Study Sesh

11. Which is the best example of coaching used to encourage and improve daily work performance? A) Let's discuss how to improve your charting notes. B) Did you enjoy working as team leader this weekend? C) Would you consider taking on the role of preceptor? D) Your interpersonal skills have shown great improvement.

Ans: C Feedback: For coaching to be effective, it must be specific, not self-serving, directed toward behavior that can be changed, well timed, and understood by the employee. This is the only option that fulfills those criteria.

11. What is the name for a provision of health care in an organized system to subscribing members in a geographical area with an agreed-on set of basic and preventive supplemental health maintenance and treatment services for a fixed, prepaid charge? A) Preferred provider organizations (PPOs) B) A traditional third-party payer indemnity plan C) A health maintenance organization (HMO) D) Diagnostic-related groupings (DRGs)

Ans: C Feedback: HMOs provide health care in an organized system to subscribing members in a geographical area with an agreed-on set of basic and preventive supplemental health maintenance and treatment services for a fixed, prepaid charge. That definition does not apply to the other options.

2. What increases the likelihood that the performance appraisal will have a positive outcome? A) The manager refrains from making any comments about the worker's performance B) The employee is encouraged to identify three areas of satisfactory performance C) The employee provides input into developing the performance standards D) The manager identifies not more than three areas of deficient performance

Ans: C Feedback: If the employee has some input into developing the standards or goals on which his or her performance is judged, there is more of a chance that the appraisal will have a positive outcome. The remaining options fail to contribute to an effective performance appraisal.

16. In performance management, appraisals are eliminated. What does the manager do in place of the appraisal? 1. Periodical coaching 2. Mutual goal setting 3. Leadership training of subordinates 4. Employee accountability for own actions A) 1, 2 B) 1, 4 C) 2, 3 D) 3, 4

Ans: C Feedback: In performance management, appraisals are eliminated. Instead, the manager places his or her efforts into ongoing coaching, mutual goal setting, and the leadership training of subordinates.

25. What is the outcome when a manager provides vague and ambiguous feedback to an employee during a performance appraisal? A) The employee receives the information in a positive manner B) The manager is able to avoid the appearance of being too negative C) The employee is uncertain of the value of the feedback D) The manager is viewed as being an ineffective communicator

Ans: C Feedback: Indirectness and ambiguity are more likely to inhibit communication than enhance it, and the employee is left unsure about the significance of the message. The employee is not likely to feel positive about the process. When the feedback is present appropriately, the manager will not be viewed as too negative but rather honest and helpful.

9. Which statement identifies an important consideration when using management by objectives (MBO) as a performance appraisal tool? A) The manager determines the objectives each employee should accomplish during the upcoming evaluation period B) Employees determine the objectives their manager should accomplish during the upcoming evaluation period C) The manager's role is supportive, assisting employees to reach goals by counseling and coaching D) Managers should encourage employees to set lofty, difficult goals in an effort to stretch the employees to their maximum

Ans: C Feedback: MBO is in use when the manager supports employees to reach goals they identify for themselves. None of the other options are associated with the use of MBO as a performance appraisal tool.

7. Why have health-care organizations been slow to adopt peer review? A) It tends to be an inaccurate performance appraisal tool B) Colleagues generally have little data they can contribute regarding a peer's work performance C) It requires staff be oriented to the process effectively D) It works better for professionals such as physicians than for nurses

Ans: C Feedback: Peer review is effective only when adequate time is spent orienting staff to the process and the necessary support is provided to complete the process. The remaining options are not generally considered barriers to the use of peer reviews.

18. Which statement accurately describes provision of service? 1. It guarantees reimbursement 2. Proof is required for need for services 3. Reimbursement is based on services provided 4. The social worker is the gatekeeper A) 1, 2 B) 1, 4 C) 2, 3 D) 3, 4

Ans: C Feedback: Provision of service no longer guarantees reimbursement. Clear and comprehensive documentation of the need for services and actual services provided is needed for reimbursement.

23. Which statement about American health-care budget spending is correct? A) A large health-care budget equals quality health-care outcomes B) America spends less than any other industrialized country on health care C) The outcomes related to lowñbirth-weight infants have not been successfully met D) The scarcity of resources is the biggest factor in the failure to reach outcomes

Ans: C Feedback: Spending more does not always equate to higher-quality health outcomes. The United States spends more per capita on health care than does any other industrialized country, and yet our outcomes in terms of teenage pregnancy rates, lowñbirth-weight infants, and access to care are worse than many countries that spend significantly less. The problem then is not a scarcity of resources. The problem is that we do not use the resources we have available, in a cost-effective manner.

18. Which term is used to identify the effect that occurs when the appraisal is based on recent performance over less recent performance during the evaluation period? A) Halo B) Horns C) Recency D) Mathew

Ans: C Feedback: Taking regular notes on employee performance is a way to avoid the recency effect, which favors appraisal of recent performance over less recent performance during the evaluation period. None of the other options accurately identifies this effect.

5. What type of budget requires rejustification for yearly fiscal needs? A) Incremental budgeting B) Perpetual budgeting C) Zero-based budgeting D) Managed care

Ans: C Feedback: Zero-based budgeting begins each year with zero and requires rejustification. This is not true of the other options.

24. Which factor is the focus of an individual's performance evaluation? A) Related knowledge B) Individual skills C) Appropriate experience D) History of task completion

Ans: D Feedback: A competence assessment evaluates whether an individual has the knowledge, education, skills, or experience to perform the task, whereas a performance evaluation examines how well that individual actually completes that task

13. What is capitation? A) A reimbursement schema whereby health-care organizations receive a predetermined amount (based on a patient's diagnosis for services provided) B) The limited availability of services to patients in managed care organizations C) The use of a ìgatekeeperî to ensure appropriate utilization of services D) A predetermined, negotiated payment to providers, per patient, regardless of whether services are used

Ans: D Feedback: Capitation is a predetermined, negotiated payment to providers, per patient, regardless of whether services are used. None of the other options correctly describe capitation.

15. Which statement best describes critical pathways? A) They determine justifiable differences among clients B) They decrease the amount of paperwork required for reimbursement C) They reduce administrative costs D) They provide a means of standardizing care for clients with similar diagnoses

Ans: D Feedback: Critical pathways are one means of standardizing care for clients with similar diagnoses. The other options are not true statements regarding critical pathways.

17. Key principles of managed care include: 1. Nurses as gatekeepers 2. Focus on prevention 3. Decreased emphasis on inpatient hospital care 4. Capitation A) 1, 2, 3 B) 1, 2, 4 C) 1, 3, 4 D) 2, 3, 4

Ans: D Feedback: Key principles of managed care include the use of primary care providers as gatekeepers, a focus on prevention, a decreased emphasis on inpatient hospital care, the use of clinical practice guidelines for providers, selective contracting, capitation, utilization review, the use of formularies to manage pharmacy care, and continuous quality monitoring and improvement.

4. Which is a leadership role in fiscal planning? A) Coordinating the monitoring aspects of budget control B) Accurately assessing personnel needs using agreed-on standards or an established patient classification system C) Assessing the internal and external environment of the organization in forecasting to identify driving forces and barriers to fiscal planning D) Being visionary in identifying short- and long-term unit fiscal needs

Ans: D Feedback: Leaders are visionary; the other roles are management related.

15. What type of evaluation has been proved to increase productivity and commitment in employees? A) Rating scale B) Checklist C) Essay D) MBO

Ans: D Feedback: MBO has been proved to increase productivity and commitment in employees. Research does not support that claim related to the other options.

16. Using a decision package to aid in fiscal priority setting is a key feature of what type of budgeting? A) Personnel workforce B) Operating C) Capital D) Zero based

Ans: D Feedback: Managers must rejustify their program or needs every budgeting cycle in zero-based budgeting. Among the options available using a decision package to set funding priorities is a key feature of only zero-based budgeting.

10. What does the employee's signature on the performance appraisal form denote? A) The employee agrees with everything written on the form B) The employee objects to what is written on the form C) The employee agrees that a merit raise is due D) The employee has read the appraisal information

Ans: D Feedback: The employee's signature on the performance appraisal form denotes that the employee has received and read the appraisal information. The signature does not mean that the employee agrees with or disagrees with the appraisal.

6. Equipment depreciation, the number and type of supplies needed by patients, and overtime that occurs in response to an emergency are all examples of what type of expenses? A) Controllable B) Fixed C) Capital budget D) Noncontrollable

Ans: D Feedback: The items mentioned are noncontrollable as these cannot be controlled or fixed and are not parts of capital costs.

horizontal violence

CONSISTENT patterns/acts of destructive behavior with the conscious/unconscious attempt to do harm - behavior controls, diminishes or devalues others

standard of care

a MINIMAL level of expertise that may be delivered to a patient - reasonable and prudent manner - this is outlined in policies

performance appraisal

a method by which the job performance of an employee is documented and evaluated - can increase productivity and retention best practices: do it in private, make standards/expectations known, employee should be establishing goals, give 2-3 days in advance and AVOID SURPRISES

self appraisal

an evaluation done by an employee that rates his or her own performance - introspective - sets goals and action plans to accomplish them drawbacks: undervalue/inflate productivity, need for validation feedback, uncomfortable doing self-appraisals

peer review

an evaluation of an employee done by a coworker drawbacks: can feel uncomfortable evaluating peers, time consuming, training is required (appropriate feedback, constructive, offers solutions) considerations: selection/numbers and a mix of reviewers, anonymity, affect on compensation, have + and - materials prepared (examples, situations) - only pick major problems to fix, dont talk about personal characteristics, seek input from the employee throughout,

primary nursing

care delivery model - each pt has a primary nurse (PN) responsible for outcomes of care, works well for specialized floors (CA, CF, etc.) ex: assess pt needs, develop plan of care, evaluate outcomes advantages: increased RN autonomy, more direct pt care, accountability for RNs, pt satisfaction and continuity of care disadvantages: more RNs needed (more $$), varying skill levels of RNs, need strong communication, limited due to scheduling patterns

functional nursing

care delivery model - evolved after WWII, uses unlicensed workers who are trained to complete certain tasks, care assigned by task and not patient (ex: medicine nurse, admission nurse, housekeeping) advantages: efficient, clear responsibilities disadvantages: fragmented care, pt has multiple caregivers, limited ownership/accountability, overlooks patient needs, reduces nurses critical thinking skills

case management

care delivery model - focuses on attaining specific patient outcomes with a specific time frame (based on major diagnoses), care coordination, financial management, advocacy, resource utilization, CLINICAL PATHWAYS AND CARE MAPS define expected treatment plan advantages: all professionals are equal, emphasis on managing interdisciplinary outcomes, nurse autonomy, patient centered care, continuity of care disadvantages: essential data needs to be available to all team members

modular nursing

care delivery model - making patient assignments based on location of rooms - version of team nursing

total patient care

care delivery model - oldest mode when care was delivered to patients in their homes, 1:1 ratio, seen in ICUs now advantages: high autonomy for nurses, responsibilities are clear, unfragmented care disadvantages: cost, skill level required, inadequate pool of nurses

team nursing

care delivery model - distributes patient care among a team, lead by the RN, increases pt satisfaction, 4-6 people per team - NEED GOOD COMMUNICATION - charge nurse- team leader- nursing staff- patients advantages: need less RNs (saves $$), staff knows their accountability, pt has fewer caregivers disadvantages: needs supervision by team leader, bad teamwork = fragmented care, poor communication, poor delegation

patient centered care

care that is respectful and responsive to individual patient preferences, needs and values - ensures patient values guide all clinical decisions

disease management (DM- population based health care)

comprehensive/integrated approach to the care and reimbursement of chronic illnesses - HIGH COST/RESOURCE UTILIZATION DISEASE ARE IDENTIFIED, population groups targeted for implementation - goal is to address conditions w max efficiency - continuum of care for chronic illnesses to have early detection and intervention - uses standard clinical guidelines to show best provider practice dz ex: cancer, otitis media (acute), DM, HLD, asthma, HTN, COPD, hormone replacement therapy, AIDS, stroke

nurse practice act

defines nursing practice boundaries by each state (different in every state) - sets standards for nursing licensure - must be consistent with provisions at the federal level

drug divergence

diverting a drug from a patient for the nurses benefit (taking it or selling it) - need to follow exact hospital protocol - need to report what you see - document exactly what happens, if you go home with a med in your pocket, bring it back - might need to pass a drug test

negligence

failure to take proper care in doing something - neglect that often results in a patient injury

overt

is the following a form of overt or covert bullying? - extreme micromanagement - verbal criticism - name calling - insults - direct threats

covert

is the following a form of overt or covert bullying? - indirect/passive - rumors/gossip - social isolation/sabotage - withholding information - unfair assignments - denied opportunities - microaggressions

Criminal

law that defines crimes against the public order, committing crimes against an individual or society ex: someone murders someone

civil

law that governs relationships between individuals and defines their legal rights - burden of proof required to be found guilty - preponderance of evidence (doesn't need to be exact proof) ex: someone sues another person to compensate for their loss

administrative

law that regulates the operation and procedures of government agencies ex: an individual is sued by a federal or state agency

stare decisis

legal term, means "to let the decision stand" - use precedents to base this off of

tort

legal wrongdoing ex: assault and battery, false imprisonment, invasion of privacy

ordinary

negligence that is a failure of a person to perform reasonable acts of care - must perform the same care any reasonable person would to avoid harming others ex: not shoveling the side walk and causing your neighbor to slip

professional

negligence where providers do not meet job standards of care and do not perform their duties - failure of a person with professional training to act in a reasonable and prudent manner ex: NOT following standards of care, using equipment in responsible/knowledgeable manner, effectively & thoroughly communicating with the client, documenting care was provided

nurse patient ratio

nurse staffing model - # of nurses per # of patients determines staffing levels

patient acuity

nurse staffing model - patient characteristics are used to determine shift staffing needs ex: acuity rating scale tool

budget based

nurse staffing model - staff allocated based on nursing hours per patient day or some other metric form ex: surgery- minutes per case

halo effect

performance appraisal pitfall - one or two positive aspects of the assessment or behavior unduly influence all other aspects of performance

recency effect

performance appraisal pitfall - recent issues weighed more heavily than in past performace

horns effect

performance appraisal pitfall - some negative aspects of the employee's performance influence the assessment to such an extent that affect other levels of job

matthew effect

performance appraisal pitfall - when employees receive the same appraisal results year after year

central tendency effect

performance appraisal pitfall - when employers rate most of their employees as "average"

star approach

performance assessment - focus attention on behaviors that got them to this performance level - can reinforce good performance and help people improve - verbally or in writing

job sharing

scheduling option - arrangement made with two people who are part-time to work full-time when their hours are combined

float pool

scheduling option - resource pool - trained on multiple units, need to meet CORE comps - costs more money - good when units are understaffed to have these nurses

closed unit staffing

scheduling option - staff members will not be floated to other units and resource nurses will not come to the unit - unit staff needs to cover all absences in schedule - nurses on call

flex

scheduling option - starts and ends shift on times that meet with one's own needs - not used where continual coverage is needed - hard for UD to coordinate, leads to under/over staffing

travel nurses

scheduling option - supplemental nursing staff - premium pay, 2-3x hour ($$$$$$$$$$$$$$$), expensive to have - employed by an external broker who offers benefits - can compromise continuity of care and dedication to the org

lifestyle

scheduling option - weekend staffing, Friday 7p to Sunday 7p - 2 weekend shifts per week or 4 in a pay period

nurse manager

the following are legal responsibilities of what nursing profession? - reporting dangerous understaffing - checking staff credentials/qualifications - carrying out discipline

assertive

the following are techniques for what type of communication? - "I" statements - direct eye contact - open body posture - steady even pace/tone - sincere and clear

pitfalls

the following are what in performance appraisals? - subjectivity, being too lenient, appraisal on intent not performance, inadequate information/specific examples ex: recency effect, halo effect, horns effect, matthew effect, central tendency effect

professional negligence

the following components are necessary for what? 1. a standard of care is in place 2. failure to meet standard of care 3. foreseeability of harm must exist 4. provable correlation between care and harm 5. ACTUAL INJURY MUST OCCUR

acuity adaptable

the future of care delivery models - ONE floor that can take patients of all acuities ex: cardiac floor- you go to this floor after surgery, if you need to be sent to ICU, etc. everything can be done on this floor goals: efficiency, reduces transfers, decreased LOS, fewer handoffs, increased pt and nurse satisfaction,

informed

type of consent obtained by the physician - pts receives full disclosure of all pertinent information regarding the surgery/procedure - pt needs to understand all risks and benefits - nurse needs to make sure pt is educated, even though physicians do this

centralized

type of staffing where a department makes everyone's schedules pros: organization wide view of staffing (good for resource nurses), policies enforced consistently, impartial, cost effective, gives UD free time cons: less flexibility, workers requests might not be taken into consideration, UD less responsive to budget control

decentralized

type of staffing where the unit director makes the staff schedule pros: UD has control on unit staffing, staff can go to UD for requests, more autonomy and flexibility for staff cons: can cause special pleading/arbitrary treatment, can be not cost effective, more time consuming for UD

universal care units

units that have capable rooms for any type of patient - focus on flexibility within existing beds

situation, task, action, result

what does STAR stand for?

shift bidding

when organizations sets an open price for shifts and nurses bid on shifts

22. Which statement regarding fiscal planning is true? Select all that apply. A) Social influences affect fiscal planning B) The successful fiscal planner is creative C) An understanding of economic forces is necessary D) Practical experience is a key to being a good fiscal planner

Ans: A, B, C, D Feedback: Fiscal planning is not intuitive; it is a learned skill that improves with practice. Fiscal planning also requires vision, creativity, and a thorough knowledge of the political, social, and economic forces that shape health care.

24. Which factor is primarily important when budgeting for a healthcare facility? A) Services provided B) Budget time frame C) Size of organization D) Acuity of patients being served

Ans: B Feedback: Selecting the optimal time frame for budgeting is important. Errors are more likely if the budget is projected too far in advance. The other options are considered but not of primary importance.

assertive

should you use assertive or passive communication to avoid bullying?

critical pathways (clinical pathways)

- started as a part of case management - expected outcomes/care strategies are made by a team - daily outcomes are outlined (day 1, day 2 and so on) - case manager looks at alterations in outcomes, deemed as a "variance" outcome ex: length of stay, time for specific interventions (ambulation, eating, etc.)

1. Which statement best describes functional nursing care delivery? A) Nursing care is holistic and patient centered B) The nurse must be a licensed person C) Emphasis is on getting work done through tasks D) It is also known as total patient care Ans: C Feedback: Functional nursing is task focused. None of the other options identify that connection. 2. The nurse is assigned to administer medications to all patients throughout the shift. What is this an example of? A) Team nursing B) Case method nursing C) Primary care delivery D) Functional nursing care Ans: D Feedback: Being assigned a specific task to do is part of functional nursing. None of the other options identify that connection. 3. A nurse has accepted a position as a staff nurse and will practice primary care nursing. The nurse will be the only RN on the team. What is an appropriate role expectation for role fulfillment? A) Planning nursing care independently of others B) Assigning work according to the expertise of group members C) Being responsible for care planning 24 hours a day D) Carrying out the majority of personal care for your patients Ans: B Feedback: In primary nursing, the sole RN would not plan the care without others input or be responsible for care planning for 24 hours. Neither would the RN carry out the majority of personal care. 4. With modular nursing, who checks the completion of tasks assigned to a team member? A) The charge nurse B) The area manager C) The team leader D) Another team member Ans: C Feedback: The team leader should check the work of team members. None of the other options identify the role correctly. 5. Which statement is correct concerning primary nursing care? A) Requires minimal RN staffing B) Is easy to implement C) Provides challenging work D) Has proved to be a failure Ans: C Feedback: Primary care provides challenging work for nurses; however, it is not easy to implement and requires an all-RN staff. None of the other options accurately describes the concept of primary nursing care. 6. What is the goal of case management? A) Containing health-care costs B) Providing challenging work C) Enhancing professionalism D) Decreasing length of hospital stays Ans: A Feedback: The ANA maintains that case management is designed to contain health-care costs. None of the other options identify a goal of casement. 7. What is the most important component in being well organized and increasing productivity on the unit? A) Adequate resources B) A well-trained staff C) A well-thought-out plan D) Time to carry out your duties Ans: C Feedback: Unless the plan is well thought out, patient care has the potential to be disorganized. None of the other options identify that connection. 8. Which statement best describes case management? A) Clinical outcomes should occur within a prescribed time frame B) Case managers do not provide direct patient care C) Managed care practice is a unit-based model of care D) The goal is outcome management for every patient Ans: A Feedback: In case management, clinical outcomes need to occur within prescribed time frames. Case managers do not provide care; neither is managed care unit based. The goal is outcome management for specific patients, but not every patient needs case management. 9. What is necessary when implementing care multidisciplinary action plans (MAPs)? A) Caregivers alter the plan as they deem necessary B) Variances be indicated for patient deviations C) Time frames for implementation be left open D) Critical paths not be considered in care planning Ans: B Feedback: In care MAPs, it is necessary to provide variances when there are patient deviations, because this is a major component to case management. None of the other options identify that connection. 10. Which is a true statement about the patterns of patient care management? A) Functional nursing is organized according to the desires of the worker B) Primary nursing and total patient care are synonymous C) Team leading includes the concept of patient care conferences D) Case load nursing provides little autonomy for nurses Ans: C Feedback: Team leading includes the need for patient care conferences. None of the other options identify that need. 11. Where did critical pathways originate from? A) Case management B) Functional nursing C) Team nursing D) Primary care nursing Ans: A Feedback: Critical pathways were developed as a result of the case management system. None of the other options identify that original connection. 12. What nursing model provides the foundation for matching patient needs with nursing competencies? A) Primary nursing practice B) Differentiated nursing practice C) Modular nursing D) Case management Ans: B Feedback: To facilitate the effective use of nursing resources, patient needs and nursing competencies should be matched. None of the other options identify that connection.

13. What is one of the most important differences between case management and disease management? A) Disease management referrals begin in the hospital inpatient setting B) Disease management is a collaborative process to meet patient needs C) High-cost population groups are targeted in disease management D) Disease management treatment is episodic Ans: C Feedback: Although there are many similarities between disease management and case management, the primary goal of disease management is to target high-cost disease populations. 14. What is the oldest form of organizing patient care that is still widely used today? A) Total patient care B) Functional nursing C) Team or modular nursing D) Primary care nursing Ans: A Feedback: Total patient care, utilizing the case method of assignment, is the oldest form of patient care organization and is still widely used today. 15. What type of nursing uses mini teams, typically an RN and unlicensed health-care workers, to provide care to a small group of patients who are centralized geographically? A) Total patient care B) Functional nursing C) Modular nursing D) Primary care nursing Ans: C Feedback: Modular nursing and model RN line use mini teams, typically an RN and unlicensed health-care worker(s), to provide care to a small group of patients, centralized geographically. None of the other options provide that staffing format. 16. Primary care nursing is organized so that the patient is at the center of the structure. How many nurses have 24-hour responsibility for care planning and coordination? A) One B) Two C) Three D) Four Ans: A Feedback: Primary care nursing is organized so that the patient is at the center of the structure. One nurse has 24-hour responsibility for care planning and coordination. 17. What was the focus historically for case management? A) Individual patient B) Care for populations C) Group of patients with same chronic illness D) Group of patients with same acute need for surgery Ans: A Feedback: While the focus historically for case management has been the individual patient, the case manager employed in a disease management program plans the care for populations or groups of patients with the same chronic illness. 18. What is included in an MAP? 1. Critical path 2. Nursing care plan 3. Indication of times when nursing interventions occur 4. Nurses follow the care plan to facilitate expected outcomes A) 1, 2, 3 B) 1, 2, 4 C) 1, 3, 4 D) 2, 3, 4 Ans: A Feedback: The care MAP is a combination of a critical path and a nursing care plan, except that it shows times when nursing interventions should occur as well as variances. All health- care providers follow the care MAP to facilitate expected outcomes. 19. When work is redesigned, it frequently has consequences for employees that must be considered. What consequences must be considered? 1. Professional interactions 2. Degree of autonomy 3. Employee evaluation 4. Communication patterns A) 1, 2, 3 B) 1, 2, 4 C) 1, 3, 4 D) 2, 3, 4 Ans: D Feedback: When work is redesigned, it frequently has personal consequences for employees that must be considered. Social interactions, the degree of autonomy, the abilities and skills necessary, employee evaluation, and communication patterns are often affected by work redesign. 20. What is the positive patient outcome during a single shift of case method nursing? Select all that apply. A) Clear lines of responsibility B) Nursing autonomy C) Holistic patient care D) Unfragmented care Ans: A, B, C, D Feedback: This method of assignment is still widely used in hospitals and home health agencies. This organizational structure provides nurses with high autonomy and responsibility. Assigning patients is simple and direct and does not require the planning that other methods of patient care delivery require. The lines of responsibility and accountability are clear. The patient theoretically receives holistic and unfragmented care during the nurses time on duty. To maintain quality care, this method requires highly skilled personnel and thus may cost more than some other forms of patient care. 21. What is the primary outcome resulting from the implementation of the functional nursing care delivery system? A) A cost-effective method of care delivery B) Another permanent care delivery option C) Ancillary staff with varying levels of training and education D) A care delivery system addressing the needs of the baby boom patient Ans: C Feedback: The employment of personnel with various levels of skill and education proliferated as new categories of health-care workers were created. Currently, most health-care organizations continue to employ health-care workers of many educational backgrounds and skill levels. None of the other options represent a primary outcome of resulting from the implementation of functional nursing. 22. Which statement demonstrates an intervention focused on the primary disadvantage of team nursing? A) We are working with 1 fewer team members today. B) The team will be meeting for a care report update in 5 minutes. C) Our patient assignment is comprised of both males and females D) We will be having a member of the float pool on our team today Ans: B Feedback: Disadvantages to team nursing are associated primarily with improper implementation rather than with the philosophy itself. Frequently, insufficient time is allowed for team care planning and communication. This can lead to blurred lines of responsibility, errors, and fragmented patient care. None of the other options address a known disadvantage of team nursing. 23. Which statement demonstrates an understanding of the factors that are considered when a change in the care delivery system is being proposed? Select all that apply. A) We have determined that our level of care would improve if we provided it differently. B) Its questionable whether our current nursing staff is large enough to support the proposed change. C) We will discuss our proposed change with the multidisciplinary team members. D) Administration has been supportive of the planned change in our care delivery system. Ans: A, B, C, D Feedback: If evaluation of the present system reveals deficiencies, the manager needs to examine available resources and compare those with resources needed for the change. There must be a commitment on the part of top-level administration and a majority of the nursing staff for a change to be successful. Because health care is multidisciplinary, the care delivery system used will have a heavy impact on many others outside the nursing unit; therefore, those affected by a system change must be involved in its planning. The philosophy of the nursing services division must support the delivery model selected. Changing the philosophy is not appropriate. 24. Which concept should a care delivery system support? Select all that apply. A) Organization B) Nursing process C) Cost effectiveness D) Patient satisfaction Ans: A, B, C, D Feedback: Each units care delivery structure should facilitate meeting the goals of the organization, be cost-effective, satisfy the patient, provide role satisfaction to nurses, allow implementation of the nursing process, and provide for adequate communication among health-care providers. While important, nursing research is not a concept that is considered when selecting a care delivery system.

1. What is the most fiscally responsible method for determining staffing needs for a hospital unit? A) Maximum patient load capacity of the unit B) Numbers of patients present for an upcoming shift C) An agreed-upon staffing formula currently in use D) Total beds on the unit Ans: C Feedback: A staffing formula is the best way to determine staffing needs, provided it is based on an accurate patient classification system (PCS). The remaining options are not as fiscally responsible since they involve uncontrollable factors. 2. Which statement about PCSs is accurate? A) Classification systems are able to solve staffing problems B) Nursing care hours assigned to a classification system should remain constant C) A good classification system is without fault D) Internal and external forces may affect classification systems Ans: D Feedback: Examples of internal and external forces that may affect a PCS are a sudden increase in nursing or medical students using the unit, a lower skill level of new graduates, or cultural or language difficulties of recently hired foreign nurses. None of the remaining options is totally accurate because of uncontrollable factors. 3. Which statement accurately reflects self-scheduling? A) Self-scheduling requires greater worker accountability B) The manager has little responsibility in self-scheduling C) Self-scheduling has few or no shortcomings D) Self-scheduling works in most organizations Ans: A Feedback: Self-scheduling requires greater worker participation in decision making and shared responsibility for adequate staffing. None of the remaining options is accurate. 4. Which is an outcome of decentralized staffing? A) Increased fairness to employees through consistent, objective, and impartial application B) Cost-effectiveness through better use of resources C) Greater manager autonomy to control the staffing on the units, resulting in an increase in self-esteem and teamwork D) Increased availability of data for monitoring the effect of staffing size and composition, quality of care, and costs Ans: C Feedback: In an institution that has no human resources department and no nurse recruiters, the unit manager does the hiring and has greater autonomy in personnel matters. The other options are not associated with decentralized staffing. 5. It is 2 PM. You are calculating the nursing care hours for the 3 to 11 PM shift and must decide whether you need to call in additional help. You have three RNs, three nursing assistants, and one ward clerk scheduled. You have 22 patients with the following acuity and nursing care hours allotted for the evening shift: Category I, 4 patients 2.0 hours Category II, 2 patients @ 2.3 hours Category III, 10 patients @ 2.8 hours Category IV, 6 patients @ 3.4 hours What are the needed hours of nursing care? A) 61 hours B) 52.6 hours C) 68.4 hours D) 48.4 hours Ans: A Feedback: Four category I patients require 8 hours of care; two category II patients require 4.6 hours of care; 10 category III patients require 28 hours; six category IV patients require 20.4 hours; total nursing care hours equal 61. 6. What is the priority goal for a manager with regard to staffing and scheduling? A) Schedule staff so there is no overtime B) Ensure that there is adequate staff to meet the needs of each patient C) Develop trust in staff by seeing that staffing is carried out in a fair manner D) Ensure that staff members usually have days off and special requests granted Ans: B Feedback: The manager is tasked with seeing that patient care needs are met first and foremost. While the other options are relevant, they are not the priority goal of the manager. 7. Which is the most accurate statement regarding staffing and scheduling policies? A) It is more important to communicate policies verbally than in writing B) It is necessary that policies are written in a manner that allows some flexibility C) Policies should focus on the process D) Managers should have autocratic control over scheduling and staffing policies Ans: B Feedback: To retain employees, the staffing policies must allow some flexibility, which could include job sharing, flextime, a part-time staffing pool for weekends, or allowing employees to exchange hours of work among themselves. 8. Which statement accurately identifies a concern associated with decentralized staffing? A) It carries risks that employees may be treated unequally or inconsistently B) It uses one individual or a computer to do the staffing C) The manager's role is that of making minor adjustments or providing input D) It provides good control for the organization Ans: A Feedback: A manager being perceived as granting special treatment to some employees is a risk of decentralized staffing. None of the other options identifies an associated concern. 9. What outcome is associated with a good PCS? A) It eliminates most staffing problems B) It decreases the amount of overtime C) It provides an understanding of staffing problems D) It eliminates the need for adjustment or review Ans: C Feedback: The main strength of the PCS is that it provides data with which to make staffing decisions. It will not solve all staffing problems, and it will not replace a manager's judgment. 10. What positive impact do new practice models have on the staffing mix? A) Automatically cancel the PCS B) Will result in fiscal savings C) Require no changes in scheduling policies D) Impact patient care assignment methods Ans: D Feedback: As new practice models are introduced, there must be a simultaneous examination of the existing staff mix and patient care assessments to ensure that appropriate changes are made to the staffing and scheduling policies. They are not associated with the impact suggested by the other options. 11. What term identifies a system that allows employees to select among variations in work start-time schedules to meet their personal needs? A) Self-scheduling B) Flextime C) Decentralized staffing D) Cyclical staffing Ans: B Feedback: When a hospital uses flextime, employees arrive at the unit and leave at many different times. The other options are not associated with the system described. 12. Which statement is correct concerning prenegotiated budget management? A) It is incompatible with ethical accountability B) It is only the responsibility of the centralized staffing office C) It is inappropriate with new practice models D) It is a critical responsibility of managers Ans: D Feedback: Accountability for a prenegotiated budget is a management function. The other options are incorrect regarding this function. 13. Which statement is true regarding legislated minimum staffing ratios? A) They are mandated by federal law B) They are required by 28 states C) They are proposed to improve patient care D) They are necessary to reduce costs Ans: C Feedback: Several states have proposed or passed mandatory staffing ratios for the purpose of improving patient care, although there is no guarantee improved care will result from such legislation. None of the other options are associated with minimum staffing ratios.

14. There are advantages and disadvantages to each type of scheduling. What is true about extending the workday with 10- or 12-hour shifts? 1. Requires overtime pay 2. Increases nurse satisfaction 3. Decreases cost 4. Increases judgment errors A) 1, 2, 3 B) 1, 2, 4 C) 1, 3, 4 D) 2, 3, 4 Ans: B Feedback: There are advantages and disadvantages to each type of scheduling. Twelve-hour shifts have become commonplace in acute care hospitals even though there continues to be debate about whether extending the length of shifts results in increased judgment errors related to fatigue. Because extending the workday with 10- or 12-hour shifts may require overtime pay, the resultant nurse satisfaction must be weighed against the increased costs. 15. What occurs when RN hours decrease in a unit's calculation of nursing care hours per patient day (NCH)/(PPD)? A) Adverse patient outcomes generally increase B) Decreased errors C) Decreased patient falls D) Decreased patient satisfaction Ans: D Feedback: A review of current literature suggests that as RN hours decrease in NCH/PPD, adverse patient outcomes generally increase, including increased errors and patient falls as well as decreased patient satisfaction. 16. When was the veteran generation born? A) 1925 to 1942 B) 1943 to early 1960s C) Early 1960s to 1980 D) Late 1970s to 1986 Ans: A Feedback: The veteran generation is typically recognized as those nurses born between 1925 and 1942. 17. What generational work group values the more flexible part-time and 12-hour shift options? A) Veteran generation B) Baby boomer C) Generation X D) Generation Y Ans: C Feedback: ìGeneration Xersî (born between 1961 and 1981), a much smaller cohort than the baby boomers who preceded them, or the Generation Yers who follow them, may lack the interest in lifetime employment at one place that prior generations have valued, instead valuing greater work hour flexibility and opportunities for time off. 18. What must staff and scheduling policies not violate? 1. Local laws 2. Labor laws 3. State or national laws 4. Union contracts A) 1, 2, 3 B) 1, 2, 4 C) 1, 3, 4 D) 2, 3, 4 Ans: D Feedback: Staffing and scheduling policies must not violate labor laws, state or national laws, or union contracts. 19. What is the advantage of decentralized scheduling? A) Unit manager understands the needs of the unit and staff intimately B) Employees will be treated equally and consistently C) Manager role is limited to making minor adjustments and providing input D) It allows the most efficient use of resources Ans: A Feedback: Advantages of decentralized staffing are that the unit manager understands the needs of the unit and staff intimately, which leads to the increased likelihood that sound staffing decisions will be made. In addition, the staff feels more in control of their work environment because they are able to take personal scheduling requests directly to their immediate supervisor. Decentralized scheduling and staffing also lead to increased autonomy and flexibility, thus decreasing nurse attrition. 20. An increasingly common staffing and scheduling alternative is the use of supplemental nursing staff such as agency nurses or travel nurses. Which statement is correct about agency nurses or travel nurses? A) Work for premium pay B) Employed directly by the health-care agency C) Result in increased continuity of nursing care D) They receive the standard facility benefits Ans: A Feedback: These nurses are usually directly employed by an external nursing broker and work for premium pay (often two to three times that of a regularly employed staff nurse), without benefits. While such staff provide scheduling relief, especially in response to unanticipated increases in census or patient acuity, their continuous use is expensive and can result in poor continuity of nursing care. 21. What is a leadership role associated with staffing and scheduling? A) Role models the use of evidence in making appropriate staffing and scheduling decisions B) Uses organizational goals and patient classification tools to minimize understaffing C) Periodically examines the unit standard of productivity to determine if changes are needed D) Evaluates scheduling and staffing procedures and policies on a regular basis Ans: A Feedback: Role modeling is a leadership responsibility. The other options are recognized management responsibilities associated with staffing and scheduling. 22. What is an advantage of centralized staffing? Select all that apply A) It is flexible B) It is staff focused C) It is cost-effective D) It is consistent and impartial Ans: C, D Feedback: Centralized staffing is generally fairer to all employees because policies tend to be employed more consistently and impartially. In addition, centralized staffing frees the middle-level manager to complete other management functions. Centralized staffing also allows for the most efficient (cost-effective) use of resources because the more units that can be considered together, the easier it is to deal with variations in patient census and staffing needs. Centralized staffing, however, does not provide as much flexibility for the worker, nor can it account as well for a worker's desires or special needs. In addition, managers may be less responsive to personnel budget control if they have limited responsibility in scheduling and staffing matters. 23. Since 2008 what is the legal minimum staffing radios for a medicalñsurgical nursing unit? A) 1:4 B) 1:5 C) 1:6 D) 1:7 Ans: B Feedback: The expected legal ratio is 1:5. 24. Which statement is true regarding the float pool nurse? Select all that apply. A) They are classified as per-diem staff B) The nurse trades increased personal flexibility for less pay C) Float pool nurses do not receive usual staff benefits D) They are crossed trained on multiple units Ans: A, D Feedback: Some hospitals have created their own internal supplemental staff by hiring per-diem employees and creating float pools. Per-diem staff generally have the flexibility to choose if and when they want to work. In exchange for this flexibility, they receive a higher rate of pay but usually no benefits. Float pools are generally composed of employees who agree to cross-train on multiple units so that they can work additional hours during periods of high census or worker shortages. Float pools are adequate for filling intermittent staffing holes but, like agency or registry staff, they are not an answer to the ongoing need to alter staffing according to census since they result in a lack of staff continuity. 25. Which external and internal forces must a manager adjust for when implementing the PCSs associated with unit staffing? Select all that apply. A) Presence of nursing students on the unit B) The hiring of two graduates as staff C) The increase of scheduled medical students D) Language barriers presented by nursing staff Ans: A, B, C, D Feedback: Regarding PCS, the middle-level manager must be alert to internal or external forces affecting unit needs that may not be reflected in the organization's patient care classification system. Examples of such forces could be a sudden increase in nursing or medical students using the unit, a lower skill level of new graduates, or cultural and language difficulties of recently hired foreign nurses. The organization's classification system may prove to be inaccurate, or the hours allotted for each category or classification of patient may be inaccurate (too high or too low). An anxious patient is not a force that should affect the staffing process.

21. Which statement concerning a budget is true? A) A budget's reliability is related to how far in advance it was created B) Budgets should be created as far in advance is possible C) A budget is revised every 3 months during a fiscal year D) Budgets are reliable only when expenses are fixed

Ans: A Feedback: A budget that is predicted too far in advance has greater probability for error. The other options are incorrect statements regarding a budget.

19. What does a competence assessment evaluate? 1. Knowledge and education to perform the task 2. Skills to perform the task 3. Experience to perform the task 4. How well the individual completes the task A) 1, 2, 3 B) 1, 2, 4 C) 1, 3, 4 D) 2, 3, 4

Ans: A Feedback: A competence assessment evaluates whether an individual has the knowledge, education, skills, or experience to perform the task, whereas a performance evaluation examines how well that individual actually completes that task.

23. What is the primary goal of a performance appraisal? A) Promotion of employee growth B) Compliance with stated regulations C) Identification of ineffective staff D) Providing a basis for staff wage increases

Ans: A Feedback: A performance appraisal wastes time if it is merely an excuse to satisfy regulations and the goal is not employee growth. None of the remaining options express the goal of a performance appraisal.

9. Determine the nursing care hours per patient day (NCH/PPD) if the following staffing existed for a 24-hour period (unit census = 10): 12 midnight to 12 noon, 1 registered nurse, 1 licensed vocational nurse 12 noon to 12 midnight, 1 registered nurse, 1 licensed vocational nurse, 1 unit clerk (8 hours only) A) 5.6 NCH/PPD B) 4.8 NCH/PPD C) 5.0 NCH/PPD D) 6.2 NCH/PPD

Ans: A Feedback: A total of 56 hours of nursing was worked in 24 hours (unit clerks are counted in NCH/PPD) and the census was 10 patients. Dividing the total number of nursing care hours by the census (56 divided by 10) yields an NCH/PPD calculation of 5.6 NCH/PPD.

14. Which use of limited resources would result in increased reimbursement revenues? A) Education on appropriate documentation on patient care records B) Number of clinical nurse specialists C) Educational paid days for licensed staff D) Mix and number of clinical staff

Ans: A Feedback: Although options B, C, and D have the potential to improve patient care, education on documentation would most likely increase revenues.

3. Although some subjectivity is inescapable in performance appraisals, what action can the manager take to arrive at a more fair and accurate assessment? A) Written anecdotal notes regarding the employee's performance should be maintained throughout the evaluation period B) Evaluation criteria that reflect on the employee as a person rather than just on work performance should be used C) Data gathered by the manager in preparation for the performance appraisal should be limited to not more than two sources, so no conflicting information is received D) The manager should rate all employees using central tendency whenever possible

Ans: A Feedback: Because a manager will tend to remember an employee's performance better in the weeks or months directly preceding the appraisal, a manager should take notes on an employee's performance throughout the year. The other options are less effective in proving a balanced appraisal.

1. What is fiscal planning? A) A learned skill that improves with practice B) A job role of the facility business manager C) Part of the organizing phase of the management process D) Reactive based on political, social, and economic forces

Ans: A Feedback: Fiscal planning is a learned skill and must include nursing management input. It should never be reactive, and it is part of the planning process of management.

8. What is the largest budget expenditure for health-care organizations? A) The personnel budget B) Short-term capital acquisitions C) The operating budget D) Supplies and equipment

Ans: A Feedback: Health care is labor intensive; therefore, the personnel budget makes up the largest expense. The other options represent less expensive expenditures.

21. How does a leader effectively use a performance appraisal? A) To motive staff B) To identify staff educational needs C) To follow up on identified deficiencies D) To provide feedback on work performance

Ans: A Feedback: Leaders use the appraisal process to motivate employees and promote growth. The remaining options are manager responsibilities.

12. What was the primary reason for the development of the prospective payment system? A) Skyrocketing health-care costs following the advent of Medicare and Medicaid B) The passage of the Health Maintenance Act of 1973 C) The introduction of the Health Security Act to Congress D) A coalition held by the three largest private insurers in 1975

Ans: A Feedback: Prospective payment systems were the result of skyrocketing medical costs in the United States. That is not true of the other options.

2. What is the basic principle of responsibility accounting? A) An organization's revenues, expenses, assets, and liabilities are someone's concern. B) Managers have a responsibility to submit their budgets on time. C) The organization's financial officer works with department heads regarding budget approval. D) Fiscal accounting should be honest and accurate.

Ans: A Feedback: Responsibility accounting requires that someone must be responsible for all revenue, expenses, assets, and liabilities. While true, the other options are not the basic principle of responsibility accounting.

20. Which method rates a person against a set standard, which may be the job description, desired behaviors, or personal traits? A) Trait Rating Scale B) Checklist C) Essay D) MBOs

Ans: A Feedback: Trait Rating Scale is a method of rating a person against a set standard, which may be the job description, desired behaviors, or personal traits. The Trait Rating Scale has been one of the most widely used of the many available appraisal methods. None of the other options rates a person against a set standard.

25. Which statement regarding a budget is true? Select all that apply. A) A budget contains an estimate of both expenses and income for a year. B) It allows for an institution to plan for the effective use of its resources C) The cost of supplies is an example of a variable expense D) A mortgage is an example of a fixed expense

Ans: A, B, C, D Feedback: A budget is a financial plan that includes estimated expenses as well as income for a period of time. Accuracy dictates the worth of a budget; the more accurate the budget blueprint, the better the institution can plan the most efficient use of its resources. Because a budget is at best a prediction, a plan, and not a rule, fiscal planning requires flexibility, ongoing evaluation, and revision. In the budget, expenses are classified as fixed or variable and either controllable or noncontrollable. Fixed expenses do not vary with volume, whereas variable expenses do. Examples of fixed expenses might be a building's mortgage payment or a manager's salary; variable expenses might include the payroll of hourly wage employees and the cost of supplies.

7. What is inferred if an item is ìcost-effectiveî? A) It is the least expensive product available B) It is worth the cost C) It is reimbursable D) Its cost was anticipated

Ans: B Feedback: Cost-effective does not necessarily imply the cheapest, but it requires that the expenditure be worth the cost. The other options are not characteristic of the term cost effective.

8. What is the term used to identify the effect that results when some negative aspect of an employee's performance unduly influence all other aspects of performance? A) A halo effect B) A horns effect C) Central tendency D) A job dimension scale

Ans: B Feedback: Data should be gathered from many different sources and must reflect the entire time period of the appraisal to avoid the horns effect, which is when some negative aspect of an employee's performance unduly influences all other aspects of his or her performance. None of the other options accurately identifies this outcome.

1. What should the manager do in completing an annual performance appraisal? A) Consider good intentions as well as actual performance B) Base the appraisal on a standard to which all are held accountable C) Always make an effort to include subjective data D) Closely observe the employee for the 2 weeks preceding the appraisal conference

Ans: B Feedback: For an objective appraisal, the manager must have a fair performance appraisal tool that is used for all employees in the same classification.

17. In preparation for an appraisal conference, how many days of advanced notice will the manager give the employee? A) 1 B) 2 to 3 C) 4 to 5 D) 6 to 7

Ans: B Feedback: Give the employee 2- to 3-day advance notice of the scheduled appraisal conference so that he or she can be prepared mentally and emotionally for the interview.

22. What factor contributes most to a performance appraisal being viewed as relevant by the employees? A) Its influence on whether a raise will be awarded B) Belief that it is based on the performance of job description related tasks C) The perception that the manager truly likes and approves of them personally D) The formality with which the appraisal is conducted and presented

Ans: B Feedback: If employees believe that the appraisal is based on their job description rather than on whether the manager approves of them, they are more likely to view the appraisal as relevant. The remaining options are not viewed as being factors in the view that the appraisal is relevant.

19. What are the results of managed care backlash? 1. Delay of payment for services provided 2. Denial of requests for additional treatment 3. Increased premiums to consumers 4. Lower co-pays and deductibles A) 1, 2 B) 1, 3 C) 2, 4 D) 3, 4

Ans: B Feedback: Providers have grown increasingly frustrated with limited and delayed reimbursement for services provided as well as the need to justify need for services ordered. This phenomenon, referred to as managed care backlash, resulted in some managed care programs beginning to say ìyesî to more treatments although they have passed the cost along with customers in the form of higher premiums, co-pays, and deductibles.

14. The nurse-manager is preparing for the unit ward clerk's annual evaluation and sends out a short questionnaire requesting feedback on the ward clerk's effectiveness in her job. The nurse-manager sent the request to one doctor who uses the unit frequently, to a staff nurse on each shift, to the housekeeping department head, and to the head of the volunteer program. In addition, the nurse-manager interviews three patients to determine how courteous the ward clerk is when answering call lights from the unit desk. What is this an example of? A) Peer review B) A 360-degree evaluation C) An overreaching performance review D) An anecdotal performance review

Ans: B Feedback: Seeking feedback from patients, staff, and other departments who interact with an employee to determine his or her effectiveness in his or her job is called a 360-degree evaluation. None of the other options are associated with the scenario described.

5. Which statement is true regarding the Behaviorally Anchored Rating Scale (BARS)? A) Has long been used as a performance appraisal tool in the health-care industry B) Requires that a separate rating form be developed for each job classification C) Is often referred to as a free-form review D) Is a rapidly scored and administered performance appraisal tool

Ans: B Feedback: The BARS key areas of responsibility are delineated and ranked by importance. This system reduces subjectivity, but has the drawback of being time-consuming.

12. What does the Joint Commission advocate about employee performance appraisals? A) They be conducted at least every 6 months B) They be based on employee job descriptions C) They be documented by anecdotal notes D) They be reflective of employees' personal goals

Ans: B Feedback: The Joint Commission advocates that employee performance appraisals be based on employee job descriptions. None of the other options are identified for this purpose.

10. The measurement of NCH/PPD will provide what information? A) The acuity level of the patients on a particular unit in a 24-hour time span B) The total number of hours worked by nursing personnel on a particular unit in a 24-hour time span divided by the patient census C) The specific amount of money spent on staffing during a 24-hour period D) The quality of nursing care that was provided on a particular unit in a 24-hour time span

Ans: B Feedback: The Personnel Budget NCH/PPD refers to number of nursing care hours worked in 24 hours divided by the patient census.

20. What changed the structure of Medicare payments from a retrospectively adjusted cost reimbursement system to a prospective, risk-based one? A) Zero-based budgets B) Diagnostic-related groupings C) Prospective payment system D) Incremental budgets

Ans: B Feedback: The impetus of diagnosis-related groupings changed the structure of Medicare payments from a retrospectively adjusted cost reimbursement system to a prospective, risk-based one. None of the other options were involved in the change.

3. Which activity is a responsibility of the unit manager regarding fiscal planning? A) To assume responsibility for achieving budgetary planning goals B) To monitor and evaluate all aspects of the unit's budget control C) To streamline the number of subordinates involved in the budgetary process D) To control unpredictable census variations that may undermine the personnel budget

Ans: B Feedback: The manager's responsibility is to monitor all aspects of the unit's budget. The other options fail to identify a manager's responsibility.

4. Which statement accurately reflects self-appraisals? A) Self-appraisals are more objective than the other types of appraisals B) Self-appraisals provide an opportunity to give positive feedback to employees C) Self-appraisals usually require some introspection on the part of the employee D) Self-appraisals should be read before the supervisor does an appraisal

Ans: C Feedback: Although they require some work on the employees' part, self-appraisals can provide introspection and personal growth. The remaining options are not accurate statements.

13. A nurse-manager is planning a performance appraisal of an employee who has a number of performance deficiencies. What is the best approach to the performance appraisal of this employee? A) Tell the employee that he or she is not performing well and ask the employee where improvement is needed B) Prepare a list of the employee's deficiencies and give him or her time to look it over before asking for a response C) Recognize the employee's strengths, focus on one or two key deficiencies, and create a long-term coaching plan D) Tell the employee that he or she is liked as a person but is not meeting the requirements for the job and will need to brush up on skills during the next year

Ans: C Feedback: An employee who is overwhelmed with negative feedback during the performance appraisal cannot grow as a result of the appraisal. The manager should recognize the employee's strengths, focus on one or two key deficiencies, and create a long-term coaching plan.

6. Which statement correctly describes using self-appraisal as a performance appraisal tool? A) It should always be totally unstructured so employees can write about whatever they want to B) It is effective because most employees are self-aware and rate themselves accurately and appropriately C) It works best when used in conjunction with other appraisal tools D) It relieves the manager of the responsibility for preparing the performance appraisal

Ans: C Feedback: Because employees cannot be objective concerning their own performance, a self- appraisal is most effective when used in conjunction with other appraisal tools. The remaining options are incorrect statements regarding self-appraisal tools.