leadership final pt. 2!

The nurse manager must develop a patient satisfaction survey. What is one of the critical elements in selecting a patient satisfaction instrument? • Being able to use the same instrument for all clinical units • Including items that are important from the patient's perspective • Being able to administer the instrument before a patient's discharge from the hospital • Being sure that the reading level is no higher than third grade

Including items that are important from the patient's perspective

The executive team at Hospital A develops a polished strategic plan that includes a mission statement, goals, and objectives. The executive team involves the marketing team, so that the plan can be communicated internally and externally. After 2 years, no significant progress has been made toward any of the goals. What has been omitted in the plan? Planning Marketing Integrated financial planning Customer focus

Integrated financial planning

A functional résumé focuses on: experience and skills gained in positions. positions held and specific roles in the positions. academic qualifications and achievements. relating skills and experience to qualifications in a specific position.

experience and skills gained in positions.

Which of the following needs revision on a résumé or CV? John Jones 87 Highway Drive City, MI 79110 [email protected] M. Howes Anyway Highway City, MO 77700 (H) 777-777-0000 e-mail: [email protected] Dr. L. Jones 99 Carway Drive City, NY 84003 (H) 999-999-0000 (Cell) 999-000-9999 Tanya Jones 67 Honeywell Drive City, MO 66907 [email protected]

Tanya Jones 67 Honeywell Drive City, MO 66907 [email protected]

At an organizational level, which of the following strategies would assist in ensuring that EBP is incorporated into nursing care? • Formation of nursing-only implementation teams • Restriction of evidence to RCTs • Formation of a network of individuals doing research and/or interested in research utilization • Avoidance of partnership with experienced researchers

Formation of a network of individuals doing research and/or interested in research utilization

The nurse manager analyzes the data from the patient satisfaction surveys. What can a nurse manager do to strengthen service recovery and improve consumer relationships? • Post comparisons of patient satisfaction scores with those of other units monthly. • Involve the staff in resolving consumer issues quickly and effectively. • Ensure that staff members apologize to patients when they complain about services. • Ask that patients with complaints about services place them in a written format.

Involve the staff in resolving consumer issues quickly and effectively.

The nursing director calls a meeting with one of the new unit managers. She is very concerned about a report of substance abuse on the manager's unit, and she reviews the procedures involved in dealing with chemically dependent staff. Which of the following statements would NOT be included in the discussion? "As a manager, you: • need to be aware of ADA issues." • should check with human resources regarding chemically dependent employees and employment practices." • check the nurse practice acts for the state in which the nurse resides." • should realize that the nurse is a professional embarrassment and should be kept out of sight of other staff."

should realize that the nurse is a professional embarrassment and should be kept out of sight of other staff."

When progressive discipline is used, the steps are followed progressively only for repeated infractions of the same rule. On some occasions, rules that are broken are so serious that the employee is: • transferred to another unit. • suspended indefinitely. • asked to attend a union grievance meeting. • terminated after the first infraction.

terminated after the first infraction.

The nurse manager knows that the most serious effect that absenteeism has on the nursing unit is that: • using replacement personnel with new ideas may be beneficial. • salary costs are lower because personnel are fewer, and outcome is favorable. • absence on the part of the rest of the staff is decreased. • unacceptable patient care may result.

unacceptable patient care may result.

Clinical incompetence is one of the more serious problems facing a nurse manager. Joyce, the nurse manager, is not aware of the problems of Sarah, a novice nurse. After she investigates, it is obvious that Sarah's peers are covering for her. Which of the following might Joyce include in her meeting with the nurses? (Select all that apply.) • "It is a nurse's professional responsibility to maintain quality control." • "All instances of clinical incompetence are to be reported." • "It is not considered being disloyal when one nurse reports another for poor care." • "Patient care is the number one concern. Meeting standards is mandatory and necessary."

• "It is a nurse's professional responsibility to maintain quality control." • "All instances of clinical incompetence are to be reported." • "It is not considered being disloyal when one nurse reports another for poor care." • "Patient care is the number one concern. Meeting standards is mandatory and necessary."

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? Search the environment to determine changes that may affect the organization. Appraise the organization's strengths and weaknesses. Identify the major opportunities for and threats to the organization. Identify and evaluate the various strategies available to the organization.

Search the environment to determine changes that may affect the organization.

The chief nursing officer has to write a strategic plan. The most difficult stage in the strategic planning process is: assessment of the external and internal environment. review of mission statement, goals, and objectives. identification of strategies. implementation of strategies.

assessment of the external and internal environment.

The clinic nurse understands that the advantages of planning include: assisting staff in critical thinking and improving decisions. orienting people to react instead of act. forcing managers to be cost-efficient and cost-effective. focusing on activities, not results.

assisting staff in critical thinking and improving decisions.

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: provide an educational session for staff on peer review. revise the mission statement, objectives, and performance standards. develop objectives and performance standards with employees. implement objectives and performance standards.

provide an educational session for staff on peer review.

Nathan tells you that he has selected nursing as a career because many jobs are available and he will have job security. Your best response to Nathan is: "With many young people going overseas, many jobs and options will be available. Stable jobs and job security will be part of the nursing employment market." "The job market for nurses will be diminished with funding cuts to hospitals." "The employment prospects for nurses are positive with many options to choose from. Flexibility and adaptability are essential to income security." "It is unlikely that nursing will survive in the long term with funding cuts and a declining population of seniors."

"The employment prospects for nurses are positive with many options to choose from. Flexibility and adaptability are essential to income security."

On your curriculum vitae, which of the following is the recommended approach for listing employment and educational history information? A. 1979 RN Diploma 1985 BScN 2002 MN B. 2002 Mount Rush Health Center Staff Nurse 1997 Cedar Falls Clinic Staff Nurse 2007 Kilkarney Rehab Center Case Manager C. 2007 MN 2005 BScN D. 1997 Sturgeon County Hospital Head Nurse 2002 Sturgeon County Supervisor 2007 Sturgeon County Director

2007 MN 2005 BScN

Which of the following actions best exemplifies advocacy? • Developing a list of agencies that will provide free services for the homeless • Working in a needle exchange program for individuals in an inner-city environment • Acting on behalf of a patient to promote end-of-life wishes to an ethics committee • Working in a free clinic for immigrant workers

Acting on behalf of a patient to promote end-of-life wishes to an ethics committee

Knowing your professional strengths is important to: A. find your fit in positions and a career path. B. maintain a professional status. C. act in a manner that is legal and ethical. D. understand the role expectations of a position.

A. find your fit in positions and a career path.

The primary difference between a résumé and a CV is that a résumé: A. reflects your skills, knowledge, and background in relation to a specific position. B. offers a detailed listing of positions held and where positions were held. B. includes a long and detailed explanation of academic and work experience. provides contact information and focuses on your background, in general.

A. reflects your skills, knowledge, and background in relation to a specific position.

At the beginning of the 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? Nursing unit managers Staff nurses All staff Administration

All staff

A clinic nurse developed objectives for a diabetic education program. The characteristics of well-written objectives include that they should be what? (Select all that apply.) Achievable Understandable and specific People-oriented Manager-oriented Means-oriented Measurable

Achievable Understandable and specific Measurable

In orienting new staff nurses to a pediatric intensive care unit, the nurse manager asks the staff nurses to answer the following question: "What is an important consideration in providing information to parents of a critically ill child?" Making sure that they receive complete information during each encounter with a member of the nursing staff Assessing parents' preferences regarding the amount of information provided Allowing parents to observe key aspects of their child's nursing care Making sure that patient education brochures explaining ICU protocols are readily available

Assessing parents' preferences regarding the amount of information provided

To enhance team leadership skills for your team leaders, you arrange opportunities for: A. certification. B. continuing education. C. graduate courses. D. volunteerism.

B. continuing education.

Which of the following strategies is most important in developing a strong vision? Seeking out evidence to support trends and out-of-the-box thinking Spending time with others with whom we discuss ideas Setting up focus groups to provide information on current realities Being honest and open about what we think for the future

Being honest and open about what we think for the future

Incivility is a disruptive behavior or communication that creates a negative environment and interferes with quality patient care and safety. The manager can implement the following steps that help to alleviate uncivil behavior on a unit. (A) Suspending the staff member from work, (B) Providing written admonishment that is discussed and placed in the employee's file, (C) Providing verbal admonishment, (D) Terminating the staff member • A, B, C, D • B, A, C, D • C, B, A, D • C, A, B, D

C, B, A, D

During an interview for a manager's position, you find the supervisor and staff unfriendly. Responses to questions are met with vague responses. After the interview, you decide not to pursue the position. What follow-up, if any, is most appropriate? A. There is no need for you to do anything further. You likely will not be offered the position anyway. B. You should file a complaint with human resources about the supervisor's lack of interviewing skills. C. You should send a thank-you note to the interviewer, indicating appreciation for her time. D. You should call and leave a voicemail, indicating your disinterest in the position.

C. You should send a thank-you note to the interviewer, indicating appreciation for her time.

An example of a career is: (Select all that apply.) A. employment in short-term contract jobs in business, nursing, and whatever is available. B. involvement in an area of practice that is regulated. C. continuous employment in the same position and the same arrangement for 20 years. D. moving into and out of nursing positions in various cities while pursuing travel and education that develop understanding of global health.

C. continuous employment in the same position and the same arrangement for 20 years. D. moving into and out of nursing positions in various cities while pursuing travel and education that develop understanding of global health.

A well-written letter of resignation is critical to: A. first announce your intent to resign. B. formally signal discontent in your current position. C. maintain a positive relationship with your former organization and colleagues. D. fulfill your legal obligations as a departing employee.

C. maintain a positive relationship with your former organization and colleagues.

Professional associations: A. set regulatory requirements and establish entry requirements for nursing. B. offer graduate programs for clinical and career advancement. C. provide opportunities for career networking and support. D. are open to all individuals who meet the criteria for membership.

C. provide opportunities for career networking and support.

To move beyond stereotypical thinking and toward thinking about the future, which of the following would be most consistent with thinking wildly in the Wise Forecast Model©? Listing everything that we know about our current situation Defining which practices will remain unchanged and which will change Asking someone with a great deal of experience to share ideas about best practice Challenging current and future practices with questions of "what if?"

Challenging current and future practices with questions of "what if?"

Which of the following will require greater attention in the future? Chronic disorders Obstetrical outcomes Prevention of hospital-based errors Team conflict resolution strategies

Chronic disorders

You are offered an opportunity to take a temporary leave from your position as a nurse manager to lead a technology implementation project. Which of the following reasons for accepting the opportunity is most consistent with developing a solid career path? A. You are pressured to do so by your supervisor. B. The organization has no other suitable candidate for the position. C. You have limited knowledge of information technology and no real interest, but this will increase your knowledge. D. Accepting a position outside of your established skill set may establish you organizationally as an innovative, adaptable leader.

D. Accepting a position outside of your established skill set may establish you organizationally as an innovative, adaptable leader.

In preparing for a fair interview process as a hiring manager, you should: A. put water out for the candidates. B. ensure that you know the names of all candidates. C. dress comfortably and professionally. D. prepare a schedule of questions to be asked of all candidates.

D. prepare a schedule of questions to be asked of all candidates.

Your organization is in the middle of re-designing patient care units, with decisions based on best practices and various other sources of evidence. In the middle of the transition, there is a temporary halt called to the transition because of a re-design of the health care system and greater emphasis on primary care. What would be a healthy response to this situation? Salvage as much of the original planning as possible so as to reduce expenditures. Engage in consultation to create innovative solutions that bridge the existing plans and the new directions. Abandon the current planning in favor of addressing the new trends. Continue with the current planning because trends come and go.

Engage in consultation to create innovative solutions that bridge the existing plans and the new

To help staff nurses adjust to using research in practice, what strategy would the nurse manager use? • Attendance at a regional research conference • Formal classes in electronic search techniques • Establishing a journal club • Issuing reports on the adverse consequences of outdated practices

Establishing a journal club

From your observation of planning activities in the organization, you have noticed that planning and decision making occur at various levels of the organization. The nurse manager has overall responsibility for which of the following? Sending out postcards Organizing a telephone follow-up Monitoring ongoing activities and projects Listing the patient population

Monitoring ongoing activities and projects

As a nurse manager, it is important to become a "future thinker." Which is an example of a "future thinker"? Keeping traditional practices Moving toward evidence-based practices Finding less need for more knowledge Believing that macromarketing will be a necessity

Moving toward evidence-based practices

In order to plan long term, you consider what the client of the future will look like. Which of the following client profiles would best capture shifting demographics and trends in health care? Younger, knowledgeable about health options Female, uses emergency care services for parents and children Older, one or more chronic disorders, diverse background Male, various occupationally generated disorders, diverse ethnic background

Older, one or more chronic disorders, diverse background

Pacific Hospital's team develops a process to include staff in development of the mission statement. Which of the following statements would indicate that the staff has been able to develop an effective mission statement? Pacific Hospital will increase its sustainability by increasing revenue streams within the next 3 years. Revenue streams are important to our hospital and are a driving force in our sustainability in the face of insurer and government funding changes. Pacific Hospital has a desire to relate to its community to enable appropriate identification of programming needs by July. Pacific Hospital will provide family-centered care to the community of Pacific Rim. It is committed to delivering a full spectrum of services that foster collaborative partnerships among clients, families, and the hospital, and it utilizes evidence-based practice to guide planning and interventions. To provide health promotion programs for school-aged children

Pacific Hospital will provide family-centered care to the community of Pacific Rim. It is committed to delivering a full spectrum of services that foster collaborative partnerships among clients, families, and the hospital, and it utilizes evidence-based practice to guide planning and interventions.

In assisting new graduates to make the role transition to graduate nurse, Ted, the unit manager initiates which of the following? • Self-check list to assess competencies that have been strengthened • Discussions that focus on what the new graduates have yet to learn • Fixed target dates for acquisition of competency and transition to RN role • Frequent formal meetings to provide feedback on performance and areas to be strengthened

Self-check list to assess competencies that have been strengthened

You have just hired a recent graduate. The graduate is thrilled with the opportunity that she has been given, as well as with the idea that "working means no more essays, tests, or assignments!" She indicates that she has no intention of touching a book, journal, or health information website for a "long time." Which of the following would be your best response? The expectations and design of educational programs means that new graduates are better prepared for the work force. The new graduate will still have to learn, but it will be job-specific learning. An ideal learning plan for nurses emphasizes followership. The amount and intensity of knowledge demands lifelong learning that includes assessment of relevancy of knowledge for practice.

The amount and intensity of knowledge demands lifelong learning that includes assessment of relevancy of knowledge for practice.

A nurse is interviewing for a manager's position. Which of the following actions is considered a role preview? Formal commitment of the employment contract Improving role performance Touring the unit Disillusionment about the expectations of the job

Touring the unit

Which of the following would be most effective in implementing the findings of a new clinical treatment for problems associated with bowel motility for the staff nurses? • Lecture by a nurse practitioner • Workshop for surgical nurses that involves discussion of case studies and application of evidence • Discussion of the findings on the bulletin boards at the workstation • Education of unit opinion leaders regarding the evidence presented in the studies

Workshop for surgical nurses that involves discussion of case studies and application of evidence

Tara, the unit manager, is explain to her colleague her recent project, which involves seeking the most effective approaches to incontinence care, with the intention of adopting evidence-supported approaches on her dementia care unit. Her colleague suggests that translation of research into practice is: • less important than knowledge-generating research, which is required to advance the nursing profession. • a priority of all healthcare practitioners to improve patient care. • characterized by lack of knowledge about how to use evidence to guide practice. • so difficult that it is useless to begin the query in the first place.

a priority of all healthcare practitioners to improve patient care.

Through the QI process, the need to transform and change the admissions process across administrative and patient care units is identified. In this particular situation, what method of data organization will be most effective? a. Flowchart b. Histogram c. Narrative d. Line graphs

a. Flowchart

A nursing unit is interested in refining its self-medication processes. In beginning this process, the team is interested in how frequently errors occur with different patients. To assist with visualizing this question, which organizational tool is most appropriate? a. Histogram b. Flowchart c. Fishbone diagram d. Pareto chart

a. Histogram

A nursing-led classification system that has led to greater reliability and standardization in data utilized for QI processes is: a. NANDA. b. AHRQ. c. NIOSH. d. nursing process

a. NANDA

An example of an effective patient outcome statement is: (SMART) a. eighty percent of all patients admitted to the Emergency Department will be seen by a nurse practitioner within 3 hours of presentation in the Emergency Department. b. patients with cardiac diagnoses will be referred to cardiac rehabilitation programs. c. the hospital will reduce costs by 3% through the annual budget process. d. quality is a desired element in patient transactions

a. eighty percent of all patients admitted to the Emergency Department will be seen by a nurse practitioner within 3 hours of presentation in the Emergency Department.

Hospital ABCD is a Magnet® hospital. One reason this designation has been applied to Hospital ABCD is because it: a. facilitates active staff participation in decision making related to quality nursing care. b. has implemented a graduate nurse orientation program. c. espouses commitment to excellence in patient care. d. is establishing career ladders for nurses.

a. facilitates active staff participation in decision making related to quality nursing care.

Examples of sentinel events include: (Select all that apply.) a. forceps left in an abdominal cavity. b. patient fall, with injury. c. short staffing. d. administration of morphine overdose. e. death of patient related to postpartum hemorrhage.

a. forceps left in an abdominal cavity. b. patient fall, with injury. d. administration of morphine overdose. e. death of patient related to postpartum hemorrhage.

Hospital Magnet® decides against creating a separate department to lead and monitor quality activities because: a. total organizational involvement is critical to QI. b. data generated by a single, separate department are generally flawed. c. monitoring and commitment to QI can come only from senior-level managers. d. staff resent suggestions for improvement that originate outside of their unit

a. total organizational involvement is critical to QI.

During review of a patient's progress, the healthcare team determines that a patient requires treatment that is generally accepted at that time in the usual illness trajectory of a patient. The patient is unable to pay. As the charge nurse, you persist in ensuring that this patient receives the treatment. You are: • empowering the patient. • avoiding litigation. • advocating for the patient. • supporting the clinical pathway.

advocating for the patient.

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage. Sarah's actions are important in avoiding role: • ambiguity. • transition. • development. • negotiation.

ambiguity

The nurse manager of a unit was demoted to staff nurse 6 months ago. Because of being near retirement, the former nurse manager wanted to be employed at the hospital and was offered a position on the same unit. The former nurse manager complains often about how infrequently the current nurse manager is available on the unit and argues with physicians and co-workers. Clients have complained about the attitude of the nurse. The behavior of the former nurse manager can be best explained as being caused by: • overwork in the staff nurse position. • inadequate mentoring in the new role. • anger as a stage of the grieving process. • demotion as a threat to personal identity.

anger as a stage of the grieving process.

A new RN staff member asks you about the difference between QA and QI. You explain the difference by giving an example of QI. a. "Last year, the management team established new outcomes that addressed issues such as medication errors." b. "At a staff meeting last year, two of our staff commented on the number of recent falls and asked, 'What can we do about it?'" c. "A process audit was done recently to determine how much time was being spent on patient documentation." d. "Errors are reported on our new computerized forms, and I follow up with staff to make sure that they understand the seriousness of their error."

b. "At a staff meeting last year, two of our staff commented on the number of recent falls and asked, 'What can we do about it?'"

With the rise of violence in the psychiatric department, the nurse manager decides that she should work with the risk manager in violence prevention. The nurse manager should: a. request all staff to accept new risk management practices. b. hold staff accountable for safe practices. c. document inappropriate behavior. d. hire more police security.

b. Hold staff accountable for safe practices. Active involvement of staff in risk management activities is key to prevention of adverse events. Nursing has a primary role in leadership in optimizing patient outcomes, preventing patient care issues, and mitigating adverse events. Accountability for safety can be one aspect of performance evaluations.

Healthcare organization X is committed to improving patient outcomes and, as part of the QI process, examines its executive structure and organizational design. This approach recognizes: a. the importance of decentralized structure in QA. b. that structure influences nurse burnout and participation in quality improvement initiatives. c. the need to ensure sufficient supervisory staff to respond in a corrective manner when mistakes occur. d. that a narrow hierarchy ensures accountability for errors and outcomes.

b. That structure influences nurse burnout and participation in quality improvement initiatives. Common organizational characteristics of Magnet™ hospitals include structure factors (e.g., decentralized organizational structure, participative management style, and influential nurse executives) and process factors (e.g., professional autonomy and decision making, ongoing professional development/education, active quality improvement initiatives). ANCC Magnet™ designated hospitals and other high-reliability organizations in the United States and Europe generally have lower burnout rates, higher levels of job satisfaction, and provide higher levels of quality care resulting in greater levels of patient satisfaction (Aiken et al., 2012; Kelly, McHugh, & Aiken, 2011).

Before beginning a continuous quality improvement project, a nurse should determine the minimal safety level of care by referring to the: a. procedure manual. b. nursing care standards. c. litigation rate of unsafe practice. d. job descriptions of the organization.

b. nursing care standards.

The nurse manager is concerned about the negative ratings her unit has received on patient satisfaction surveys. The first step in addressing this issue from the point of view of quality improvement is to: a. assemble a team. b. establish a benchmark. c. identify a clinical activity for review. d. establish outcomes.

c. Identify a clinical activity for review. In theory, any and all aspects of clinical activity could be improved through the QI process. However, QI efforts should be concentrated on changes to patient care that will have the greatest effect.

Patient perceptions are useful in: a. determining disciplinary actions in QI. b. establishing the competitive advantage of QI decisions. c. providing one source of data for QI initiatives. d. establishing blame for poor-quality care.

c. Providing one source of data for QI initiatives. Customers define quality and patient dissatisfaction as useful indicators of which areas are of greatest concern to patients and of what matters then to nurses and organizations. Patient perceptions guide areas of inquiry; however, they do not establish what disciplinary decisions will be made.

Your institution has identified a recent rise in postsurgical infection rates. As part of your QI analysis, you are interested in determining how your infection rates compare with those of institutions of equivalent size and patient demographics. This is known as: a. quality assurance. b. sentinel data. c. benchmarking. d. statistical analysis.

c. benchmarking.

A new graduate is asked to serve on the hospital's quality improvement (QI) committee. The nurse understands that the first step in quality improvement is to: a. collect data to determine whether standards are being met. b. implement a plan to correct the problem. c. identify the standard. d. determine whether the findings warrant correction

c. identify the standard.

The chief executive officer asks the nurse manager of the telemetry unit to justify the disproportionately high number of registered nurses on the telemetry unit. The nurse manager explains that nursing research has validated which statement about a low nurse-to-patient ratio? The low ratio: a. promotes teamwork among healthcare providers. b. increases adverse events. c. improves patient outcomes. d. contributes to duplication of services.

c. improves patient outcomes.

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: marketing surveys. focus groups. informal feedback. comparison of data against benchmarks.

comparison of data against benchmarks.

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. public macro competitive social

competitive

A method commonly used in quality assurance to monitor adherence to established standards is: a. a Pareto chart. b. brainstorming. c. patient interviews. d. chart audit.

d. Chart audit. Chart audits are a common method of addressing process standards. Chart audits over time yield trend charts.

As a nurse manager, you tried a new pain scale on your unit that is supported by numerous research studies. You compare the patient outcomes with the new scale against the existing scale. Feedback from staff suggests that the new scale is too difficult for patients who have limited language skills and who are already under duress to understand. The difficulty in implementing the new scale refers to testing: • efficacy. • effectiveness. • practice failure. • comparative error.

effectiveness

At Hospital Alpha, there has been a 20% increase in instruments and sponges being left in patients during surgery and surgeries on the wrong limbs. These are known as: a. sentinel events. b. medically sensitive events. c. nurse-sensitive events. d. Never Events.

d. Never Events

As a nurse manager, you know that the satisfaction of patients is critical in making QI decisions. You propose to circulate a questionnaire to discharged patients, asking about their experiences on your unit. Your supervisor cautions you to also consider other sources of data for decisions because: a. the return rate on patient questionnaires is frequently low. b. patients are rarely reliable sources about their own hospital experiences. c. hospital experiences are frequently obscured by pain, analgesics, and other factors affecting awareness. d. patients are reliable sources about their own experiences but are limited in their ability to gauge clinical competence of staff.

d. patients are reliable sources about their own experiences but are limited in their ability to gauge clinical competence of staff.

The nurse gives an inaccurate dose of medication to a patient. After assessment of the patient, the nurse completes an incident report. The nurse notifies the nursing supervisor of the medication error and calls the physician to report the occurrence. The nurse who administered the inaccurate medication understands that: a. the error will result in suspension. b. an incident report is optional for an event that does not result in injury. c. the error will be documented in her personnel file. d. risk management programs are not designed to assign blame.

d. risk management programs are not designed to assign blame.

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: revisiting the mission statement and objectives. reevaluating external and internal factors affecting evidence-based practice. preparing a budget to support implementation. developing unit-based objectives related to the plan.

developing unit-based objectives related to the plan.

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage. Sarah finds that she has begun to think negatively about the way nursing care is delivered on her nursing unit. She often wishes that she was back on her old unit and in her familiar staff nurse role. This behavior: • is natural when assuming a new position. • diverts energy from internalization of Sarah's new role. • is justified if practices are deficient on the new unit. • reflects Sarah's astuteness as a clinician.

diverts energy from internalization of Sarah's new role.

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage. After beginning her new position, Sarah finds that she spends a great deal of time in direct patient care. Her staff begins to complain that they are never able to find her when they need her, and that some aspects of her responsibilities fall behind, such as scheduling. Sarah is most likely: • lacking an understanding of the nurse management role. • attempting to prove her clinical skills to the nursing staff. • experiencing difficulty in unlearning old roles. • lacking enjoyment in her new role.

experiencing difficulty in unlearning old roles.

To develop a curriculum vitae, or résumé, a nurse must develop a personal data file. The goal of a personal data file is to: A. create an opportunity to be interviewed. B. have a listing of facts about your professional life. C. have a tool in place for marketing yourself. D. create a document that lists your skills.

have a listing of facts about your professional life.

Nurses are valuable partners in marketing strategies because they: are more likely than other members of the organization to use marketing tools. have a strong background in using evidence to support decisions. have close involvement with patients, who are the target group for marketing. constitute the largest staff group in most healthcare organizations.

have close involvement with patients, who are the target group for marketing.

Nursing professionals in the twenty-first century will accomplish most of their work: through teams of internationally prepared professionals. in teams and through group work. through long term, secure jobs. in competitive environments and work groups.

in teams and through group work.

Your unit has several patients who have undergone limb amputation. In working with the clients, you begin to think beyond therapies such as pharmacotherapeutics and surgery and you explore biomechanics, robotics, mind-body approaches, and cognitive behavioral therapies as possibilities in working with these clients. You begin to collect information in several areas with which you previously had little familiarity. According to the Wise Forecast Model©, you are: acting wildly. learning wildly. engaging in interprofessional care. increasing your complexity compression.

learning wildly.

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. public macro competitive social

macro

Benchmarks in the strategic marketing planning process are useful in: establishing programs. setting targets. rewarding employees. measuring progress.

measuring progress.

Assessment of the needs of the consumer or client (in developing a strategic marketing plan) focuses on: present needs only. present and future needs. the development of surveys. secondary analysis of existing data.

present and future needs.

In developing curricula that will address needs based on forecasts for the future, nursing educators need to contemplate: (Select all that apply.) prevention strategies. leadership skills and knowledge. violence de-escalation strategies. strategies for job security.

prevention strategies. leadership skills and knowledge. violence de-escalation strategies.

A nurse is applying for a new position. This position is one in which she will serve as a liaison between a hospital and a school of nursing. The nurse must update her résumé to include her teaching experience. The goal of the resume is to: A. have a listing of facts about your professional life. B provide potential employers with information about where you are in your career. C. respond quickly whenever a position becomes available. D. be certain you can recall facts for a prospective position.

provide potential employers with information about where you are in your career.

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage. A strategy that may help to make the transition to her management role and to respond to relationships and situations in her new position is: • avoiding discussion of her personal beliefs with staff until she is ready to do so. • finding a network of clinicians with interests similar to her own. • researching clinical literature to maintain her clinical assessment skills for the unit. • recognizing her strong commitment to care in the management process through journaling.

recognizing her strong commitment to care in the management process through journaling.

A unit manager recently graduated as a clinical nurse specialist with a focus in gerontology. She applied to take a certification exam. Certification is designed to recognize: A. basic knowledge in a specified area. B. advanced practice in functional roles. C. special knowledge beyond basic licensure. D. continued competence as a registered nurse.

special knowledge beyond basic licensure.

A stroke unit experiences numerous changes related to implementation of new technology, a changed nursing care delivery model, and staff turnover within a period of 6 months. Staff members begin to show signs of reluctance to implement any more changes. This exemplifies: a poor relationship between leaders and staff. lack of knowledge regarding the importance of changes. striving to achieve stability during great disequilibrium. the importance of chaos in promoting adherence with established practices.

striving to achieve stability during great disequilibrium.

Nursing research has indicated that the foundation for becoming a nursing leader is the ability to: write effectively. speak two or three languages. focus on day-to-day priorities. think futuristically.

think futuristically.

A cover letter and a résumé together should be no longer than ________ page(s). A. two B. one C. four D. three

three

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage. Sarah finds a mentor, Amy, who has been in the role of unit manager for 3 years and has a similar interest in clinical excellence. During their frequent meetings, Amy provides assistance with learning aspects of the manager's role, including technical aspects, such as how to interpret budget printouts and to achieve budget outcomes. The success of Amy's coaching depends on: • clarity of Amy's information. • organizational support for the mentor relationship. • the congruence of Amy's beliefs with Sarah's beliefs. • willingness of Sarah to receive feedback.

willingness of Sarah to receive feedback.

As a result of Amy's coaching, Sarah, a nursing graduate of 5 years, completes a ROLES assessment. This assessment is helpful in: (Select all that apply.) • identifying her clinical knowledge. • role development. • areas of conflict in expectations. • expected work time commitments.

• role development. • areas of conflict in expectations. • expected work time commitments.

As a new manager, you reflect on what professional development would be most valuable to assist you in taking on this role. Which of the following would you most likely identify? Opportunities to hone clinical skills that are used most often on the unit that you will manage A workshop on conflict management and communication skills Attendance at a conference on global healthcare economics Attendance at a workshop on survey tool development and statistical measurement

A workshop on conflict management and communication skills

The nurse manager wants to use evidence-based recommendations to prevent ventilator-associated pneumonia. What is the critical first step to effectively gather evidence for guiding practice? • Develop the clinical question. • Identify the databases to be used. • Appraise the evidence. • Integrate available evidence with unit expertise.

Develop the clinical question.

After several months in the role of manager of a dialysis unit, Maryanne finds herself still questioning the gap in expectations between her and her staff and management and is also questioning if she can reconcile her concerns about quality care with the strong cost-containment orientation of the facility. At this point, Maryanne is in which stage of role transition? • Internalization • Acceptance • Development • Discrepancy

Discrepancy

Which of the following is an effective approach in the appraisal of research studies? • Accept only studies that use a RCT design. • When ranking research studies, choose RCTs over qualitative studies. • Select only studies with a large sample size. • Evaluate the quality of the research based on the standard for that type of research.

Evaluate the quality of the research based on the standard for that type of research.

John is an older adult patient who comes regularly to the multigroup practice in which you are a nurse practitioner. He says that he doesn't understand what he is supposed to be doing about his medications, because every time he comes to the clinic, he sees a different provider. John's experience represents what aspect of the current consumer experience? • Nurses are well-trusted members of the healthcare team. • Fragmentation of care results in lack of respect and trust. • Care providers often have conflicting ideas about care. • The public does not trust care providers other than nurses.

Fragmentation of care results in lack of respect and trust.

Nathan has been on the cardiac unit for 6 months and has found it difficult to adjust to the expectations of his team. Which of the following behaviors would most likely signal that Nathan is intending to resign from his position on the unit? • Increased absenteeism over the past month • Increased attempts to discuss his concerns with his colleagues • Testing of workplace guidelines • Frequent defensiveness

Increased absenteeism over the past month

Before implementation of the new policy and procedure on central line catheter care, the nurse manager uses an appraisal system to evaluate the evidence. What is important in using an appraisal system to evaluate the evidence gathered in preparation for development of a new protocol? • Limiting the search to randomized clinical trials • Matching the appraisal tool to the type of evidence • Eliminating qualitative research studies • Using only preprocessed evidence

Matching the appraisal tool to the type of evidence

In designing a program for young adults regarding safe sexual practices, which of the following might reach the greatest number in the target group? • Web-based applications • Print-based media such as newspapers • Television advertisements • Brochures in kiosks in malls

Web-based applications

All of the following are grounds for immediate dismissal except: • failing to pursue further medical help for a patient; patient dies. • selling narcotics obtained from the unit supply of narcotics. • restraining a patient in bed for 7 hours, unsupervised, as punishment for hitting a staff member. • grabbing the unit manager and threatening further physical harm after a poor performance appraisal

failing to pursue further medical help for a patient; patient dies.

Before terminating an employee, a nurse manager must: • be an expert in all legal aspects of termination and discipline practices. • follow the organization's specific policies for addressing disciplinary problems and termination. • function as a counselor for problem employees. • do everything to assist and protect the employee by adjusting standards and policies.

follow the organization's specific policies for addressing disciplinary problems and termination.

In keeping with guidelines of the organization, the nurse manager documents staff problems. Documentation of disciplinary problems should: • include a plan to correct them and to prevent future occurrences. • state a detailed history of past problems that are related to the current one. • be written at the convenience of the manager. • not be discussed until the formal performance evaluation.

include a plan to correct them and to prevent future occurrences.

An interviewee for a nurse manager position asks for a copy of the organizational chart. Organizational charts provide information about the role component of: • expectations. • opportunities. • responsibilities. • lines of communication.

lines of communication.

Seth is hired as the nurse manager for a surgical unit. After a year, the hospital reorganizes, and his position is lost. In leaving the unit, it is important for Seth to: • engage in clarifying why the hospital did not state its expectations for the unit at the time of hiring. • hire a lawyer to represent his interests during this unexpected role transition. • seek counseling to deal with his shock and anger. • negotiate a reasonable settlement.

negotiate a reasonable settlement.

A nurse manager notices that Nathan, an RN who has been on the unit for approximately 3 years, has an interest in health technology and seems to be very enthusiastic about working with software and hardware at home. She speaks with Nathan and asks him if he would lead investigation of software applications on the unit. This is an example of: opportunity. delegation. role negotiation. role transition.

opportunity.

Which of the following activities would represent a customer-friendly approach in a healthcare setting? (Select all that apply.) • Using a local anesthetic before inserting a needle into a child's arm • Repeating patient history information to the admitting clerk, the admitting nurse, and the ultrasound technician • Ensuring that birthing preferences are on file and available in a laboring mother's chart • Providing support to families when a family member is brought into trauma

• Using a local anesthetic before inserting a needle into a child's arm • Ensuring that birthing preferences are on file and available in a laboring mother's chart • Providing support to families when a family member is brought into trauma

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? Objectives, philosophy, and mission statement Philosophy, objectives, and mission statement Philosophy, mission statement, and objectives Mission statement, philosophy, and objectives

Mission statement, philosophy, and objectives

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? Motivate the target market. Research the target market. Communicate benefits to the target group. Package the product.

Research the target market.

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage. After a year, Sarah successfully transitions into the nurse manager role and considers taking the examination to become a certified nurse executive. Amy advises her that this is not possible because Sarah will need: a graduate degree. at least a nursing diploma. 24 months of experience. 5 years of successful experience.

24 months of experience.

Which aspect of our tradition and history in nursing may impede our movement toward future- oriented thinking? Lack of confidence Focus on the discipline of nursing Focus on details in the everyday practice Mistrust of trends and new evidence

Focus on details in the everyday practice

During performance appraisal interviews, Joanne's nurse manager notices Joanne's excitement when she talks about how she has helped patients on a rehab unit understand the complexities of their regimens. When Joanne's nurse manager asks her about her career path plans, Joanne says that she wants to become a nurse administrator. The best response to Joanne would be: A. "Nursing administration is rewarding. What experiences would help you along this path?" B. "You do not appear excited about nursing administration. Unless you are excited by that career path, I wouldn't advise going in that direction." C. "You seem to find teaching others very rewarding. Have you considered that as a possible career path?" D. "You are too inexperienced to consider administration. Work for a few years, and then consider administration."

C. "You seem to find teaching others very rewarding. Have you considered that as a possible career path?"

As a team, you and the staff have determined that there is a need to reduce medication errors on your unit. Together, you developed the questions that you would like to address and search the literature for relevant research studies. Based on the evidence, you suggested a change to your practices and now are involved in implementation of these changes. Today, there was a major study released that would significantly change what you have decided to do. What are you and your staff experiencing? Compression complexity Distress Information lag Technology advancement

Compression complexity

An experienced staff nurse applies for a distinct position of patient advocate at a new clinic. Based on the various tools available to her, which of the following should she bring to her interview to best present her skills? A. Résumé B. Annual evaluations C. Portfolio D. Patient advocacy project

Portfolio

Who of the following might be the most appropriate mentor for Becky, a new nurse manager on the cardiac unit who has 4 years of previous clinical experience? • Sam, near retirement. He has 20 years of clinical nursing and recently assumed role of charge nurse in an interim capacity because of the incumbent's illness. • Leslie, who has been a clinical educator at the institution for a number of years. She has been tired of her role and aspires to become a nurse manager. She looks at mentorship as an opportunity to understand the role better. • Courtney, who has been a nurse manager for 3 years. Her staff and supervisor value her skills and her leadership acumen and championship of innovation. • Ben, who was nurse manager for 3 years, soon after graduation. He left the role because he was uncomfortable with the expectations and has been a team leader on surgery for 15 years.

Courtney, who has been a nurse manager for 3 years. Her staff and supervisor value her skills and her leadership acumen and championship of innovation.

A young male nurse began in nursing as a staff nurse at a hospital. After 3 years, he moved to a home healthcare agency for increase in pay and taking a position as a manager in the agency. What type of motivation does this exemplify in career success? A. Internal B. External C. Spiral D. Entrepreneurial

External

The chief nursing officer has been developing her portfolio for years. What is the chief nursing officer modeling? Her clinical expertise Affection for tradition Her employability Her busy professional life

Her employability

Which of the following situations is most likely to result in a productive, whole work situation? A. Amy, RN, 5 years of experience in the Emergency Department. Amy accepts a position working with older clients in a home health agency because she has relocated, and this is the only full-time position available. B. Adam, RN, 8 years of experience in various nursing positions, including that of a nurse manager. Adam accepts a new nurse manager position because he has a family and wants more regular hours. He is most comfortable working in direct client care. C. Louise, RN, 10 years of experience in an Emergency Department. She accepts a position as a case manager in home health care, working with older clients. She especially enjoys working with older adults and wants to take on leadership and management challenges. D. Courtney, RN, a new graduate. Courtney is getting comfortable with delivering nursing care as an RN. She is offered a position on surgery as a permanent team leader. The unit has had a great deal of turnover recently, and only limited mentorship is available.

Louise, RN, 10 years of experience in an Emergency Department. She accepts a position as a case manager in home health care, working with older clients. She especially enjoys working with older adults and wants to take on leadership and management challenges.

Your organization is in the middle of re-designing patient care units, with decisions based on best practices and various other sources of evidence. In the middle of the transition, there is a temporary halt called to the transition because of a re-design of the health care system and greater emphasis on primary care. As a manager in this situation, your staff experience a gap between what they expected (the original re-design of the units) and what is actually happening (a need to integrate primary care in some way). According to Selye, the nurses on your nursing team are likely experiencing what? Eustress Distress Stress Compression

Stress

Which of the following represents a well-written objective? Hospital-acquired infections are reduced, and procedures to reduce infections are implemented. To increase staff satisfaction and to decrease burnout. To increase the health of the community. To implement evidence-based practice on nursing units, as evidenced by adoption of evidence-based processes, by June 1.

To implement evidence-based practice on nursing units, as evidenced by adoption of evidence-based processes, by June 1.

To meet the social and human needs of a target market, it is critical to: assess the needs and priorities of the target market. revise the organization's mission statement to reflect external needs. assess the internal culture and needs. develop highly sophisticated media.

assess the needs and priorities of the target market.

In addition to providing coaching, a nurse mentor may provide counseling to the mentee. For counseling to be successful, the mentor must: provide a quiet environment away from the unit. keep the focus on technical and management responsibilities. assure confidentiality. present assignments that stretch the intellectual and technical ability of the mentee.

assure confidentiality.

A new graduate is seeking a new position in nursing and wants to "sell" herself effectively. The best strategy is to: A. create a résumé. B. practice interviewing. C. call the personnel offices. D. create a curriculum vitae.

create a résumé.

After a year, the staff at Pacific Hospital is frustrated, and implementation of evidence-based practice has gone poorly. In responding to this situation, the strategic planning team at Pacific Hospital: recommends that the mission, objectives, and goals of the hospital be reassessed. revises the goal statements in the strategic plan. consults an external team on preparation of materials on evidence-based practice. holds focus groups with staff to determine what kinds of issues, challenges, and obstacles have occurred in implementation.

holds focus groups with staff to determine what kinds of issues, challenges, and obstacles have occurred in implementation.

A necessary leadership strength for nurses of the future is: inspiring others to work their best to create the future. understanding the nuances of fundraising to make up funding shortfall. guarding the tendency of other professions to encroach on nursing roles. adapting work life to an aging nursing work force.

inspiring others to work their best to create the future.

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage. Sarah finds that she is comfortable with the expectations of staff and her supervisor regarding her management role and responsibilities and has been able to affect a strong commitment to quality clinical care on the unit. At this point, Sarah has likely attained this role: development. acceptance. symmetry. internalization.

internalization.

To conduct assessment of the internal environment, the strategic planning team for Pacific Hospital: invites community members and staff of the hospital to an evening focus group session. discusses what it sees as the primary threats and opportunities in demographic shifts affecting the hospital. invites all levels of staff to focus groups on the effectiveness of the hospital environment, including information systems and staffing. asks the board to provide a summary of major opportunities for the future.

invites all levels of staff to focus groups on the effectiveness of the hospital environment, including information systems and staffing.

The reasons cited by nursing administrators for not planning in a systematic manner include: lack of understanding of the planning process. lack of knowledge regarding the internal and external operations of the organization. not enough hours in the day for both day-to-day operations and planning. delegation of the task to subordinates.

lack of understanding of the planning process.

Ellen is a novice nurse on your unit. Even though she has come to you highly recommended, as her supervisor, you have noticed some knowledge and skill deficiencies. These deficiencies have been noticed by her peers as well, who cover for her because she is new and they like her. Which of the following is likely to be the greatest asset to Ellen in improving her performance? • Ignore Ellen's errors until she has more experience. • Instruct staff to avoid working with Ellen until she learns to how do things herself. • Ask Ellen to complete a self-assessment, using a standard skills checklist. • Encourage staff to report every behavior of Ellen's that is different from theirs

Ask Ellen to complete a self-assessment, using a standard skills checklist.

Based on data from the patient satisfaction survey, the nurse manager decides that a change should be made in communication with family members. What would be important for a nurse manager to consider when instituting a change to improve customer service? • Assess the perceptions of the nursing staff regarding the specific service problem. • Include community representatives on a planning committee to address the change. • Involve physicians, other healthcare professionals, and ancillary staff. • Review all patient complaints with the nursing staff.

Assess the perceptions of the nursing staff regarding the specific service problem.

A nurse manager introduces prompted voiding into nursing practice on a unit, which is supported by clinical guidelines based on evidence-based practice. The nurses on the unit resist implementation, indicating that bathrooms are too far away for efficient implementation of the guidelines, and that resources are too few to accomplish the initial voiding observations. For the nurse manager in this situation, it is important to have further discussion with the staff regarding: (Select all that apply.) • compatibility of this intervention with the values of staff on the unit. • advantages of prompted voiding over incontinence products and catheterizations. • usefulness of prompted voiding with the particular population of patients on the unit. • feasibility of the program with respect to unit design.

• compatibility of this intervention with the values of staff on the unit. • advantages of prompted voiding over incontinence products and catheterizations. • usefulness of prompted voiding with the particular population of patients on the unit. • feasibility of the program with respect to unit design.

The chief nursing officer develops a mentoring program to help new staff members adjust to their new jobs. The main purpose of mentoring is: promoting staff retention. promoting staff attrition. developing new role expectations. promoting staff supervision.

promoting staff retention.

The new charge nurse on telemetry has been in the position for 3 months. The charge nurse and the administrator disagree on how much time the charge nurse should allot to various aspects of the role. Staff members on the unit complain that the charge nurse is unavailable for clinical concerns because of being off the unit while attending meetings. To facilitate the process of role transition, the charge nurse should: • develop policies consistent with the head nurse's prior workplace. • attend a workshop on how to deal with difficult people. • decide to give the position 3 more months and then leave if things do not improve. • schedule a series of meetings with staff and the administrator to clarify expectations.

schedule a series of meetings with staff and the administrator to clarify expectations.

Marie is a long-term staff nurse on the rehab floor. Her unit manager has been eager to adopt evidence-based recommendations related to family-centered care on the unit. Marie's response has been that she rarely has time to provide care to patients, let alone families, and that there is no good reason to do anything different than what she is already doing. An approach that may gain Marie's support of the idea is to: • invite Marie to review the studies for herself. • suggest that she does not need to provide family-centered care. • avoid discussion of the idea with her until she initiates it. • secure the support of her closest colleagues on the unit.

secure the support of her closest colleagues on the unit.

Which of the following exemplifies a service orientation for a facility? • Staff members on the unit are encouraged to chart details about family support networks. • Chart audit reveals that details related to assessment of family history are missing. • The palliative care unit organizes a "tree of light" fundraiser each year to highlight the importance of palliative care. • A children's preoperative holding area is implemented in response to requests from families and staff nurses for development of an area.

A children's preoperative holding area is implemented in response to requests from families and staff nurses for development of an area.

The chief nursing officer at a local hospital seeking Magnet® status creates staff development classes about incorporating evidence-based practice in nursing. What best describes evidence-based practice? • Applying best research evidence to care of patients • Using research-based information to develop practice guidelines • Conducting a randomized control trial to determine effectiveness of handwashing techniques • Developing standards for practice

Applying best research evidence to care of patients

The chief nursing officer at a local hospital seeking Magnet® status creates staff development classes concerning translation of research into practice (TRIP). What best describes TRIP? • Conducting an integrative review of the literature • Searching the literature for a systematic review • Providing the results of research studies to practitioners • Applying strategies that aid in adoption of research in practice

Applying strategies that aid in adoption of research in practice

As part of performance appraisal, the nurse manager designs strategies to acknowledge staff members. What practices by the nurse manager best acknowledge staff accountability and contribution? • Providing new and varied learning experiences for staff members • Fostering group cohesiveness through standardization of unit activities • Allowing professionals greater influence on their practices • Giving recognition for success and support for failure to staff members

Allowing professionals greater influence on their practices

You are excited by evidence supporting the use of workstations on wheels (WOWs) at the bedside to improve documentation and patient outcomes. You have disseminated the information through discussions and e-mails and are now ready to begin the process of considering implementation on the unit. To develop positive attitudes toward the use and implementation of the technology, you would discuss your ideas with (Rogers' diffusion of innovations theory): • Harvey, RN, a technology guru, who enthusiastically tries on all new software. • Berta, RN, who thoughtfully considers evidence and regularly uses it to try new approaches in her practice. • Carol, LPN, who is positive about new ideas but looks to her friends for their ideas about whether or not to try something new. • Ben, a 10-year veteran of the unit, who wonders why technology should be used at all. He says that he will use it when there is no chance of security breaks.

Berta, RN, who thoughtfully considers evidence and regularly uses it to try new approaches in her practice

Nurses generally experience difficulty in identifying behaviors and actions that could signal chemical dependency in a co-worker. Which of the following is not a behavioral change that occurs with chemical dependency? • Personality and behavioral changes • Job performance changes • Changes in educational involvement and pursuit • Absenteeism

Changes in educational involvement and pursuit

The nurse manager of an ICU wants to implement the revised policy and procedure on central line catheter care. What would be the most effective method of getting the staff nurses to incorporate a new evidence-based practice into their care? • Conducting an interactive educational workshop • Distributing educational materials on clinical units • Sharing the results of a chart audit with staff • Providing staff with a short DVD on the topic

Conducting an interactive educational workshop

As a charge nurse, you are concerned about the service orientation on your unit. Which of the following findings and approaches might provide useful information for you? • Patients find nurses friendly and accessible; data are aggregated for the institution as a whole. • Data indicate that nurses are responsive to requests for assistance; data are available for the unit and the institution. • Specific questions related to management of comfort are included for the institution as a whole. • The survey asks for a range of responses for the unit and the organization, with a focus on facilities, such as cleanliness and responsiveness of administrative services.

Data indicate that nurses are responsive to requests for assistance; data are available for the unit and the institution.

The unit manager on 4E is concerned about the performance of Jean, a staff nurse. She is not involved directly with Jean, so she has not been able to determine whether the problem is one of motivation, ability, or both. If Jean lacks ability, which of the following strategies might the nurse manager use? • Dismiss or transfer Jean. • Document all problem areas and then discuss them with Jean. • Develop appropriate solutions and make recommendations to human resources. • Smooth over the problems if they are minor in nature.

Document all problem areas and then discuss them with Jean.

A nurse manager must be familiar with the agency's policies regarding termination. Termination procedures include which of the following? • Following specific procedures from other organizations • Having an attorney present at the termination meeting • Having adequate written documentation to support the action • Having a friend present during the termination meeting

Having adequate written documentation to support the action

A nurse manager understands that the second step in handling an employee with a disciplinary problem is to document the incident. Which of the following is best for documentation of personnel problems? • Use of the performance appraisal on an annual basis • Notes made immediately after an incident that include a description of the incident, actions taken, plans, and follow-up • A tally sheet of medication errors and other specific problems that will be used at annual review • Copies of reports, placed in his or her file, of all unusual occurrences involving the employee

Notes made immediately after an incident that include a description of the incident, actions taken, plans, and follow-up

In writing the patient satisfaction survey, the nurse manager is aware of the education levels of the families. What is the most critical element in the concept of health literacy? • Providing instructional materials at appropriate reading levels • Facilitating access to translators for persons with language barriers • Obtaining, processing, and understanding basic health information so appropriate decisions can be made • Knowing that most people have limited health literacy skills

Obtaining, processing, and understanding basic health information so appropriate decisions can be made

What is a strategy that can be used by a small community hospital with limited resources to develop an evidence-based nursing practice program? • Hiring a nurse researcher • Partnering with nurse researchers at a local university • Subscribing to journals devoted to evidence-based nursing • Including research competencies in managers' job descriptions

Partnering with nurse researchers at a local university

The unit manager discusses absenteeism with the unit clerk. She indicates that it is a serious problem on the unit. Which of the following points would they have likely discussed? • Employee morale is at a high level. • Patient care will be jeopardized and possibility below standards. • Existing staff have experienced little effect from the absenteeism. • Cost for the unit remains the same when new staff are hired.

Patient care will be jeopardized and possibility below standards.

Volunteers in a study are assigned randomly to groups. Some of the volunteers receive an herbal supplement that is reputed to control nausea, and some of the volunteers are assigned to a control group where a placebo is administered. This is an example of a(n): • longitudinal study. • RCT. • meta-analysis. • appraisal tool.

RCT

The chief nursing officer is pleased with the nurse manager's strategy of improving patient satisfaction in the pediatric intensive care unit. She decides to implement these changes throughout the hospital. What would be important to consider in implementing a new program focused on improving relationships with consumers? • Recognition of the nursing staff for excellence in promoting consumer relationships • Holding the staff accountable for resolving patient complaints • Selecting a staff nurse leader to implement the program • Identifying key staff members who have already demonstrated excellence in consumer relationships

Recognition of the nursing staff for excellence in promoting consumer relationships

Incivility is a disruptive behavior or communication that creates a negative environment and interferes with quality patient care and safety. The manager can implement steps that help to alleviate uncivil behavior on a unit. Which of the following would not be an appropriate first step? • Suspending the staff member from work • Providing written admonishment that is discussed and placed in the employee's file • Providing verbal admonishment • Terminating the staff member

Terminating the staff member

The nurse manager places a staff member on probation because of reports of chemical dependency. The nurse manager should be aware that which of the following statements is true regarding chemical dependency? • The chemically dependent employee usually hides any changes in behavior. • When confronted with the issue, the affected employee is usually relieved to have someone to talk to about the problem. • The chemically dependent nurse affects the entire healthcare organization. • Hospital policy, state laws, and nurse practice acts address procedures for the chemically dependent employee in the most general terms.

The chemically dependent nurse affects the entire healthcare organization.

Nurse Stacey is a self-admitted drug addict and has been a heavy abuser of codeine. Stacey and the unit manager decide that changes have to occur. Stacey enrolls in an addiction program, and the manager has her transferred to a drug-free area. What other strategies might be appropriate? • The manager could refer Stacey to the human resources department. • The manager could assist in monitoring Stacey's progress. • The manager could counsel Stacey if Stacey has formed a trusting relationship with her. • Stacey needs to be asked not to involve her family in the recovery program because this is a work-related situation.

The manager could assist in monitoring Stacey's progress.

A 27-year-old woman is admitted to your ICU in a coma, following an accident. The family of the patient, who is a Native American, places a medicine pouch in the bed with the young woman. As the nurse in this situation, it is important to: • explain to the family that the medicine pouch may contain herbs that may bother other patients. • ask the family about the significance of the medicine pouch for them. • remove the pouch when the family is not present. • put the medicine pouch on the shelf beside the bed.

ask the family about the significance of the medicine pouch for them

The most important approach that a nurse manager can take with an emotionally troubled employee is to: • act as a therapist for the employee. • adjust the standard of care to assist the employee. • assist the employee in obtaining professional help. • adjust the employee's work schedule to decrease stress.

assist the employee in obtaining professional help.

The outcome statement "Patients will experience a ten percent reduction in urinary tract infections as a result of enhanced staff training related to catheterization and prompted voiding" is: a. physician-sensitive and nonmeasurable. b. measurable and nursing-sensitive. c. precise, measurable, and physician-sensitive. d. patient care-centered and nonmeasurable.

b. measurable and nursing-sensitive.

A nurse manager wants to decrease the number of medication errors that occur in her department. The manager arranges a meeting with the staff to discuss the issue. The manager conveys a total quality management philosophy by: a. explaining to the staff that disciplinary action will be taken in cases of additional errors. b. recommending that a multidisciplinary team should assess the root cause of errors in medication. c. suggesting that the pharmacy department should explore its role in the problem. d. changing the unit policy to allow a certain number of medication errors per year without penalty

b. recommending that a multidisciplinary team should assess the root cause of errors in medication.

The nurse educator of the pediatric unit determines that vital signs are frequently not being documented when children return from surgery. According to quality improvement (QI), to correct the problem, the educator, in consultation with the patient care manager, would initially do which of the following? a. Talk to the staff individually to determine why this is occurring. b. Call a meeting of all staff to discuss this issue. c. Have a group of staff nurses review the established standards of care for postoperative patients. d. Document which staff members are not recording vital signs and write them up.

c. Have a group of staff nurses review the established standards of care for postoperative patients.

A nurse is explaining the pediatric unit's quality improvement (QI) program to a newly employed nurse. Which of the following would the nurse include as the primary purpose of QI programs? a. Evaluation of staff members' performances b. Determination of the appropriateness of standards c. Improvement in patient outcomes d. Preparation for accreditation of the organization by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

c. Improvement in patient outcomes

The chief nursing officer decides to establish a client advocacy position in an oncology unit. Advocacy is best represented by: • establishing private and professional networking systems. • asking social services to handle clients' concerns. • identifying community support groups. • empowering others by promoting self-determination.

empowering others by promoting self-determination.

The complexity of the healthcare environment for consumers is increased by: • falling levels of education among the public. • increased levels of poverty. • complex compensatory systems and a variety of delivery systems. • increased numbers of uninsured or underinsured.

complex compensatory systems and a variety of delivery systems.

Corrine, a student nurse, often hears that nurses are gatekeepers and wonders what that term means. As a nurse leader, you explain that this is a reference to the: • assessment and admission of patients into care. • orientation of patients to services once they are admitted. • function of controlling which patients see the physician and which do not. • coordination of care, services, advocacy, and access for patients within the healthcare system.

coordination of care, services, advocacy, and access for patients within the healthcare system.

You are involved in designing a clinic for women in an inner-city neighborhood. A goal of this clinic might be: • development of services that are identified in various studies as important for this target group. • partnership with area city councilors and health professionals to provide services that are consistent with their vision and funding sources. • provision of immunization and addictions services and health screening services for women in the area. • development of services that have been identified by the women and neighborhood advocates as necessary for their health care.

development of services that have been identified by the women and neighborhood advocates as necessary for their health care.

The unit leader on an inpatient psychiatric unit of a large hospital has been in the position for 3 months. The unit leader is frustrated by how little time is available to work with clients and how few changes have been implemented in that time. The phase of role transition being experienced is the role of: • acceptance. • negotiation. • discrepancy. • internalization.

discrepancy

During unit staff meetings, you observe that Marg rolls her eyes and snorts whenever Julia makes a comment. Your first response as a unit manager is to: • discuss what you have observed with Marg. • file immediate documentation in Marg's personnel file. • ask Julie to monitor Marg's behavior during meetings. • ignore the behavior, as Marg is one of your strongest nurses.

discuss what you have observed with Marg.

Within a multisite healthcare system, the most appropriate strategy for translation of research would be: • widespread development of protocols using EBP at unit levels. • dissemination of EBP and recommendations to individuals, units, and the organization. • development of the skills of individual managers on how to build guidelines based on EBP. • establishment of an interdisciplinary center to guide and lead the translation of research findings into practice.

establishment of an interdisciplinary center to guide and lead the translation of research findings into practice.

The chief nursing officer understands that clinical incompetence is best prevented by a(n): • flexible protocol for evaluating competency skills. • standardized clinical skills checklist. • administration of personality tests and competency assessments at point of hire. • formalized competency program with established standards for practice.

formalized competency program with established standards for practice.

An example of a factor that would impede a patient's learning is: • poverty. • limited health insurance. • being an older adult. • heavy sedation.

heavy sedation.

The new nurse manager feels pulled between the expectations of staff, the demands of hospital administrators, and family obligations. According to the theory by Hardy (1978), unrelieved role stress and strain will lead to (p.471): • frustration and anger. • alienation of family and friends. • low productivity and performance. • physical symptoms and acute illness.

low productivity and performance.

During an employment interview for the manager's position in a home health agency, the applicant asks questions about the medical director and about retention of staff. The nurse executive assures the applicant that the agency has few personnel problems and receives excellent support from the medical director. The applicant knows that the agency has a 50% turnover rate and has had three medical directors in the past year. The nurse executive is: • unaware of the turnover rate and difficulties with the medical director. • lying about the problems and hoping to resolve them by hiring the applicant. • denying that the agency has a turnover problem with staff or medical directors. • minimizing the challenges of the position to make a positive impression on the applicant.

minimizing the challenges of the position to make a positive impression on the applicant.

Susan, a new graduate, is upset that so many staff have been absent lately from the unit. She declares to you that all absenteeism could be eliminated with proper management. Your response is based on understanding that: • not all absenteeism is voluntary. • high personal control contributes to absenteeism. • direct discussions with employees who have high levels of absenteeism are not recommended. • all absenteeism is related to personal issues and needs.

not all absenteeism is voluntary.

The nurse manager on a pediatric intensive care unit wants to evaluate patient satisfaction. The nurse manager understands that ultimately, positive relationships with consumers of care are evaluated by the: • cultural sensitivity of staff. • cost-effectiveness of care delivery. • economic value of service. • outcomes for clients and their perceptions of care.

outcomes for clients and their perceptions of care.

A nurse manager understands that the typical first step in handling an employee with a disciplinary problem is a: • verbal reprimand. • written reprimand. • reminder of employment standards. • day off without pay.

reminder of employment standards.

John, a new nurse manager, complains to his colleague that he feels very uncomfortable with the conflict between what he thinks he should be doing as the manager and what his supervisor thinks he should be doing. According to Hardy's role theory, John is experiencing: • stress. • role stress. • role strain. • role exploration.

role strain.

The education consultant for the hospital is presenting a workshop titled "Documentation: A Manager's Responsibility." What statement is incorrect regarding documentation? Documentation: • cannot be left to memory. A notation must be placed in the personnel file. • should avoid discussion of the problem. • should include what was done about the problem when it occurred. • needs to include date, time, and place.

should avoid discussion of the problem.

The chief nursing officer reviews the policy about "progressive discipline process." The progressive discipline process includes which of the following? The manager: • acts as a counselor and friend to the employee. • should reprimand and suspend the employee as a last resort. • should rehire the employee after a reasonable length of time. • should terminate the employee if the problem persists.

should terminate the employee if the problem persists.