Leadership Final
Call out
"Call out"- a strategy used to communicate important or critical information Example: •Leader: "Airway status?" •Resident: "Airway clear." •Leader: "Breath sounds?" •Resident: "Breath sounds decreased on right." •Leader: "Blood pressure?" •Nurse: "BP is 96/62."
A client scheduled for cardiac catheterization in 2 hours requests more information about the risks and benefits of the procedure. The nurse calls the cardiologist who demands that the nurse provide the client with the information and tell the client to sign the consent. What is the nurse's best response?
*"My role in informed consent is to act as a witness, not to provide information the procedure and its risk and benefits".* The nurse needs to keep the dialogue professional but also remind the physician of the legal responsibilities surrounding the informed consent.
Types of violence- Type 3
*Employee-Employee* -Relationship between employees
Compromising
*LOSE-LOSE* Involves both assertiveness and cooperation on the part of everyone and requires maturity and confidence. Compromise leads to middle ground between one and another and in result nobody gets everything he or she thinks he or she needs, but a sense of energy exists that is necessary to build important relationships and teams. *Negotiation* is a learned skills that is developed over time and along with compromise, is more like trading, "You can have that if I can have that".
National Institute of Health (NIH)
*Large organization that has many functions, some of which are research and setting clinical guidelines*
A charge nurse often provides guidance to the staff and helps with problem solving as challenges arise. The charge nurse uses which strategy to develop staff members?
*Personal Attention Strategy* includes providing support and problem solving and employees are treated as associates.
Situation monitoring- STEP
*STEP* *S*tatus of patient *T*eam member *E*nvironment *P*rogress toward goal
A nurse manager needs to determine the *staff mix* for the unit. What should the manager do *third*?
*Schedule staff according to regulated ratios dictated by the regular bodies*
What characteristics are noted to make an productive and effective team?
*Trustworthiness* *Respect* *Open communication* *Eagerness to get the job done*
The nurse manager would recommend which of the following as the best measure to *improve the culture of safety on a nursing unit*?
*When there is effective negotiation amongst the committee members*- presents the best characteristics of collaboration because everyone has a voice that is heard and considered
Food and Drug Administration (FDA)
*Whom adverse effects of medication would be reported to*
Delegation rules
- Delegator retains legal accountability and is responsible for prudent action - Delegator must never delegate 1) Assessment 2) Diagnosis 3) Planning 4) Teaching 5) Evaluation -Delegator must follow up with task to ensure the delegated tasks were performed -Delegator MUST *supervise* the task (direct, guide, and influence the outcome of the task being done)
Huddle
-Ad hoc planning to reestablish situation awareness; reinforce plans already in place; and assessing the need to adjust the plan
Types of workplace violence: type 1
-Criminal Intent •No relationship with employees or organization
Scheduling a meeting
-Schedule before lunch or at the end of the day -Limit meeting to 1.5-2 hours -Limit interruptions -Set ground rules (Robert's Rule of Order) -Assign leader and facilitator to keep group on task
Delegatee is able to refuse task (Follower resistance) if...
-They don't have the *ability* -They are not *willing to* due to their task load
What increases incivility/toxicity amongst staff?
1) High stress levels 2)inadequate staffing 3)Organizational change 4) Unrealistic expectations
5 Rights
1) Right task (appropriate and legal) 2) Right Circumstance (appropriate environment/resources/equipment) 3) Right person (willing and able with expertise) 4) Right direction/communication (Clear and concise instructions) 5) Right supervision (monitor and evaluate patient)
2 ways in which you can support a team member (Mutual support)
1) Task assistance (delegation) 2) Feedback -Timely -Respectful -Specific -Directed towards improvement -Considerate
Principles of Quality Management (QM) and Quality Improvement (QI)
1. Flat, democratic, organization structure 2. Commitment to QI 3. Goal is to improve systems not assign the blame 4. Customers define quality 5. QI focuses on outcomes 6. Decisions must be based on data
Check back
1. Sender initiates the message. 2. Receiver accepts the message and provides feedback. 3. Sender double-checks to ensure that the message was received
Understanding potential violence
1. Stressful event 2. Reacts with thought 3. Thoughts turn into emotions 4. Emotional response determines behavior
Role theory
A theory that provides an appreciable framework for the development and evaluation of staff. The role of the professional nurse is complex. Role acquisition, role clarity, and role performance are enhanced by the use of clear position desriptions and evaluation standards.
Performance appraisal- Critical incidents
A type of performance appraisal method in which a manager keeps a written record of positive and negative performance of employees throughout a designated time period. No standard form is use; however; a list of documented incidents is kept for employment and legal purposes.
The level of communication that is concerned with communication between individuals is: a. interpersonal. c. public. b. intrapersonal. d. physiological.
A: Interpersonal communication is concerned with communication between individuals, either person to person or in small groups.
Lately Brooke has been setting challenging goals and expecting subordinates to perform at their highest level. She is acting as a(n) ______________ leader. achievement-oriented participative supportive directive
Achievement orientated leader
Centers for medicare and Medicaid Services (CMS)
Advocate & control payment
Lateral violence
Aggressive and destructive behavior or psychological harassment of nurses against each other. *New nurses*
Key to nurse retention
An atmosphere that consists of mutual respect, trust and *empowerment* Empowerment- feedback/ coaching, achievement recognition, support for new ideas *Shared governance* is used as a guide for accountability in which it promotes power, control, and decision making abilities which can empower staff and enhance individual and group accountability.
Magnet Hospitals Environment
Autonomous, self managing, self governing work environment *Allows nurses to fully practice their clinical expertise, flexible staffing, adequate staffing ratios, and clinical career opportunities*
25) Which of the following statements about the normative decision model is true? A) The model shifts focus away from the leader and followers to the situation. B) Decision tree questions focus on the problem and situational factors. C) The model focuses on the effects of formal authority systems. D) It is about personal opinions rather than theory.
B) Decision tree questions focus on the problem and situational factors. A decision tree is formed in the normative model (Vroom & Yetton, 1973) where situational parameters are represented as a series of questions. When a leader is seeking a decision strategy of maximum effectiveness, he or she is required to analyze situational factors that include the structure and 28 clarity of the task and the surrounding information. The decision tree then predicts how much participation the situation calls for (Figure I), and delegation follows. the normative leadership model suggests strategies on how to make decisions in specific situations
Which of the following is NOT one of the QSEN competencies nurses should focus on to improve patient outcomes? A. Patient-centered care B. Personal Improvement and Independence C. Evidence-based practice D. Quality Improvement E. Safety F. Informatics
B. Personal Improvement and Independence
A nurse manager who uses a leadership style that is participatory and where authority is delegated to others is most likely using which of the following leadership styles? a. Autocratic b. Democratic c. Laissez-faire d. Employee-centered
B: Democratic leadership
1 way to evaluate the quality of outcomes is to compare one agency's performance with that of similar organization in a process called ______
Benchmarking
Identifying potentially violent people
Body language is the most significant cue when predicting violence. *STAMP* *S*taring *T*one and volume of voice *A*nxiety *M*umbling *P*acing
In the context of the Situational Leadership model, which of the following depicts selling as a leadership behavior? A) high task behavior, low relationship behavior B) low task behavior, low relationship behavior C) high task behavior, high relationship behavior D) low task behavior, high relationship behavior
C) high task behavior, high relationship behavior
When engaging in evidence-based health care, the nurse understands that it was originally started as a way to: a. teach medical students the art and science of medicine. b. promote technological advances in medicine. c. integrate individual experience with clinical research. d. incorporate collaboration within all health care disciplines.
C: D. L. Sackett, well known in the EBM movement, encouraged evidenced-based medicine as a way to integrate individual clinical medical experience with external clinical evidence using a systematic research approach.
Check back/ Read back
Check-back also called read-back is a process of employing closed-loop communication to ensure that information conveyed by the sender is understood by the receiver as intended. Steps include: 1. sender initiates the message 2. receiver accepts the message and provides feedback confirmation 3. the sender verifies the message was received Example: Doctor: "Give 25 mg Benadryl IV push." Nurse: "25 mg Benadryl IV push." Doctor: "That's correct."
The _________ has the authority to supervise the fx of the entire facility.
Chief operating officer (COO)
Interpersonal conflict
Conflict between and among patients, family members, nurses, physicians, and members of other departments. These conflicts occur because of differencterm-107es in opinion, priority, or approach.
Intrapersonal conflict
Conflict occurring within a person when confronted with the need to think or act in a way that seems at odds with one's sense of self. Ex. 1. Do I want to pursue my degree now or later? 2. I know my newesterm-106t charge nurse likes the autonomy of working nights. Do I really want to ask him to move days to become a preceptor? 3. That nurse is performing that wrong, but I don't want to say anything because I don't want to ruin our friendship.
Brooke should understand that the path-goal theory is a(n) ______________ model of leadership that extracts key elements from the expectancy theory of motivation. a. fixed b. alternative c. contingency d. untested
Contingency model of leadership
In some cases, _______ or ___________ style of management is appropriate, such as in emergency situations and when working in a large percentage of new and inexperienced team members.
Controlled or *Autocratic* style of management
Types of workplace violence: type 2
Customer/Client Relationship with organization and employees Becomes violent when served
A nurse manager is developing a mission statement for an organization and must consider several questions. Which of the following questions is not necessarily part of developing a mission statement for the organization? a. What do we stand for? b. What principles are we willing to defend? c. Who are we here to help? d. Where are we going?
D Organizational mission statements state the purpose of the organization. Questions that need to be asked when developing this statement are What do we stand for?, What principles are we willing to defend?, and Who are we here to help? The question of where we are going pertains to more long-range goals, which are reflected in the vision statement of an organization.
Lateral violence in nursing can result in the following EXCEPT? A) Reduced retention rates B) Decreased safety C) Decreased job satisfaction D) Reduced costs E) Negative outcomes
D) Reduced costs Lewis and Malecha calculated lost productivity due to workplace violence at $11,581 per nurse per year.
24) If a decision has a rational or objectively determinable "better or worse" alternative, a leader should select the better alternative. This most likely refers to A) strategic agility. B) decision acceptance. C) problem solving. D) decision quality.
D) decision quality.
Which two broad categories of leader behaviors did the situational leadership model originally identify? A. Directive and supportive B. Transformational and transactional C. Behavior-oriented and cognitively-oriented D. Initiating structure and consideration
D. Initiating structure and consideration
Which group offered the following definition of nursing informatics? "Nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge and wisdom into nursing practice." a. AMIA b. NSNA c. ANCC d. ANA
D: This is the ANA's definition of nursing informatics.
A group of nurses wishes to create an evidenced-based environment within the institution where they work. Which of the following is an attribute of such an environment? a. Maintaining the status quo b. Using the organizational external structure c. Maintaining the culture d. Creating a capacity to change
D: Three specific attributes of establishing an evidence-based environment within an institution are (1) create a capacity for change, (2) establish the culture, and (3) use the organizational infrastructure to sustain and reinforce change.
Brooke generally lets subordinates know what's expected of them, schedules work to be done, and gives specific guidance as to how to accomplish tasks. She would be termed a(n) ______________ leader. achievement-oriented participative supportive directive
Directive leader
Incivility/Lateral Violence
Disruptive behavior or communication that creates a negative work environment that interferes with quality care and safety Nurse to nurse Provider to provider *Zero tolerance for incivility* First step of the manager- discussion with the nurse bullying Second step- written documentation in the personnel file if the behaviors don't stop Third step- Stepwise disciplinary action in association with human resource department New nurse experiencing being bullied should support increased teamwork by behaving in a positive, upbeat manner and to not become emeshed in negative behavior on the units.
______________ decision making is NOT effective in collaboration.
Dominant decision making
Strategic Planning Process: Phase 5
Evaluation
Malpractice
Failure of a person with PROFESSIONAL EDUCATION AND SKILLS to act in a reasonable and prudent manner (wrong care)
Goals/outcomes
Focused statements of "what we hope to achieve"
Objectives
Focused steps on "How we plan to meet out goals/outcomes" SMART objectives
Formal leaders
Have legitimate power and the ability to reward and punish.
Situation monitoring- I'M SAFE
I'M SAFE *I*llness *M*edication *S*tress *A*lcohol and drugs *F*atigue *E*ating and elimination
Strategic Planning Process: Phase 3
Identification of strategies: Short term and Long term
Strategic Planning Process: Phase 4
Implementation
Incivility
Includes behaviors: eye rolling, yelling, personal attacking both physical and psychological.
Mentoring Strategy
Includes the leader sharing skills with the staff.
Precepting Strategy
Includes training staff.
Negligence
Lack in care with a NON NURSING PROFESSIONAL
Preceptors must
Learn the new employees learning style by using various learning style assessment tools. By knowing their learning style, it allows a better focus for implementation of the orientation goals is provided.
Magnet
Nurse-friendly
Internal stressors
Personal triggers -Death of a loved one -Loss of a job -Getting married/divorces -Pregnant -Illness -Lifestyle
Lewin's Change Model
Planned, First-Order Change -Linear change process -Evolutionary (cont. improvement) *Unfreezing* *Movement* *Refreezing*
The Natioterm-120nal Committee for Quality Assurance (NCQA)
Quality
What outcome would indicate that the nursing staff is using high level collaboration?
Quality care and benchmarking results
Role strain
Reflected by: -withdrawal from interaction -reduced involvement with colleagues and organization -decreased commitment to the mission and team -job dissatisfaction *Leads to absenteeism* Management of absenteeism is based on the belief that competent role performance requires interpersonal competence. *Interpersonal competence is demonstrated through the ability of a person to act in a way that honors both the tasks and the interpersonal relationships. Role behavior occurs in a social context rather than in isolation.
Ways to deal with nurse burnout
Reframing Humor Leisure activities Vacations Social support Meditation Limit caffeine Take time for self Counseling (employee assistance programs) Time management techniques Effective leadership/management
Brooke has decided that the appropriate leadership style would be to show friendliness and concern for the needs of her subordinates. She wishes to be a(n) ______________ leader. achievement-oriented participative supportive directive
Supportive
To increase client safety, the nurse manager must develop a _________________ to problem solving when working within the nursing unit an as a presentative on various hospital committees.
Systemic approach (not intricate)
Team STEPPS
Team Strategies and Tools to Enhance Performance and Patient Safety
The _________ has the authority to assign beds on all the units, transfer clients, and respond to codes.
The *Supervisor* monitors the influx of clients admitted and DC. In addition, the supervisor oversees changing conditions on the various units and also responds to codes.
Path goal theory
The leader works to motivate followers and influence goal accomplishment
Overt resistance
Those who do not try to hid that they are resistant to change. This person is comfortable with their power.
Hand off
Transfer of information (along with authority and responsibility) during transitions in care across the continuum; to include an opportunity to ask questions, clarify and confirm. Examples: Shift change Patient transfers
Hand-off
Transferring information (along with authority and responsibility) during transition of care across the continuum; to include an opportunity to ask questions, clarify and conform. Ex. During shift change or pt. transfers
1. Which type of leaders attempts to instill in followers the ability to question not only established views but those views held by the leader? transactional charismatic trait transformational
Transformational
The _________ has the authority to supervise the day-to-day operations of the unit.
Unit manager
Chaos Theory (change)
Unplanned, Second-Order Change. Nonlinear change process Complex change environment -Periods of rapid change as well as periods of relative stability -Constant state of flux (flexible, fluid) -Butterfly effect
QSEN (Quality and Safety Education for Nurses)
Use of data to monitor the outcomes of care processes and use of improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems -Patient centered care -Teamwork and collaboration -Evidence based care -Quality improvement -Informatics -Safety
Systems theory
Views the system as a whole; not a series of unrelated parts: -Closed system -Open system
1. ______________ leadership is the ability to create and articulate a realistic, credible, and attractive vision of the future for an organization or organizational unit that grows out of and improves on the future. Visionary Charismatic Trait Transactional
Visionary
Whistleblowing
Warning issued by a current or former employee of an organization to the public about a serious wrongdoing or danger created or concealed within the organization.
External stressors
Work environment stressors -High acuity -Workload -Floating -Rotating shifts -Low staff -Gender roles -Role stress (new grads)
Types of workplace violence: type 3
Worker-to-Worker Relationship between employees
Contingency theory
a leadership theory states that to maximize work group performance, leaders must be matched to the situation that best fits their leadership style. Views the pattern of leader behavior as dependent on the interaction of the personality of the leader and the needs of the situation. Fiedler's theory of situational favorableness assumed that the leader is most effective when the leader manages the situational factors of the group he or she is leading. Being successful or achieving a desired outcome, the leader in this theory must adapt his or her personality style to the situation and the style of the subordinates. Therefore, Fielder's situational theory focused on three situational factors: (a) the degree of cooperation and support offered by followers, (b) group task structure and clarity, and (c) the 25 formal authority of the leader to reward and direct followers.The complex nature of the contingency model predictions and the assumptions made that a leader can be both task-oriented and relationship-oriented depending on the situation were also criticized. Fiedler believed that training did not help, and he also believed that it was better to modify the situation.
A nurse manager who uses a leadership style involves centralized decision making, with the leader making decisions and using power to command and control others.is most likely using which of the following leadership styles? a. Autocratic b. Democratic c. Laissez-faire d. Employee-centered
a. Autocratic leadership
To engage your staff in awareness of their current practice and how it is affirmed or not by evidence, you plan a short series of learning presentations on evidence and use of heparin and saline to maintain IV patency. You meet with the educator to plan out the goals for each session with the overall purpose of increasing knowledge and awareness of staff in readiness to consider questions related to the IV practice. This learning approach is an example of which change management approach? a. Linear b. First-order c. Facilitative d. Integrative
a. Linear In the second stage, the moving or changing stage of Lewin's first-order, planned change process, planned interventions and strategies are executed to support the implementation of the change. One commonly used method is educating staff about the need for the change.
After speaking with Elizabeth a few days later you discover that she is now fine with the change but is concerned that other areas of the organization might resist the change because of perceptions related to patient safety and cost. She suggests that it is important to bring pharmacy on board as they have had previous concerns about the use of heparin. In relation to change theory, this is indicative of: a. Systems level thinking. b. Linear thinking. c. Interprofessional collaboration. d. First-order change.
a. Systems level thinking. Senge's complexity theory, Bevan's Seven Change Factors, and general systems theory all highlight connectivity and the idea that changes are not isolated events.
A nurse manager is assisting with the magnet application process when a staff nurse asks, "What is a gap analysis?" The most appropriate response by the nurse manager would be which of the following? a. The space between where the organization is and where it wants to be b. A research study of community needs that are not being met by the organization c. An audit of the organization's financial ability to undertake the magnet process d. A study of the community's need for a magnet-recognized organization
a. The space between where the organization is and where it wants to be
According to path-goal theory, a leader who lets subordinates know what's expected of them, schedules work to be done, and gives specific guidance as to how to accomplish tasks is termed _______________. a. directive b. achievement oriented c. participative d. supportive
a. directive
Fiedler's dimension termed ______________ is the degree of confidence, trust, and respect subordinates had for their leader. a. leader-member relations b. power relationship c. task structure d. authority
a. leader member relations
Kayse was the supervisor that the employees went to for general decisions that needed to be made. Kayse holds ____ power? a. legitimate b. coercive c. reward d. expert
a. legitimate
1. Which of the following is the type of power a person has because of his or her position in the formal organizational hierarchy? a. legitimate power b. coercive power c. reward power d. expert power
a. legitimate power
Clay was the person employees went to when they were to receive special recognition; Clay holds _____ power? a. reward b. legitimate c. coercive d. referent
a. reward
1. ______________ is the power to give positive benefit or rewards. a. Reward power b. Coercive power c. Expert power d. Referent power
a. reward power
Unintentional Torts
negligence and malpractice
How does the ANA define nursing informatics?
"Nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge and wisdom into nursing practice."
Absenteeism
(n) staying away from work, especially often and without good reasons. *Linked to role stress & role strain* If the employee is experiencing some form of role stress, it might be manifested through absenteeism. This leads to inadequate staffing because employees are then working overtime to cover for absent workers which creates physical and mental stress, increases cost, decreases productivity and quality of patient care. Co-workers become resentful about being forced to assume heavier workloads and are pressured to work extra hours. Chronic absenteeism leads to increased staff conflicts which leads to increased absenteeism amongst the entire staff (Decrease in nurse retention!) *Manager must discuss the situation directly with the employee* -"I feel concerned when I see that you have been absent 3 days this month" -" Can you see how excessive absences affect the smooth functioning of the unit, the workload of other team members, and the safety of patients?" -"The rate of absences can not continue. What is your plan for addressing this situation?" If the manager believes that the issue is due to work dissatisfaction, *unit based discussions may lead to insight about the sources- this provides an excellent opportunity for the novice nurse to listen, learn, and speak to issues. If the manager feels the employee is going to continue absenteeism even after discussing the issue and does not provide a written plan of action when asked, they should be terminated.
A nurse receives a call from a client's son who is requesting about the client's diagnosis for "insurance purposes". How should the nurse respond to the client's son?
*"Privacy regulations preclude me from disclosing information about our clients"*. According to HIPPA, regulations had been created that do not permit healthcare workers to disclose information about the client unless the client has signed a release of information form. There is no way to verify the person's identity over the phone.
Last will and testament
*A last will and testament* is a legal document that gives individuals the right to name others as possessors of property after the party has died.
Living will
*A living will* is a client's statement indicating the type of care he or she does or does not want should a terminal condition incapacitate the client.
___________________ and ___________________ represent external factors that influence staffing.
*Accreditation standards* *State regulations*
OSHA (Occupational Safety and Health Administration)
*Act that mandates that all employers have a general duty to provide their employees with a work place free from recognized hazards likely to cause death or serious physical harm. This includes lateral, horizontal violence, bullying and incivility*
The nurse leader attempts to resolve conflict b/t 2 nurses. Which communication skill should the leader use first?
*Active listening* The leader needs to listen to both nurses *separately and then together (meeting)*. During the meeting, the nurse should *clarify issues that are ambiguous*. Acknowledgement and clarification should lastly occur to indicate all parties are listening.
Managers
*Address COMPLEX and CHANGE* address complex issues by organizing, planning, budgeting and setting target goals. They meet their goals by organizing, staffing, controlling and solving problems.
Leaders
*Address only CHANGE* Build a culture of teamwork, set a direction, develop a vision and communicate that direction to staff
A nurse manager needs to determine the *staff mix* for the unit. What should the manager do *second*?
*Assess the competency of staff*
A nurse manager needs to determine the *staff mix* for the unit. What should the manager do *first*?
*Assess the type of care required by the clients* which is determined by acuity.
The nurse manager would recommend which of the following as the best measure to improve culture of safety on a nursing unit? 1. Have certified nursing assistants monitor clients when nurses are busy with an emergency 2. Have 2 nurses verify warfarin doses 3. Ask nurses to purchase back support devices to use for all lifting 4. Assist with a plan to install automated medication dispensing stations on the unit
*Assist with a plan to install automated medication dispensing stations on the unit* Automated medication dispensing stations provide safety features that help prevent medication errors
A nurse was recently promoted to a middle-level manager position. The nurse's title would most likely be which of the following? a. First-line manager b. Director c. Vice president of patient care services d. Chief nurse executive
*B: A middle-level manager is called a director.* A low managerial-level job is called the first-line manager. A nurse in an executive level role is called a chief nurse executive or vice president of patient care services.
According to Vroom's Theory of Motivation, force: a. is the perceived possibility that the goal will be achieved. b. describes the amount of effort one will exert to reach one's goal. c. describes people who have free will but choose to comply with orders they are given. d. is a naturally forming social group that can become a contributor to an organization.
*B: According to Vroom's Theory of Motivation, Force describes the amount of effort one will exert to reach one's goal.* Valence speaks to the level of attractiveness or unattractiveness of the goal. Expectancy is the perceived possibility that the goal will be achieved. Vroom's Theory of Motivation can be demonstrated in the form of an equation: Force = Valence Expectancy (Vroom, 1964). The theory proposes that this equation can help to predict the motivation, or force, of an individual as described by Vroom.
A nurse is appointed to a leadership position in the local hospital. The nurse's position would be considered which of the following? a. Informal leadership b. Formal leadership c. Leadership d. Management
*B: Formal leadership is based on occupying a position in an organization.* Informal leadership is shown by an individual who demonstrates leadership outside the scope of a formal leadership role or as a member of a group. Leadership is a process of influence whereby the leader influences others toward goal achievement. Management is a process to achieve organizational goals. DEFINITION OF LEADERSHIP
The theory that includes maintenance and motivation factors is: a. Maslow's hierarchy of needs. b. Herzberg's two-factor theory. c. McGregor's theory X and theory Y. d. Ouchi's theory Z
*B: The two-factor theory of motivation includes motivation and maintenance factors.* Maslow's hierarchy of needs includes the following needs: physiological, safety, security, belonging, and self-actualization. In theory X, employees prefer security, direction, and minimal responsibility. In theory Y, employees enjoy their work, show self-control and discipline, are able to contribute creatively, and are motivated by ties to the group, organization, and the work itself. The focus of theory Z is collective decision making and long-term employment that involves slower promotions and less direct supervision. TWO-FACTOR THEORY
A nurse manager who *uses their personal traits to draw their staff to them* is demonstrating what type of leadership?
*Charismatic*
Which of the following is an example of a third party payer? 1`. Centers for Medicare and Medicaid Services (CMS) 2. Cigna Insurance Company 3. Medicaid 4. Medicare
*Cigna Insurance Company* It is a private insurance company that collects premiums from enrollees for coverage. Third party payers provide a variety of services which depend on the type of coverage granted by the company.
The nurse leader is aware that which of the following are *internal factors* that impact staffing? 1. Client acuity 2. State regulations 3. Availability of staff 4. Accreditation standards 5. Levels of competence
*Client acuity* *Availability of staff* *Levels of competence* *-ALL REPRESENT INTERNAL FACTORS WITHIN THE HEALTHCARE ORGANIZATION THAT INFLUENCE STAFFING-*
A nurse leader reviews the client's charts for which of the following because they indicate effectiveness of tx and care? 1. Indicators 2. Outcomes 3. Critical pathways 4. Standards
*Client outcomes* Outcomes are key indicators of the effectiveness of tx and care received during hospitalization.
Types of violence- Type 2
*Client-Employee* -Relationship with organization and employees -Pt. becomes violent when be cared for
Critical method to developing a high performance nursing staff
*Coaching staff* that communicates clearly with expectations and accountabilities based on *role theory* is pivotal to role clarity of employees
The nurse striving to be a leader would focus on continued development of which characteristics?
*Compassion* *Loyalty* *Mission driven* *Process-orientated*
A nurse manager who *rewards a staff nurse* for creating teaching boards for parents is demonstrating what type of leadership?
*Compassionate* Compassionate leadership is characterized by the use of rewards to motivate staff for excellence in practice.
An RN delegates complicated wound care to a licenses LPN/LVN. The LPN/LVN has only changed this type of dressing once. Which component of delegation has the RN neglected?
*Competency* consideration. Because the RN did not consider the LPN/LVN skills and knowledge of complicated dressing changes if the LPN/LVN had only completed complicated wound care once before. The RN should show the LPN/LVN how to perform the skill before delegating it.
Types of violence- Type 1
*Criminal Intent* -No relationship with employees or organization
The nurse leader is starting to work on a team project with members of a diverse agency workforce. The nurse is aware that *which of the following will primarily influence communication among group members because they have different beliefs, practices, and assumptions?*
*Culture* Plays a very vital role in communication because it has a direct impact on the fashion in which people communicate with each other.
According to R. N. Lussier, motivation: a. is unconsciously demonstrated by people. b. occurs externally to influence behavior. c. is determined by others' choices. d. occurs internally to influence behavior.
*D Motivation is a process that occurs internally to influence and direct our behavior in order to satisfy needs.* Motivation is not explicitly demonstrated by people, but rather it is interpreted from their behavior. Motivation is whatever influences our choices and creates direction, intensity, and persistence in our behavior.
The six traits identified by Kirkpatrick and Locke that separate leaders from non-leaders were: a. respectability, trustworthiness, flexibility, self-confidence, intelligence, sociability. b. self-confidence, progression of experiences, influence of others, personal life factors, honesty, drive. c. intelligence, self-confidence, determination, integrity, sociability, honesty. d. drive, desire to lead, honesty, self-confidence, cognitive ability, knowledge of business.
*D: Research by Kirkpatrick and Locke concluded that leaders possess six traits: drive, desire to lead, honesty, self-confidence, cognitive ability, and knowledge of the business.* Woods identified five dominant factors that influenced leadership development: self-confidence, innate qualities, progression of experience, influence of significant others, and personal life factors. Stogdill identified the following traits of a leader: intelligence, self-confidence, determination, integrity, and sociability. Murphy and DeBack identified the following leader characteristics: caring, respectability, trustworthiness, and flexibility. LEADERSHIP CHARACTERISTICS
Nonpunitive discipline
*Discipline without punishment* A model that tallows employees to free themselves from role stress by clarifying role expectations and assumptions so that the undesirable behaviors (absenteeism) can be successfully altered. This can lead to satisfaction from the realization of the employee, that a problem may not be inadequate performance caused by personal faults, but rather a lack of clarification of role expectations within the organization. *FOCUS IS ON THE CLEAR UNDERSTANDING OF THE SITUATION, GROWTH OF INDIVIDUAL, AND SMOOTH AND EFFECTIVE FUNCTIONING OF THE TEAM.*
The nurse leader who is trying to build an effective work team tries to motivate staff nurses by explaining that __________, ___________, and ___________ are benefits of a productive team.
*Diverse solutions to problems* *Personal satisfaction* *Efficiency of services*
A nurse leader attempts effective collaboration with charge nurses. Which components of effective leadership should the leader use?
*Downward communication* *Trust* *Administrative support* *Accountability of leadership and staff*
Lewin's Change Theory: Driving Sources
*Driving forces* are those that push in a direction that causes the change to occur or that facilitate the change because they push a person in a desired direction
May benefit from *education and training*. Frequent errors in judgement or techniques are often an indication of lack of knowledge, skill, or critical thinking. The nurse manager should then search for trends in documentation and suggest that the employee is having problems, then cite them to the employee which in result they may agree to more education or training to improve their skills.
*Emotional intelligence underdevelopment* that results in such problem as being socially inept or unable to control one's impulses. These employees are frequently *defensive* and *emotional *tearful*. This employee has problems b/c of lack of self worth, power and self control. Nurse manager should relate this employee in a positive manner. A sense of humor and ability to ease the employee into a more receptive mood is helpful. However the leader needs to determine whether the undesirable behavior are reflecting a state of being uncomfortable or incompetent. Ex. Employee: "The administration is always making decisions to make our job harder" Leader response: "I notice you seem angry about this new policy. Let's talk about it some more". *Leader should react calmly w/o anger and best to confront the employee with a specific problem and define realistic limits of acceptable behavior with consequences for non adherence* If the employee continues to test management in other areas, the leader myst continue the same limit setting technique. Praise and affirmation are valuable tools that the leader can use to help the employees feel better about themselves.
Types of violence- Type 4
*Employee-Personal relationships* -No relationship with organization, but with the employee outside of the workplace
A nurse leader collaborates with team members to establish new goals. Which of the following is the best action for the nurse leader to take foster success in this project?
*Establish "buy in" from other team members*- whenever planning new ideas, it is beneficial to *get support from* other members of the team because the action may decrease resistance.
steps in progressive discipline
*First infraction: Informal verbal reprimand.* Manager and employee meet. Discuss the issue. Suggestions for improvement/correction. *Second infraction: Written warning.* Manager meets with employee to distribute written warning. Review of specific rules/policy violations. Discussion of potential consequences if infractions continue. *Third infraction: Employee placed on suspension without pay.* Time away from work gives the employee opportunity to examine the issues and consider alternatives. *Fourth infraction: Employee termination.* Follows after multiple warning have been given and employee continues to violate rules and policies.
What *strategy* should the nurse leader use to *help develop critical thinking skills in the nursing staff*?
*Foster the effective use of the nursing process*
Quality Improvement (QI)
*GOAL- To improve systems; not assign blame*
The nurse leader should use which *strategy* when communicating with team members at the *beginning of a team project*?
*Give clear directions about the nature and scope of the project* so that members have a clear vision about what is to be accomplished and the processes that will be used in the group. *Clear and concise communication addresses collaboration*
"I PASS the BATON"
*I*-introduction *P*-patient *A*-assessment *S*-situation *S*-safety concerns the *B*-background *A*-actions *T*-timing *O*-ownership *N*-next
1st step in QI process
*Identify problem!* Identify the nursing standard we are addressing ; its help with innovation and prevents error through staff development and improves systems not assign blame
Followers
*Implement patient care change and provide input into organizational change* Collaborate and communicate to translate that direction into action and share perceptions about facilitators and barriers to achieving the vision
Movement stage
*Implementation Stage* *Hardest step to overcome due to uncertainty* *Best time to provide training on the change* (1) persuading others that the status quo is not beneficial and encouraging others to view a problem with a fresh perspective; (2) working with others to find new, relevant information that can help effect the desired change; and (3) connecting with powerful leaders who also support the change (Kristonis, 2005). *This second stage is often the most difficult due to the fact that there is a level of uncertainty and fear associated with change (Shirey, 2013). Therefore, it is important to have a supportive team and clear communication in order to achieve the desired change*
A charge nurse begins the shift overwhelmed by many nursing care activities that need to be completed. *The staff has been working short- handed for months, and the charge nurse has become reluctant to delegate nursing activities such as checking the code cart and performing narcotic counts to other qualified staff.* When questioned by the nursing supervisor about *insufficient delegation*, the nurse explains which *barrier* is of key concern @ the time?
*Inadequate support* With insufficient number of healthcare workers, the nurse is handicapped in the ability to delegate because of *inadequate support*.
A nurse who has been employed with the organization for 20 years is knowledgable, has excellent ideas, and actively participates in meetings. The nurse manager submits the nurse's name for an agency award to *reward which type of leadership* exemplified by the nurse?
*Informal leader* The nurse who is an informal leader *does not hold an official title in the organization, BUT demonstrates profound efficiency influencing other*.
Mentor
*Knowledgable and Skilled* Someone who models behavior, offers advice and criticism, and coaches the novice to develop a personal leadership style. A mentor helps *boost staff's self confidence thereby helps them gain professional satisfaction*
Avoiding
*LOSE-LOSE-NO WIN* AKA withdrawing from the conflict. It is very unassertive and uncooperative because people who avoid neither pursue their own needs, goal or concerns nor assist others to pursue theirs. This approach only ensures that conflict is postponed and in result may escalate in intensity when ignored. Positive side of avoiding is when postponing an issue until a better time or simply walking away from a "no-win" situation.
Accommodating
*LOSE-WIN* An unassertive, cooperative approach to *conflict* in which the *individual neglects personal needs, goals, and concerns in favor of satisfying those of others* Ex. - A coworker requests you to cover her weekends during her child's holiday break. You had hoped to visit friends from college but you know how important it is for her to have more time with her family. So you agree to taking those shifts. In result, those who accommodate when dealing with conflict feel disappointed and resentment because they get "nothing in return".
The ______ plays a key role in the selection and development of the staff.
*MANAGER* should be a role model when creating the type of work environment that exists. They must be be supportive and develop their staff to their highest potential. They must also have accurate position descriptions and tools for evaluation of employee performance which are integral to role development and professional socialization. They must use various communication methods to empower the employees. Coaching and implementation of empowerment strategies positively contribute to overall staff performance.
When *planning change on a nursing unit*, which elements of the organizational structure should the nurse leader consider?
*People* *Resources* *Structure* Planned change should include *situational elements of the organization* such as people, resources, and structure.
A nurse manager plans to *start data collection* about venipuncture as it is performed on the nursing unit. Which tool should the manager use to facilitate this process? 1. Plan-To-Do-Study-Act (PDSA) 2. National Quality Forum (NQF)term-8 3. Agency Healthcare Research & Quality (AHRQ) 4. Quality Plus Program
*Plan-To-Do-Study-Act (PSDA)* The PDSA is a tool used for data collection. It measures the current status of procedures and is the guideline that provides quick and easy direction in data collection.
A nurse who is self analyzing personal leaderships characteristics would correctly conclude that the presence of which characteristics are consistent with those of an effective leader.
*Power and influence on others* *Ability to motivate others* *Consistent actions and beliefs*
Medicaid, Medicare and CMS are part of the __________________ __________________ ____________________
*Prospective payment system*
National Database of Nursing Quality Indicators (NDNQI)
*Provides benchmarks* Is a national nursing quality measurement program from the ANA that provides hospitals with unit level performance reports with comparisons with regional, state, and national percentile rankings. Ex. -Nursing hours per pt. day -Nursing turnovers -Nosocomial infections -Pt. falls -Pressure ulcer rates -Restraint use These are nursing measures that deal with 3 key standards: Patient outcomes, Nursing care interventions, System center measures and how the system connects. Decisions need to be based on data.
The nurse leader in a health care facility works with other organizational leaders to review and possibly revise the organization's mission statement. The nurse leader requests input from staff on the nursing unit, explaining that the *mission statement should do which of the following*?
*Provides direction and keep the ground focused* The mission statement is a broad statement that describes the *purpose of the organization* to internal and external constituents and provides the team with guidance and focus.
Refreezing stage
*Reinforcing, stabilizing and solidifying the new change* *New status quo* *Important for leader to ensure that people to not revert back to the old ways of thinking or doing* *Positive rewards of individualized efforts are often used to reinforce the new state bc positive reinforced behavior will likely to be repeated* Involves establishing the change as a new habit. The third stage is necessary to ensure that the change implemented (in the second stage) will "stick" over time (Kristonis, 2005). Success at this stage will create a new equilibrium state known to be the new norm or higher level of performance expectation (Shirey, 2013).
Emotional problems
*Remember EAP & ADA!* The nurse leader should not be a therapist but must intercede, not only to help the individual with the problems, but also maintain proper fx of the unit. Manager must *provide support and encouragement and assist the individual to obtain appropriate help to employee assistance programs (EAP) and must check with the human resources department about any implications that may occur b/c of the Americans with Disabilities Act (ADA). If the employee has a documented mental illness, the agency may be under certain legal constraints as specified in the ADA.* The manager should never feel required to know all the legal implications but rather know the available resources to help.
Lewin's Change Theory: Restraining Source
*Restraining forces* are those that counter the driving force and hinder the change because they push a person away from a desired direction. Finally, change can occur if the driving forces override or weaken the restraining forces.
The nurse identifies a client at high risk for development of pressure ulcers and orders an air mattress for the client. This nurse is attempting to accomplish which of the following? 1. Risk management 2. Culture of safety 3. Quality assurance 4. Risk reduction
*Risk reduction* In risk reduction, the nurse *identifies* that the client may develop poor outcomes and *takes measures to prevent negative client outcomes.*
Strategic Planning Process: Phase 1
*SWOT ANALYSIS* Assessment of the *external environment* Ex. Healthcare trends, Market, Competition, Technology, Economic factors, Social factors Assessment of *internal environment* Ex. Size and structure of the facility, financial resources, human resources, educational systems, research and development capabilities, information systems
The culture of a healthcare organization is changing. Nurses are allowed to self schedule, and administrators seek input from the staff on major decisions. A nurse who has been interviewed for a nursing position in this organization concludes that there has been a shift to which type of managerial model?
*Shared governance model* Characterized by input from all employees of the facility and a culture of *"this is the workplace of the employees"* and employees are treated as associated.
When interviewing for a position on a hospital nursing unit, the nurse learns that members of the nursing staff are allowed to develop and deliver in services and participate on hospital committees. The nurse concludes that this nursing unit uses which of the following models?
*Shared governance model* Leadership model that involves employees in decision making and fosters open communication with staff.
A nurse is caught stealing narcotic pain medications. The nurse manager reports this incident to which of the following regulating bodies?
*State Board of Nursing* has authority by the governor to discipline nurses for behavioral problems as well as drug problems. The board investigates any violations of state statues and regulations.
On admission to the hospital a client gives the nurse a document naming an individual to make choices in the case of the client becoming incapacitated. The document also includes the client's end-of-life wishes. The nurse communicates during intershift report that the client has a copy of which document in the medical record?
*The Durable Power of Attorney* gives an individual the authority to make decisions on behalf of another; in addition, clients may choose to add their wishes to this document.
When determining the number of full time equivalents (FTEs) needed for the unit, the nurse manager should start with:
*The number of hours of work for staff* When calculating FTEs, the unit manager should consider the # of FTEs per pay period.
Quality assurance (QA)
*The nurse focuses on getting the task done correctly* Used to monitor health care which ensures conformity to a standard. QA focuses on clinical aspects of the provider's care, often in response to an identified problem such as documentation or adherence to practice standards) Ex. "Did the nurse document the response to pain medication within the required time period? *Chart audits and chart reviews are used to detect errors and determine the person responsible for the error (looked at negatively by staff) but they are more used for annual performance appraisals or clinical laadders*
A nurse is assigned to the care of a client with an unsteady gait. The client is later found by the CNA lying on the flood, the client reports right hip pain. How should the nurse document this incident?
*The nurse should complete an incident report and document the fall in the client's medical record. The incident report is an internal risk management tool to monitor incidents within the facility* -Never place the incident report in the clients charts -Never make a copy of the incident report and place it in the nurse's record -Never provide the incident report to the client's caretakers
Competing
*WIN-LOSE* Occurs when people pursue their own needs and goals at the expense of others just to "win". term-112 WIN-LOSE
Collaborating
*WIN-WIN* *BEST APPROACH* *WIN-WIN* Although it is time consuming, it is the most creative and is both assertive and cooperative because people work creatively and openly to finds the solution that most fully satisfies all important concerns and goals to be achieved. Ex. When nurse and physicians work together, they can collaborate by asking, "What is the best thing we can do for the patient right now and how does each of us fit into the plan of care to meet their needs?" This requires discussion about the plan and how it will be accomplished. Collaboration may also lead to one withdrawing appropriately or let another person win but only if *knowing it is best to for the patient*
Centers for Disease Control and Prevention (CDC)
*Whom communicable diseases should be reported to*
The RN has completed making assignments for the shift and is preparing to delegate appropriate nursing care activities to the staff. Which tasks may the RN delegate to the CNA?
-Ambulating pt. -Recording and chart I&O -Measuring and chart VS -Measuring and chart O2 levels NO ASSESSMENT NO TEACHINGS
Unfreezing stage
-Disrupting the status quo -Gaining acceptance of problem identification *Communication and education to how the the PROS of the change out way the CONS*
Debrief
-Informal information exchange session designed to improve team performance and effectiveness; after action review
A nurse manager would draw on knowledge in ____________, ______________, and __________________ areas to balance human and fiscal resources in fulfilling role responsibilities.
1) *Healthcare financing* to manage budgets 2)*Government resources* for funding and reimbursement 3)*Consumer demographics* to identify trends and types of future services that will be needed Nursing process and use of adaptive equipment are areas in which staff nurses should be knowledgable, not the nurse manager.
Strategic planning process: Phase 2
1) Mission 2) Philosophy 3) Goals/Outcomes 4) Objectives
Dynamics of Stress
1) Perceived stressor 2) Fight/flight response 3) Emotional reaction 4) Change: stressor or person or neither 5) Physical response 6) Cognitive response 7) Adaptation or burnout
Nonpunitive discipline steps
1) Remind the employee of the policies and procedures of the agency 2) When the oral reminder doesn't result in behavior change, put the reminder in *writing*. 3) If the written reminder fails, only then *grant the employee a day of decision, which is a day off with pay to arrive at a decision about future action*, pay is given for this day so that it is not interpreted as punishment. *This is voluntary on employees part* 4) If the employee decides not to adhere to standards, *termination results*. How ever if they agree to adhere to the standards and in the future does not, *they have terminated employment*. *The leader should keep a copy of written agreements and give a copy to the employee.*
JCAHO GOAL- COMMUNICATION- National Patient Safety Goals (NPSG)
1)Improves effectiveness of communication among caregivers -Read back -Handoff 2)Accurately and completely reconciles medication and other tx across the continuum of care -Address specifically during handoff 3)Encourages the active involvement of pt. and family members in the pt. care as a pt. safety strategy
Termination
1. Manager must be confident that everything possible has been done to help the employee correct the behavior 2. Manager must recognize that if employment continues, it will have a deleterious effect on overall organizational fx 3. The employee must have been made fully aware of the problem performance and of the fact the all of the correct disciplinary steps have been followed 4. Manager should check w/ human resources and legal documents before proceeding to ensure that termination is justifiable legally and that proper steps have been followed
Guideline to assist in having difficult conversation in conflict situations
1. Start with heart- encourage a free flow of conversation 2. Learn to look- be conscious of when a conversation needs to occur 3. Make it safe- be respectful and value the other persons perspective 4. Master your story- be clear about your feelings and why they were evoked 5. State your path- ask the other nurses how they reached their perspective 6. Move to action- nurses decides how the issue being discussed will be resolved
JCAHO suggested actions to workplace violence
1. educate workers on appropriate professional behavior 2. Hold all team members accountable for modeling desirable behaviors 3. Developing "Zero tolerance" policy for intimidating/disruptive behavior
The nurse manager who is attempting to increase client safety should work on which of the following within the nursing unit and as a presentative on various hospital committees. Select all that apply. 1. Setting clear expectations 2. Developing an intricate approach to problem solving 3. Establishing consistent policies across disciplines 4. Developing maximum levels of expectations 5. Rewriting policies and proterm-16cedures yearly
1.*Setting clear expectations* 2.*Establishing consistent policies across disciplines*
Documentation of problems
A brief notation that includes date, time, and brief description of the incident is written and put in employees files. Along with this, the nurse manager should keep a log or summary sheet of all reported errors, incidents and accidents and should be tallied monthly for analysis by the manager. This tracking can be used to pinpoint an individuals problem areas and gives the manager greater control in the management of personal and personnel problems. *Description of incident- objective statement of facts r/t incident* *Actions- statements describing the plan to correct problem* *Follow up- dates and times that the plan is to be carried out, including required meeting with the employee*
Conflict
A disagreement in values or beliefs within oneself or between people that has the potential to cause harm if unresolved or stimulates change for a more favorable outcome if effectively addressed. Conflict can be desirable at times and can be a strategic tool when used appropriately. Conflict is necessary ti achieve organizational goal and cohesiveness of employees, facilitate organizational change and contribute to creative problem solving and mutual understanding. *Generates creativity, a problem solving atmosphere, a strong team spirit and motivation of workers*
Progressive discipline
A formal discipline process in which the consequences become more serious if the employee repeats the offense (harassment or chemical abuse) *This consists of evaluating performance and providing feedback within a specified structure of increasing sanctions which are labeled as least severe to most severe.* *When the nurse leader suspects this specific behavior leading to progressive discipline, it is critical that all interactions are documented and human resources are involved in the process to ensure accurate adherence to all policies*
Nurse leaders
A leader uses *charisma* and *social skills* to exert power and influence over others. They *embrace change and get their followers to adapt change*. They facilitate others in changing their behaviors when appropriate.
Delegation
A multifaceted decision Involves making a strategy which implements to improve the work performance of the staff and implements to achieve nursing goals and improve pt. care outcomes. Definition- transfer of authority and responsibility of a task to the delegatee, NOT total care! *Increases time efficiency* *Decreases stress*
Delegation
A multifaceted decision-making strategy -Implemented to improve the work performance of in the healthcare organization -Implemented to achieve nursing goals and improve patient care outcomes
Bullying
A practice closely related to lateral or horizontal violence, but a real or *perceived power differential between the instigator and recipient must be present in bullying*
The Joint Commission (TJC)
A private, not-for-profit organization that evaluates and accredits hospitals and other healthcare organizations on the basis of predefined performance standards; formerly known as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
Strategic Planning Process
A process that helps an organization allocate its resources under different conditions to accomplish its objectives, deliver value, and be competitive in a market-driven economy. *This process is a long range of planning, 3-5 year process!*
Performance appraisal- Behaviorally anchored rating scale (BARS)
A process which provides a description of every assessment along a continuum. BARS describes the employees performance both quantitatively and qualitatively.
Service recovery
A strategy for identifying complaints and rectifying service failures to retain or recover dissatisfied consumers HEART H - hear E - empathize A - apologize R - respond T - thank
Call-Out
A strategy used to communicate important or critical information -informs all team members during urgent situations -Helps team members anticipate next steps -Important to direct responsibility to a specific individual responsible to carry out the task (if not assigned, it most likely won't be done) Ex. Leader: "Airway stat?" Nurse: "Airway clear" Leader: "Breath sounds?" Nurse: "Breath sounds decreased on right"
TeamSTEPPS
A teamwork system designed to increase patient safety Situation Monitoring: *S*tatus of pt. *T*eam member *E*nvironment *P*rogress toward goal "I"M SAFE" checklist *I*llness *M*edication *S*tress *A*lcohol and drugs *F*atigue *E*ating and elmination
Benchmarking
A widespread search that is conducted to identify the best performance against which to measure others. Through this process of comparing the best practices with your practice and process, your organization learns to identify desired standards of quality performance.
A clinical instructor is teaching a nursing student about lateral violence. The student indicates she has a clear understanding of lateral violence when she states which of the following? (Select all that apply) A). Lateral violence is a major cause of interpersonal conflict. B). Heavy workload and short staffing are situations that may lead to lateral violence. C). Lateral violence includes a real or perceived power difference between the instigator and recipient. D). Newly licensed nurses and nursing students are especially vulnerable to lateral violence. E). Lateral violence is between doctors who show hostile behavior or psychological harassment to nurses.
A). Lateral violence is a major cause of interpersonal conflict. B). Heavy workload and short staffing are situations that may lead to lateral violence. E). Lateral violence is between doctors who show hostile behavior or psychological harassment to nurses. C refers to bullying D refers to horizontal violence
Which of the following may contribute to a toxic environment and foster increased incivility among staff? (Select all that apply) A. High stress level B. Inadequate staffing C. A residency program for newly hired nurses D. Organizational change E. Unrealistic expectations
A. High stress level B. Inadequate staffing D. Organizational change E. Unrealistic expectations
A nurse recognizes that the most important essential of magnetism is which of the following? a. Concern for the patient b. Good nurse-physician relationship c. Control over nursing practice d. Authoritative nursing managers
A. concern for the patient
Follower readiness refers to a(n): A. follower's ability and willingness to accomplish a particular task. B. assessment of an individual's personality in certain situations. C. personal trait or value that is difficult to change. D. follower's reaction to certain leadership styles.
A. follower's ability and willingness to accomplish a particular task.
A student asks a nurse manager why they should use a SWOT analysis. The nurse manager explains that a SWOT analysis is: a. useful in strategic planning. b. an acronym for a type of quality improvement technique. c. a financial management term. d. a human resource process.
A: A SWOT analysis is an environmental analysis used in strategic planning to measure an organization's strengths (S), weaknesses (W), opportunities (O), and threats (T).
The chief executive officer of an organization announces that the company will adopt a new policy. This organizational communication is called: a. downward. c. lateral. b. upward. d. diagonal.
A: A chief executive officer's communication is considered downward communication. The message starts at the top and is disseminated by levels through the chain of communication.
The chief executive officer of an organization announces that the company will adopt a new policy. This organizational communication is called: a. downward. b. lateral. c. upward. d. diagonal.
A: A chief executive officer's communication is considered downward communication. The message starts at the top and is disseminated by levels through the chain of communication.
Active listening for what is said and how it is said, as well as noting nonverbal cues that support or negate congruence, is called: a. attending. c. clarifying. b. responding. d. confronting.
A: Attending is the active listening for what is said and how it is said as well as noting nonverbal cues that support or negate congruence. Responding is verbal and nonverbal acknowledgement of the sender's message. Clarifying is restating, questioning, and rephrasing to help the message become clear. Confronting is identifying the conflict and then clearly delineating the problem.
A nursing instructor is evaluating whether the nursing students understand the 3 fundamental qualities that leaders share. According to Bennis and Nanus, the fundamental qualities of effective leaders are: a. guided vision, passion, and integrity. b. knowledge of self, honesty, and maturity. c. intelligence, self-confidence, and determination. d. honesty, self-awareness, and sociability.
A: Bennis and Nanus list guided vision, passion, and integrity as fundamental qualities of *effective leaders.* Knowledge of self, honesty and maturity; intelligence, self-confidence and determination; self-awareness and sociability are all *desirable traits* in leaders as well as in others. LEADERSHIP CHARACTERISTICS
The level of communication that is concerned with communication between individuals is: a. interpersonal. b. public. c. intrapersonal. d. physiological.
A: Interpersonal communication is concerned with communication between individuals, either person to person or in small groups. Intrapersonal communication is self-talk. Public communication is communicating with a group of people with a common interest. Kinesthetic communication involves touch and physiological responses.
An accountant at the local hospital would understand that which of the following government organizations is responsible for the administration of Medicare and Medicaid? a. Health Care Financing Administration (HCFA) b. Social Security Department c. Tax Equity and Fiscal Responsibility Act (TEFRA) d. Congress
A: It is the responsibility of the Health Care Financing Administration (HCFA) to administer and oversee the Medicare and Medicaid programs. In 1982, the Tax Equity and Fiscal Responsibility Act (TEFRA) went into effect as a means of establishing new payment regulations in an attempt to reduce the increasing governmental expenditure for these programs.
You have been appointed president of your state's local nursing association. The power derived from this appointment is referred to as which of the following? a. Legitimate power c. Referent power b. Expert power d. Reward/coercion power
A: Legitimate power is power derived from the position a nurse holds in a group. As the president of the nursing association, you have legitimate power and the authority over the actions of the association
Improvement in quality patient outcomes has been reported in magnet organizations. According to several studies, which of the following is thought to contribute significantly to quality patient outcomes? a. Nurse's work environment b. Quality assessment practices c. Performance improvement practices d. Shorter lengths of stay in the hospital
A: Research by Lake and Friese; Aiken, Smith, and Lake; and Aiken, Sloane, Lake, Sochalski, and Weber support the importance of the nurse's work environment to enhanced continuity of patient care, increased levels of patient satisfaction, and lower mortality rate.
According to R. N. Lussier, there are content motivation theories and process motivation theories. Which of the following is considered a process motivation theory? a. Equity theory b. Hierarchy of needs theory c. Existence-relatedness-growth theory d. Hygiene maintenance and motivation factors
A: The *process* motivation theories are equity theory and expectancy theory.* The *content* motivation theories include Maslow's hierarchy of needs theory, Aldefer's existence-relatedness-growth (ERG) theory, and Herzberg's hygiene maintenance factors and motivation factors. MOTIVATION THEORIES
A nurse manager is developing a comprehensive unit-based performance quality improvement program that includes outcomes tracked from four domains. Which of the following would the nurse manager least likely choose as one of the domains? a. Process c. Cost b. Service d. Clinical quality
A: Unit-based quality improvement programs need to track certain aspects of care that reflect the unit's goals in order to ensure their compliance with regulatory and quality initiatives. These outcomes should come from four domains: access, service, cost, and clinical quality. Process is not included, but various processes will be used in the tracking and monitoring procedure
Delegation is important for which reason? a. It is a means to organize the patient care needs according to acuity, desired outcomes, and staff levels. b. It provides a way to assign difficult patients to uncooperative nurses. c. It enables new nurses to gain experience with difficult patients by themselves. d. It is a means to organize the patient care needs according to acuity, desired outcomes, and staff levels, and it provides a way to assign difficult patients to uncooperative nurses.
A: While delegation, as defined by the ANA, is "the transfer of responsibility for the performance of an activity from one individual to another while retaining accountability for the outcome," the RN can use this skill to organize how the staff is utilized to meet the patient care needs for the shift. When delegating tasks to nursing personnel, the RN should take into consideration the patient's condition (acuity), staff skills and experience, complexity of the task assigned, staff workload, desired outcomes, and the amount of supervision needed to achieve the desired outcomes for the shift.
Which of the following was initiated to help ensure that the quality and safety of care was not compromised? a. CQI b. HSA c. TEFRA d. PPO
A: With the increase of monitoring and accountability for health care expenditure and the decrease of available services per health care dollar, attention to the quality and safety of the care given arose. Programs such as continuous quality improvement (CQI) and total quality improvement (TQI) were begun to help assure society that these cost management efforts were not compromising care.
1. Planning is a process designed to achieve goals in dynamic, competitive environments. As a new manager, what is the first step you will undertake to develop a strategic plan of action for a congestive heart failure program? a. Search the environment to determine changes that may affect the organization. b. Appraise the organization's strengths and weaknesses. c. Identify the major opportunities for and threats to the organization. d. Identify and evaluate the various strategies available to the organization.
ANS: A Assessment of the external environment is the first step in the strategic planning process.
6. The chief nursing officer has to write a strategic plan. The most difficult stage in the strategic planning process is: a. Assessment of the external and internal environment. b. Review of mission statement, goals, and objectives. c. Identification of strategies. d. Implementation of strategies.
ANS: A Determination of strengths, weaknesses, opportunities, and threats requires openness to what is being said and observed and is critical to setting the stage for relevant responses in the latter phases of strategic planning.
3. Northwestern Hospital has decided to implement peer review. As a clinical leader in the Emergency Department, you have overall responsibility for ensuring that this is in place by next month. The most important step in this process is to: a. Provide an educational session for staff on peer review. b. Revise the mission statement, objectives, and performance standards. c. Develop objectives and performance standards with employees. d. Implement objectives and performance standards.
ANS: A Once a strategic plan has been developed, the next step is open communication and execution of the specific plan, which, in this instance, is peer review.
19. Shifts such as changes in the percentage of seniors in the population, governmental initiatives in health care, and the influence of income on health status are factors in the __________ environment. a. Public b. Macro c. Competitive d. Social
ANS: B The external environment in strategic marketing planning includes the public, competitive, and macro environments. Demographic, social, and political factors are included in the macro environments.
5. As a nursing leadership student, you have had the opportunity to develop a palliative care manual that will be utilized by the palliative care network (PCN) in your region for teaching healthcare professionals. The PCN has requested that you provide a prioritized plan of action for marketing the manual on a regional and state basis. What is the first priority? a. Motivate the target market. b. Research the target market. c. Communicate benefits to the target group. d. Package the product.
ANS: B To put a strategic plan into place for marketing, it is necessary to conduct an external assessment.
18. Nurses are valuable partners in marketing strategies because they: a. Are more likely than other members of the organization to use marketing tools. b. Have a strong background in using evidence to support decisions. c. Have close involvement with patients, who are the target group for marketing. d. Constitute the largest staff group in most healthcare organizations.
ANS: C As nurses are directly involved with patients who use services and who are the target group for marketing efforts, nurses have excellent insights into patient needs.
10. To conduct assessment of the internal environment, the strategic planning team for Pacific Hospital: a. Invites community members and staff of the hospital to an evening focus group session. b. Discusses what it sees as the primary threats and opportunities in demographic shifts affecting the hospital. c. Invites all levels of staff to focus groups on the effectiveness of the hospital environment, including information systems and staffing. d. Asks the board to provide a summary of major opportunities for the future.
ANS: C Assessment of the internal environment should include all levels of staff and facilitates feedback on effectiveness of strengths and weaknesses of systems and processes within the institution.
20. A private ambulance clinic established a few streets away from Pacific Hospital markets its services as quality-based within caring relationships. The clinic is part of the __________ environment. a. Public b. Macro c. Competitive d. Social
ANS: C The competitive environment includes factors and elements that compete for resources with another organization. These elements may include those in public and macro environments.
13. At the beginning of its strategic planning processes, Pacific Hospital learns that nursing staff members are uncomfortable with utilizing evidence-based practice, and that staff perceives that only limited resources are available to support translation of evidence into their usual practice. Because this issue has been identified, the management team determines that a plan of action is required to address the issue. Who should be involved at this point? a. Nursing unit managers b. Staff nurses c. All staff d. Administration
ANS: C The first phase in planning is conducting an assessment of the external and internal environments. Assessment of the internal environment should include all levels of staff and facilitates feedback on effectiveness of strengths and weaknesses of systems and processes within the institution.
17. After an extensive campaign to ensure that the community surrounding Pacific Hospital has been exposed to the emphasis of excellence in clinical care that occurs through the use of evidence, the marketing team finds that the public perception has changed little. This determination is made possible through: a. Marketing surveys. b. Focus groups. c. Informal feedback. d. Comparison of data against benchmarks.
ANS: D Developing benchmark data at the beginning of a project enables comparison of later data against the benchmark to determine if a marketing plan has met its objectives.
Benchmarks in the strategic marketing planning process are useful in: a. Establishing programs. b. Setting targets. c. Rewarding employees. d. Measuring progress.
ANS: D Establishing benchmarks enables measurement of the interim and final achievements of programs.
2. A community-based pain management program is being planned for your region. As a coordinator of a home care agency, you have been requested to develop a conceptual framework, mission statement, philosophy, and objectives for the program. In what order will you pursue this endeavor? a. Objectives, philosophy, and mission statement b. Philosophy, objectives, and mission statement c. Philosophy, mission statement, and objectives d. Mission statement, philosophy, and objectives
ANS: D The development of the mission statement is the first step in defining the purpose and direction of the organization after an assessment has been completed.
14. In implementing the strategic plan for effective utilization of evidence to guide nursing practice at Pacific Hospital, the nursing unit managers take the next step, which is the implementation. Implementation most likely would involve: a. Revisiting the mission statement and objectives. b. Reevaluating external and internal factors affecting evidence-based practice. c. Preparing a budget to support implementation. d. Developing unit-based objectives related to the plan.
ANS: D The previous planning (assessment of internal and external environments, development of a mission and plan, and allocation of resources) has already been completed. The next step involves adapting the strategic plan to the nursing units.
Delegation-Supervision
An active process of directing, guiding and influencing the outcome of the individual performance of an activity It is interpersonal and goal directed Requires: -knowledge of own scope of practice, role dimensions, job description -knowledge of UAPs scope, role dimensions and job description -thorough understand of skill sets of the UAP (if not delegator should show delegatee before delegating)
What are some challenges that occur within the workplace? (Select all that apply) A. Absenteeism B. Chemically dependent employees C. Immature employees D. Relationship problems within the workplace E. Unproductive employees
Answer A, B, C, E: Problems such as absenteeism, uncooperative or unproductive employees, clinical incompetence, employees with emotional problems, and chemically dependent employees are just a few challenges in the workplace
Consequences of violent occurrences in the workplace include: (select all that apply) A. Saving time and money B. Reduced productivity C. Loss of organizational investment D. Reduced quality care
Answer B, C, D B. Reduced productivity C. loss of organizational investment D. Reduced quality of care
Cindy, a nurse manager, feels an immature employee is targeting her when she attacks multiple decisions the leadership makes. What should the other manager remind Cindy of? A. It is important to take what she says into consideration. B. The attack is not against you, it is a personal issue she is dealing with herself. C. Don't sweat it, her opinion doesn't matter anyway. D. Just focus on doing the best you can.
Answer B: The leader must keep in mind that this employee may be displaying dynamics rooted in unresolved personal areas and the behavior is not a personal attack
Ryan is a nurse on an oncology unit. While at work, his wife shows up at the nursing station screaming his name. As Ryan approaches the nursing station, his wife throws a clip board at him. This type of violence is known as: A. Criminal Intent (Type I) B. Customer/Client (Type II) C. Worker-on-Worker (Type III) D. Personal Relationship (Type IV)
Answer D: Personal Relationship (Type V)
Which is true about the termination process? (Select all that apply) A. The manager can fire an employee after they are confident that everything possible was done to help correct the situation B. The employee must be aware of the consequences following discussion about the issue at hand. C. The nurse manager must consult her boss before terminating the individual. D. The manager must verify that continuing employment would have negative effects on patient care.
Answer: A, B, DNot C: The nurse does not need to consult her boss before terminating the individual. The manager must check with human resources to ensure termination is justifiable legally and the proper steps have been followed
A community clinic receives a number of complaints from patients about waiting up to 2 hours for scheduled appointments to see a licensed practitioner. The nurse manager is following the quality improvement process and determines that the next step in the process would be to do which of the following? A. Collect data to evaluate the implementation of the plan and the achievement of outcomes B. Assemble a multidisciplinary team to review the identified consumer needs and services C. Collect data to measure the current status of these services D. Establish measurable outcomes and quality indicators E. Select and implement a plan to meet the outcomes
Answer: B Assemble a multidisciplinary team to review the identified consumer needs and services *First step to QI process is to identify the consumers needs* 2. Assemble an inter professional team to review the identified consumer needs and services. 3.Collect data to measure the current status of these services 4.Establish measurable outcomes and quality indicators 5.Select and implement a plant to meet the outcomes 6.Collect data to evaluate the implementation of the plan and the achievement of outcomes
Followers during change
Are critical to the change process! -They should offer information, suggestion and concerns -They should have a constructive/positive attitude -They should be flexible -They should tolerate ambiguity (openness) -They should thoughtfully support the change agent -They should seek opportunities to participate
Compassionate leaders
Are driven by the needs of their employees.
Situational leader
Arises based on given situations (first responder to a code, anesthesia administration)
Nurse responsibility delgating
As nurses maintain responsibility and liability for the actions of unlicensed personnel, it is imperative they understand the scope of practice of 62 unlicensed workers. There needs to be a consistent approach to UAP training and education RNs must be aware of the specific skill levels the UAP possess, and what skills the RN can delegate. Ultimately, the RN must supervise the UAP to ensure the UAP is providing safe patient care and meeting patient goals or outcomes.
What should leaders first assess in order to apply the situational leadership model? A. The level of task and relationship behavior that will likely produce successful outcomes. B. The readiness level of the follower relative to the task to be accomplished. C. The leader's behavior that best suits the current situation and task. D. The historical behavior patterns of the leader and follower.
B. The readiness level of the follower relative to the task to be accomplished.
A nurse is using general systems theory to describe the role of nursing to provide health promotion and patient teaching. Which statements reflect key points of this theory? Select all that apply. A. A system is a set of individual elements that rarely interact with each other. B. The whole system is always greater than its parts. C. Boundaries separate systems from each other and their environments. D. A change in one subsystem will not affect other subsystems. E. To survive, open systems maintain balance through feedback. F. A closed system allows input from and to the environment.
B. The whole system is always greater than its parts. C. Boundaries separate systems from each other and their environments. E. To survive, open systems maintain balance through feedback.
The nurse manager on one of the hospital units views the staff as basically lazy and only motivated by threats and coercion. Which theory of motivation would support the manager's beliefs? a. Theory W b. Theory X c. Theory Y d. Theory Z
B. Theory X
The difference between bullying in the workplace and lateral violence is that: A. lateral violence is verbal harassment whereas bullying is both verbal and physical harassment. B. bullying occurs when there is a real or perceived power difference between the people involved. C. bullying only occurs when the people involved are at different levels of authority. D. bullying only happens in grade school.
B. bullying occurs when there is a real or perceived power difference between the people involved.
As an RN, you recognize that delegation involves which of the following? a. Assigning your staff to tasks that need to be completed b. Transferring responsibility for the performance of a task from one individual to another while retaining accountability for the outcome c. Identifying the appropriate individual to give care and demonstrate accountability for that care d. Transferring accountability for the provision of care to the individual assigned to give the care
B: As an RN, you would recognize that delegation involves the transfer of responsibility for the performance of a task from one individual to another while retaining accountability for the outcome. When making assignments, you would identify the appropriate staff members to complete specific tasks. While the staff members are responsible for their assigned tasks, you as the RN always retains accountability.
One of the top benefits of magnet designation for a hospital is: a. being self-insured for all employees. b. improved nurse recruitment and retention. c. lower on-job back injuries reported by staff. d. larger number of culturally diverse employees.
B: Hospitals attaining magnet designation may achieve multiple benefits. The major benefits are improved patient quality outcomes, enhanced organizational culture, improved nurse recruitment and retention, enhanced safety outcomes, enhanced competitive advantage, and higher nurse job satisfaction.
When a nurse recommends to the nurse manager a more efficient approach to organizing care, this type of organizational communication is called: a. downward. c. lateral. b. upward. d. diagonal.
B: In upward communication, the idea originates at some level below the top of the structure and moves upward ORGANIZATIONAL COMMUNICATION
When a nurse recommends to the nurse manager a more efficient approach to organizing care, this type of organizational communication is called: a. downward. b. lateral. c. upward. d. diagonal.
B: In upward communication, the idea originates at some level below the top of the structure and moves upward.
When the nurse says to himself, "I can do this procedure," it is a form of what level of communication? a. Interpersonal c. Nonverbal b. Intrapersonal d. Nonpublic
B: Intrapersonal communication can be thought of as self-talk. It is what people do within themselves, and it can present as either doubts or affirmations.
When the nurse says to himself, "I can do this procedure," it is a form of what level of communication? a. Interpersonal c. Nonverbal b. Intrapersonal d. Nonpublic
B: Intrapersonal communication can be thought of as self-talk. It is what people do within themselves, and it can present as either doubts or affirmations. Interpersonal communication is communication between individuals or small groups. A nurse presenting a workshop is an example of public communication. Nonverbal language deals with body language or facial expressions.
QSEN is an initiative focused on: a. computer literacy for nurses. b. reform in nursing education in the areas of quality and safety. c. statistics for nurses working in environmental health care. d. improving patient satisfaction in the areas of safety and wellness.
B: Quality and Safety Education for Nurses (QSEN) was developed as part of a Robert Wood Johnson-funded project designed to facilitate reform in nursing education in the areas of quality and safety. QSEN is a comprehensive resource for quality and safety
QSEN is an initiative focused on: a. computer literacy for nurses. b. reform in nursing education in the areas of quality and safety. c. statistics for nurses working in environmental health care. d. improving patient satisfaction in the areas of safety and wellness.
B: Quality and Safety Education for Nurses (QSEN) was developed as part of a Robert Wood Johnson-funded project designed to facilitate reform in nursing education in the areas of quality and safety. QSEN is a comprehensive resource for quality and safety education for nurses.
Your agency hires a nurse consultant who is certified in wound care. The consultant is scheduled to work with staff nurses on methods to promote wound healing. Which type of power does the nurse consultant possess? a. Legitimate power c. Referent power b. Expert power d. Reward/coercion power
B: The knowledge and skills nurses possess are referred to as expert power. Since the consultant is certified in wound care, the consultant would possess expert power.
The nurse is informed that the clinic employs all four principles of the whole-systems shared governance. The nurse knows that which of the following is NOT one of these four principles? a. Partnership c. Accountability b. Collaboration d. Ownership
B: The principles of whole-systems shared governance are partnership (implies horizontal linkages between nursing and other staff roles), equity (staff roles are based upon relationships, not titles), accountability (individuals are accountable for their actions), and ownership (individuals own the work they perform).
Your supervisor compliments you on your ongoing ability to integrate and apply the knowledge, skills, judgment, and personal attitudes required to practice safely and ethically. The supervisor is commenting on which of your qualities? a. Authority c. Responsibility b. Competence d. Right
B: The supervisor is complimenting you on your competence as an RN. Competence is the ongoing ability of a nurse to integrate and apply the knowledge, skills, judgment, and personal attitudes required to practice safely and ethically in a designated role and setting
A nurse manager is trying to develop a means to facilitate professional staff development by building upon the skills, abilities, and experience of each practitioner. This method is otherwise known as: a. career enhancement. c. the novice to expert model. b. clinical ladder. d. situational leadership model.
B: The use of a clinical ladder is a means of ensuring staff competence, and it acknowledges that staff members have varying skill sets and abilities based upon their education and experiences. The clinical ladder helps to evaluate these abilities and rewards each staff member differently according to his placement in the designed (ladder) clinical structure.
A new graduate RN assigns a NAP to provide basic ADL (activities of daily living) to several patients on her unit. The NAP obtains vital signs and helps to bathe and feed the patients assigned. The nurse is: a. accountable only for the actions done by herself. b. accountable for all her own actions and those of the NAP. c. accountable only for the basic ADL provided by the NAP. d. not accountable for anything the NAP does outside of the NAP's scope of practice.
B: Through the act of delegation, the nurse is accountable for the actions or inactions of the assigned NAP. The NAP is always responsible for completing the tasks assigned, but accountability stays with the RN
As the nurse manager of the unit, it is important for you to consider which of the following when making patient assignments? a. Staff education levels, skill sets, cultural traditions, willingness to be a team player b. Staff education levels, scope of practice, experience, and patient acuity c. Staff skill sets, education levels, timeliness, and patient acuity d. Patient acuity, staff experience, education, and ethnicity
B: When making patient care assignments, you must consider staff education levels, scope of practice, experience, and patient acuity. An assignment is a distribution of work that each staff member is to accomplish during a given time period according to their scope of practice. An NAP should not be assigned to irrigate a colostomy or do a dressing change of a stage II decubitus ulcer even if the NAP is very experienced. Willingness to be a team player and skill level are important, but they should not be the sole factors when making assignments.
American Academy of Nursing AAN
Began accrediting hospitals with well-qualified nurse executives in a *decentralized environment* with organizational structures that emphasized open, participatory management in the early 1980s. *Magnet*
Magnet hospitals are known for enhanced safety outcomes. According to Aiken, Sloane, and Klocinski, magnet hospitals are known to have: a. less than 1 percent nosocomial infections per year. b. zero to five reported OSHA violations per year. c. fewer needle sticks. d. fewer back injuries.
C. Fewer needle sticks
Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effects." You follow up with Elizabeth and discover that she is really quite angry about the information sessions because she feels that you are implying that "what she has been doing all these years means that she is incompetent and doesn't care about her patients." Elizabeth is an example of a(n): a. Early adopter. b. Late majority. c. Laggard. d. Resister.
C. Laggard Laggards prefer keeping traditions alive ("We have always done it this way") and openly express their resistance to ideas (speaking out against the change). Late majority individuals are openly negative but will engage with new ideas when most others adopt the change.
The leadership theory that considers follower readiness as a factor in determining leadership style is: a. contingency. b. path goal. c. situational. d. charismatic.
C. Situational theory Considers the follower readiness as a factor in determining leadership style
Katie is working in the ED. She feels that her co-workers often act unprofessionally and that her nurse manager does not discipline them appropriately. At times, she feels dehumanized because her co-workers make rude comments about the care she provides. Katie's work environment can be defined as a(n): A. Happy Environment B. Conducive Environment C. Toxic Environment D. Health Promoting Environment
C. Toxic Environment
The new nurse manager of a medical unit focuses on day-to-day operations and short-term goals, while the nurse manager of the mental health unit is committed to the vision that empowers the staff. The manager of the medical unit would most likely be considered which type of leader? a. Transformational leader b. Charismatic leader c. Transactional leader d. Autocratic leader
C. Transactional leader
1. The _______________ style of leadership describes a leader who tends to involve employees in decision making, delegate authority, encourage participation in deciding work methods and goals, and use feedback as an opportunity for coaching employees. a. cultural b. autocratic c. democratic d. laissez-faire
C. democratic
A nursing student is experiencing horizontal violence from a staff nurse at her clinical site. Which step should the student take in addressing this problem? A.) Ignore it and go on about her day. B.) Confront the nurse in front of the floor staff at the nurses station. C.) Inform her instructor or floor manager and ask for assistance in handling this issue. D.) Avoid the staff nurse for the rest of the day.
C.) Inform your instructor or floor manager in charge and ask for assistance in handling this issue. Rationale: Incorporating workplace civility in nursing orientation programs and modeling professional behaviors provides a foundation to promote a healthy work culture. Nursing students and new graduates often lack the confidence and skill set to prevent interpersonal conflict and must rely on experienced nurse managers and leaders to reduce the likelihood of horizontal violence or bullying. Nurse educators have a similar responsibility to develop nursing curricula that educate and encourage dialogue about horizontal violence to increase awareness and provide nursing students the skills to combat horizontal violence (Yoder-Wise, 2015).
A nurse manager is composing a vision statement for the organization. The nurse should include which of the following of the four elements of a sound vision statement? a. It is written down. b. It is written in the present tense using action words. c. It covers a variety of activities and spans specific short-term time frames. d. It balances the needs of providers, patients, and the environment.
C: An effective vision statement will include a range of activities that can be accomplished within a specified time frame
The Health Insurance Portability and Accountability Act (HIPAA) was developed to: a. make it easier to transport and transmit your personal health information. b. guard against insurance companies selling their client list of names and addresses. c. protect all individuals' identifiable health information held or transmitted. d. make health insurance companies more accountable for payment of claims.
C: HIPAA was developed to protect all individually identifiable health information held or transmitted by a covered entity or its business associate, in any form or medium, whether electronic, paper, or oral.
The nurse manager is aware that situational leadership maintains there is no one best leadership style, but rather effective leadership lies in matching the appropriate leadership style to the individual's or group's level of task-relevant readiness. The nurse manager wishes to help promote and develop the manager's staff and followers. Under the situational leadership model, which of the following is not necessarily correct to achieve this outcome? a. Coaching c. Collaborating b. Supporting d. Delegating
C: Hersey and Blanchard's (1993) situational leadership framework is based upon four stages of behavior through which leaders can move back and forth as they determine which style they need to use to promote staff development. These stages are directing, coaching, supporting, and delegating (not collaborating).
A nurse manager is engaged in a process designed to achieve goals in dynamic, competitive environments through allocation of resources. This process is called: a. process improvement. c. strategic planning. b. total quality improvement. d. market analysis.
C: Strategic planning is the process by which specific goals are met through an allocation of resources. It also involves clarifying the organization's philosophy, mission, and vision and analyzing the current environmental state.
The Magnet Hospital Recognition Program was created to achieve three major goals. Which of the following is considered a goal? a. Decrease and attempt to abolish the nursing shortage b. "Pay for performance" or higher wages for higher quality work c. Identify excellence in the delivery of nursing services to patients d. Drive down the soaring cost of health care in the United States
C: The goals are to identify excellence in the delivery of nursing services to patients, promote quality in a milieu that supports professional nursing practice, and provide a mechanism for the dissemination of best practices in nursing services.
Chaos change theory
Characterized by order that emerges from rapid and unplanned fluctuations. Change is supposed to be linear, not orderly.
The _________ has the authority to supervise the activities on the unit during a specific shift.
Charge nurse
A nurse manager meets regularly with other nurse managers, participates on the organization's committees, and attends meetings sponsored by professional organizations in order to manage relationships. These activities are considered which function of a manager? a. Informing b. Problem solving c. Monitoring d. Networking
D Networking
There is a contemporary move toward addressing nursing as a science or as evidenced-based practice. This suggests that: A) One theory will guide nursing practice. B) Scientists will make nursing decisions. C) Theories will be tested to describe or predict client outcomes. D) Nursing will base client care on the practice of other sciences.
D) Nursing will base client care on the practice of other sciences.
During preparation of the application for magnet status, a nurse asks the supervisor, "What is meant by nursing sensitive indicators"? The supervisor would be correct in responding: a. Indicators that a nurse is vulnerable to depression b. Indications as to whether a nurse is sensitive to stress c. Nurses working with sensitive and confidential information d. Measures that reflect the outcomes of nursing actions and cares
D. The supervisor would be correct in responding that nursing sensitive indicators measure the outcome of nursing care. These indicators represent the patient's response to the various strategies implemented by the nursing staff.
The provision of guidance, direction, evaluation, and follow-up by a licensed nurse for tasks provided by an NAP (nursing assistive personnel) is: a. delegation. c. authority. b. accountability. d. supervision.
D: According to the ANA (1997, p. 20), supervision is "the active process of directing, guiding, and influencing the outcome of an individual's performance of an activity." The supervisory nurse provides clear direction and information to staff concerning what tasks are to be accomplished, for what patients, at what time, and how the tasks are to be done.
A nurse manager is attempting to devise a statement that reflects the purpose of a health care agency. This statement is referred to as which of the following? a. Core values c. Vision b. Philosophy d. Mission
D: An organization's mission statement reveals its purpose, direction, and reason for existence. A philosophy is a statement of beliefs based upon core values (inner forces that give it purpose). A vision statement reflects the organization's vision (foresight) of what it wants to be. MISSION STATEMENT
Saint Cecil's hospital recently achieved "magnet" status. This means that the hospital has met the: a. AHA distinguished service award for excellence in community service. b. JC patient care performance measures with no deficiencies. c. OSHA compliance with all guidelines and no deficiencies. d. ANCC nursing excellence requirements.
D: Magnet status is awarded to health care organizations that have met the rigorous nursing excellence requirements of the American Nurses Credentialing Center (ANCC), a division of the American Nurses Association (ANA). Achievement of magnet status designation represents the highest level of recognition the ANCC accords to health care organizations that provide the services of registered professional nurses.
Nine characteristics define magnet nursing services. Which of the following is NOT a characteristic of the program's appraisal process? a. High quality patient care b. Clinical autonomy and responsibility c. Community involvement d. High compensation and benefits
D: Nine characteristics define magnet nursing services: high quality patient care, clinical autonomy and responsibility, participatory decision making, strong nurse leaders, two-way communication with staff, community involvement, opportunity and encouragement of professional development, effective use of staff resources, and high levels of job satisfaction.
A nurse has just started to work for an organization that employs a shared governance organizational framework. The nurse understands that this type of framework is grounded in a philosophy of decentralized leadership; however, the nurse understands that which of the following may not necessarily be correct regarding shared governance? a. It implies the allocation of power and control. b. It fosters autonomous decision making. c. It consists of mutually interested or vested parties. d. It encourages professional liaisons among all hospital levels.
D: Shared governance is an organizational framework positioned in a framework of decentralized leadership, and it implies the allocation of control, power, or authority (shared) and fosters autonomous decision making and professional nursing practice among mutually (shared) interested parties such as management and clinicians (not all hospital levels).
An instructor wants to determine whether a group of nursing students understands the process for conducting evidence reports in nursing using a PICO-based approach. Which of the following comments by the students would indicate that learning has occurred? a. Select problem, identify methods for assigning level of evidence, report evidence, report findings, make recommendations, give summary b. Select problem, report evidence, identify methods for assigning level of evidence, report findings, make recommendations, give summary c. Select problem, report findings, report the evidence, identify methods for assigning level of evidence, give summary, and make recommendations d. Formulate a well-built question, identify articles and other evidence-based resources that answer the question, critically appraise the evidence to assess its validity, apply the evidence, reevaluate the application of evidence and areas for improvement
D: The steps in the method for conducting evidence reports in nursing based on a PICO-based method are to formulate a well-built question, identify articles and other evidence-based resources that answer the question, critically appraise the evidence to assess its validity, apply the evidence, reevaluate the application of evidence and areas for improvement.
An instructor wants to determine whether a group of nursing students understands the process for conducting evidence reports in nursing using a PICO-based approach. Which of the following comments by the students would indicate that learning has occurred? a. Select problem, identify methods for assigning level of evidence, report evidence, report findings, make recommendations, give summary b. Select problem, report evidence, identify methods for assigning level of evidence, report findings, make recommendations, give summary c. Select problem, report findings, report the evidence, identify methods for assigning level of evidence, give summary, and make recommendations d. Formulate a well-built question, identify articles and other evidence-based resources that answer the question, critically appraise the evidence to assess its validity, apply the evidence, reevaluate the application of evidence and areas for improvement
D: The steps in the method for conducting evidence reports in nursing based on a PICO-based method are to formulate a well-built question, identify articles and other evidence-based resources that answer the question, critically appraise the evidence to assess its validity, apply the evidence, reevaluate the application of evidence and areas for improvement. PICO-BASED APPROACH TO GUIDING AN EVIDENCE SEARCH
In contingency theory, the feelings and attitudes of followers regarding acceptance, trust, and credibility of the leader are called: a. task structure. b. position power. c. low task structure. d. leader-member relations.
D: leader-member relations *In contingency theory, leader-member relations are the feelings and attitudes of followers regarding acceptance, trust, and credibility of the leader.* Task structure of contingency theory means the degree that work is defined, with specific procedures, explicit directions, and goals. Low task structure involves work that is not routine, predictable, or clearly defined. Position power in contingency theory is the degree of formal authority and influence associated with the leader.
State boards of nursing *protect the public from incompetent nurses*. The safety of the public is secured by which of the following?
Each nursing graduate must apply to take the *national licensure examination* with the appropriate state board of nursing. The state board *regulates nursing practice* and *provides a definition of practice* in each state. States require that practicing nurses take *continuing education courses* of maintain competency in practice.
I-SBAR-R
Effective communication tool that improves patient outcomes *I*ntroduce *S*ituation *B*ackground *A*ssessment *R*ecommendations *R*ead back
Charismatic leaders
Empower their employees, foster participation in decision making and attempt to transform individuals.
Occupational Safety and Health Administration (OSHA)
Enforces safety standards and provides training and outreach to employers to ensure safe and healthful working conditions. OSHA defines workplace violence as any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the worksite. *LATERAL AGGRESSION, HORIZONTAL VIOLENCE, BULLYING*
Performance appraisal
Evaluations of the individuals work performance which ideally are conducted on an ongoing basis. They are mainly done annually and may be required after a scheduled orientation period for new employees. They are intended to encourage improvement in performances of employees who's work is at minimum and intended to encourage employees with previously outstanding performance to maintain that level. Should never be done at a time when an employee first hears that they are performing below a minimum acceptable level. It is best received at a time closest to the incident being evaluated. *Addressing both POSITIVE and NEGATIVE issues r/t performance is important* *Designed so that they can be supported in court if need arises. Court decisions can be made based on the evidence or lack of evidenced, presented in the evaluation instrument. Example would be justifying the fairness for termination. Can be informal or formal. Brief anecdotal notes- note that describes an occurrence either favorable or unfavorable in a brief or consider manner and should be entered in employees folder on a regular basis. Over time as these notes accumulate, it provides a more accurate cumulative appraisal. *The purpose is to assist the manager with information throughout the entire rating period*. Competency assessment- combines skills, knowledge, and behaviors to properly perform in a variety of patient care situations. This is integrated into evaluation process and further enhances *sense of empowerment*. *Coaching* process in which personal approach of manager & employee occurs on a regular basis promotes *team building and optimal performance of the employees*. This enhances communication.
After an incident occurred that involved the use of a medical device and the incident resulted in a serious injury to a client, the nurse manager explains to staff that the report will be forwarded to which federal agency?
Facilities that receive Medicare and Medicaid funding must report sentinel events to the *Centers for Medicare and Medicaid Services (CMMS)*
A comprehensive quality and risk program that proactively identifies and reduces risks to patient safety is done through the completion of a....
Failure mode and effects analysis (FMEA) -a systematic, proactive method for evaluating a process to identify where and how it might fail and to asses the relative impact of different failures to identify the parts of the process that are most in need of change.
UAP Delgations
Health related, non-nursing functions, clerical, dietary, and transportation (NYSNA, 2004). Health related functions include taking vital signs, measuring intake and output, mobility measures such as transfers from bed to chair or wheelchair, providing range of motion exercises, bathing patients, collecting specimens, collecting data on patients' conditions, including pain, and reporting changes to the registered nurse. Housekeeping functions consist of environmental cleaning such as stripping and cleaning beds, general and 60 special equipment cleaning. Ordering supplies, processing requests, charting vital signs are clerical tasks. Transportation functions include escorting nonacute patients, delivering supplies, specimens, and blood, and delivering linen. Dietary functions include documenting food and oral intake and delivering nourishments (NYSNA, p. 3-4). The role of the UAP, therefore, is to assist the nurse in many non-nursing specific ways, providing direct patient care consistent with national standards of practice and state nursing practice acts.
Lewin's Force Field Analysis
Highlights that at any moment there are forces for and against change. This model identifies how change may be brought about. Barriers- timing, lack of energy Facilitators- Knowledge improve pt. outcomes, skills, resources
Toxic workplace
Horizontal violence- Involves conflictual behaviors among individuals who consider them selves peers with equal power but with little power within the system (Nurse to nursing student or new nurse) Lateral aggression- Aggressive and destructive behavior of co workers against each other (Doctor to nurse) Bullying- A real or perceived power and recipient are present Interpersonal conflict- Conflict between coworkers OCCUR
Magnet Hospitals
Hospital that attracts and retains nurses even in times of nursing shortages. The characteristics that Magnet hospitals obtain, facilitate professional practice in nursing and promote quality pt. outcomes -decentralized and flat organizational structure -participative management style -influential nurse executives -professional autonomy and decision making -lower burnout rates, high levels of job/pt. satisfaction
Factors r/t turnover costs (120,000$/ year)
Human resource costs Lost of productivity Training Relocation expenses Terminal pay outs
A nurse inserted a urinary drainage catheter without properly cleaning the client's perineal area according to agency policy and the directions on the prepackaged kit. Subsequently, the client developed urosepsis and died. The nurse understands that, in a court of law, these actions would be considered grounds for which of the following most specific charges?
In healthcare, *negligence* is referred to as a failure to provide a standard of care other nurses or healthcare providers give in similar situations. Negligence is a form of tort (but tort is too broad of a term).
Role Stress
Incongruence between perceived role expectations and achievements. Role stress for new graduate nurses is r/t role ambiguity and role over load. Role stress is particularly acute for new graduate nurses, whose lack of clinical experience and organization skills, combined with new situations and procedures, may increase feelings of overwhelming stress. Conflict b/t what was learned in the classroom and actual practice compounds the situation and increases stress. AKA *Reality Shock*
The vision statement of a healthcare system is "Provide quality, cost effective care to clients in our region". The nurse manager best demonstrates the vision statement by:
Instituting care maps for patients with diabetes mellitus. Care maps are guiding to provide nationally accepted, standardized care. The care is scheduled aggressive care to prevent increased length of the hospital stat while maintaining satisfactory client outcomes.
Horizontal violence
Involves conflictual behaviors among individuals who consider themselves peers with equal power but with little power within the system. Describes aggressive and destructive behavior of co-workers against each other. *Nurses already working and competing for power*
Performance appraisal- Graphing rating scale
Is a checklist on which a manager rates employee performance on a continuum such as excellent, good, average, and poor. The continuum usually includes a numerical scale from 1 (low) to 5 (hight)
Procrastination
Is not a character flaw but a set of behaviors, which were *developed over a period of time* and behaviors that can be changed.
2 Challenge Rule
It is your personal responsibility to assertively voice your concerns at least 2 times to ensure it has been heard so that the team members challenging you acknowledges your concern. If the outcome is still not acceptable, take a stronger course of action or use supervisor or chain of commands "It's okay to *CUS* at work!" "I am *C*oncerned!" "I am *U*ncomfortable!" "This is a *S*afety concern!"
2 challenge rule
It is your personal responsibility to assertively voice your concerns at least TWO TIMES to ensure it has been heard The team members being challenges must acknowledge your concern If the outcome is still not acceptable: -Take a stronger course of action -Use supervisor or chain of commands
Key to dysfunction with change is
Lack of trust!
Workplace violence
Lateral/Horizontal/Organizational 1) OSHA- published voluntary guidelines for workers in the health cares but not all states have enacted these laws, standards or recommendations r/t healthcare workplace security and safety (WI) 2) The Joint Commission on the Accreditation of Healthcare- Strengthened leadership standards requirements for accreditation
Chemical dependency
Manager must intervene bc pt. care may be jeopardized. The manager should face the problem with compassion yet therapeutic, knowing that *denial* is a primary sign of abuse and strive the employee to the EAP who always protect the employees privacy. This removes the manager from the counseling role and helps employee get professional help they need with out fear of a breach in confidentiality. If employee accepts to go into the rehab program, they are still able to work but are monitored by the manager, the manager is responsible for providing feed back about the employees progress to the employee and to the state or rehab program involved. This employee is also either not able to work in a facility where that drug is passed or may work there but can not pass that certain drug. If employee refuses to seek help, the manager is responsible for following the established policies for substance abuse and must remember if the employee is terminated and not reported to State Board Of Nursing, manager is violating the law. Manager is responsible for upholding the nurse practice act *(NPA)* and check with the human resource department for help with how to handle the employment of a chemically dependent employee. *The state board of nursing is key* to determine specific details. Manager should notice any behavioral change in employee such as someone that is normally tidy becoming untidy or unusual interest in their patients or increase in absenteeism or tardies may indicate chemical dependency. Manager should show empathy and understanding instead of punishing.
Uncooperative or unproductive employees
May benefit from *education and training*. Frequent errors in judgement or techniques are often an indication of lack of knowledge, skill, or critical thinking. The nurse manager should then search for trends in documentation and suggest that the employee is having problems, then cite them to the employee which in result they may agree to more education or training to improve their skills.
To increase client safety, the nurse manager must develop ______________ levels of expectations when working within the nursing unit an as a presentative on various hospital committees.
Minimum expectation (not maximum)
An organization with no conflict is characterized by...
NO CHANGE
JCAHO goals in communication
National Patient Safety Goals (NPSGs) 1) Improved effectiveness of communication among caregivers -Read back -Handoffs
Organizational conflict
Occurs when discord exists about policies and procedures, personnel codes of conduct or accepted norms of behavior and patterns of communication. Some of this conflict is related to hierarchical structure and role differentiation among employees.
Clinical incompetence
One of the most frustrating problems that the nurse leader faces because this can occur with new employees where despite an effective interview process, a lack of fit exists and the nurse can be coached and supported to find a different position, on that fully utilizes their skills. It is also hard because other employees fail to report the poor practice which is unprofessional and can not be tolerated. To avoid, *skill checklists or a competency evaluation program* is used to ascertain that their employees have and maintain essential skills for the job. A skills checklist is one way to determine clinical competency and contains a number of basic skills along with ones that are essential for safe functioning in the specific area of employment.
Liability
Personal Liability Personal responsibility and accountability for their own actions or omissions Vicarious Liability Respondeat Superior doctrine "Let the Master answer" Indemnification Allows institutions to countersue for damages paid based on negligence Corporate Liability Institutional liability for maintaining an environment that ensures quality healthcare delivery to consumers Hiring and firing Safety of physical environment Qualified, competent and adequate staff Product Liability a product may be held to HIGHER liability than a person equipment and other products fall within the scope of nursing responsibility
Types of workplace violence: type 4
Personal Relationships No relationship with organization, but relationship with employee outside of the workplace
Nurse manager
Persuades other staff nurses to buy into the agency's vision, mission and special projects and to embrace change. The nurse manager is expected to have these leadership abilities in addition to their management skills.
Which activity demonstrates the organizational Chaos Theory? -Preparing the yearly unit budget -Planning for unexpected staffing shortages -Preparing a rubric to guide staff performance reviews -Setting unit goals related to quality control of client care
Planning for unexpected staffing shortages . The Chaos Theory suggests that a degree of order can be attained by viewing complicated behaviors and *unpredictable* situations as predictable by planning for them. The other options are not considered unpredictable.
While reading an article on power, a nurse would most likely hypothesize that power can be described as which of the following? a. Authority and influence b. Accountability and responsibility c. Personal and professional approaches to life d. Ability to create, get, and use resources to achieve one's goals
Power is the ability to create, get, and use resources to achieve one's goals. Power can occur at various levels, including personal, professional, and organizational. Authority, influence, accountability, and responsibility may result from power; however, these terms do not define power.
Performance appraisal- Management by objectives (MBO)
Process in which a manager and employee jointly set goals for the employee, periodically evaluate performance, and reward according to results. During the performance appraisal, the employee and manager address the goal and objectives.
Situation monitoring
Process of continually scanning and assessing what is going on around you o maintain situational awareness
Situation monitoring
Process of continually scanning and assessing what is going on around you to maintain situational awareness
Cross monitoring
Process of monitoring actions of team members. This is an error reduction strategy and provides a safety net within the team while ensuring mistakes are caught quickly and easily "watching each other's backs"
Performance appraisal- Narrative
Process which requires manager to write a statement about the employees performance. This can be done in the form of a written letter/document and is based on the managers writing style and content.
Whistleblowing Protection
Protects federal workers however the current environment in health care, places the "at will" employee who voices concern about quality of care at risk for termination at any time for any reason except discrimination. "At will" workers, work at the will of the employer and works without a contract.
Incivility
Range of behaviors from ignoring others, to rolling one's eyes, to yelling, and eventually to personal attacks, both physical and psychological which are both unacceptable at the workplace.
De-Escalating
Reduces the level of tension to the point at which the person under stress can regain control and avoid violence. 1)Allow them to have control -a stressful event can be magnified if the person feels they do not have the resources to handle the situation 2)Improve communication -decreases frustration due to ineffective communication -listen -act calm 3)Allow the person a way to back-down without embarrassment 4)Do not allow an environment that is conducive to violence -have security cameras with 24 hr surveillance -have others present -use public place *The nurse needs to understand how they handle stress which can influence their ability to effectively de-escalate others*
Identifying potentially violent people: STAMP
STAMP Staring Tone and volume of voice Anxiety Mumbling Pacing *Nurse stand between door if patient looks violent
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
Safety & Standards
Philosophy
Set of beliefs and values critical to achieving the mission
Shared Governance Model
Shared governance is a working model of participatory decision making in which nurses are organized to make decisions about clinical practice standards, quality improvement, staff and professional development, and research. ANCC considers the concepts of shared governance throughout an organization when granting both Magnet and Pathway to Excellence program recognition. The shared governance model is based on four core principles, and this month at Cleveland Clinic's annual 'Shared Governance Day' the Cleveland Clinic Nursing Institute unveiled a new enterprisewide shared governance structure centered on these principles. Equality: Shared and equal focus on patients, services, and staff as all essential to providing safe and effective care Empowerment: Authority and autonomy to make decisions about nursing practice Accountability: Responsibility and willingness to invest in ethical practices through shared decision-making Partnership: Emphasis on collaboration and teamwork among caregivers and between caregivers and patients/families
Brief
Short information session prior to start to discuss team formation; assign essential roles; establish expectations and climate; anticipate outcomes and likely contingencies
Environment for performance appraisal
Should be communicated during a quiet and private time where interruptions are avoided. This time is important for clarification of employee and organizational goal. It should be objective and unemotional and the atmosphere should be relaxed yet professional. The evaluation instruments should be clearly completed and time should be allowed for discussion. (review specific examples for both positive and negative behaviors- keep an anecdotal file for each employee) (employee should be allowed to express their opinions, orally or in writing). Goals may be established and follow up dates to monitor for improvements may be necessary. The manager and employee should sign the appraisal forms and each should be provided with a copy. *Mainly relies on the manner in which the manager uses the tools and feedback effectively to the employee- sincere, constructive in both praise and criticism* Show the employee confidence in their performance. Effective communication between manager and employee can prevent potential performance problems on a unit.
When caring for a violent patient, the nurse should make sure to...
Stand at an angle to the person, slightly outside their personal space (usually 3 ft or so) rather than in their face. Between the door and the hallway so you are not blocked from getting out!!
Mission
Statement of "Who we are and why were here"
Strategic Plan Process
Strategic planning enables an organization to look into the future in an orderly and systematic way, ensures that a hospital remains relevant and responsive to patient and community needs and provides a clear and consistent organizational focus. Long range planning 3-5 year process Emphasizes on the organization's mission statement 1. Assess the external environment 2. Assess the internal environment 3. SWOT analysis- strengths, weaknesses, opportunities, threats 4. Look at the mission "who we are and why we are here" 5. Look at the philosophy (beliefs and values) 6. Look at goals "what we hope to achieve" 7. Look at the objectives "how we place to meet the goals" SMART 8. Identify short and long term strategies 9. Implement 10. Evaluation (ongoing surveys, interviews, studies_
Which strategy should the nurse leader use to foster a climate of *collaboration* on the nursing unit? 1. Place emphasis on tasks to be accomplished during each shift 2. Display an open attitude toward new ideas and suggestions 3. Focus on high quality care and benchmarking results 4. Use firm communication about items of importance to the nurse leader
The best strategy the nurse can use to foster collaboration is *developing/displaying openness towards ideas and suggestions of the nursing staff* -Emphasis on tasks is not effective in collaboration - Firm communication is not effective in collaboration -Focusing on quality care is an appropriate strategy for a nurse leader BUT is rather an out come of high level collaboration among staff. This question focuses on collaboration as a process
Empowerment
The expansion of employees' knowledge, tasks, and decision-making responsibilities Empowerment is the ability to complete tasks through other people (McConnell, 1995). The leadership style of empowerment is an important tool that can be used in delegation as the RN needs to possess skills of empowerment (i.e., facilitation, advising, training, and being a teammate) when delegating to UAPs (McConnell, 1995). Through the use of empowerment when delegating, the RN shares his or her power with the UAP. This sharing of power between the RN and the UAP can help subordinates gain satisfaction by increasing the subordinate's knowledge and power base, where the subordinate feels more fulfillment and is self-directed, leading to goal attainment for the institution.
Which performance appraise method is best?
The mission and goals of the organization determine the methods used. *A combination of methods is best and better than any one method being used* The primary success of any performance appraisal lies in the skills and communication abilities of the manager. The manager has the responsibility to educated employees about the process and told for performance appraisals. *Role ambiguity and uncertainty of standards of practice and methods for evaluation are significant contributors to decreased work satisfaction. The best designed instrument will fail if the manager is ineffective and cannot communicate with the employee. Some linkage of the outcomes of the appraisal process to salary and benefits conveys a reinforcement of the process of appraising and its importance for individual professional development.
Risk management
The nurse analyzes problems to reduce the risk of pt. harm resulting from falls and preventing healthcare associated pressure ulcers.
A nurse assists a client in room A with lunch. The charge nurse calls the nurse to report that the client in room C reports pain and is requesting pain medication. What is the nurses best action?
The nurse should *stop feeding the client in room A and medicate the client for pain in room C*. While eating is a priority, it does not take presence over an individual with pain. The client in pain is experiencing discomfort that should be addressed immediately. The nurse could also delegate the activity of feeding the client in room A as long as it is delegated to the appropriate person (not the charge nurse), such as the nursing assistant. The charge nurse is busy overseeing the fx of the unit and feeding is not an appropriate activity for the nurse to *reverse delegate* to the charge nurse.
Culture of Safety
The nurse uses a strategy in which the organization designs systems to prevent and detect errors.
Causation
The nurses actions or lack of actions are aimed directly to cause harm to the patient (direct relationship)
Late majority: response to change
They are openly negative and wait for others to change first
Laggards: response to change
They are traditionalist and openly resist change
Early majority: response to change
They prefer stasis but accept change
Rejecters: response to change
They refuse change and will sabotage any effort forward the change
Early adopters: response to change
They sought out by peers for advice on change
Innovators: response to change
They thrive on change
Covert resistance
Those who deliberately are resistant to change but done in a manner that allows the perpetrators to appear *as though they are not resisting* FAKE and passive resistant! *Key to approach this is draw the team member out of silence*
Legal
Torts: Torts are civil laws that address the legal rights of patients and the responsibilities of the nurse in the nurse patient relationship. Some torts specific to nursing and nursing practice include things like malpractice, negligence and violations relating to patient confidentiality. (Berman and Synder, 2012) Unintentional Torts: Unintentional torts include things like malpractice and negligence. Intentional Torts: Intentional torts include things like false imprisonment, assault, battery, breaches of privacy and patient confidentiality, slander and libel. Liability: Liability is vulnerability and legal responsibility, simply stated. For example, nurses are liable when they fail to carry out doctor's orders. (Berman and Synder, 2012) Respondeat Superior: Respondeat Superior is the legal doctrine or principle that states that employers are legally responsible for the acts and behaviors of its employees. Respondeat Superior does not, however, relieve the nurse of legally responsibility and accountability for their actions. They remain liable. (Berman and Synder, 2012) Negligence: Negligence is a nonintentional tort. Negligence occurs when the nurse fails to follow established policies, procedures and standards of care in the same manner that another "reasonable" nurse would do in the same situation. (Berman and Synder, 2012) Malpractice: Malpractice, also a nonintentional tort, has six elements. The elements of malpractice include a duty, a breach of duty as a nurse, reasonable foreseeability that the nurse's act has a connection with the patient injury that occurred, the patient was harmed, the link that act directly led to the harm and the patient has the right to financial compensation or damages. (Berman and Synder, 2012) Assault: Assault, an intentional tort, is threatening to touch a person without their consent. (Berman and Synder, 2012) Battery: Battery, another intentional tort, is touching a person without their consent. (Berman and Synder, 2012) False Imprisonment: False imprisonment is restraining, detaining and/or restricting a person's freedom of movement. Using a restraint without an order is considered false imprisonment. (Berman and Synder, 2012) Defamation: Defamation is making false statements about a person in writing or orally that leads to the destruction of a person's reputation. (Berman and Synder, 2012) Slander: Slander is oral defamation of character using false statements. Libel: Libel is written defamation of character using false statements.
Transformational leaders
Transformational leadership results in long-term effectiveness, an advantage because the style addresses the higher order needs of individuals (Medley & Larochelle, 1995). The transformational leader does not use these behaviors. The transformational leader motivates through the use of charisma, intellectual stimulation, and individualized consideration. Transformational leaders are charismatic, and followers want to identify with them, trust them, and develop intense feelings about them. Transformational 51 leaders differ from leaders who are merely charismatic. This is because the transformational leader is able to accomplish change by motivating employees to exceed task expectations (Medley & Larochelle). Therefore, organizations characterized by leaders who use transformational leadership are more successful than those organizations that do not use this style
When goals/outcomes are somewhat unclear in early preparation for a complex change, the manager and the change management team develop several acceptable goals/outcomes. This change in management approach is termed: a. Unfreezing. b. Nonlinear. c. Cybernetic. d. Linear.
Unlinear While Lewin's theory was designed to describe planned or first-order changes, many scholars think the theory is too simplistic to address how unplanned or second-order change occurs. In complex situations with an uncertain change environment, a nonlinear approach that involves flexibility improves overall outcomes. Linear change is appropriate to stable, less complex, and more predictable situations. *Chaos theory*
Cross monitoring
Used as an error reduction strategy which involves: -Monitoring actions of other team members -Providing a safety net within the team -Ensuring mistakes or oversights are caught easily and quickly *Watching each others back*
Skills checklist
Very effective method for the leader to assess the skill level of employees and to determine where additional education and training may be needed. At the completion of the assessment, a specific plan for remediation can be developed or if the leader feels there is lack of knowledge, formal education may be indicated. 1) It is a 3 phase tool to enable the newly hired RN and the nurse manager to determine individual learning needs, verify competency, and plan performance goals. 2) The RN will complete the self assessment of clinical skills during the first week of employment and use the appropriate scale to document current knowledge of clinical skills. 3) The nurse manager will document observed competency of the orientee or delegate this to a peer. All columns must be completed on the *inventory level* 4) At the end of orientation, the new RN and manager will use the inventory to identify performance goals on the plan sheet. the skills inventory will be in a specified place on the nursing unit so that it is available to the manager and other RNS. it should be update at appropriate intervals.
Shared vision
When all members uphold goals created by the administration
To increase client safety, the nurse manager must rewrite policies and procedures ______________ when working within the nursing unit an as a presentative on various hospital committees.
When needed, based on evidence based practice research and change in standards of care (not yearly)
An individual who is seeking health care services and who has limited proficiency in English has the right to have an interpreter available to facilitate communication within the health care system. This statement is according to what legal requirement? a. Title VI of the Civil Rights Act of 1964 b. The Joint Commission c. U.S. Code Title XIX addressing individuals entitled to medical assistance d. Health Information Portability and Accessibility Act
a. Title VI of the Civil Rights Act of 1964
An individual who is seeking health care services and who has limited proficiency in English has the right to have an interpreter available to facilitate communication within the health care system. This statement is according to what legal requirement? a. Title VI of the Civil Rights Act of 1964 b. The Joint Commission c. U.S. Code Title XIX addressing individuals entitled to medical assistance d. Health Information Portability and Accessibility Act
a. Title VI of the Civil Rights Act of 1964
As a new manager, you are shocked to learn that your unit is still using heparin in heparin locks. You are aware of evidence related to this practice and want to change this practice as quickly as possible on your unit. You are in which stage of Lewin's stages of change? a. Unfreezing b. Experiencing the change c. Moving d. Refreezing
a. Unfreezing Although you may be at a higher level of change in relation to your individual practice and knowledge of the use of change, in this situation, you are recognizing the need for change in relation to practice on the unit that you are managing. This phase is the initial phase in first-order change and will involve listening to staff to see if they perceive a similar problem.
Which of the following is an example of whistle blowing? a. a nurse contacts administration about a colleague who takes supplies to use for a mission trip. b. a client sues a nurse because she failed to call the physician about his wound infection c. a cna calls for help when a client falls out of bed d. a client developed a sacral pressure ulcer when he was not turned in bed over 4 hours
a. a nurse contacts administration about a colleague who takes supplies to use for a mission trip. Whistle blowing involves notifying administration or a supervisor about activities taking place that are unethical or illegal. Nurses who act as whistle blowers may be reluctant to speak up because of fear of reproach from colleagues or the consequences of their actions on the person acting unjustly.
The Informatics Nurse Specialist is expected to: a. demonstrate the competencies enumerated in the Standard of Practice for Nursing Informatics, as outlined by the ANA. b. serve as the department's IT go-to person. c. have a bachelor's degree in nursing informatics. d. share knowledge and best practices of informatics by teaching seminars and holding training sessions for hospital employees.
a. demonstrate the competencies enumerated in the Standard of Practice for Nursing Informatics, as outlined by the ANA.
A staff nurse asks the supervisor, "What is an essential element to giving quality care in magnet hospitals?" Which response by the supervisor would be the most appropriate? a. Higher salary, benefits, and paid time off than in non-magnet hospitals b. Adequate nurse staffing and support for continuing professional development c. Cross-training for flexibility in practice and higher compensation when flexed d. Moving from one magnet hospital to another without loss of seniority or benefits
b. Adequate nurse staffing and support for continuing professional development
Which of the following provides a competitive advantage for hospitals with magnet designation? a. High turnover and low job satisfaction b. Low turnover and high job satisfaction c. High turnover and high job satisfaction d. Low turnover and low job satisfaction
b. Low turnover and high job satisfaction
A culturally sensitive nurse can use which of the following techniques when communicating with colleagues of different cultures? a. Use only written communication channels. b. Minimize the use of jargon specific to the nurse's culture. c. State "I'm trying to get through to you, don't you understand." d. Continue to listen even when the nurse doesn't understand the message.
b. Minimize the use of jargon specific to the nurse's culture.
Based on Elizabeth's insights and suggestions, you involve pharmacy, only to discover that the change in practice involves practice committees, a medical practice committee, and concerns from administration about potential costs and safety of the proposed change to the IV protocols. The change process at this point is: a. Linear. b. Nonlinear. c. Sabotaged. d. Neutralized.
b. Nonlinear. Complex change involves nonlinear processes and a variety of strategies to negotiate influences on change. Complexity theories alter the traditional systems thinking approach by asserting that system behavior is unpredictable. This theory views change as emergent, nonlinear, and highly influenced by all individuals and subsystems in an organization. *Chaos theory*
1. What did the most comprehensive analysis identify as a characteristic that differentiates charismatic leaders from noncharismatic ones? a. They are sensitive only to follower needs. b. They are willing to take risks to achieve a vision. c. They exhibit ordinary behaviors. d. They have a mission.
b. They are willing to take risks to achieve a vision.
A nurse manager who implements the bureaucratic management style will most likely do which of the following? a. Emphasize efficiency b. Use explicit rules and regulations for governing activities c. View the individual worker as the source of control, motivation, and productivity d. Expect unity of command and direction
b. Use explicit rules and regulations for governing activities
Tamera was the person employees went to when disciplinary action had to be taken. Tamera held _____ power? a. legitimate b. coercive c. reward d. expert
b. coercive
1. ____________ is the power that rests on the leader's ability to punish or control. a. Reward power b. Coercive power c. Expert power d. Referent power
b. coercive power
According to the Ohio State studies, the dimension of leader behavior that is defined as the extent to which a leader had job relationships characterized by mutual trust and respect for group members' ideas and feelings is called ______________. a. initiation b. consideration c. cultural d. physical
b. consideration The leadership dimension of *consideration* involves activities that *focus on the employee.*
1. Evidence indicates that transformational leadership is strongly correlated with _______________. a. lower turnover rates and lower levels of goal attainment and follower well-being b. lower turnover rates and higher levels of productivity and creativity c. higher turnover rates and lower levels of productivity and employee satisfaction d. higher turnover rates and higher levels of employee satisfaction and follower well-being
b. lower turnover rates and higher levels of productivity and creativity
Franklin was the person employees went to when they needed resources or sought his charisma. Franklin holds _____ power? a. legitimate b. referent c. reward d. expert
b. referent
1. __________ is the power that arises because of a person's desirable resources or personal traits. a. Expert power b. Referent power c. Reward power d. Legitimate power
b. referent power
1. All of the following are sources of leader power except ______________. a. legitimate b. status c. expert d. coercive
b. status
The SBAR technique (situation-background-assessment-recommendation) is designed to improve communication among health care personnel. Which of the following is an example of assessment? a. "I'm calling about Mr. Jones in 312." b. "Mr. Jones hasn't had a bowel movement in 2 days, which is unusual for him." c. "Mr. Jones has decreased peristalsis, abdominal discomfort, and is on a narcotic analgesic." d. "Can we start him on Colace 2 BID and add magnesium citrate if no BM within 8 hours?"
c. "Mr. Jones has decreased peristalsis, abdominal discomfort, and is on a narcotic analgesic."
The home health agency hired an expert in financial management to evaluate and propose a plan for reversing growing expenses and decreasing revenues. The expert is well respected, both personally and professionally, by members living in this small community. To be effective, staff will need to perceive this change agent as: a. Trusted, quiet. b. Flexible, informal. c. Credible, enthusiastic d. Communicative, personable.
c. Credible, enthusiastic To influence the decision, the expert must be seen as having knowledge of what matters to the people that they lead and of the change area itself. The expert also must be enthusiastic and communicative and have referent power.
As the unit manager on the unit that is leading changes to heparin locks, you find that Elizabeth is very valuable in terms of her observations about other units and her knowledge of organizational processes, and now in discussing the new procedure with others. Elizabeth might be considered an: a. Engager. b. Innovator. c. Informal change agent. d. Informant.
c. Informal change agent. Informal change agents are those who do not have formal, positional power but who have credibility through expertise and can model the new way of thinking, or who offer suggestions, ideas, and concerns.
According to the Ohio State studies, which of the following dimensions of leader behavior refers to the extent to which a leader is likely to define and structure his or her role and the roles of group members in the search for goal attainment? a. intelligence structure b. psychological structure c. initiating structure d. consideration structure
c. Initiating structure Initiating structures of leadership involves an emphasis on the work to be done, the focus on the task and the focus on production.
A nurse manager who is passive and permissive, and in addition defers decision making is most likely using which of the following leadership styles? a. Autocratic b. Democratic c. Laissez-faire d. Employee-centered
c. Laissez-faire
Edith has been vocal about her negative concerns related to a new charting system and frequently expresses the view that keeping the "old system" would have been "just fine." In facilitating change, your best approach to Edith would be to: a. Put her in the pilot planning group for the change. b. Determine if she has considered retirement. c. Schedule her work assignment so that it coincides with those of two staff members who are confident with technology and the change. d. Avoid discussion of the change, and trust that with sufficient training and information, she will change.
c. Schedule her work assignment so that it coincides with those of two staff members who are confident with technology and the change. Laggards prefer keeping traditions and openly express their resistance to new ideas. Having a group of change agents and innovators on board to champion an idea builds what Patterson et al. call "social motivation" and "social ability." This group can help staff, such as laggards, who are less adept at change.
Which of the following is an accurate statement about transformational leaders? a. They are poor motivators. b. They clarify task requirements. c. They exhibit more than just charisma. d. They focus on tasks and pay little attention to followers.
c. They exhibit more than just charisma.
A leader who sets challenging goals and expects very high performance levels from subordinates is classified as what type of leader, according to path-goal theory? a. supportive b. participative c. achievement oriented d. democratic
c. achievement oriented
In working with his employees, Carlos tries to ensure that they are involved in decision making and he encourages them to participate in deciding their work methods and goals. Carlos's leadership style can best be described as ______________. a. autocratic b. laissez-faire c. democratic d. despotic
c. democratic
When engaging in evidence-based health care, the nurse understands that it was originally started as a way to: a. teach medical students the art and science of medicine. b. promote technological advances in medicine. c. integrate individual experience with clinical research. d. incorporate collaboration within all health care disciplines.
c. integrate individual experience with clinical research. D. L. Sackett, well known in the EBM movement, encouraged evidenced-based medicine as a way to integrate individual clinical medical experience with external clinical evidence using a systematic research approach.
According to path-goal theory, a manager who consults with subordinates and uses their suggestions exhibits what type of leadership behavior? a. directive b. achievement oriented c. participative d. supportive
c. participative
According to the path-goal theory, directive leadership will lead to higher employee satisfaction when there is ______________ within a work group. a. cohesiveness b. high structure c. substantial conflict d. internal locus of control
c. substantial conflict
1. Carrie stopped Sondra in the lunchroom and just had to tell her about ______________, where followers make claims about heroic or extraordinary leadership abilities when they observe certain behaviors. a. charismatic leadership b. transactional leadership c. transformational leadership d. situational leadership
c. transformational leadership
1. Carrie stopped Harry in the hall and just had to tell him about ______________, that is, leadership characterized by enthusiasm, self-confidence, and the ability to influence people to behave in certain ways. charismatic leadership transactional leadership situational leadership attributional leadership
charismatic leadership
Brooke would like to become a participative leader. She should ________________. let subordinates know what's expected of them, schedule work to be done, and give specific guidance as to how to accomplish tasks be friendly and show concern for the needs of subordinates consult with subordinates and use their suggestions before making a decision set challenging goals and expect subordinates to perform at their highest level
consult with subordinates and use their suggestions before making a decision
A nurse manager who focuses on the human needs of subordinates. is most likely using which of the following leadership styles? a. Autocratic b. Democratic c. Laissez-faire d. Employee-centered
d. Employee-centered
1. In the University of Iowa behavioral studies, group members' satisfaction levels were generally __________. a. higher under an autocratic leader in the long run b. improved when the leader was considerate of the outcomes c. maintained when the leader was autocratic on the short run d. higher under a democratic leader than under an autocratic one
d. Higher under a democratic leader than under an autocratic one
Which of the following is not one of the hypotheses that have evolved from the path-goal theory? a. Supportive leadership results in high employee performance and satisfaction when subordinates are performing structured tasks. b. Directive leadership is likely to be perceived as redundant among subordinates with high perceived ability or with considerable experience. c. The clearer and more bureaucratic the formal authority relationships, the more leaders should exhibit supportive behavior and deemphasize directive behavior. d. Subordinates with an external locus of control will be less satisfied with a directive style.
d. Subordinates with an external locus of control will be less satisfied with a directive style.
Resistance is most likely when change: a. Is not well understood. b. Involves many layers in an organization. c. Involves nonprofessional workers. d. Threatens personal security.
d. Threatens personal security. Resistance and reluctance commonly occur when personal security is threatened and may involve loss of confidence in abilities or loss of job or financial security.
Path-goal theory identifies two classes of situation variables that moderate the leadership-behavior outcome as _________________. a. tact and relationship b. path and goal c. people and history d. environment and followers
d. environment and followers
Juan was the person employees went to when knowledge of a topic was needed. Juan holds what power? a. legitimate b. reward c. referent d. expert
d. expert
1. Which of the following describes the leadership style in which the leader generally gives the group complete freedom to make decisions and complete the work in whatever way it sees fit? a. cultural style b. autocratic style c. democratic style d. laissez-faire style
d. laissez-faire style
Transactional leaders are leaders who guide _________________. a. and direct groups towards their goals and tasks b. and clarify the followers' goals and task requirements c. or clarify the group's goals and roles d. or motivate their followers in the direction of established goals by clarifying role and task requirements
d. or motivate their followers in the direction of established goals by clarifying role and task requirements
Nurses use informatics in order to: a. play computer games for entertainment. b. foster collaboration among nurses and others who are interested in nursing informatics. c. provide management training for nurses interested in communication technology. d. substitution, innovation, and transformation of patient care, nursing administration, or educational preparation.
d. substitution, innovation, and transformation of patient care, nursing administration, or educational preparation.
According to path-goal theory, a leader who is friendly and shows concern for the needs of subordinates is termed _______________. a. directive b. achievement oriented c. participative d. supportive
d. supportive
1. Which of the following is not one of the qualities that are related to effectiveness in the roles of visionary leaders? a. the ability to explain the vision to others b. the ability to express the vision not just verbally but through behavior c. the ability to extend or apply the vision to different leadership contexts d. the ability to stimulate and inspire followers to achieve extraordinary outcomes
d. the ability to stimulate and inspire followers to achieve extraordinary outcomes
Role ambiguity
in the workplace creates and environment for misunderstanding and hinders effective communication. Individuals do not have a clear understanding of what is expected of their performance or how they will be evaluated. *Empowerment and control* are linked to increased personal health, job satisfaction and individual performance and in result, are more likely to be committed to the organization and to provide higher level of patient care.
DNR order
is a physician order based on a client's decision to not be resuscitated. This is an informed decision.
Role Modeling Strategy
is the encouragement of self management and assessment along with openness.
Transactional leaders
leaders who guide or motivate their followers in the direction of established goals by clarifying role and task requirements Transactional leadership has three main components: (a) contingent reward, in which staff is rewarded for producing desired work; (b) active management by exception, in which the leader's goal is to ensure work performance is rewarded or corrected as required and goals are met; and (c) passive management by exception, where the leader waits until problems arise and then deals with the issue, usually after mistakes have occurred. the transactional leader uses contingent reward, management-by-exception (Bass, 1985), maintenance of the status quo, negative feedback, and the flexible use of reward and punishment. In transactional leadership, an exchange of rewards and punishments encourages effort. Although transactional leadership can lead to short-term solutions, it often does not result in long-term effectiveness. The transactional leader does not intervene as long as standards are being maintained. He or she uses motivational techniques that increase confidence and raises the values of work related outcomes for his or her followers (Medley & Larochelle, 1 995).
Sentinel event
serious, unexpected occurrence involving death or severe physical or psychological harm such as inpationt suicide, infant abduction, or wrong-site surgery.
Carrie stopped Perry in the parking lot and just had to tell him about ______________, where leaders guide or motivate their followers in the direction of established goals by clarifying role and task requirements. situational leadership transactional leadership transformational leadership attributional leadership
transactional leadership
1. A leader, such as Bill Gates of Microsoft, who can inspire followers above their own self-interests and can have a profound effect on their performance, is known as a(n) _____________. transactional leader directive leader informational leader transformational leader
transformational leader
1. Carrie stopped Steve in the parking lot and just had to tell him about ______________, where leaders provide individualized consideration, intellectual stimulation, and possess charisma. charismatic leadership transactional leadership transformational leadership attributional leadership
transformational leadership
Near miss
unplanned event that did not result in injury, illness, or damage but had the potential to do so. A near miss highlights an imminent problem that must be corrected and can provide useful lessons in terms of risk analysis and reduction.
