Module 39 Managing Care Pearson MyLab

The nurse manager is preparing to create tools to measure the performance of the emergency department staff when responding to cardiac emergencies. Which function is the nurse manager carrying out? A. Planning B. Controlling C. Directing D. Organizing

B Controlling involves comparing actual results with projected results, similar to the evaluation step in the nursing process; in this scenario, the nurse is controlling. Planning involves addressing the questions of what, why, where, when, how and by whom. Organizing is the process of coordinating the work to be done. Directing is the process of getting the organization's work done.

A participant at a healthcare reform discussion states that the best approach to healthcare would allow continued use of public and private providers with all necessary medical services covered by the government. This type of approach would best fit which category of healthcare systems? A. Mandatory health insurance B. Multipayer systems C. Socialized medicine D. Socialized insurance

D Socialized insurance describes a system that uses public and private providers and in which all necessary medical services are covered by the government. Mandatory health insurance refers to countries that have large nonprofit health organizations that cover care. In a socialized medicine approach, the state owns and controls all healthcare services. Mandatory and voluntary insurance systems are referred to as multipayer, while socialized approaches are referred to as single-payer.

The registered nurse (RN) has asked a licensed practical nurse (LPN) to complete a dressing change for one of the RN's assigned patients. Which is the responsibility of the delegate after the RN explains how to do the dressing change? A. Communicating understanding of the dressing change B. Informing the patient when performing the task that it is being done on behalf of the RN C. Ensuring that the nurse will be in the room during the dressing change to supervise the process D. Reviewing provider orders to make sure that the dressing change has been prescribed

A After the delegator has explained the task, the delegate has a responsibility to communicate to the delegator that they understand the task. It is not necessary for the delegate to inform the patient that they are doing the task on behalf of the RN, to check the provider's orders, or to have the nurse directly supervise the task (unless the delegate is unsure of how to complete the task).

An elderly adult patient with diabetes, obesity, and peripheral vascular disease has been admitted for a left below-the-knee amputation. Which service should the nurse initiate to best meet the needs of this patient as they transition in and out of the hospital setting? A. Case management B. Managed care C. Long-term care D. Primary nursing

A Case management is the coordination of patient care using an interprofessional team. It offers intensive services to meet the individual's needs and is most effectively and efficiently used for patients with multiple or complex health problems such as those that exist with the patient in this scenario. Primary nursing is a delivery model in which one nurse is responsible for overseeing the total care of a number of patients 24 hours a day, 7 days a week. Primary nursing can provide comprehensive, individualized care but would not provide the best approach for this patient. Managed care refers to a healthcare delivery system that focuses on decreasing costs and improving outcomes for groups of patients; it would not be a service to which the nurse would refer the patient. Long-term care refers to settings that provide 24-hour care for individuals who can no longer live independently. It would not best meet the needs of the patient at this time.

The home care nurse manager is reviewing applications received from nurses for a case manager role. Which applicant should the nurse manager initially identify as the best fit for the position? A. A baccalaureate (BSN) prepared nurse with 15 years of experience in acute and community-based care B. A nurse with an associate's degree (AD) and 20 years of experience that includes managerial experience C. A nurse with 25 years of experience who is returning to practice after teaching fundamentals of nursing at a local community college for the past 10 years D. A newly graduated advanced practice nurse (APN) who recently completed a direct baccalaureate (BSN) to APN program

A Case managers require nurses with advanced degrees and considerable experience in nursing. In this scenario, the BSN-prepared nurse with 15 years of acute and community-based experience would be the best fit for the position. A new graduate who went straight from a BSN to an APN will likely not have the clinical experience needed for the position. While the nurse with an AD has a great deal of experience, the education is the minimum required for a registered nurse. The returning nurse educator has many years of experience but has been out of the practice arena for the last 10 years, potentially impacting the fit for the case manager role.

The nurse is working on a unit where the unit manager has indicated that they want to enhance the delivery of care through shared governance. Which action by the unit manager would best exemplify implementation of shared governance? A. Creation of a group, including staff nurses, to make decisions concerning long-range planning for the unit B. Development of specific job descriptions for nurses according to their education or training to maximize use of staff C. Creation of interprofessional teams that have full responsibility for planning and assessing the needs of patients D. Development of guidelines to support delivery of care by teams led by a professional nurse

A Creation of a group, including staff nurses, to make decisions concerning long-range planning for the unit would best reflect the concept of shared governance. Differentiated practice would involve development of specific job descriptions for nurses according to their education or training to maximize the best use of all nursing staff. The creation of interprofessional teams that have full responsibility for planning and assessing the needs of patients reflects case management, not shared governance. Development of guidelines to support delivery of care by teams led by a professional nurse describes team nursing.

The unit nurses describe the unit nurse manager as someone who encourages them to be involved in decision making and discussions about matters concerning the unit. Which types of leadership style is the nurse manager exhibiting? A. Democratic and laissez-faire B. Authoritarian and participative C. Laissez-faire and autocratic D. Bureaucratic and democratic

A Democratic leaders encourage group discussion and decision making, which describes the nurse manager, while a laissez-faire leader recognizes the group's need for self-regulation. These descriptions do not fit bureaucratic, authoritarian, or autocratic leadership styles.

The nurse is reviewing dietary limitations with a patient, when the patient states that they will not follow the recommendations. How should the nurse initially address this situation using a patient-focused approach? A. Inform the patient of the risks associated with not following the dietary restrictions. B. Acknowledge the patient's comments and inform the healthcare provider. C. Enlist the help of the patient's family to help persuade the patient to follow the dietary restrictions. D. Inform the patient that, if they are noncompliant, they will immediately be discharged.

A Patient-focused care seeks to honor the patient's preferences to the greatest degree possible. The nurse would never threaten to discharge the patient for noncompliance. However, the nurse should not agree to activities that will potentially harm a patient's well-being. In cases when this occurs, the nurse should initially inform the patient of the risks associated with the action to help the patient clearly understand possible outcomes.

The nurse leader is trying to identify the why, where, when, how, and by whom during unit budget development. Which management function is the nurse completing? A. Planning B. Controlling C. Directing D. Organizing

A Planning involves addressing the questions of what, why, where, when, how, and by whom. Organizing is the process of coordinating the work to be done. Directing is the process of getting the organization's work done. Controlling involves comparing actual results with projected results, similar to the evaluation step in the nursing process.

The nurse case manager has been assigned a 3-year-old patient with cystic fibrosis. As the nurse initiates care, which resource should they use to guide care? A. Critical pathway B. Nursing standards of care C. Cystic Fibrosis Foundation Age-Specific Guidelines D. Cystic fibrosis concept map

A Successful case management relies on the use of critical pathways, which refers to the expected outcomes and care strategies developed by collaboration with the healthcare team. A concept map would not support effective case management of this patient, because it describes only nursing interventions. Nursing standards of care delineate the overall standards that guide nursing care; they would not guide specific care or case management for this patient. The Cystic Fibrosis Foundation Age-Specific Guidelines may be used as a reference when developing case management guidelines but do not provide guidance for the overall care management process for a patient with this disease.

The nursing unit director at a large acute care facility is reviewing possible care delivery models. Which factor should the nurse identify as a strong advantage of the functional approach to care delivery? A. Allows centralized direction and control, increasing efficiency B. Maximizes the time and skill of individual staff members C. Allows all care to be provided by nurses, supporting more consistent care D. Includes nursing staff in decision making regarding patient care policies

A The functional method of care delivery is economical and efficient, permitting centralized direction and control. A case method or primary care nursing approach, not a functional approach, includes all care being provided by nurses. Maximization of the time and skills of individual staff members is an advantage of the differentiated practice system. Shared governance includes nursing staff in patient care policies.

The nurse delegates a task to the unlicensed assistive personnel (UAP). After delegating, the nurse receives a call from the patient requesting assistance related to the task that has been delegated. Which is the most appropriate action for the nurse at this time? A. Alerting the UAP that the patient is asking for assistance B. Asking another UAP to assist the patient C. Responding to the call and assisting the patient D. Reprimanding the UAP for not assisting the patient

A The nurse must delegate the responsibility and authority for the task to be completed. The UAP might have instructed the patient to call the nurse if assistance was required. The nurse has no way of knowing this. The nurse should not ask another UAP to complete a task once it is delegated. By responding to the call and helping the patient, the nurse would not be permitting the UAP to complete the task. This would not be the best use of the nurse's time and would not assist the UAP to better understand the delegation process or to take responsibility and authority for the task that the UAP accepted. It would be inappropriate for the nurse to reprimand the UAP prior to the task being completed.

The nurse has delegated certain aspects of care to an unlicensed assistive personnel (UAP) during a busy shift. During the second step of the delegation process, which is the most appropriate action for the nurse to complete? A. Checking the medical record for documentation of a patient's urine output B. Explaining the importance of correctly measuring a patient's urine output C. Deciding that help is needed to measure a patient's urine output D. Determining that the UAP is qualified to measure urine output

B The delegation process consists of four distinct steps: assessment and planning; communication; surveillance and supervision; and evaluation and feedback. These steps should be followed for every situation involving delegation. In the second step of the delegation process, the nurse should specifically review with the delegate the importance of the task to the patient. Checking the medical record for documentation of a patient's urine output is performed in the fourth step of the delegation process. Deciding that a task needs to be completed is performed in the first step of the delegation process. Determining that the delegate is sufficient for the task is also performed in the first step of the delegation process.

The nurse manager is discussing issues on the unit with extended stays for Medicare patients due to possible infection control issues. One staff nurse asks why it matters since insurance providers cover the cost of the care and therefore the financial aspects are not really that important. Which response by the nurse manager best addresses this statement? A. "While that may be true, it is prudent for us to try to control costs to keep the healthcare system functional." B. "Unless there is a major uncontrollable event for the patient, we only get reimbursed a specified predetermined amount for care, regardless of how long they are here." C. "Depending on which Medicare plan they have, they may not have coverage that will cover these extended stays, thus placing a financial obligation on the patient." D. "The things that are happening are a direct result of improper infection control practices; it's not fair for the patient or the insurance company to shoulder costs for our errors."

B Diagnosis related groups (DRGs) specify a fixed amount for which the facility can bill for a specific diagnosis unless a major uncontrollable event occurs. When patient stays exceed the average length of stay, the costs will not be reimbursed, which impacts the hospital financially. The statement that it is prudent to try to control costs to keep the healthcare system functional is important but not the best response to the nurse's statement. While supplementary Medicare plans can differ, the main plan that includes hospitalization benefits the same is not a valid statement. While stating that the issues are due to improper infection control practices may be true, it is not the best response to this statement.

A recently graduated nurse has begun working at a facility that uses the team nursing approach. The nurse asks if there are any resources available that can help nurses better understand how to safely delegate tasks to the other members of the healthcare team. Which resource would be most helpful to the nurse? A. Job description for unlicensed assistive personnel at the facility B. The ANA's Five Rights of Delegation C. Clinical practice guidelines for registered nurses D. Nursing scope and standards for medical-surgical nursing

B In order to better understand the process of delegation, the nurse would refer to the ANA's Five Rights of Delegation or the appropriate state nurse practice act. Nursing scope and standards for medical-surgical nursing, job description for unlicensed assistive personnel, and clinical practice guidelines for registered nurses may help provide guidance concerning the role of nurses and unlicensed assistive personnel but would not provide the best guidance for the process of delegation.

The nurse manager notes that a new nurse is overwhelmed with patient care tasks and rarely asks other team members, including unlicensed assistive personnel (UAPs), for assistance. When the manager asks the new nurse why they are not using the UAPs, the nurse replies, "I don't feel that I should since I'm still accountable for the task they do; that frightens me." How should the nurse manager best respond to the new nurse? A. "It's okay, I was kind of the same way myself. When you're ready let me know and I can help you learn how to effectively delegate." B. "I understand. Let's review the state practice act and the ANA's Five Rights of Delegation to help you understand how to address your fears." C. "You will burn out if you don't start delegating, so it's important that you deal with your fears concerning it." D. "By not delegating, you might be missing some things which actually jeopardizes the patients more than if you did delegate."

B In this scenario, it is important for the nurse preceptor to address this issue with the new nurse as soon as possible without adding to the nurse's stress by initially discussing the negative consequences of not delegating. State practice acts and the ANA's Five Rights of Delegation serve as guidelines that can help the new nurse alleviate fears about being accountable for the actions of the UAPs.

The nurse delegated a task to the unlicensed assistive personnel (UAP). A few minutes later, the UAP returns and tells the nurse that the patient wants to speak to her before the task is done. When the nurse speaks with the patient, the patient shares that they thought only nurses could do the task. How should the nurse best respond to the patient's comment? A. "There are many things that UAPs can do but normally don't if we have time to do them ourselves." B. "This is something that they are allowed to do. They reviewed the task with me and demonstrated they could do it safely." C. "They are allowed to do these tasks if we are busy, so please allow them to come back and complete it." D. "It made the UAP feel bad when you questioned their ability. Do you have a problem with the UAP taking care of you?"

B It is important for the nurse to help the patient understand that the nurse delegated the task to the UAP and that the task can be safely delegated. Additionally, the patient should be informed that the nurse reviewed instructions concerning the task with the UAP before they completed the task. It would not be professional to state that they only do the tasks when nurses are busy. There is no information in the scenario to indicate that the patient does not like the UAP; this would not be the best response.

A nurse who has been hired to fill a case management role begins working with other healthcare team members to provide care for older patients who are diagnosed with heart failure. Which should the nurse do initially after establishing a collaborative practice team? A. Determine the responsibilities of each collaborative practice team member. B. Define expected outcomes of care for this population within specified time frames. C. Identify potential variances that may occur for patients with heart failure. D. Determine specific interventions to be achieved within specified time frames.

B Nursing case management organizes patient care by major diagnosis or diagnosis-related groups (DRGs). DRGs allow nursing case managers to manage the care of a specific patient population by establishing a collaborative practice team. This is followed by the definition of expected outcomes for the specific population. Determining specific interventions, determining responsibilities of team members, and identifying variances in patients occur after this step.

A facility has decided to use the case management process to manage the care of patients with juvenile diabetes in the primary care clinic. Using the case management approach, when should identification of expected outcomes occur? A. After development of the critical pathway to guide care B. After a collaborative practice team is established C. Once all potential patient variations have been discussed D. After potential interventions have been identified

B Once a specific patient population has been identified, the first step is to establish a collaborative practice team that then develops expected outcomes for the population. Identification of specific interventions and potential variations occurs later in the process, along with the development of critical pathways.

The nurse manager is discussing the principles of accountability versus responsibility with nursing staff during a continuing education session. Which information provided by the nurse manager best clarifies the differences between the two? A. Responsibility is clearly reflected in an institution's mission and philosophy, while accountability is reflected at the individual level. B. Accountability helps nurses to feel empowered and confident in their abilities, while responsibilities tend to be more task oriented and routine. C. Accountability is being willing to accept the consequences of one's behavior, while responsibility is an obligation to perform tasks. D. Responsibility is reflected in national standards of practice, while accountability is determined facility by facility.

C Accountability is the ability and willingness to assume responsibility for one's actions and to accept the consequences of one's behavior, while responsibility is an obligation to meet objectives and perform tasks. This would be the best description of differences between the two. Accountability, not responsibility, is reflected in national standards of practice and in an institution's mission or philosophy. Accountability does not necessarily support empowerment and confidence in one's role. This is enhanced by a manager who is supportive.

During the orientation of new nurses to an acute care facility, diagnosis-related groups (DRGs) are discussed. Which statement by one of the orientees indicates accurate understanding of DRGs? A. "DRG rates are fixed, regardless of the occurrence of major uncontrollable events." B. "DRG rates are revised quarterly to reflect the constant changes that occur in the healthcare system." C. "DRGs determine what will be paid for care by the insurer before the patient is admitted." D. "DRG rates are grouped by body system, with predetermined pay determined by system."

C DRGs are a prospective payment system that identifies a predetermined amount that facilities will be paid for a specific diagnosis. It is not true that they are fixed, regardless of the occurrence of a major uncontrollable event. DRGs are grouped by specific diagnosis, not body system. DRG rates are set a year in advance; they are not revised quarterly.

The nurse is working at a facility that uses a case method delivery model of care. Which statement by the nurse best describes this model? A. It uses specific job descriptions to differentiate the practice of each nurse who may provide care. B. One nurse oversees a group of patients 24 hours a day. C. The patient has consistent contact with one nurse during the shift. D. Unlicensed assistive personnel (UAPs) provide less complex care.

C In a case method delivery model, one nurse is assigned to and made responsible for the comprehensive care of a group of patients during their shift. In primary nursing, a nurse oversees the care of a set group of patients 24 hours a day, 7 days a week. In primary nursing delivery models, one consistent nurse is not assigned to do total care, they oversee management of all care. Differentiated practice delivery models use specific job descriptions to clearly delineate roles, not the case method.

The nurse manager encourages the nurses on the unit to attend educational offerings to stay current by providing a small stipend and time off to attend one offering a year. Which management responsibility is the nurse manager best fulfilling through provision? A. Managing resources B. Managing time C. Enhancing employee performance D. Holding nursing staff accountable

C Provision of time and money to support attendance at educational offerings enhances employee performance, which is a management responsibility. This would not best represent the responsibility of managing resources, holding staff accountable, or managing time.

The nurse is temporarily assigned to a unit that is receiving multiple admissions secondary to a mass casualty event. The unit's nurses are busy, but an unlicensed assistive personnel (UAP) states to the nurse, "Help complete vital signs on the rest of the patients in the unit." What type of delegation is best reflected by this request? A. Overdelegation B. Unnecessary delegation C. Reverse delegation D. Ineffective delegation

C Reverse delegation occurs when someone of a lower rank delegates a task to someone with more authority; this would best characterize the UAP delegating vital signs to the nurse for the rest of the unit's patients. Overdelegation occurs when the delegator loses control of a situation by providing the delegate with too much authority or too much responsibility. Unnecessary delegation or duplication results when related tasks are given to too many people. Ineffective delegation occurs when the delegation process is not followed or barriers remain unresolved.

A nursing unit manager is looking at historical nursing staff costs as she creates a budget for the next fiscal year. Which issue related to a recent nursing shortage makes it difficult to determine the actual costs of nursing staff? A. Increased number of nurses with less than a baccalaureate degree B. Increased use of unlicensed assistive personnel and decreased number of nurses C. Increased salary fluctuations D. Increases in labor union participation

C When nursing shortages occur, employers are forced to compete for the same available pool of nurses, which results in an increase in wages to hire and retain staff. As positions are filled and more nurses enter the workforce, employers begin to slow the rate at which they increase wages, leading to salary fluctuations and contributing to the challenge of determining the actual costs of nursing. Difficulty in determining nursing staff costs during shortages is not due to increased labor union participation, decreased level of education of the nurses, or increased use of unlicensed assistive personnel.

The nurse manager is meeting with nurses who have recently been promoted to the managerial level. The manager encourages the nurses to review the nursing standards of practice and the state nurse practice act. Which principle of management is reflected in these documents? A. Influence B. Authority C. Responsibility D. Accountability

D Accountability is reflected in national standards of practice and state nurse practice acts. Responsibilities, authority, and influence are not reflected in these documents.

A nursing work group is tasked with finding cost-effective ways to enhance care provision. The group is pulling together a proposal for administrative review that includes hiring more unlicensed assistive personnel (UAPs). Which benefit of delegation should the working group include in their proposal to best enhance potential support for the proposal? A. The availability of more UAPs to whom tasks can be delegated requires fewer nurses, decreasing overall staffing costs. B. A better mix of nurses and UAPs allows the organization more flexibility to respond to ever-changing patient needs. C. It allows delegates (the UAPs) to gain new skills and abilities. D. Use of delegation increases efficiency of care and productivity, which can improve the organization's financial position.

D Benefits of delegation for organizations include increased efficiency of care and productivity, which can improve the organization's financial position. A decrease in the number of nurses needed would not be considered an organizational benefit. Additional flexibility is not a benefit of delegation for an organization either. While expansion of skills and abilities may ultimately benefit the organization, this is a greater benefit to the delegate and would not necessarily encourage the administration to support the proposal.

Which activity by a nurse manager would best fulfill the management responsibility of enhancing employee performance? A. Ensuring adequate staffing, supplies, and materials for patient care B. Establishing a process to address conflict on the unit between team members C. Working with staff to use delegation appropriately and effectively D. Encouraging nurses to pursue advanced degrees

D Employee performance is enhanced when the nurse manager identifies and facilitates learning opportunities and educational advancement. Establishing a process to address conflict would be an aspect of managing conflict. Working with staff to use delegation effectively would be an aspect of managing time. Ensuring adequate staffing and resources would be an aspect of managing resources.

The preceptor is orienting a staff nurse to primary nursing. Which statement by a staff nurse most accurately reflects primary nursing? A. "Primary nursing relies solely on the nurse to provide all care." B. "In primary nursing, there is participation by the nurse in making, implementing, and evaluating patient care policies." C. "In primary nursing, responsibility is given to the person doing the work." D. "With primary nursing, a nurse is responsible for overseeing a group of patients 24 hours a day, 7 days a week."

D In primary nursing, one nurse is responsible for overseeing the total care of a number of patients 24 hours a day, 7 days a week, even if the nurse does not deliver all of the care personally. In primary nursing, the nurse oversees total care but does not necessarily provide it. Functional nursing, not team nursing, describes a model in which total responsibility and accountability for work being done is given to the person completing the work. Shared governance describes the process of involving nurses in making, implementing, and evaluating patient care policies; this is not a description of primary nursing.

A managed care facility is attempting to increase participation by nursing staff in decision making throughout the organization. Which model should the facility leadership select to best achieve this outcome? A. Case management B. Managed care C. Team nursing D. Shared governance

D Shared governance involves inclusion of nursing staff at all levels of the organization in making decisions related to patient care policies. Managed care refers to a healthcare delivery system focused on decreasing costs and improving outcomes for groups of patients, not including nurses in decision making. Case management is the coordination of patient care over time using services necessary to meet patient needs. Team nursing is a care delivery approach that provides individualized nursing care to patients by a team led by a professional nurse.

A nurse who works at a facility that uses a primary nursing approach to patient care explains to a colleague the benefits of this approach. Which benefit of primary nursing should the nurse include? A. "Primary nursing requires 24-hour responsibility for a patient thereby increasing costs." B. "Primary nursing makes it difficult to focus on acutely ill patients because the nurse just oversees and does not personally deliver all care." C. "Primary nursing delineates the roles of all personnel." D. "Primary nursing is focused on consistency of care."

D The advantages of primary nursing are related to the ability to provide comprehensive, individualized, and consistent care. The statement that primary nursing requires 24-hour responsibility for a patient, thereby increasing costs, is not valid. The statement that primary nursing makes it more difficult, particularly for acutely ill patients, is not valid. Specific delineation of the roles of all personnel describes differentiated practice, not primary nursing.

Two nurses who work at different facilities are discussing their unit managers. One nurse shares that their manager is truly concerned about how they feel. The second nurse shares that they feel very loyal because the nurse manager provides incentives when extra effort is required. Which leadership comparison would refer to the first leader described as compared with the second leader? A. Transformational versus servant B. Servant versus charismatic C. Transactional versus transformational D. Charismatic versus transactional

D The description of the first leader would best reflect a charismatic leader who has a charming personality and evokes feelings of strong commitment, while that of the second leader best describes a transactional leader, who is one who evokes loyalty by providing incentives for performance. Neither of these descriptions characterize transformational or servant leadership.