Chapter 10: Leadership, Managing and Delegating

In a nursing unit, the RN delegates nursing tasks to the nursing assistant. Keeping in mind the delegation guidelines, which statement denotes the right communication for the nursing assistant?

"Dispose of the disconnected IV set." Explanation: The statement, "Dispose of the disconnected IV set" is in accordance with the delegation guidelines of right communication. The nurse should provide all the necessary information to carry out the assigned task. The other statements do not follow the delegation guideline of right communication. The tasks mentioned in the other instructions are not a nursing assistant's role.

Which of these statements reflects the expected functioning at a hospital that has achieved Magnet status?

Staff nurses are developing innovative solutions to problems. Explanation: A hospital that has achieved Magnet status has recognition of quality client care that is provided by nursing staff who are professional and well-qualified. The staff nurses participate in self-governance and, therefore, work toward innovative solutions to problems. Having an increased turnover among staff nurses and a lack of quality client outcomes would not be characteristics of a Magnet hospital.

The nurse has recently been promoted to nurse manager on a pediatric unit and has decided to accept input from staff regarding changes they would like to see on the unit. Which type of leadership style is the nurse embodying?

Democratic Explanation: Democratic leadership style involves sharing the decision making process and activities with others who have an interest. Autocratic leadership style involves assuming control over the decisions and activities of the group. Laissez-faire leadership style involves the leader relinquishing power or control to the group. Quantum leadership style involves seeing an organization and members as interconnected and collaborative. This style involves change as continually unfolding, and frequently incorporates technology.

A nurse informs the client that the client has no choice and must take a bath in the morning. What type of leadership does this exemplify?

Directive leadership Explanation: Directive (also known as autocratic or authoritarian) leadership describes a leader who makes all the decisions and tells followers what to do. Democratic, or participative, leadership style and shared governance involve sharing the decision-making process and activities with others who have an interest. Institutional governance is governance by the institution.

The registered nurse (RN) and unlicensed assistive personnel (UAP) are working together to admit a pediatric client to a nursing unit. Which task would be inappropriate for the RN to delegate to the UAP?

Initiating intravenous therapy Explanation: When delegating, the RN must determine the skill level and education of the UAP, the client's condition and the complexity of that condition, and the potential for harm. Initiating intravenous therapy is reserved for the RN due to the potential for harm and the scope of the UAP. The UAP can assist the nurse by obtaining equipment, securing the client, and soothing the client.

Which attributes should be characteristic of a nurse mentor? Select all that apply.

Is supportive Is resourceful Demonstrates leadership abilities Is an experienced, licensed professional Explanation: Mentors should demonstrate characteristics that will help the less experienced person grow in the profession. Mentors should be supportive, resourceful, experienced, respectable, and trustworthy leaders. Mentors do not receive financial compensation for their effort as preceptors typically do. Mentors should not embrace conflict that is disruptive to tasks. Mentors should build and use health care networks, not deconstruct them.

The nurse is working to enhance time management skills and has to administer pain medications to several patients, obtain vital signs, and assist clients with bathing. What should the nurse do next?

Delegate bathing and vital signs tasks. Explanation: Steps to enhancing time management include: establish goals, evaluate ability to meet goals and identify tasks that can be delegated, establish a timeline, evaluate success of the plan, and use the evaluation to make future plans. Goals were established in the stem of the question and therefore, the next step would be to delegate task.

A nurse manager has asked the staff to create a plan to improve patient outcomes. In the past, the staff have not met deadlines. How can the nurse manager use transactional leadership style to ensure that the deadline is met?

Offer 2 days of paid vacation. Explanation: The transactional leadership style involves a task and reward system. Paid vacation is a reward for meeting the deadline. Asking politely, demanding efficiency, and giving extensions are not rewarding behaviors.

A charge nurse on a medical-surgical unit is asked by the nurse manager to serve as a mentor to another staff nurse who is less experienced. Which of these would best describe this role?

The charge nurse is providing support for the staff nurse in new responsibilities. Explanation: A mentor is not a paid position, but, instead, is a person who provides support and encouragement to a less experienced nurse who is learning new responsibilities for a current role or an expanded one. Preceptorship typically is a paid position, and is provided for a new or experienced nurse who is training for a new position on a unit. The preceptor would teach the new nurse about hospital policies and procedures, as well as supervise the nurse in daily assignments.

When a staff member has successfully completed the activities delegated by the nurse manager, the result is usually that the staff member is more:

committed. Explanation: Because successful completion of delegated activities helps staff members to grow and to become more committed to the organization, delegation is an important development method. The staff member is not necessarily more cost effective, time efficient, or responsive.

A nurse is successful in promoting change on the nursing division. This nurse would be considered a:

leader. Explanation: The role of a leader is to direct or motivate a person or group to achieve set goals. The role of a manager is to plan, organize, direct, and control available human, material, and financial resources to deliver quality care to patients and families. A guide can show the way to a desired result but cannot effect change in the way that a leader can. A specialist is one who has expert skills and knowledge in a specific area of practice.

On a medical unit, the nurses complain that they have no voice in the decisions that are made in the operation of the unit. The nurses state they are always told by the nurse manager to perform tasks instead of being asked. Which of these best describes the leadership style of the nurse manager?

Autocratic Explanation: This nurse manager, by not soliciting staff feedback and telling the staff what to do rather than ask, would be demonstrating autocratic leadership. Democratic leadership involves equal sharing of power between the leader and the staff; everyone is working together toward a mutual vision and goals. Laissez-faire leadership, which is also known as nondirectional leadership, gives power to the group rather than the leader.

A staff nurse is talking with a clinical nurse leader and asks, "What exactly do you do?" Which statement by the clinical nurse leader would be appropriate?

"I collaborate with health care teams to promote client care." Explanation: A clinical nurse leader is a master's-prepared nurse who has earned the certified CNL credential and works collaboratively with the health care team to facilitate, coordinate, and oversee care provided to clients. This role is not considered an administrative or management role, but rather one of leadership in all health care settings. Clinical nurse specialists are advanced practice nurses with specialist education in a defined area of practice.

In the hospital setting, a nurse is responsible for overseeing the quality and financial outcomes of client care while working collegially with health care providers. What type of professional nursing practice is this considered?

Case management Explanation: The case management model is when one nurse is responsible for overseeing the quality and financial outcomes of client care; the nurse works collegially with physicians and other caregivers as well as with payers to manage clients along an agreed-on clinical pathway. Functional nursing is when nurses and other staff are assigned to specific tasks for a group of clients. This model is based on the assembly-line concept. Specializing tasks increases efficiency but results in impersonal care. Primary nursing is when a nurse is accountable for planning, evaluating, and directing the care of a client 24 hours a day throughout the client's stay. Nurse mentorship can be key in helping a less experienced nurse assume added responsibilities and position changes but does not relate to issues with clients.

A nurse manager of a hospital unit is working within a decentralized management structure. Which nursing action best exemplifies this type of system?

Decisions are made by those who are most knowledgeable about the issue. Explanation: The best example of a nurse manager of a hospital unit working within a decentralized management structure would be that decisions are made by those who are most knowledgeable about the issue. Nurses would be greatly involved in decisions involving client care. Senior managers would not make all the decisions within a decentralized management structure. Nurse managers could be accountable for clients, staffing, supplies, and/or budgets.

The registered nurse (RN) is preparing to delegate tasks to an unlicensed assistive personnel (UAP) for a client who recently had a stroke. Which task would be inappropriate for the RN to delegate to the UAP?

Feeding Explanation: When delegating, the RN must determine the skill level and education of the UAP, the client's condition and the complexity of the condition, and the potential for harm. Feeding should not be delegated to the UAP because the client is at an increased risk for aspiration due to recently experiencing a stroke. Bathing, obtaining vital signs, and assisting to use a bedpan are all within the scope of a UAP and offer minimal harm to the client.

A nurse on a telemetry unit is admitting a client and has an unlicensed assistive person (UAP) helping with the admission process. Which task can the nurse delegate to the UAP?

Obtaining an admission weight for the client utilizing the client's bed scale Explanation: The nurse should delegate obtaining the initial weight to the UAP, as this is within the capability of the UAP. The task of obtaining a history, including home medications, is a responsibility of the nurse with documentation in the medical record. The nurse should also interpret the initial rhythm of the client. Although UAPs may be able to interpret the rhythm based on special training, there is no indication of this being true for the UAP in the scenario and the nurse should still verify the initial rhythm interpretation is correct.

Which nursing model results in the greatest continuity of care?

Primary nursing Explanation: Primary nursing results in increased continuity of care because the same nurse is assigned to provide care for a given client over an extended period of time. The other approaches listed involve multiple nurses providing care to the client at the same time.

A nurse manager is educating the staff on new forms of charting. Within the education session, the manager sets a goal for complete use of the charting. Through goal setting, the manager is acting as:

a leader. Explanation: Leadership is the ability to influence others to strive for a vision or goal or to change. Thus, goal setting is the act of a leader. Although educators may set educational goals, the primary focus of an educator is teaching. A guide provides advice but does not set goals. A clinical specialist develops expert skills and knowledge in one specific area of practice.

The nurse is conducting an in-serve on change theories. Which example should the nurse include in the presentation illustrating Lewin's three stages of change?

A need for a safer intravenous therapy pump is identified. New intravenous therapy pumps are purchased and training for staff nurses is provided. Intravenous therapy pumps are placed on the nursing unit for client care. Explanation: Lewin's three stages of change are: unfreezing - recognizing need for change; moving - initiating change after planning; and refreezing - making change operational. Identifying a need for new intravenous therapy pumps, training staff to use the pumps, and then placing the pumps for client care is the only option that illustrates Lewin's stages.

The registered nurse on a busy telemetry floor is delegating tasks to an unlicensed assistive person (UAP). Which task is appropriate for the UAP to complete?

Bathing a combative client Explanation: Bathing a client, whether combative or not, is within the scope of practice of a UAP. Skills such as inserting an indwelling catheter, taking a physician order, and assessment must be completed by licensed nurses, however.

The nurse is working at a facility that is applying for Magnet® Recognition. The nurse knows that compared with other hospitals, Magnet® hospitals have which direct effect on client care?

Better patient outcomes Explanation: Magnet® hospitals have better patient outcomes than facilities without the recognition. Magnet® hospitals have higher nurse retention and job satisfaction scores, but these do not have a direct effect on client care. Magnet® hospitals have shorter, not longer, patient stays.

A registered nurse checks the American Nurses Association (ANA) regulations prior to delegating tasks to unlicensed assistive personnel (UAP) on a burn unit. Which principles regarding the regulation, education, and use of UAP are recommended by the ANA? Select all that apply.

It is the purpose of assistive personnel to work in a supportive role to the registered nurse. It is the role of the assistive personnel to carry out tasks to enable the professional nurse to concentrate on nursing care for the client. It is the registered nurse who is responsible and accountable for nursing practice. Explanation: The nurse must be familiar with the delegation guidelines when working as a registered nurse. The purpose of assistive personnel is to work in a supportive role to the registered nurse. It is the role of the assistive personnel to carry out tasks to enable the professional nurse to concentrate on nursing care for the client. It is the registered nurse who is responsible and accountable for nursing practice. It is the nursing practice act of each state, not the health care institution, that determines the scope of nursing practice within a given state. The LPN does not supervise the assistant, the RN does. It is not the role of the LPN, rather the RN, to assign nursing duties.

The nurse recognizes that a new mother is having difficulty breastfeeding. The nurse demonstrates various positions in which to hold the baby while feeding. The nurse also educates the mother on ways to ensure proper latching. The new mother attempts to breastfeed the baby again using the new techniques and is successful. Which statement in this scenario illustrates Lewin's stage of refreezing?

The new mother attempts to breastfeed the baby again using the new techniques and is successful. Explanation: Refreezing involves making a change operational, or a part of one's everyday life. The mother feeding the baby using new techniques is an example of refreezing. The nurse recognizing that a new mother is having difficulty breastfeeding is an example of unfreezing, in which the need for a change is recognized. The nurse educating the mother on ways to ensure proper latching and demonstrating various positions in which to hold the baby while feeding are examples of moving, in which change is initiated after a careful process of planning.

Two new nurses are requesting the same preceptor for unit orientation. Both new nurses have been very vocal about being unhappy if they do not receive their choice of preceptor. Which illustrates the nurses using a compromise approach to conflict resolution?

The nurses agree to have the preceptor precept one nurse at the beginning of the orientation and the other at the end. Explanation: Compromise involves both parties willingly relinquishing something of equal value. The nurses' decision to share the preceptor, with one having the preceptor at the beginning of the orientation and the other at the end, demonstrates compromise. The nurses ignoring each other's request illustrates avoidance. Allowing the preceptor to decide which nurse to precept encourages competition. Competition involves a win-lose approach to conflict. The nurses agreeing that one nurse will obtain the preceptor for orientation in exchange for that nurse working each weekend illustrates accommodation. Accommodation involves one party deciding to let the other party win in exchange for something else of value.

Following a myocardial infarction (heart attack), a client begins to recognize the need to increase exercise, eat a low-fat diet, and implement relaxation techniques. According to Lewin, this client is in which stage of the change process?

Unfreezing Explanation: Unfreezing is stage in the change process in which the person recognizes the need for change and the dissolution of previously held patterns of behavior. Unfreeze, move (or change), refreeze, also known as the Kurt Lewin Change Model, is a method for managing change within a client or organization. For a client to change, the client must be melted (unfreeze), poured into a mold (move), and frozen again in the new shape (refreeze). Prizing is not a component of the model.

A staff nurse who has been working as a clinical manager is demonstrating strong leadership qualities on the unit. Which behaviors and competencies by the nurse would be recognized by senior management as indicators of strong leadership during evaluation? Select all that apply.

When delegating tasks to unlicensed assistive personnel, the nurse supervises, guides care, and evaluates outcomes. The nurse has achieved certification in the field of professional practice and belongs to that professional practice. The nurse has recognized an error in practice and performance and is managing a task force to change policy. Explanation: One of the competencies according the American Nurses Association that demonstrates leadership in the professional practice setting and profession is that the nurse retains accountability for delegated nursing care. Another competency that demonstrates leadership is that the nurse contributes to the evolution of the profession through participation in professional organizations. The nurse also demonstrates leadership by influencing policy to promote health. Working to promote financial gain is not a demonstrated quality of leadership. Avoidance of conflict rather than promoting an environment that supports and maintains respect, trust, and dignity does not demonstrate a level of leadership competency.

The nurses who provide care on a medical unit are skeptical about the planned change from a traditional narcotic cupboard to a computerized medical supply and management system. Which statement best demonstrates mistrust about the benefits of this proposed change?

"I've heard those machines don't even cut down on medication errors like they say they do." Explanation: Resistance to change takes many forms, including doubts about the benefits of a change. Expressing doubt that a new process will reduce medication errors expresses such a doubt. Fears about the necessary learning, cost, and effects on workload are also common points of resistance, but these do not focus on the purported benefits.

The new nurse is having difficulty managing the time required to care for a group of complex clients and is several hours behind in completing nursing interventions. Which intervention should the nurse complete first?

Administer a dose of digoxin that is two hours behind schedule. Explanation: The first step in time management is to determine which tasks are priority. Digoxin is a critical client medication and therefore takes priority over the other options. Dressing changes, discharge orders, and completing facility forms can be delayed until critical tasks are complete.

A client is received into the emergency department after getting shot in the chest. The client is hemorrhaging profusely and is in hypovolemic shock. The nurse calls a code blue. What type of leadership style will be most effective during the management of the code?

Autocratic leadership Explanation: Autocratic leadership will be most effective in this scenario. Autocratic leadership involves the leader assuming control over the decision and activities of the group. During code blue, a leader is needed to direct the actions needed and make quick decisions to positively affect the client. Laissez-faire leadership would ultimately lead to the demise of the client. Democratic leadership could possibly delay the client receiving life-sustaining measures and would be less effective than autocratic leadership. Transactional leadership would involve a reward system which would be unethical in this situation.

A nurse manager is trying to resolve a conflict between the day and night shifts. The nurse manager wants to convince the involved persons to set aside their differences, determine a priority common goal having to do with improved client care, and accept mutual responsibility for achieving this goal. The nurse manager is using which type of conflict resolution?

Collaborating Explanation: Collaborating has all parties set aside previously determined goals, determine a priority common goal, and accept mutual responsibility for achieving this goal. This requires mutual respect, honest communication, and shared decision making. Avoidance, as a method of conflict resolution, involves looking the other way and doing nothing to resolve the conflict. Competing has one side winning at the expense of the other. Compromising means that each side gives up something of equal value.

A staff nurse works on a medical unit where staff retention is very high. There is a sense of equality between the leader and the staff nurses. The unit decisions and activities are shared between the leader and the group. The designated nurse leader practices which leadership style?

Democratic Explanation: The democratic leadership style is characterized by a sense of equality among the leader and other participants and shared decision making. The autocratic leader assumes complete control over the decisions and activities of the group. Transformational leaders create intellectually stimulating practice environments, and challenge themselves and others to grow personally, to grow professionally, and to learn. In laissez-faire leadership, also called nondirective leadership, the leader relinquishes power to the group, such that an outsider could not identify the leader in the group.

The nurse manager has recently promoted a staff nurse to the charge nurse position. Which type of power does the charge nurse now have?

Explicit Explanation: Explicit power is determined by virtue of the nurse's position. A charge nurse is responsible for making decisions and carrying out tasks not performed by staff nurses. Implied power involves a person without a leadership position being in a position of authority with peers. Reward power involves rewarding staff with something that they deem important. Coercive power involves using threats of punishment to force staff to do something they do not want to do.

A nurse leader is planning to change the scheduling process to improve staffing on the unit. Which would be the next step in implementing this change?

Explore the pros and cons of potential scheduling models. Explanation: Before beginning to plan the process of change, a nurse leader should fully explore different model options and select the new system to be implemented. After selecting the new system, the nurse leader can begin the process for the change by describing how the change will be implemented, along with the timetable of implementation, and enlist supporters from the staff, who will champion the cause.

A registered nurse is delegating activities to unlicensed assistive personnel (UAP) on a hospital unit. Which activities could this nurse normally delegate? Select all that apply.

Giving a bed bath to a client Taking routine vital signs Transferring a client to another floor Explanation: The nurse should be familiar with guidelines for delegating nursing care. The nurse could delegate the following tasks to UAP: giving a bed bath to a client, taking routine vital signs, and transferring a client to another floor. The nurse could not delegate the administering of medications, planning client education for a client with a colostomy, or the determination of a nursing diagnosis.

Which style of leadership is rarely used in a hospital setting because of the difficulty of task achievement by independent nurses?

Laissez-faire Explanation: In laissez-faire leadership, also called nondirective leadership, the leader relinquishes power to the group, such that an outsider could not identify the leader in the group. Autocratic leadership, also called directive leadership or authoritarian leadership, involves the leader assuming control over the decisions and activities of the group. Transformational is often described as charismatic; transformational leaders are unique in their ability to inspire and motivate others. Democratic leadership, also called participative leadership, is characterized by a sense of equality among the leader and other participants.

A nurse is caring for a client with pneumonia. Which task is most appropriate for the nurse to delegate to an experienced unlicensed assistive personnel (UAP)?

Obtaining vital signs every 4 hours Explanation: Having the UAP obtain vital signs every 4 hours is most appropriate, as it is within the UAP's scope of practice to perform this task. Assessment, teaching, and administration of medication are not in the current scope of practice for UAPs.

A nurse manager best demonstrates effective leadership characteristic by which action?

Sharing a vision for the unit and enlisting support Explanation: The nurse leader on a nursing unit should have a vision for the unit and be able to share this with the staff in order to enlist support and cooperation among the staff. The nurse leader should already be a role model, rather than just demonstrating interest. This would be related more to someone who was developing leadership qualities. The nurse leader should be flexible, not rigid, and does not have to know all information about the unit; rather, the nurse leader needs to know what resources are available among the staff and other leadership in helping reach expected goals and outcomes.

The registered nurse (RN) wants to delegate measuring a client's urinary output to an unlicensed assistive personnel (UAP). Which factors should the nurse consider before delegating the task?

The stability of the patient's condition, potential for harm, and complexity of the activity Explanation: RNs should consider the following when delegating tasks to UAPs: qualifications and capabilities of the UAP (not the age of the UAP or the RN's skill level), stability of the patient's condition (not the autonomy of the patient), complexity of the activity to be delegated (not the time required to complete the activity), potential for harm, predictability of the outcome (not the predictability of the UAP or the desired outcome), and overall context of other patient needs.

Which of these statements regarding a nurse manager role is accurate?

To effectively manage the nursing unit, the nurse manager should also be a leader. Explanation: In order to be an effective nurse manager, the nurse manager must also be a leader. This is important with management of a healthy work environment, which is a responsibility of the nurse manager. This is done by helping ensure that interpersonal conflicts are resolved. The nurse manager is also accountable for client census, staffing, supplies, and budget, but is not responsible for setting financial targets for the budget; this is usually managed at the executive level.

A nurse manager reviews an employee's contribution to the nursing division annually. This process is:

performance appraisal. Explanation: Performance appraisal is typically conducted annually. Each organization determines a reward structure to define and to acknowledge success. Interpreting quality indicators pertains to evaluation of general client care, not of an individual nurse. An employee's job satisfaction survey is a tool that allows the employee to give feedback on the employee's satisfaction with work, not a review of the employee's contribution conducted by the nurse manager.

The nurse manager who asks staff members to give suggestions on how to improve collaboration between nurses and physicians is exhibiting what style of leadership?

Democratic Explanation: The nurse manager who involves staff members in decision-making by asking for suggestions is exhibiting a democratic style of leadership. Autocratic leadership style would be exhibited by a leader who gave staff little opportunity to give feedback or suggestions. Transactional leadership also involves little input by staff into decision-making and is instead focused on providing rewards when tasks are completed. A leader with a laissez-faire style would give all control to staff members to determine how to improve collaboration.

The nurse manager is concerned about the large number of teenage mothers being seen in the obstetrics clinic. How can the nurse manager use the transformational leadership style to address the concern?

Enlist volunteers to help develop a community outreach project that will educate teenagers on methods to prevent pregnancy. Explanation: Transformational leaders create revolutionary change and inspire others to become involved with their cause or concern. Enlisting others to make a change in the community is an example of transformational leadership. Creating new policies to distract attention from the problem and talking individually to each teenager does not inspire others to become involved in the change. Conducting research may be a step taken when developing the community outreach project; however, conducting research does not involve others getting inspired to be a part of the change.

A nurse can improve one's skill with time management by taking which action?

Evaluating success with accomplishment of goals in client care Explanation: Time management is a skill that can be improved for nurses by taking time during the day to evaluate whether goals have been accomplished and then setting new priorities based on this. Goals and priorities should be established at the beginning of each day, and clients and their families should be involved in this. At the end of the day, a nurse should look back and determine what has and has not been accomplished; this helps to set a time line for the next day. If a timeline is not set each day, then the nurse will allow the flow of the day to control the day, rather than having a plan for what needs to be accomplished.

The unit manager on a medical unit is trying to encourage the nursing staff to use a new protocol for documentation. To help with this, the nurse manager recruits one of the staff nurses to serve as a role model for many of the staff. Which type of power does the staff nurse exhibit?

Implied Explanation: The staff nurse, as a role model for the rest of the staff and, therefore, influential with making change, would have implied power. Explicit or legitimate power is that power that is directly given, such as with the unit manager role; coercive power is a negative type of power that results from using threats or punishment to force people to do what they do not want to do.

A nurse leader on a unit allows the staff to make all decisions and direct themselves, including filling out the work schedule. The nurse leader is practicing which leadership style?

Laissez-faire Explanation: In laissez-faire leadership, also called nondirective leadership, the leader relinquishes power to the group, such that an outsider could not identify the leader in the group. The democratic leadership style is characterized by a sense of equality among the leader and other participants. The autocratic leader assumes complete control over the decisions and activities of the group. Transformational leaders create intellectually stimulating practice environments and challenge themselves and others to grow personally, to grow professionally, and to learn.

The nurse is advising a client about health problems related to being overweight. The client acknowledges the need to lose weight. The nurse provides education on how to count calories in food and the importance of daily exercise. The client states an intention to begin counting calories with the next meal. The client also states an intention to begin an exercise program with friends. Which statement associated with this scenario illustrates Lewin's stage of unfreezing?

The client acknowledges the need to lose weight. Explanation: In unfreezing, one recognizes the need for change. The client's acknowledgment of the need to lose weight is the only example provided of unfreezing. The nurse providing education on how to count calories in food and the importance of daily exercise is an example of moving, in which change is initiated after a careful process of planning. The client's intentions to begin an exercise program with friends and to begin counting calories with the next meal are examples of refreezing, which involves making a change operational, or a part of one's everyday life.

The nurse is caring for an older adult client who states the need to use the restroom. Which safety intervention must the nurse perform first?

Assess the need for assistance with ambulation. Explanation: The diverse physiologic and psychologic capabilities of people and encounters with various safety hazards across the lifespan put various age groups at risk for different safety concerns and potential injuries. Older adult clients are at a higher risk for falling. Thus, the nurse should assess the client's ability to ambulate independently before allowing the client to go to the restroom and to provide assistance, if needed. The nurse would lower, not raise, the bedside rails before having the client exit the bed. The nurse would put nonskid footwear like slippers, not socks, on the client to help prevent falls. Furniture should be arranged so that the client has a clear and easy path to the restroom.

After a nurse manager implements a solution to the problem of delays in obtaining supplies, the first task for the manager is to:

assess whether the desired results have occurred. Explanation: The nurse manager must evaluate the results of the efforts to determine whether the desired results have occurred. The nurse manager should solicit input from staff members about potential solutions before, not after, implementing a solution. Monitoring the supply cabinets would be more appropriate if the problem were suspected drug diversion by staff but would be unnecessary for evaluating for improvement in delays for obtaining supplies. Making an appointment with the chief nursing officer is not necessary and would not help the nurse manager evaluate the change in procedure related to obtaining supplies.

A nurse manager informs the staff members during a meeting that unlicensed assistive personnel will no longer be allowed to check clients' blood glucose levels. The nurse manager informs the group that this is a new policy on the unit and that discussions will not change the enforcement of this policy. What type of leadership style is the nurse manager demonstrating?

Autocratic Explanation: Autocratic leadership involves the leader assuming complete control of the decisions and activities of the group. An extremely autocratic leader might make all decisions for the workers or followers without considering their ideas or feelings. Democratic leadership is characterized by a sense of equality among the leader and the other participants. In laissez-faire leadership, the leader relinquishes power to the group. Transformational leadership can create a revolutionary change and may be directed by a charismatic leader who has a unique ability to inspire and motivate others.

The nurse manager for the psychiatric unit sees that there are major conflicts between the day and night shift staff. The nurse manager suggests that each shift put aside their differences for a time and determine a common major goal. Which conflict resolution style does the nurse manager display?

Collaborating Explanation: With the collaborating approach to conflict resolution, there is a joint effort to resolve the conflict with a win-win solution. All parties set aside previously determined goals, determine a priority common goal, and accept mutual responsibility for achieving this goal. With avoiding there is awareness of the conflict situation, but the parties involved decide to either ignore the conflict or avoid or postpone its resolution. Competing is an approach that results in a win for one party at the expense of the other. Smoothing is an effort to complement the other party and focus on agreement rather than disagreement, thus reducing the emotion in the conflict. The original conflict is rarely resolved with this technique.

After talking with a group of staff nurses on the medical-surgical unit, the nurse manager identifies a need for change. When developing a plan for change, which question would the nurse manager need to ask first?

Is the behavior something that can be changed? Explanation: Before planning to make a change, a nurse manager should first ask whether or not the situation or behavior is amenable to change. Considering this question may reveal a behavior not amenable to change. Then other questions to ask would include: How does the group function as a unit? Certain forces within a group may favor change, whereas other forces may resist it; is the person or group ready for change and, if so, at what rate can that change be expected to be accepted? The pace of change must be consistent with the person's or group's readiness to assimilate change. Readiness involves both the ability and willingness to change; are the changes major or minor? A series of small changes may be more easily accomplished than one large, dramatic change.

The nurse manager calls a staff into a unit meeting to discuss patient satisfaction. During the meeting, several staff members assume control. The nurse manager does not intervene to regain control of the group. Which type of leadership style is the nurse embodying?

Laissez-faire Explanation: Laissez-faire leadership style involves the leader relinquishing power or control to the group. Democratic leadership style involves sharing the decision making process and activities with others who have an interest. Autocratic leadership style involves assuming control over the decisions and activities of the group. Quantum leadership style involves seeing an organization and members as interconnected and collaborative. This style involves change as continually unfolding, and frequently incorporates technology.

The charge nurse on the orthopedic unit believes in giving the staff as much power as possible. The nurses are allowed, among other things, to create their own work schedules, provide dates and times for unit meetings, and create the agendas, to which the charge nurse contributes. The charge nurse's style of leadership can be described as which?

Laissez-faire Explanation: With laissez-faire leadership, the leader relinquishes power to the group. Autocratic leadership involves the leader assuming complete control. Democratic leadership displays a sense of equality among the leader and other participants. Transformational leaders create intellectually stimulating practice environments and challenge themselves and others to grow personally and professionally and to learn.