Chapter 22, Nurse Leader, Manager, and Care Coordinator

The nurse has just graduated with a Bachelor of Science in Nursing and is eager to find a mentor at this early stage in her career. Which of the following individuals is most likely to be an appropriate mentor for the nurse? A) An experienced nurse who was a preceptor in a previous clinical placement B) The nurse educator on the hospital unit where the novice nurse has been hired C) A colleague who graduated with honors at the same time as the novice nurse. D) The unit manager who the novice nurse.

Ans: A Feedback: A person who demonstrates positive qualities and who possesses more experience is often a good choice to be a nurse's mentor. A person in formal authority or oversight, such as the unit educator or manager, is a less ideal choice, and a peer is not normally an ideal choice of mentor.

A student nurse has just graduated with a baccalaureate degree in nursing. What type of nursing leadership will this nurse be expected to provide? A) Nursing care of the individual client B) Demonstration of selected critical skills C) Ability to be a follower rather than a leader D) Nursing care of groups of clients

Ans: A Feedback: New graduates have leadership responsibilities when they begin nursing. Nursing leadership begins with nursing care of the individual client.

Which of the following nursing care tasks is acceptable for a graduate nurse to delegate to unlicensed assistive personnel (UAP)? A) Assisting a client with ambulation B) Evaluation of nursing care delivered to a client C) Initial and ongoing assessments D) Development of a client teaching plan

Ans: A Feedback: Tasks that should be performed by a registered nurse include initial and ongoing assessments, determining nursing diagnoses, plan of care, evaluation of client progress, evaluation of the nursing care delivered to the patient, supervision and education of nursing personnel, and client education. Tasks such as ambulation, assistance with meals and hygiene, and obtaining vital signs are acceptable tasks for a UAP to perform.

The nurse is caring for a client who had a sudden episode of vomiting, which produced 900 mL of frank blood. The nurse directed and delegated to colleagues in order to notify the physician. She started intravenous fluids, and provided physical and emotional support for the client. Different situations call for different leadership styles. Which of the following leadership styles did the nurse display in this situation? A) Democratic B) Laissez-faire C) Autocratic D) Transformational

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

A head nurse assumes the leadership role when directing and supervising coworkers. Which of the following are attributes of a leader? Select all that apply. A) Philosophical B) Task-oriented C) Charismatic D) Dynamic E) Intimidating

Ans: A, C, D Feedback: Leadership involves philosophy, perception, and judgment whereas management tasks are the core of the management role. Leaders need to be comfortable with themselves (i.e., have a positive self-image) and present themselves as role models for followers. Ideally, they also have a vision that energizes the group and brings forth the best efforts of members. Leaders may be charismatic, dynamic, enthusiastic, poised, confident, and self-directed.

In general, how do most people view change? A) By how it affects the cohesiveness of the group B) By how much it will cost in time and resources C) By how they are affected personally D) By how it will affect others on the staff

Ans: C Feedback: In general, people view change in terms of how they are affected personally. Examples include threats to self-esteem, amount of work required, and effect on social relationships.

In Lewin's classic theory of change, what happens during unfreezing? A) Planning is conducted. B) Change is initiated. C) Change becomes operational. D) The need for change is recognized.

Ans: D Feedback: In Lewin's change theory, during unfreezing the need for change is recognized. Unfreezing does not include planning, initiating, or operationalizing change.

What type of leader shares decisions and activities with group participants? A) Democratic B) Autocratic C) Laissez-faire D) Situational

Ans: A Feedback: Democratic leadership, also called participative leadership, is characterized by equality among the leader and other participants. Decisions and activities are shared.

The nurse is having an exceptionally busy shift on an obstetrical unit. Which of the following tasks is the nurse justified in delegating to an unlicensed care provider? A) Emptying a client's Foley catheter bag and reporting the volume to the nurse B) Helping a first-time mother achieve a good latch when breast-feeding her infant C) Assessing the size and quantity of clots that are in a client's bedpan and informing the nurse D) Giving an anti-inflammatory to a client who is eight hours postdelivery

Ans: A Feedback: Emptying a Foley catheter bag and reporting the volume is within the scope of an unlicensed care provider. Assistance with breast-feeding, assessments, and medication administration are not tasks that should be delegating to anyone but an RN.

What type of leadership can a graduate nurse working in a magnet hospital expect? A) Democratic B) Autocratic C) Situational D) Quantum

Ans: A Feedback: Working in a magnet hospital can maximize the potential of new graduates who prefer democratic leadership.

A nurse leader is described as charismatic, motivational, and passionate. Communications are open and honest, and the nurse is willing to take risks. What type of leadership is the nurse practicing? A) Democratic B) Autocratic C) Quantum D) Transformational

Ans: D Feedback: Transformational leaders are often described as charismatic, challenging, and passionate about their vision. They communicate openly and honestly, show concern for others, and are willing to take risks.

A nurse believes in listening to clients and coworkers more than talking to them, allowing more personal control for all involved. This is a quality of which of the following managerial mindsets? A) Reflective B) Analytical C) Worldly D) Collaborative

Ans: D Feedback: The collaborative mindset involves listening more than talking, and allowing people to take initiative and control their own work. The reflective mindset allows managers to mentally digest experiences and reflect on them in a different way. The analytical mindset encourages introspection so that one can recognize biases and see things in a unique way. This facilitates a change in course and movement toward resolution of problems. The worldly mindset recognizes cultures and contexts or "seeing differently out to reflect differently in."

Which of the following tasks could the nurse safely delegate to unlicensed assistive personnel? A) An initial assessment of a client B) Determination of a nursing diagnosis C) Evaluation of client progress D) Documentation of client's I+O on a flow sheet

Ans: D Feedback: Nursing care or tasks that should never be delegated except to another RN include (Ayers & Montgomery, 2008) the following: the initial and ongoing nursing assessment of the client and his or her nursing care needs; the determination of the nursing diagnosis, nursing care plan, evaluation of the client's progress in relation to care plan, and evaluation of the nursing care delivered to the client; the supervision and education of nursing personnel; client education that requires an assessment of the client and his or her education needs; and any other nursing intervention that requires professional nursing knowledge, judgment, and/or skill.

The ANA, which is committed to monitoring the regulation, education, and use of NAPs, recommends adherence to which one of the following principles? A) It is the nursing profession that determines the scope of nursing practice. B) It is the RN who defines and supervises the education, training, and use of any unlicensed assistant roles. C) It is the assigned NAP who is responsible and accountable for his or her nursing practice. D) It is the purpose of the RN to work in a supportive role to the assistive personnel.

Ans: A Feedback: It is the nursing profession that determines the scope of nursing practice, and defines and supervises the education, training, and use of any unlicensed assistant roles involved in providing direct nursing care. It is the registered nurse who is responsible and accountable for nursing practice, and who supervises any assistant involved in providing direct client care. It is the purpose of assistive personnel to work in a supportive role to the registered nurse, carrying out tasks that enable the professional nurse to concentrate on caring for the client.

A nurse manager has encountered resistance to a planned change. What is one way the nurse can overcome the resistance? A) Tell the staff that if they don't like it, they can quit. B) Implement change rapidly and all at once. C) Encourage open communication and feedback. D) Let the staff know that the change is mandated.

Ans: C Feedback: Providing opportunities for open communication and feedback is one way to overcome resistance to change.

In which of the following conflict resolution strategies is the conflict rarely resolved? A) Collaborating B) Compromising C) Competing D) Smoothing

Ans: D Feedback: 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.

A nurse strives to establish trusting interpersonal relationships with clients, peers, subordinates, and superiors to facilitate goal achievement and personal growth of all participants. Which type of skills is this nurse demonstrating? A) Communication skills B) Problem-solving skills C) Management skills D) Self-evaluation skills

Ans: A Feedback: Communication skills involve the ability to establish trusting interpersonal relationships with clients, peers, subordinates, and superiors to maximize goal achievement and enhance the personal growth. Problem-solving skills refer to the ability to analyze all sides of a problem, to suspend judgment, to explore multiple options, and to work toward a creative solution. Management skills pertain to the ability to direct others toward goal achievement. Selfevaluation skills involve the ability to assess honestly one's effectiveness, to accept both praise and criticism, and to direct personal professional growth and development.

A nurse is described as a "quantum leader." Which action characterizes this type of leadership? A) A nurse conducts a blind survey to evaluate her leadership skills. B) A nurse relinquishes power to a group deciding hospital policy. C) A nurse makes policy decisions for coworkers without consulting them. D) A nurse sticks to the "tried and true" methods when implementing client care.

Ans: A Feedback: Quantum leaders must have excellent communication skills, encourage personal critiques, and challenge current ways of thinking and doing. A nurse who relinquishes power to a group to make decisions is using laissez-faire leadership. A nurse making decisions for coworkers without considering their feelings is an autocratic leader.

Nurses with varying levels of experience possess leadership skills. A graduate nurse walks out of the nurse manager's office after a meeting. The graduate nurse reflects on the positive and negative feedback that she received from the manager regarding her three months working on the unit. What nursing leadership skill is best illustrated by the graduate nurse in this scenario? A) Self-evaluation skills B) Communication skills C) Problem-solving skills D) Management skills

Ans: A Feedback: Self-evaluation skills incorporate the ability to assess honestly one's effectiveness, to accept both praise and criticism, and to direct personal professional growth. Communication skills demonstrate the ability to establish trusting interpersonal relationships with clients, peers, subordinates, and superiors to maximize goal achievement. Problemsolving skills include the ability to analyze all sides of a problem, to suspend judgment, to explore multiple options, and to work toward a creative solution. Management skills are the ability to direct others toward goal achievement.

The nursing student is working to improve his time management. Which of the following would assist the nursing student in accomplishing his goal? Choose all that apply. A) Identify priorities for the day. B) Evaluate time management at the end of the day. C) Establish a reasonable time line. D) Plan to arrive right at start of shift. E) Plan on his cohorts helping him

Ans: A, B, C Feedback: Establish goals and priorities for each day. The nurse should identify what needs to be accomplished each day, differentiating need to do from nice to do tasks. Then nurse should establish a time line so that it is clearly evident when he or she is falling behind schedule, in time to correct it. The nurse should evaluate success or failure and use the results to plan the next day 's time management. The nurse should plan to arrive at least 15 minutes or more before the start of shift so that he or she can be prepared to receive change of shift report. Then nurse should plan time to assist his cohorts instead of them helping him. The cohorts may be too busy to assist or may need assistance themselves.

A nurse is attempting to change the method for documenting client care in a hospital setting. Which of the following should be considered before planning change? Select all that apply. A) What is amenable to change? B) How does the group function as a unit? C) Is the group ready for change? D) Are the changes major or minor? E) How can I keep from changing again?

Ans: A, B, C, D Feedback: Before planning to make a change, a nurse manager should consider the following; What is amenable to change? Considering this question might reveal a behavior not amenable to change. How does the group function as a unit? Is the person or group ready for change and, if so, at what rate can that change be expected to be accepted? Are the changes major or minor? A series of small changes might be more easily accomplished than one large, dramatic change. Change is inevitable; a more appropriate question to ask is how often this change needs to be evaluated.

The nurse is a manager on an orthopedic unit. The unit changed to a new computer documentation system three days ago. One of the night nurses has called in sick every shift since the new system started. The nursing manager is aware that this situation has to do with resistance to change. Which of the following are common reasons why people resist change? Choose all that apply. A) Feel threatened B) Fear increased responsibility C) Lack of understanding D) See no benefits to the change E) Dislike hospital chief officer

Ans: A, B, C, D Feedback: The most common reasons people resist change are threat to self, lack of understanding, fear of increased responsibility, envisioning a lack of benefits to the change, and being unable to tolerate working in a state of flux. Dislike of the hospital CEO is not a common reason to resist change.

Planned change is a purposeful, systematic effort to alter or bring about change. What occurs next after alternative solutions to a problem are determined and analyzed? A) All of the alternative solutions are implemented. B) A course of action is chosen from among the alternatives. C) The effects of the change are evaluated. D) The change is stabilized and established.

Ans: B Feedback: After determining and analyzing alternative solutions to a problem, select a course of action from the possible alternatives. It is best to avoid initiating too many courses of action and thereby dissipating resources and energy.

When comparing team nursing with functional nursing, what characteristic is found? A) Team nursing is very similar to functional nursing. B) Team nursing focuses on individual client care. C) Functional nursing has a stronger focus on the client. D) Functional nursing is based on total client care.

Ans: B Feedback: In team nursing, a registered nurse and other caregivers provide care to a designated group of clients for a given shift. Team nursing modifies the depersonalized approach of functional nursing and focuses on individual client care.

Which type of skills is not needed for nursing leadership? A) Communication skills B) Technical skills C) Problem-solving skills D) Self-evaluation skills

Ans: B Feedback: The four basic types of skills needed for nursing leadership are communication, problem solving, management, and selfevaluation. Technical skills are important to other nursing roles, but are not leadership skills.

During a staff meeting, the nurse is discussing new quantum leadership. The nurse explains that in this type of leadership change is viewed as which of the following? A) Constant and predictable B) Dynamic and constantly unfolding C) Evolving very slowly D) An entity needing planning

Ans: B Feedback: We are in a difficult transition period between the old and the new age. In the old age, change was viewed as an entity to be planned, carefully managed, and accepted. In the new quantum age, change is conceived as dynamic, ever-present, and continually unfolding.

A nurse manager has directed a registered nurse who is out of school for one year to become a member of the institution's policy and procedure committee. A goal in the nurse manager's delegation is to assist the nurse to what? A) Be involved in the hospital B) Be confident in employment C) Grow in her profession D) Understand the hospital setting

Ans: C Feedback: Delegation of activities to staff members will assist them to grow and become more committed to their organization.

A senior student has been elected president of the Student Nurses Association. Which of the following qualities is essential to being a nursing leader? A) Physical stamina B) Physical attractiveness C) Flexibility D) Independence

Ans: C Feedback: Flexibility is a must for all nurse leaders. The needs of clients, families, and the nursing team can change from minute to minute. Leaders of nursing organizations must also demonstrate the characteristics of a nursing leader.

Which of the following is a characteristic of mentorship? A) It is a paid position to orient new nurses to the workplace. B) It involves membership in a professional organization. C) It is a link to a protégé with common interests. D) It is not encouraged in health care settings

Ans: C Feedback: Mentorship is a relationship in which an experienced individual (the mentor) advises and assists a less experienced individual (protégé). This is an effective way of easing a new nurse into leadership responsibilities. Mentors link with protégés by common interest and provide support, information, and network links. The relationship does not include financial reward. An alternative model is preceptorship. The preceptor (experienced nurse) is selected (and generally paid) to introduce an employee to new responsibilities through education and guidance.

Which of the following statements accurately describes the use of power by change agents? A) They know that power comes from one source—management. B) When introducing change they do not enlist the support of key power players. C) They are often accomplished professional women. D) They do not recognize their own strengths and weaknesses.

Ans: C Feedback: Power,the ability to influence others to achieve a desired effect, has many sources. When introducing change, it is helpful to recognize and enlist the support of key power players who can then encourage others to become involved. Women are accomplished professionals and occupy powerful leadership positions in corporations, health care organizations, and political arenas. Nursing leaders recognize the strengths and limitations of their own power and encourage others to develop and use power constructively.

A nurse is considering the delegation of administering medications to an unskilled assistant. What is the first question the nurse must ask herself before doing so? A) Has the assistant been trained to perform the task? B) Have I evaluated the client's response to this task? C) Is the delegated task permitted by law? D) Is appropriate supervision available?

Ans: C Feedback: The first question the nurse should always consider before delegating a task is "Is the delegated task permitted by law?" In this case, it would not be, and the task (administering medications) would not be delegated.

Which of the following statements accurately describes recommended guidelines for overcoming resistance to change? Select all that apply. A) Explain the proposed changes only to the managers of the people involved. B) Whenever possible, use technical language to describe the changes. C) List the advantages of the proposed change for members of the group. D) Avoid relating the change to the group's existing beliefs and values. E) If possible, introduce change gradually.

Ans: C, E Feedback: To overcome resistance to change, the nurse should explain the proposed change to all affected people in simple, concise language; list the advantages of the proposed change, both for the individual and for members of the group; relate the proposed change to the person's (or group's) existing beliefs and values; if possible, introduce change gradually; provide incentives for commitment to change such as money, status, time off, or a better working environment.

A nurse manager makes all of the decisions for staff activities. What type of leadership is demonstrated by this action? A) Democratic B) Self-governance C) Laissez-faire D) Autocratic

Ans: D Feedback: Autocratic leadership involves the leader assuming complete control over the decisions and activities of the group. An extremely autocratic leader might make all decisions for workers without considering their ideas or feelings.

A nurse working on leadership skills should keep in mind which of the following accurate statements regarding leaders? A) People are born leaders. B) Leadership should be approached quickly. C) Leaders develop leadership skills in undefined situations. D) All nurse leaders began as inexperienced nurses.

Ans: D Feedback: Leadership should be approached like any other new role or skill: slowly and carefully. Nursing students and beginning nurses should be prepared with all of the necessary tools or skills before attempting the new role. Initially, nurses develop leadership skills in well-defined clinical situations. With each experience, growth occurs and leadership is strengthened. All nurse managers, nurse administrators, and nursing leaders also began as inexperienced nurses.

There is a perception in a long-term care facility that the older adult residents are experiencing falls more often than in the past. An audit of incident reports has confirmed this, and the nursing leadership has recognized the need to make changes to reduce the incidence of falls. How should the leaders proceed with this planned change? Place the following steps in the correct order. 1. Implement the change in nursing practice. 2. Choose a new protocol that is likely to reduce falls. 3. Take measures to ensure that nursing practice does not revert. 4. Determine and analyze different solutions to the problem. 5. Develop a plan for implementing the change. A) 1, 2, 3, 4, 5 B) 1, 3, 2, 4, 5 C) 5, 1, 2,, 3, 4 D) 4, 2, 5, 1, 3 E) 3, 1, 4, 5, 2

Ans: D Feedback: The eight-step program of planned change is similar to the nursing process of assessment, diagnosis, planning, implementation, and evaluation. After this process, measures are taken to ensure that the change is stabilized and made permanent.