be more easily achieved.

A Feedback: The organization can be more effective if movement within it is directed at specified goals and objectives. Because a plan is a guide to reach a goal, it must be flexible and allow for readjustment as unexpected events occur. Reevaluation is often necessary to ensure this happens. The manager should include in the planning process all people and units that could be affected by a plan, not just administrators and executives. A plan that is too global or unrealistic discourages rather than motivates employees because attainment of the goals can never be clearly determined.

A nurse is considering applying for employment at a new health-care facility. How should the nurse best identify the aims and priorities of the organization? a. Review the organization's mission statement. b. Speak with as many front-line workers as possible. c. Ask interviewers about recent responses to consumer satisfaction surveys. d. Review the organization's policy and procedures documents.

A Feedback: The purpose or mission statement is a brief statement identifying the reason that an organization exists. The mission statement identifies the organization's position regarding ethics, principles, and standards of practice. The nurse should be able to infer the organization's aims and priorities from this statement. Consumer feedback will not necessarily reveal the organization's aims and priorities. Similarly, workers are often unable to identify these priorities. Policies and procedures identify the preferred ways of completing tasks but not the organization's aims and priorities.

The manager is leading a team to develop a unit-level philosophy statement. What guideline should the team use during this process? a. The unit philosophy should align with the larger organization's philosophy. b. The unit's philosophy should include a mission statement and vision statement. c. The statement should reflect the values and priorities of the specific unit manager. d. The statement should be consistent with that of other similar health-care agencies

A Feedback: The unit philosophy will be congruent with the organizational philosophy. Vision and mission are distinct from philosophy statements. The statement should transcend any one particular manager and does not necessarily have to align with other organizations.

The manager on a hospital unit has highlighted some of the large gaps between desired client outcomes and actual client outcomes. What component of Lewin's change theory is the manager demonstrating? a. Unfreezing b. Movement c. Refreezing d. Resistance

A Feedback: Unfreezing occurs when the change agent coerces members of the group to change, or when guilt, anxiety, or concern can be elicited. This impetus for change must precede the other phases, such as movement and refreezing. There is no indication that the manager's information has caused resistance

Which components are considered a part of an organizational structure? Select all that apply. a. The individuals included in the group b. Lines of communication c. Decision-making process d. Channels of legitimate authority e. Organizational culture

A, B, C, D Feedback: Organizational structure refers to the way in which a group is formed (membership), its lines of communication, and its means for channeling authority and making decisions. Organizational culture is an important aspect of every organization but this is not conveyed in the organizational structure.

The nurse-manager is describing the forces that are driving change in today's health-care environment. What phenomena should the nurse describe? Select all that apply. a. Increased cost of health-care services b. Shortages of health-care professionals and providers c. Decreased third-party reimbursement for health-care services d. Decreased use of technology due to high cost of implementation e. Increased need to update health-care-related technologies

A, B, C, E Feedback: Many forces are driving change in contemporary health care, including rising health-care costs, declining reimbursement, workforce shortages, increasing technology, the dynamic nature of knowledge, and a growing elderly population. Even though technology is expensive, its use is increasing.

The leadership of a large health-care organization has arranged a series of meetings with stakeholders. What individuals or groups would be included in this category? Select all that apply. a. A community group that advocates for the rights of people addicted to drugs b. Representatives from the labor union that represents many staff members, an external organization, or individual c. A community group that promotes client safety in health care d. Members of the local media e. The surgeons and anesthetists who work in the operating room

A, B, C, E Feedback: Stakeholders are those entities in an organization's environment that play a role in the organization's health and performance or that are affected by the organization. Stakeholders may be both internal and external, they may include groups. As a result, groups that focus on client safety or a particular vulnerable population would be considered stakeholders. As well, staff members or the organizations representing their interests would be considered stakeholders. The media would not normally play a role in the organization's health and performance or be affected by the organization

The nurse-manager is participating in organizational planning. Which factors should the team consider when identifying variables that may complicate the planning process? Select all that apply. a. Government regulations b. Rapidly changing technologies c. Decreased acknowledgement of the importance of planning d. Changing population demographics e. Public mistrust of the nursing profession

A, B, D Feedback: Because of the rapidly changing technology, increasing government regulatory involvement in health care, changing population demographics, and reduced provider autonomy, health-care organizations are finding it increasingly difficult to appropriately identify long-term needs and plan accordingly. Nurses are generally well trusted by the public, and there is acknowledgment that planning is important in health-care organizations

Which statements are true regarding planned change? Select all that apply. a. Resistance to change should be expected as a natural part of the change process. b. Change should be viewed as a chance to do something innovative. c. Technical changes are more resisted by staff than social changes are. d. Change affects the homeostasis of a group. e. Careful planning can guarantee the success of a change initiative

A, B, D Feedback: Change should not be viewed as a threat but as a challenge and a chance to do something new and innovative. Change should be implemented only for good reason. Because change disrupts the homeostasis or balance of the group, resistance should be expected as a natural part of the change process. The level of resistance to change generally depends on the type of change proposed not the age of the staff affected by the change. Technological changes encounter less resistance than changes that are perceived as social or that are contrary to established customs or norms. Planning increases the chance of success, but it can never be guaranteed.

Which statements are true concerning a bureaucratic organization? Select all that apply. a. It is commonly referred to as a line organization. b. It is typically found in large health-care organizations. c. It is rooted in individual personalities. d. They resemble Weber's original design of organization. e. Its authority is represented by its staff organizational chart

A, B, D, E Feedback: Bureaucratic organizational designs are commonly called line structures or line organizations. Their structure is illustrated by an organizational chart. These designs are common in large health-care organizations and are based on Weber's original conceptualization. Policies and rules govern the organization rather than individual personalities.

The nurse-manager is reviewing the rules that the previous manager had put into place. When reviewing these rules, what principles should guide the manager's actions? Select all that apply. a. Rules should be flexible. b. The number of rules should be kept to a minimum. c. Rules should be changed on a regular basis. d. Enforcement of the rules supports staff morale. e. Consistent rule enforcement supports organizational structure.

A, B, D, E Feedback: Rules are fairly inflexible, so the fewer rules, the better. Existing rules, however, should be enforced to keep morale from breaking down and to allow organizational structure. It is neither reasonable nor necessary for all involved parties to agree with the rules but all must follow them. Rules require regular evaluation, but change may not be warranted.

A nurse has been asked to join the health-care organization's strategic planning committee. What actions should the committee perform in order to create an efficient and evidence-based planning process? Select all that apply. a. Enlist members with expertise in health-care economics. b. Carefully consider political issues related to health care. c. Prioritize the role of intuition in the planning process. d. Identify and implement a planning theory. e. Include as many stakeholders as possible in the planning process

A, B, D, E Feedback: Strategic planning requires managerial expertise in health-care economics, human resource management, and political and legislative issues affecting health care, as well as planning theory. Stakeholders should be engaged in the process. Intuition is not assigned a high value in organizational planning processes and is not normally prioritized over other decision-making processes.

A new employee is attempting to implement appropriate power-building strategies. What actions should this employee perform? Select all that apply. a. Maintaining a sense of humor b. Gaining additional nursing certifications c. Suggesting major changes to the unit's workflow d. Learning the institution's organizational culture e. Attending a training seminar on a new piece of unit equipment

A, B, D, E Feedback: Trying to induce change when one is a new employee is not an appropriate power-building strategy while the other options are all appropriate for a new employee to engage in.

Max Weber, as part of the scientific management era, contributed immensely to the development of organizational theory. Which statements are representative of his beliefs? Select all that apply. a. Bureaucracy could provide a rational basis for administrative decisions. b. Worker satisfaction was integral to productivity. c. Organization charts could depict the hierarchy of authority. d. Impersonality of relationships should exist in organizations. e. Advancement and placement should be based on relationships.

A, C, D Feedback: Weber emphasized the impersonality of work relationships, the ability of bureaucracy to provide rational decisions, and the role of organizational charts. Max Weber's theories did not address worker satisfaction. Weber advocated promotions based on competence, not relationships.

The nurse-manager would be justified in making a change for which reasons? Select all that apply. a. To solve an existing problem b. To test workers' abilities to adapt c. To increase staff efficiency d. To reduce unnecessary workload e. To improve staff productivity

A, C, D, E Feedback: Change should be implemented only for good reasons such as the solution of an existing problem, increasing staff efficiency, eliminating unnecessary workload, and improving productivity. Introducing change for the sole purpose of testing workers' abilities to adapt would be unnecessary, disruptive, and likely unethical.

A nurse is participating in the process of values clarification. What are the characteristics of a true value? Select all that apply. a. It is freely chosen from among alternatives. b. It aligns with the dominant values of society. c. It is prized and cherished. d. It is positively affirmed. e. It is acted upon.

A, C, D, E Feedback: McNally identified the fact that a value is prized and cherished, positively affirmed and acted on, and chosen freely from among alternatives. It is possible for a value to be true while not aligning with the dominant values of the society.

Which statements concerning the role of the leader-manager in organizational planning are true? Select all that apply. a. The leader-manager must be future-oriented. b. The leader-manager has to be willing to take risks. c. The leader-manager should possess human resource management skills. d. The leader-manager must evaluate the social climate that affects the organization. e. The leader-manager must be the most experienced clinician in the organization.

A,B,C,D Feedback: Planning requires managerial expertise in health-care economics, human resource management, political and legislative issues affecting health care, and planning theory. Planning also requires the leadership skills of being sensitive to the environment, being able to appraise accurately the social and political climate, and being willing to take risks. A leader-manager can give effective oversight without being the most experienced clinician on the unit.

Which statement is true concerning the refreezing phase of the change process? Select all that apply. a. The focus of this phase is to integrate the change into the status quo. b. Stabilization of change requires a 6- to 9-month period of time. c. If refreezing is incomplete, prechange behavior will be resumed. d. The change agent must remain involved until the refreeze stage is complete. e. The priority in this phase is to identify resistance.

A,C,D Feedback: During the refreezing phase, the change agent assists in stabilizing the system change so that it becomes integrated into the status quo. If refreezing is incomplete, the change will be ineffective and the prechange behaviors will be resumed. For refreezing to occur, the change agent must be supportive and reinforce the individual adaptive efforts of those affected by the change. Because change needs at least 3 to 6 months before it will be accepted as part of the system, the change agent must be sure that he or she will remain involved until the change is completed. The successfulness of the refreezing stage is dependent on the acceptance of change by all staff. Identiying resistance and addressing it is performed during the unfreezing and movement stages.

The top-level managers of a hospital have chosen to apply for magnet designation. The decision to grant this designation will be largely based on what factor? a. Input from local nursing educators and academics b. The findings from an onsite visit by assessors c. The results of a local public opinion survey d. Review of the organizational chart

B Feedback: A detailed onsite visit is a major component of the magnet accreditation process. Nurse educators from outside the organization would not normally be consulted, and a public opinion survey is not normally taken. Accreditors would review the organizational chart, but this is a lesser piece of data compared with the results of a site visit

An organization is considering a revision to its philosophy. What characteristic of the current philosophy would most clearly indicate a need for revision? a. The philosophy is more than 5 years old. b. Staff claim the stated unit philosophy is in contrast to the care that is being given. c. The philosophy was appropriated from a different health-care facility. d. The philosophy was created after the organization's vision and mission were determined.

B Feedback: An organizational philosophy that is not or cannot be implemented is useless. An old philosophy is not necessarily obsolete, and it is possible to adopt a philosophy from another facility if it is appropriate in a different setting. It is acceptable for an organization's philosophy to flow from the vision and mission statements.

The nurse-manager is chairing a committee, most of whose members are subordinates. When communicating with the members during meetings, the manager should: a. ensure their contributions are recorded for performance appraisal purposes. b. avoid overt demonstrations of power or authority. c. reserve the right to impose decisions on the committee. d. avoid informality in speech or writing.

B Feedback: During committee work, encouraging interaction that is free of status and power is important. Recording for performance appraisal purposes is likely to be intimidating for committee members. There is no reason for all communication to be formal in a committee setting

A planned change has been imposed by upper management at a large hospital and will greatly affect the delivery of care on inpatient units. What is an appropriate role for the leader-manager in this time of change? a. Mobilizing resistance in a respectful but assertive way b. Demonstrating a positive attitude toward the prospect of change c. Implementing the change as rapidly as possible d. Dialoguing with staff about the benefits of maintaining the status quo

B Feedback: Even when a change process has not been collaborative, the leader-manager still has a responsibility to demonstrate a positive outlook on change. Mobilizing resistance would be a subversive act that would be reserved for only the most harmful of proposed changes. Rapid change can sometimes cause chaos rather than efficiency. Dialoguing with staff about keeping the status quo would have the effect of increasing resistance.

1. Which of the following nurses would be considered to have expert power? a. A nurse-manager who dispenses favors to nurses who are willing to work overtime b. A nurse with extensive experience and specialized training in perioperative nursing c. A nurse whose dynamic and engaging personality makes it easy to create alliances d. A nurse who is positioned high on the hospital's organizational chart

B Feedback: Expert power is gained through knowledge, expertise, or experience, as exemplified by a nurse with advanced education and experience in perioperative nursing. Dispensing rewards is associated with reward power; a dynamic and engaging personality is associated with charismatic power; high position on the organizational chart is associated with legitimate power.

. A nurse-manager is creating an organizational plan. What characteristic of the plan is more likely to promote success? a. A midterm evaluation of the planning process b. Several predefined evaluation checkpoints c. The rejection of any earlier plans that did not succeed d. Overplanning to accommodate predicted lapses in the planning process

B Feedback: Good plans have several built-in evaluation checkpoints so that there can be a midcourse correction if unexpected events occur. A single midterm evaluation is likely insufficient. If goals were not met, the plan should be examined to determine why it failed. However, this does not necessarily mean that similar plans cannot be reattempted. Overplanning can result in an excessive and inefficient commitment to minor details

A manager is participating in introducing a shared governance model to a health-care organization. What is the manager's best action? a. Remove lines of authority. b. Form joint practice committees. c. Eliminate performance appraisals. d. Increase the number of first-level managers.

B Feedback: In shared governance, the organization's governance is shared among board members, nurses, physicians, and management. Joint practice committees are developed to assume the power and accountability for decision making, and professional communication is egalitarian rather than hierarchical. Shared governance does not require a complete removal of lines of authority or the elimination of performance appraisals. Shared governance would not require more first-level managers.

A multidisciplinary team has been assigned responsibility for managing the change process in a large health-care organization. What goal should this team set for their activities? a. Resistors will face workplace discipline. b. Employees will not sabotage the change process. c. Change will happen as quickly as possible. d. Change will become a constant state in the organization.

B Feedback: In some organizations, a team manages the communication between the people leading the change effort and those who are expected to implement the new strategies. Ultimately, this increases the chances of successful change and decreases the chance of sabotage. This is not achieved in a coercive way, such as punishing resistors. Rapid or constant changes are not typical goals; efficiency does not necessarily depend on speed

A nurse intends to enroll in graduate school and has informed a colleague of this intention. What response suggests that the colleague is in the precontemplation stage of change? a. "I haven't decided, but I might start looking into doing that as well." b. "That's a good idea for you, but I'm just thankful that I'm done with school." c. "I suppose that will open up some new opportunities for you." d. "That's my plan as well. When will you start?"

B Feedback: In the precontemplation stage, the individual has no intention of changing in the foreseeable future. Exploring the possibility of making a change would suggest the contemplation stage, and transitioning to movement characterizes the preparation stage

A workplace health initiative has been launched in which subsidies are being offered for gym memberships and exercise equipment. This initiative is most likely to affect individuals who are in which phase of the stages of change model? a. Precontemplation b. Contemplation c. Action d. Maintenance

B Feedback: Motivations and incentives are particularly effective among individuals who are in the contemplation stage of change. In this case, this may be staff who would like to begin exercising but who have not yet done so. Staff who are in the precontemplation stage would not likely be affected because they have no desire to change their lifestyle. People in the action and maintenance stages are already engaging in change and likely need no further motivation.

A nurse is ostracizing a staff member who dresses "unprofessionally" and is encouraging other nurses to treat the staff member in the same way. This most closely represents which change strategy? a. Power-coercive b. Normative-reeducative c. Rational-empirical d. Resistance-withdrawal

B Feedback: Normative-reeducative strategies use group norms and peer pressure to socialize and influence people so that change will occur and do not require the change agent to have a legitimate power base. This exercise of power is not the principle guiding any of the other options

A leader-manager plans to implement normative-reeducative strategies to facilitate change in a community health clinic. What action will the leader-manager most likely choose? a. Addressing likely points of resistance before they can be stated by nurses who are reluctant to change b. Communicating the fact that the majority of nurses are enthusiastic supporters of the change c. Publicizing the benefits of the proposed change and the research that supports it d. Providing incentives to nurses who are willing to adopt the change early

B Feedback: Normative-reeducative strategies use group norms and peer pressure to socialize and influence people so that change will occur. The change agent assumes that humans are social creatures, more easily influenced by others than by facts. Communicating the fact that most nurses support the change is an example of this form of pressure or persuasion. This does not necessarily involve a proactive approach to resistance. A focus on evidence is more consistent with the rational-empirical strategy. Incentives may be beneficial, but these do not necessarily create peer pressure.

Which factor is the greatest contributor to the resistance encountered with organizational change? a. Poor organizational leadership b. Presence of employee mistrust c. Ineffective organizational management d. Insufficient staff involvement in the process

B Feedback: Perhaps the greatest factor contributing to the resistance encountered with change is a lack of trust between the employee and the manager or the employee and the organization. Although the other options may increase resistance, employee distrust is the primary barrier to change.

Which statement regarding nursing policies and procedures is most important to their successful application in achieving goals? a. The policies and procedures are created by staff representatives. b. All policies and practices are based on current evidence related to practice. c. Policies and procedures are reviewed at fixed times, every 5 years. d. One hundred percent of the staff adheres to established policies and procedures 100% of the time

B Feedback: Policies and procedures should be evidence-based. It is unrealistic to expect 100% compliance, 100% of the time. A policy that is created by staff representatives but which is not evidence-based is not appropriate because it may be unsafe. Ongoing, cyclical review should be implemented.

A nurse-manager can implement the principles of preactive planning by: a. responding quickly to emergent problems. b. using new technologies to accelerate change. c. preferring the status quo as a stable environment. d. directing planning in response to a crisis.

B Feedback: Preactive planners utilize technology to accelerate change and are future oriented. Unsatisfied with the past or present, preactivists do not value experience and believe that the future is always preferable to the present. Their focus is not necessarily crisis response.

Which characteristic of an organization would suggest that flattening is occurring? a. There is a collective spirit. b. There is reduction in the administration levels. c. There are shared work goals across units. d. There are formal and informal systems are in place to address conflicts.

B Feedback: Reducing the numbers of administration levels is called flattening the organization. A collective spirit, shared work goals, and adequate structures for conflict resolution are not related to organizational flattening.

A manager has accepted a new position and there are more than 20 people who directly report to the manager. What description of this manager's role is most accurate? a. The manager's workload is unrealistic. b. The manager has a large span of control. c. The manager has a top-level management position. d. The manager is working in a poorly designed organization.

B Feedback: The number of people directly reporting to any one manager represents that manager's span of control and determines the number of interactions expected of him or her. Without knowing more about the manager's role, there is no way of knowing if the workload is unrealistic or if this is a top-level position. This manager's large span of control is not necessarily a marker of a poorly designed organization.

A society that highly values social equity and equality is likely to support a health-care system which: a. prioritizes the role of the free market in providing health-care services. b. entitles all citizens to similar levels of health-care services. c. relies on the private sector to organize and provide health care. d. is cost-effective and efficient.

B Feedback: Values strongly influence the formation of health-care policy. A society that values equality of access and social equity is likely to create a health-care system in which each citizen has similar access to services. In many cases, the roles of the free market and the private sector are eclipsed by government, which provides or coordinates services accessible to all. This type of system may or may not be cost-effective, depending on numerous variables

The manager of a clinic is considering a change in the scheduling of vacation time in which nurses would self-schedule their vacation rather than having the manager respond to their submitted requests. A nurse has pointed out that it is possible that newer nurses may feel intimidated by more experienced nurses on the unit when scheduling their vacation. This observation constitutes what component of a SWOT analysis? a. S b. W c. O d. T

B Feedback: Weaknesses are those internal attributes that challenge an organization in achieving its objectives. In this case, possible intimidation within the culture of the unit would be considered an internal attribute that could complicate the proposed system. Threats are also potential confounding factors, but these are external, not internal, factors. Strengths and opportunities are positive attributes.

A nurse-manager has been commissioned to create a new workplace committee that will focus on client safety issues. When forming this committee, the manager should: a. meet at least twice per week for the first month to create momentum. b. aim for diversity of genders and cultures among the membership. c. ensure that half of the members are the manager's subordinates and half are the manager's superiors. d. give members permission to attend meetings as often or as rarely as they wish in order to accommodate their schedules.

B Feedback: When assigning members to committees, cultural and gender diversity should always be a goal. The manager should make efforts to accommodate members' schedules, but giving members' permission to attend as rarely as they wish will compromise the group's cohesion and effectiveness. Momentum must be created after the committee is formed, but this does not necessarily require twice-weekly meetings. It is unnecessary and unrealistic to split the membership between the manager's subordinates and superiors.

At the unit level, what time frame may be considered long-range planning? a. 3 months b. 6 months c. 12 months d. 18 months

B, C, D Feedback: At the unit level, any planning that is at least 6 months in the future may be considered long-range planning.

The nurse-manager works in a health-care facility that has applied for Magnet status. What characteristics of the organization will support the application? Select all that apply. a. Centralized decision-making environment b. Open, participatory management c. Improved patient outcomes d. High staff nurse satisfaction e. Large number of registered nurses and an absence of practical nurses

B, C, D Feedback: Magnet designation is conferred by the ANCC to health-care organizations exemplifying well-qualified nurse executives in a decentralized environment, with organizational structures that emphasize open, participatory management. Magnet-designated organizations demonstrate improved patient outcomes and higher staff nurse satisfaction than organizations that do not have Magnet status. Magnet status is not dependent of registered nurses performing roles that are otherwise performed by practical nurses.

A nurse-manager is on a strategic planning team that is applying the balanced scorecard while strategic planning. The team should specifically consider what variables when creating the scorecard? Select all that apply. a. Legislation that governs the organization's operations b. The health-care organization's budget c. Goals identified by similar organizations d. The existing processes that are in place e. Opportunities for learning and growth f. Feedback that clients and families have provided

B, D, E, F Feedback: Strategic planners using a balanced scorecard develop metrics, collect data, and analyze that data from four organizational perspectives: financial, customers, internal business processes (or simply processes), and learning and growth. This particular model does not explicitly include other organizations' goals or legislation as major components of planning.

What characteristic of a health-care organization most clearly suggests that is an aged organization? a. The organization was established more than 75 years ago. b. The organization used to be the largest in the region but is now smaller than several similar organizations. c. The organization has a history of stifling innovation. d. The organization is having difficulty attracting new graduates.

C Feedback: A history of suppressing innovation is a hallmark of aged organizations. Age alone does not constitute an aged organization; well-established organizations can stay "fresh" and avoid becoming aged by promoting positive change and innovation. Many factors can contribute to being overtaken in size or in attractiveness to new graduates. These phenomena do not necessarily mean that it has become an aged organization

A health-care organization has adopted a new philosophy statement. What observation best shows that the philosophy is being implemented? a. The philosophy is displayed prominently in client care areas and staff areas. b. The philosophy aligns with the organization's vision and mission. c. The philosophy is reflected in the care that clients and families receive. d. The philosophy was created by an interdisciplinary group that included nurses.

C Feedback: A philosophy is being implemented if it is evident in the care that clients and families receive. Displaying the philosophy prominently, aligning it with vision and mission, and collaboratively creating the philosophy do not guarantee that the philosophy is actually being implemented.

The nurse-manager is on a team that is performing a SWOT analysis of the staffing system at a community clinic. What should the manager do when addressing the "S" component of the SWOT analysis? a. Identify stakeholders in the current staffing system. b. Examine the factors indicating that a change in the staffing system is necessary. c. Identify any characteristics of the staffing system that currently help the clinic meet its goals. d. Strategize about ways that the staffing system could possibly be improved.

C Feedback: After identifying the issue, SWOT analysis begins with identifying strengths, which are the internal attributes that help an organization achieve its objectives. The "S" does not denote stakeholders or strategizing. It is important to identify the rationale for a change, but this is not a component of the SWOT model of analysis.

A middle-manager who oversees the operations of several nursing units has a high degree of organizational centrality. What is most likely true about this manager? a. The manager is isolated from top-level managers. b. The manager interacts with a comparatively small number of coworkers. c. The manager receives much communication from varied directions. d. There are more middle-level managers than first-level managers in the organization.

C Feedback: Centrality is a position on an organizational chart where it is possible to have many different types of communication (upward, downward, lateral, and diagonal). This does not suggest that there are more middle-level managers than lower level managers or that this manager is isolated from his or her superiors.

During a strategic planning committee meeting to develop technology goals, several unit managers spend a considerable amount of time discussing current staffing problems. What is the primary action of the chairperson of this committee? a. Take the remainder of the meeting time to discuss staffing with all members. b. Adjourn the meeting and reschedule at a time when there are no staffing problems. c. Request that committee members return to discussing items on the agenda. d. Excuse those discussing staffing from the remainder of the meeting.

C Feedback: Committee time is wasted when agendas are not adhered to. The chairperson should avoid facilitating discussion of peripheral issues. It is unrealistic to put the committee's work "on hold" pending resolution of this problem. Dismissing the members who are discussing irrelevant issues is a heavy-handed approach that is unnecessary and which would be disruptive.

A health-care organization has undergone an organizational restructure that increases nurses' autonomy and empowerment. What effect is most likely? a. Increased interdisciplinary collaboration b. Increased communication c. Increased effectiveness of client care d. Increased client autonomy

C Feedback: Current research suggests that changing an organization's structure in a manner that increases autonomy and work empowerment for nurses will lead to more effective client care. There is no evidence that increasing the autonomy of nurses causes enhanced communication or collaboration, or that it has an effect on client autonomy

A female manager has worked hard in her career to reach a high position in the organization. What action by the manager will directly prevent her from developing the queen bee syndrome? a. Emphasizing formal demonstrations of power rather than informal demonstrations b. Aiming for an equal number of male and female subordinates c. Working with other women to help them achieve similar success d. Increasing accountability to subordinates

C Feedback: Female-dominated professions such as nursing often exemplify the queen bee syndrome. The queen bee is a woman who has struggled to become successful, but once successful, she refuses to help other women reach the same success. Conscious effort to help other women succeed will prevent this phenomenon. Hiring more men will not prevent this and there is no direct benefit in increasing accountability or emphasizing formal power.

An organization has proposed a policy stating that no more than five people should report to any single manager in the organization. What is the most likely outcome of this change in organizational structure? a. Decision making will become unpredictable. b. Workplace satisfaction will increase. c. Efficiency will decrease in the organization. d. Worker autonomy and empowerment will increase

C Feedback: Having too few people report to a manager creates an inefficient and top-heavy organization. Decision making is likely to become similarly inefficient, although it may not become more unpredictable. This change in structure will not necessarily increase the autonomy or satisfaction of employees who may be under closer scrutiny.

One of the most commonly used tools in health-care organizations is SWOT analysis. What is the definition of the "O" component of this model? a. Internal attributes that help an organization achieve its objectives b. Internal attributes that challenge an organization in achieving its objectives c. External conditions that promote achievement of organizational objectives d. External conditions that challenge or threaten the achievement of organizational objectives

C Feedback: Opportunities are external conditions that promote achievement of organizational objectives. Strengths are internal attributes that help an organization achieve its objectives. Weaknesses are internal attributes that challenge an organization in achieving its objectives. Threats are external conditions that challenge or threaten the achievement of organizational objectives.

The nurse is participating in a planning process in a large health-care organization. The nurse and the other members of the team should: a. avoid specifics so that the plan can be applied in any health-care setting. b. ensure that long-term priorities are always prioritized over short-term priorities. c. ensure that evaluation occurs at several points during the process. d. begin to engage employees in the process after the plan has been implemented

C Feedback: Planning can be short term or long term but should always include built-in evaluation checkpoints so there can be a midcourse correction if unexpected events occur. Excessive generalization (vagueness) can make a plan difficult to implement because of the lack of specifics. Employee engagement should occur early in the process. Short-term and long-term interests must be balanced; long-term priorities do not always supersede short-term priorities

The nurse-manager is working in a facility where two of the organizational goals are to increase physician satisfaction and reduce costs. A unit goal is to increase professional RN staffing. Which statement best supports all the stated goals? a. Increasing the RN staff will cut down on nursing errors, prevent burn out, and decrease the cost associated with staff turnover. b. Increasing the use of unlicensed assistive personnel will result in increased patient safety and quality care, and thus improve physician satisfaction. c. Increasing the RN staff will free more nurses to be available to address doctors' concerns during their rounds and will reduce our costly use of overtime. d. Increasing the RN staff will lead to improved patient education and a reduction in costly patient stays.

C Feedback: Politically wise requests should always be made using the goals of the organization; therefore, stating that increasing the staff would meet the organization's goals is most appropriate. This option meets the organizational goals and the unit goal. None of the other listed options addresses each of these goals. Increased use of UAPs is unlikely to increase safety.

A nurse-manager has been asked for the first time to join the health-care facility's strategic planning committee. What action should the manager take first? a. Approach potential mentors on the committee. b. Perform a SWOT analysis of the issues facing the committee. c. Identify and examine his or her own planning style. d. Review the committee's most recent Balanced Scorecard.

C Feedback: Self-reflection is a necessary first step when a nurse is becoming involved in strategic planning. This should precede efforts such as finding mentors. Performing SWOT analysis and creating balanced scorecards constitute the work of the committee

Which element should influence the nurse executive most heavily when assessing the organization's philosophy of nursing services for possible revision? a. Consumer surveys b. Input from other health disciplines c. The organization's mission statement d. Policy statements

C Feedback: The philosophy flows from the mission statement, the highest priority in the planning hierarchy. Each of the other sources may be considered, but none should be as influential as the mission statement of the organization

A nursing administrator believes that the organization supports an inadequate distribution of power. What is an appropriate action to combat this situation? a. Bring the issue to the state board of nursing. b. Propose a plan to the CEO for organizational restructuring. c. Seek entry into an informal power group. d. Seek employment in a new setting

C Feedback: To gain power, one needs entry into informal lines of communication provided by informal power groups. Going directly to the CEO would likely be premature and the nurse should first try to work within his or her sphere of influence. A state board of nursing would not become involved in this type of issue. The nurse should attempt to resolve the situation before resorting to a new job.

There is one vertical, solid line connecting a middle manager and a top-level manager on a clinic's organizational chart. What should a nurse conclude from this aspect of the organizational chart? a. The middle- and top-level manager share equal authority. b. The middle manager is in a permanent position. c. The middle manager has only one boss. d. The top-level manager was originally promoted from being a middle-manager.

C Feedback: Unity of command means one immediate boss per employee and is denoted by a single vertical line. This does not suggest equal authority among the two managers or that the top-level manager was promoted from the position below him or her. This portion of the chart does not indicate that the middle manager's position is permanent.

What determines the size of the authority-power gap between a manager and an employee? a. The organizational philosophy b. The degree of rigidity in the organizational chart c. How credible the manager is perceived to be d. How much informal power the manager possesses

C Feedback: When a manager loses credibility, the authority-power gap widens. The authority-power gap is not determined by the philosophy, rigidity of the organizational chart, or the degree of informal power possessed by the manager

The nurse who provides oversight to a large health-care organization can best demonstrate leadership during a time of change by: a. clearly and assertively reminding nurses of their responsibilities to accept change. b. asking permission of nurses before proposing a change process. c. acknowledging that there is going to be resistance during the change process. d. communicating a vision that change is an opportunity to be embraced.

D : The leader should be open and receptive to change and views change as a challenge and an opportunity for growth. A focus on responsibilities may create a backlash and increase resistance. Collaboration is necessary, but this is not synonymous with asking permission for change. Resistance should be expected, but stating this fact does not demonstrate leadership.

The nurse-manager has begun the movement stage of a proposed change. What is the manager's most appropriate activity? a. Gather data about the need for change. b. Accurately diagnose the problem. c. Decide whether change is needed. d. Collaborate with stakeholders to develop a plan

D Feedback: A responsibility during the movement stage is to develop a plan. Responsibilities of the change agent in the unfreezing stage include gathering data, accurately diagnosing the problem, and deciding if change is needed.

A nurse-manager has established a new committee and will be chairing the committee. The committee consists of six representatives from various departments, at various levels within the organization. What goal should the committee members set? a. Creating a new organizational chart b. Adding four to six new members c. Emphasizing formal communication d. Implementing shared decision making

D Feedback: A shared decision making is a desirable goal in most committees. This maximizes productivity and input. Communication does not necessarily need to be formal and a committee does not necessarily have to consist of 10 to 12 members. It would unusual for a committee to be charged with creating an entirely new organizational chart.

When applying the principles of complex adaptive systems (CAS) theory, the nurse-manager should consider what principle? a. Change must occur by organized, linear steps. b. Change should be guided by intuition instead of being constrained by planning. c. Change is easier in small organizations than large organizations. d. Small variations in the change process can have major effects.

D Feedback: CAS theory emphasizes the fact that even small variations can dramatically alter choice of action. It recognizes that change is often nonlinear and that it requires careful planning. Change is not necessarily easier in smaller organizations.

A nurse-manager is applying chaos theory to a proposed change in the structure of care at a clinic. What skills will best facilitate the manager's application of this theory? a. Creating "buy-in" from the stakeholders b. Finding solutions to resistance to change c. Changing attitudes more than increasing knowledge d. Finding underlying order in seemingly random data

D Feedback: Chaos theory requires finding underlying order in apparently random data. This particular theory of change does not explicitly focus on creating buy-in, addressing resistance, or changing attitudes, although none of these activities is contrary to the theory.

3. Which is a true statement about planning? a. All plans should be defined at the outset so that changes are not necessary. b. Long- and short-range plans should be kept separate so priorities do not become confused. c. Objectives and goals must be established before the philosophy is written. d. All plans should be flexible to accommodate changing circumstances.

D Feedback: Every plan should be flexible because unexpected events are inevitable. It is impossible to identify every aspect of the plan at the outset because circumstances are always changing. Short- and long-range plans should be complementary and integrated, not separate. The philosophy should form the foundation of objectives and goals.

. A nurse-manager has identified the following objective for the care on the unit: "At least 95% of new clients' health records will contain a completed assessment for intimate partner violence." How should the manager improve this objective? a. Increase the objective to 100% of health records. b. Include the rationale for the objective. c. Focus on client actions rather than documentation. d. Include a time frame in the statement.

D Feedback: For objectives to be measurable, they should have certain criteria. There should be a specific time frame in which the objectives are to be completed, and the objectives should be stated in behavioral terms, be objectively evaluated, and identify positive outcomes rather than negative outcomes. It is appropriate for an objective to include references to documentation and it may or may not be appropriate to expect 100% compliance, depending on many factors. The rationale is not normally included in an objective statement.

Which statement best describes the philosophy of nonlinear change theories? a. Change occurs in sequential steps of varying speed. b. Change is predictable with proper analysis. c. Change success relies on clear policies and hierarchies. d. Change is necessary because organizational stability is brief

D Feedback: Most 21st-century organizations experience fairly brief periods of stability followed by intense transformation. Change is rarely sequential or linear, and it is usually difficult to predict, even with careful analysis. Policies and hierarchies are often not adaptable enough to accommodate nonlinear change.

A nurse has begun working in a new health-care facility and is beginning to understand the organizational culture. When seeking to understand the organizational culture, the nurse should: a. carefully examine the demographic characteristics of the workforce. b. ask the middle- and upper level managers about the potential for advancement. c. ask coworkers at various levels to interpret the organizational chart. d. try to perceive the dominant values, traditions, and beliefs in the organization.

D Feedback: Organizational culture is the symbols and beliefs, values, history, and communication patterns of the organization. It differs from organizational climate, which is how the employees perceive the organization. Employees may not be able to articulate the organizational culture due to their proximity to it. Culture does not determine the potential for advancement and is not solely a reflection of demographics.

Which statement about power is correct? a. It is a finite quality and, once gained, is very difficult to lose. b. It is destructively manipulative but is necessary for effective management. c. Women generally view power more positively than do men. d. Having power generally results in the gain of additional power.

D Feedback: Power is likely to bring more power in an ascending cycle, whereas powerlessness often generates more powerlessness. Power is not difficult to lose and it is often viewed more positively by men than women. Power does not have to be a "necessary evil" and can be used for the betterment of many.

A recent nursing graduate has not performed a dressing change on a central catheter for several months and is unsure of how to correctly perform this. The nurse should refer to the: a. documentation. b. practice rules. c. organization policy. d. procedure manual.

D Feedback: Procedures delineate a series of specific steps of a required action, such as performing a specific type of dressing change. Policies are plans reduced to statements or instructions that direct organizations in their decision making, not specific nursing actions. Procedures are not synonymous with documentation of "practice rules."

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

D Feedback: Recognizing the need for planned change and identifying the options and resources available to implement change are management functions. Inspiration, role modeling, and exercising vision are more closely aligned with leadership functions.

An experienced nurse has been assigned to a management position. What task will this new manager most likely have to accomplish in order to address a common reluctance among women to hold positions of power? a. Seeking frequent counsel from other women who are leaders b. Limiting the influence of men on the unit whenever possible c. Organizing an educational inservice about gender in the workplace d. Challenging any negative preconceptions of power that she may have learned while growing up

D Feedback: Some of the reluctance of women to embrace power in relationships can be explained by their socialization to the female role. Some women, in particular, may hold negative connotations of power and never learn to use power constructively. It may be necessary for the new manager to consciously confront such views. Other women may or may not be able to help the manager confront this issue. Limiting the role of men is unlikely to be beneficial or ethical.

A clinical nurse specialist (CNS) is included on a hospital department's organizational chart. However, there are no solid lines leading to or from the nurse's position on the chart. What does this imply? a. The CNS lacks productive relationships with colleagues. b. Any member of staff may exercise authority over the CNS. c. The CNS is not accountable for his or her practice. d. The CNS does not have formal authority over other staff members.

D Feedback: The absence of a "line position" denotes an absence of formal decision-making authority. This is often the case for an advisory (staff) position such as CNS. However, this does not suggest that every other staff member holds authority over the CNS or that the CNS is not accountable for his or her safe practice and adherence to standards. Line positions do not represent personal relationships

Which activity should a change agent perform in order to best assure a successful implementation of a change? a. Helping followers arrive at total consensus regarding the change b. Encouraging subgroup opposition to change so many viewpoints can be heard c. Using change by drift if the resistance to change is too strong d. Being available to support those affected by a change until the change is complete

D Feedback: The change agent needs to offer support to others so that the change occurs. Total consensus is not normally a realistic goal. The change agent should encourage a diversity of views, but not by fostering opposition by subgroups. Resistance should be expected and does not indicate that planned change should not occur

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

D Feedback: The change agent should not proceed to the movement stage until the status quo has been disrupted and the need for change is perceived by the others. Although the other options will affect the process, perception of the need to change by all affected by the change is the most impactful of the options provided.

A nurse-manager is aiming to project a powerful image of a team leader who empowers subordinates. What statement is most appropriate to this goal? a. "I'm in charge here, and so all requests need to come to me. Please let me know if you have any questions." b. "I'm too tired to deal with Dr. Jones today. When he gets here, tell him I've gone to lunch." c. "Is it okay with the rest of you if I do all the charting and you do the direct patient care?" d. "We have a great deal to accomplish today, but I am confident that we can do it by working together."

D Feedback: The empowerment of staff is a hallmark of transformational leadership. To empower means to enable, develop, or allow. The manager's statement about working together exemplifies this principle. Insisting that "I'm in charge" asking an employee to be dishonest or tentatively asking permission from subordinates does not demonstrate empowerment or team leadership.

A leader has launched an organizational planning process that requires the development of new policies. How should the leader utilize subordinates during this process? a. Delegate the evaluation phase of organizational planning to subordinates. b. Ask subordinates to brainstorm alternatives and then have industry experts evaluate each alternative. c. Limit the involvement of subordinates to developing unit-level policies and procedures. d. Include subordinates early in the process and include them in all aspects of policy formation

D Feedback: The leader should encourage subordinates to be involved in policy formation, including developing, implementing, and reviewing unit philosophy, goals, objectives, policies, procedures, and rules. The leader should work alongside the subordinates, not just delegate to them. Subordinates should contribute to evaluation rather than this role limited to experts. The role of subordinates should not be limited to policies and procedures at a unit level

What should the leader remember when forming committees? a. Committees work best when there is an adequate supply of workers, with 10 members being the minimum. b. Willingness to work hard is the most important criterion for appointment. c. Written agendas provide excessive structure and stifle committee creativity. d. There should be sufficient expertise among committee members to accomplish the assigned task.

D Feedback: The most important criterion for committee selection is overall adequate expertise to accomplish the agenda. Effort is an important criterion for membership, but this quality is not productive unless it is accompanied by expertise. There is no absolute minimum of 10 members. Written agendas provide structure and focus for committee meetings and the manager should provide these.

Which statement best describes an emerging paradigm that is likely to influence strategic planning for health care in the 21st century? a. Reduced emphasis on cost containment b. Reduced regulatory oversight of health-care organizations c. A shift from interdependence of health-care professionals to greater autonomy d. Continued increases in the cost of pharmaceuticals

D Feedback: The rising cost of pharmaceuticals and ongoing drug shortages will continue to be a problem for US hospitals for at least the next 3 years. Cost containment, regulatory oversight, and interdependence of health-care providers are predicted to continue.

A rural hospital is considering a sharp reduction in the range and availability of the services it provides. Before making this change, the hospital's leadership should: a. decentralize its decision-making model. b. implement shared governance. c. review its organizational chart. d. consult with local stakeholders.

D Feedback: The stakeholders are all the internal and external individuals and groups that have an interest in an organization's operations. In a rural community where few options for health care exist, it would be prudent to consult with local stakeholders before a major change in service. There is no obvious need for this organization to decentralize, implement shared governance, or review its organizational chart.

Nurses on a hospital unit have been informed that a change to the documentation system is being proposed. What factor surrounding this change is most likely to cause unfreezing? a. The proposed documentation system has been introduced in many hospitals in the region. b. The leader-manager supports a change in the documentation system. c. An influential nurse has extensive experience with different documentation systems. d. The nurses find the current documentation system unwieldy and inefficien

D Feedback: Unfreezing occurs when the change agent convinces members of the group to change or when guilt, anxiety, or concern can be elicited. Thus, people become discontent and aware of a need to change. In this case, dissatisfaction with the current documentation system creates a powerful impetus for change. This factor is likely more significant than the support of the leader-manager and influential nurse or the fact that similar institutions have made a change.

The organization of work in a large health-care facility reflects Weber's theories around bureaucracies. What characteristic is most likely to exist in this facility? a. High flexibility in the way that work is structured b. Promotion and advancement on the basis of relationships c. Absolute autonomy of each employee d. A clear division of labor among employees

D Feedback: Weber emphasized the need for a clear division of labor. Advancement was to be based on competence, not relationships. A high degree of accountability was to exist rather than absolute autonomy. The flow of work is more structured than flexible.

The nurse-manager has held an educational workshop about the need for nurses to be more comprehensive with their client assessments. What outcome would suggest that there is a wide authority-power gap? a. The nurses respond by improving their assessments because of the respect they hold for the manager. b. The nurses do not make significant changes to the way that they assess clients. c. The nurses improve their assessments out of fear for the consequences of not doing so. d. The nurses seek an extended dialogue about the issue.

The nurse-manager has held an educational workshop about the need for nurses to be more comprehensive with their client assessments. What outcome would suggest that there is a wide authority-power gap? a. The nurses respond by improving their assessments because of the respect they hold for the manager. b. The nurses do not make significant changes to the way that they assess clients. c. The nurses improve their assessments out of fear for the consequences of not doing so. d. The nurses seek an extended dialogue about the issue.