leadership PrepU
The new nurse is evaluating the effectiveness of the assigned nurse mentor. Which characteristic should the new nurse recognize as being inappropriate for the nurse mentor to role model? Providing daily feedback to the new nurse Introducing the new nurse to members of the interdisciplinary team Encouraging the new nurse to enroll in continuing education courses Advising the new nurse to consult the nurse mentor before making decisions regarding client care
Correct response: Advising the new nurse to consult the nurse mentor before making decisions regarding client care Explanation: Effective mentors should provide feedback to the mentee, encourage opportunities for continued growth, and provide resources that will be supportive in the new role of nurse, including members of the interdisciplinary team. Effective mentors should promote confidence in the new nurse in the decision making process. Requiring the new nurse to report to the nurse mentor before making decisions can hinder the new nurse's confidence level.
A nurse is caring for a client who has a PPO health care plan. What is the greatest advantage of this type of plan? Ease of referrals Cost effectiveness Care coordination Improved health outcomes
Correct response: Cost effectiveness Explanation: Cost effectiveness is the greatest advantage of the PPO health care plan. PPOs are not known for the ease of referrals, care coordination, or improved health outcomes.
The nurse manager has recently promoted a staff nurse to the charge nurse position. Which type of power does the charge nurse now have? Explicit Implied Reward Coercive
Correct response: Explicit Explanation: Explicit power is determined by virtue of the nurse's position. A charge nurse is responsible for making decisions and carrying out tasks not performed by staff nurses. Implied power involves a person without a leadership position being in a position of authority with peers. Reward power involves rewarding staff with something that they deem important. Coercive power involves using threats of punishment to force staff to do something they do not want to do.
transformational leadership
type of leadership in which the person creates revolutionary change and commits to the personal and professional growth of self and others
The nurse manager calls a staff into a unit meeting to discuss patient satisfaction. During the meeting, several staff members assume control. The nurse manager does not intervene to regain control of the group. Which type of leadership style is the nurse embodying? Quantum Autocratic Democratic Laissez-faire
Correct response: Laissez-faire Explanation: Laissez-faire leadership style involves the leader relinquishing power or control to the group. Democratic leadership style involves sharing the decision making process and activities with others who have an interest. Autocratic leadership style involves assuming control over the decisions and activities of the group. Quantum leadership style involves seeing an organization and members as interconnected and collaborative. This style involves change as continually unfolding, and frequently incorporates technology.
The nurse manager of a medical-surgical unit is planning to make changes, because the unit is understaffed. What is the first action the manager takes to plan the change for the unit? Recognize the symptoms that indicate a change is needed and collect data Determine and analyze solutions to the problem Plan to make the change Evaluate the interventions made to correct the issue
Correct response: Recognize the symptoms that indicate a change is needed and collect data Explanation: The first step in planned change is recognizing symptoms that indicate a change is needed and collect supporting data. Determining and analyzing solutions to the problem comes after recognizing the symptoms. Planning and evaluation are the end results of the planned change.
Which are examples of personal leadership skills necessary for nurse leaders? Select all that apply. Knowledge of all nursing Communication Problem solving Religious values Self-evaluation
Correct response: Communication Problem solving Self-evaluation Explanation: Communication, problem solving, and self-evaluation are three of the four basic nursing leadership skills. Religious values are personal and may contribute to a person's strength, but are not included in what is needed for a public leader. No individual nurse can ever know everything there is to know about nursing.
transactional leadership
leadership style based on maintaining control by rewarding good behavior and punishing negative or detrimental behavior
A client asks a nurse about the benefit of using diagnosis-related groups (DRGs) as a reimbursement method. Which is the nurse's best response? "DRGs have helped to reduce healthcare costs by decreasing the overall length of a client's hospital stay." "This innovative cost-cutting approach has led to a decrease in hospital admission rates." "DRGs are an inefficient way for the government to manage a client's hospital recovery." "This reimbursement method focuses on preventing illness through screening and health promotion."
Correct response: "DRGs have helped to reduce healthcare costs by decreasing the overall length of a client's hospital stay." Explanation: The DRG system has been largely responsible for marked decreases in hospital lengths of stay. If hospital costs exceed the DRG payment for a client's treatment, the hospital incurs a loss, but if costs are less than the DRG amount, the hospital makes a profit. Decreasing hospital admission rates has not been shown to reduce the costs of health care. Health maintenance organizations (HMOs) focus on preventing illness through screening and health promotion.
An inner-city hospital is seeing a declining client census. The nurse managers begin to strategically plan to determine ways to increase their client population. In the implementation of these strategies, they also evaluate their success and failure and renew their plan. This activity is: directive initiatives. continuing processes. controlling client outcomes. problem solving.
Correct response: problem solving. Explanation: Management involves getting a job done or accomplishing a goal. The process they use is similar to the problem-solving process, which is based on the scientific or research method. The nurses are not making directive initiatives. Although this work is a continuing process, this description is too vague. Nurses cannot control patient outcomes; they can only hope to improve them by making changes that may or may not work.
Conflict has emerged on a nursing unit because new graduates have found that some of the more experienced nurses are manipulating the client assignment to ensure a lighter workload during night shifts. How should the manager of the unit best address this conflict? Arrange a meeting where the issue can be discussed and addressed by as many of the nurses as possible. Gather evidence over the next several weeks in order to determine if the practice is indeed happening. Arrange for the newer nurses to organize the client assignment for a trial period. Reassure the new graduates that the more experienced nurses are acting in the interests of both staff and clients.
Correct response: Arrange a meeting where the issue can be discussed and addressed by as many of the nurses as possible. Explanation: Open, explicit, and participatory conflict resolution that is based on collaboration is an effective strategy for the management of conflict. Gathering evidence does not directly address the conflict that currently exists and reassurance may be unwarranted and false. Allowing the new graduates to create the client assignment may perpetuate selfish practices and does not resolve animosity between the two camps.
A nurse manager is educating the staff on new forms of charting. Within the education session, the manager sets a goal for complete use of the charting. Through goal setting, the manager is acting as: an educator. a leader. a guide. a clinical specialist.
Correct response: a leader. Explanation: Leadership is the ability to influence others to strive for a vision or goal or to change. Thus, goal setting is the act of a leader. Although educators may set educational goals, the primary focus of an educator is teaching. A guide provides advice but does not set goals. A clinical specialist develops expert skills and knowledge in one specific area of practice.
After a nurse manager implements a solution to the problem of delays in obtaining supplies, the first task for the manager is to: ask the staff members for other solutions. plan to monitor the supply cabinets. assess whether the desired results have occurred. make an appointment with the chief nursing officer.
Correct response: assess whether the desired results have occurred. Explanation: The nurse manager must evaluate the results of the efforts to determine whether the desired results have occurred. The nurse manager should solicit input from staff members about potential solutions before, not after, implementing a solution. Monitoring the supply cabinets would be more appropriate if the problem were suspected drug diversion by staff but would be unnecessary for evaluating for improvement in delays for obtaining supplies. Making an appointment with the chief nursing officer is not necessary and would not help the nurse manager evaluate the change in procedure related to obtaining supplies.
A nurse is successful in promoting change on the nursing division. This nurse would be considered a: guide. leader. manager. specialist.
Correct response: leader. Explanation: The role of a leader is to direct or motivate a person or group to achieve set goals. The role of a manager is to plan, organize, direct, and control available human, material, and financial resources to deliver quality care to patients and families. A guide can show the way to a desired result but cannot effect change in the way that a leader can. A specialist is one who has expert skills and knowledge in a specific area of practice.
Which of these statements regarding a nurse manager role is accurate? The nurse manager's main role in the nursing unit is to manage the unit budget. To effectively manage the nursing unit, the nurse manager should also be a leader. A healthy work environment is not within the scope of the nurse manager's role. The nurse manager will decide on the financial targets for the nursing unit.
Correct response: To effectively manage the nursing unit, the nurse manager should also be a leader. Explanation: In order to be an effective nurse manager, the nurse manager must also be a leader. This is important with management of a healthy work environment, which is a responsibility of the nurse manager. This is done by helping ensure that interpersonal conflicts are resolved. The nurse manager is also accountable for client census, staffing, supplies, and budget, but is not responsible for setting financial targets for the budget; this is usually managed at the executive level.
A nurse leader on a unit allows the staff to make all decisions and direct themselves, including filling out the work schedule. The nurse leader is practicing which leadership style? Autocratic Democratic Laissez-faire Transformational
Correct response: Laissez-faire Explanation: In laissez-faire leadership, also called nondirective leadership, the leader relinquishes power to the group, such that an outsider could not identify the leader in the group. The democratic leadership style is characterized by a sense of equality among the leader and other participants. The autocratic leader assumes complete control over the decisions and activities of the group. Transformational leaders create intellectually stimulating practice environments and challenge themselves and others to grow personally, to grow professionally, and to learn.
The nurse is conducting an in-serve on change theories. Which example should the nurse include in the presentation illustrating Lewin's three stages of change? Nurses work in groups to care for clients. Physicians collaborate with nurses. Quality client care is provided. Staff voice concerns among themselves about the requirement of mandatory overtime. A unit meeting is called to discuss the issues with management. The mandatory overtime requirement is reinforced by management. A need for a safer intravenous therapy pump is identified. New intravenous therapy pumps are purchased and training for staff nurses is provided. Intravenous therapy pumps are placed on the nursing unit for client care. Multifunctional machines monitor clients' vital signs. Data from the machines is used to create trends in clients' health. The trends are compared to national norms and used to determine if measures can be taken to improve client care.
Correct response: A need for a safer intravenous therapy pump is identified. New intravenous therapy pumps are purchased and training for staff nurses is provided. Intravenous therapy pumps are placed on the nursing unit for client care. Explanation: Lewin's three stages of change are: unfreezing - recognizing need for change; moving - initiating change after planning; and refreezing - making change operational. Identifying a need for new intravenous therapy pumps, training staff to use the pumps, and then placing the pumps for client care is the only option that illustrates Lewin's stages.
A nurse is in charge of a large group of employees on a busy surgical floor. Today's care must be completed early due to a special event involving most of the employees. Which management style would work best in this situation? Authoritarian Coercive Democratic Laissez-faire
Correct response: Authoritarian Explanation: With authoritarian, or autocratic, leadership, the leader determines, dictates, and directs the activities of the group, with no input from the followers on decisions. It is particularly effective when decisions for a large group need to be made quickly and efficiently, as in this scenario. Coercion--involving forcing actions upon the staff--is not a recognized leadership style and, in any case, would not be an advisable approach as it would likely trigger resistance in the group and be counterproductive. Democratic leadership is appropriate when the task, or decision at hand, is not one that requires urgent action, when subordinates can be expected to make meaningful contributions, and when their input can be taken into account. Laissez-faire management provides little or no direction; coworkers develop their own goals, make their own decisions, and take responsibility for their own management.
A client is received into the emergency department after getting shot in the chest. The client is hemorrhaging profusely and is in hypovolemic shock. The nurse calls a code blue. What type of leadership style will be most effective during the management of the code? Autocratic leadership Laissez-faire leadership Democratic leadership Transactional leadership
Correct response: Autocratic leadership Explanation: Autocratic leadership will be most effective in this scenario. Autocratic leadership involves the leader assuming control over the decision and activities of the group. During code blue, a leader is needed to direct the actions needed and make quick decisions to positively affect the client. Laissez-faire leadership would ultimately lead to the demise of the client. Democratic leadership could possibly delay the client receiving life-sustaining measures and would be less effective than autocratic leadership. Transactional leadership would involve a reward system which would be unethical in this situation.
A nurse manager is trying to resolve a conflict between the day and night shifts. The nurse manager wants to convince the involved persons to set aside their differences, determine a priority common goal having to do with improved client care, and accept mutual responsibility for achieving this goal. The nurse manager is using which type of conflict resolution? Avoiding Collaborating Competing Compromising
Correct response: Collaborating Explanation: Collaborating has all parties set aside previously determined goals, determine a priority common goal, and accept mutual responsibility for achieving this goal. This requires mutual respect, honest communication, and shared decision making. Avoidance, as a method of conflict resolution, involves looking the other way and doing nothing to resolve the conflict. Competing has one side winning at the expense of the other. Compromising means that each side gives up something of equal value.
A staff nurse works on a medical unit where staff retention is very high. There is a sense of equality between the leader and the staff nurses. The unit decisions and activities are shared between the leader and the group. The designated nurse leader practices which leadership style? Autocratic Democratic Laissez-faire Transformational
Correct response: Democratic Explanation: The democratic leadership style is characterized by a sense of equality among the leader and other participants and shared decision making. The autocratic leader assumes complete control over the decisions and activities of the group. Transformational leaders create intellectually stimulating practice environments, and challenge themselves and others to grow personally, to grow professionally, and to learn. In laissez-faire leadership, also called nondirective leadership, the leader relinquishes power to the group, such that an outsider could not identify the leader in the group.
A nurse informs the client that the client has no choice and must take a bath in the morning. What type of leadership does this exemplify? Directive leadership Participative leadership Shared governance Institutional governance
Correct response: Directive leadership Explanation: Directive (also known as autocratic or authoritarian) leadership describes a leader who makes all the decisions and tells followers what to do. Democratic, or participative, leadership style and shared governance involve sharing the decision-making process and activities with others who have an interest. Institutional governance is governance by the institution.
A nurse is reviewing the different types of health care delivery services available in the community. Which method would the nurse identify as having the primary care goal of reducing costs by preventing illness? Health maintenance organization (HMO) Preferred provider organization (PPO) Accountable care organization (ACO) Community health center
Correct response: Health maintenance organization (HMO) Explanation: Health maintenance organizations (HMOs) are prepaid, group-managed care plans that allow subscribers to receive all the medical services they require through a group of affiliated providers. Their primary care goal is to reduce costs by preventing illness. Preferred provider organizations provide services at a lower fee in return for prompt payment and a guaranteed volume of clients and services. Accountable care organizations offer incentives to provide integrated, well-coordinated care. Community health centers ensure that everyone who needs care has access regardless of the ability to pay.
The designated charge nurse on the telemetry unit organizes and facilitates the unit meetings; however, during most of the meetings, another registered nurse runs the show and influences staff decisions just by her charisma and personality. Her power to lead is defined by which of the following terms? Implied Situational Democratic Explicit
Correct response: Implied Explanation: Implied power arises when a person who has no official assigned role assumes a leadership role by virtue of the force of his or her personality and charisma. The designated charge nurse's official assigned role gives her explicit power by virtue of that assignment. Situational and democratic are types of leadership rather than power.
Which cost-cutting measure in health care is most likely to facilitate improved client outcomes? A prospective payment system, such as diagnosis-related groups (DRGs) Comparative effectiveness analysis Improving transitions across settings Increased emphasis on capitation and managed care
Correct response: Improving transitions across settings Explanation: Improving transitions across settings is most likely to improve client outcomes because it involves better client hand-offs during changes from one level of care to another. DRGs help reduce costs but do not directly improve patient outcomes. Comparative effectiveness analysis encourages the provider to carefully select technologies with cost in mind. Capitation and managed care may actually decrease positive client outcomes if there is too much emphasis on cost cutting.
A registered nurse serves as the chair of the Nursing Practice Committee for the hospital. The meetings of this committee do not have a planned agenda; members of the committee who are interested in a particular topic feel free to suggest it and then to lead the subsequent discussion. This chair's leadership style could be most accurately termed what? Laissez-faire Decentralization Democratic Autocratic
Correct response: Laissez-faire Explanation: Little or no direction is provided in laissez-faire management: coworkers develop their own goals, make their own decisions, and take responsibility for their own management. Democratic leadership, also known as participative or shared leadership, involves members of the group taking a more participative role in the decision-making process. Autocratic leadership, also known as authoritarian leadership, is characterized by the leader's individual control over all decisions and little input from group members. Decentralized decision-making is any process in which the decision-making authority is distributed throughout a larger group.
The nurse manager notices a trend in nurses routinely arriving to work late. How can the nurse use the transactional leadership style to get nurses to arrive to work on time? Allow the nursing staff to develop a plan to decrease tardiness within the unit. Emphasize the importance of arriving to work on time during a monthly unit meeting. Monitor time clock reports on a monthly basis and enter all nurses who have not been tardy into a raffle for a paid day vacation. Generate a report of nurses who routinely arrive to work late and set an example by firing the nurse who has been tardy the most.
Correct response: Monitor time clock reports on a monthly basis and enter all nurses who have not been tardy into a raffle for a paid day vacation. Explanation: Transactional leadership style involves creating a reward system to get the desired outcome. Entering the nurses who have not been tardy is the only option that provides a reward. Allowing the nursing staff to assist in correcting the problem is an example of democratic leadership style. Emphasizing the importance of arriving to work on time is an example of autocratic leadership. Firing is an example of coercive power.
A nurse is helping a client choose a new health care plan. The client states a preference being able to choose a physician. Which plan would be the best option for this client based on the stated preferences? HMO PPO POS LTC
Correct response: PPO Explanation: Preferred provider organizations (PPOs) allow a third-party payer (agencies that pay health care providers for services provided to people, such as a health insurance company) to contract with a group of health care providers to provide services at a lower fee in return for prompt payment and a guaranteed volume of clients and services. The client may choose to use a physician within the PPO for a lower service fee or choose a provider outside the PPO and pay a higher service fee. A point of service (POS) plan is a mix between an HMO and PPO, but the client usually does not have the ability to choose the primary health care provider. Health maintenance organizations (HMOs) are prepaid, group-managed care plans that allow subscribers to receive all the medical services they require through a group of affiliated providers. The client would not be able to choose the provider in most HMOs. Long-term care (LTC) is not a type of health care plan.
A nurse manager best demonstrates effective leadership characteristic by which action? Being very structured and rigid with the unit flow Knowing all information about the unit processes Indicating an interest in becoming a role model Sharing a vision for the unit and enlisting support
Correct response: Sharing a vision for the unit and enlisting support Explanation: The nurse leader on a nursing unit should have a vision for the unit and be able to share this with the staff in order to enlist support and cooperation among the staff. The nurse leader should already be a role model, rather than just demonstrating interest. This would be related more to someone who was developing leadership qualities. The nurse leader should be flexible, not rigid, and does not have to know all information about the unit; rather, the nurse leader needs to know what resources are available among the staff and other leadership in helping reach expected goals and outcomes.
A charge nurse on a medical-surgical unit is asked by the nurse manager to serve as a mentor to another staff nurse who is less experienced. Which of these would best describe this role? The charge nurse is being paid to supervise the staff nurse. The staff nurse is learning about all the hospital policies from the charge nurse. The charge nurse is providing support for the staff nurse in new responsibilities. The staff nurse is orienting to the unit as a newly hired nurse.
Correct response: The charge nurse is providing support for the staff nurse in new responsibilities. Explanation: A mentor is not a paid position, but, instead, is a person who provides support and encouragement to a less experienced nurse who is learning new responsibilities for a current role or an expanded one. Preceptorship typically is a paid position, and is provided for a new or experienced nurse who is training for a new position on a unit. The preceptor would teach the new nurse about hospital policies and procedures, as well as supervise the nurse in daily assignments.
The nurse is advising a client about health problems related to being overweight. The client acknowledges the need to lose weight. The nurse provides education on how to count calories in food and the importance of daily exercise. The client states an intention to begin counting calories with the next meal. The client also states an intention to begin an exercise program with friends. Which statement associated with this scenario illustrates Lewin's stage of unfreezing? The client acknowledges the need to lose weight. The client also states an intention to begin an exercise program with friends. The client states an intention to begin counting calories with the next meal. The nurse provides education on how to count calories in food and the importance of daily exercise.
Correct response: The client acknowledges the need to lose weight. Explanation: In unfreezing, one recognizes the need for change. The client's acknowledgment of the need to lose weight is the only example provided of unfreezing. The nurse providing education on how to count calories in food and the importance of daily exercise is an example of moving, in which change is initiated after a careful process of planning. The client's intentions to begin an exercise program with friends and to begin counting calories with the next meal are examples of refreezing, which involves making a change operational, or a part of one's everyday life.
The nurse recognizes that a new mother is having difficulty breastfeeding. The nurse demonstrates various positions in which to hold the baby while feeding. The nurse also educates the mother on ways to ensure proper latching. The new mother attempts to breastfeed the baby again using the new techniques and is successful. Which statement in this scenario illustrates Lewin's stage of refreezing? The nurse also educates the mother on ways to ensure proper latching. The nurse recognizes that a new mother is having difficulty breastfeeding. The nurse demonstrates various positions in which to hold the baby while feeding. The new mother attempts to breastfeed the baby again using the new techniques and is successful.
Correct response: The new mother attempts to breastfeed the baby again using the new techniques and is successful. Explanation: Refreezing involves making a change operational, or a part of one's everyday life. The mother feeding the baby using new techniques is an example of refreezing. The nurse recognizing that a new mother is having difficulty breastfeeding is an example of unfreezing, in which the need for a change is recognized. The nurse educating the mother on ways to ensure proper latching and demonstrating various positions in which to hold the baby while feeding are examples of moving, in which change is initiated after a careful process of planning.
