Exam 3 - L&M

ANS: A The primary nursing model assumes that the primary nurse is accountable for patient care, even while off duty. The primary nurse is responsible for establishing the patient plan of care and therefore for altering it with the input of an associate. The associate is responsible for implementation of the established care plan when the primary nurse is off duty.

A conflict develops between an associate nurse and a primary nurse over the assessment of a patient with pulmonary edema. Based on her assessment of the patient, the associate nurse insists that it is her role to change the care plan because she is the one who has made the assessment. As the nurse manager, you clarify that: a. It is the role of the primary nurse to make alterations based on assessment data and input. b. The associate nurse is accountable and responsible while the primary nurse is off duty and therefore is able to alter the care plan. c. Neither the primary nor the associate should make changes without first consulting you as the manager. d. It really does not matter who alters the nursing care plan as it depends on situation and time to do so.

ANS: C Significant overlap can be seen between primary nursing and total patient care in terms of breadth of assessment and knowledge required to provide holistic care. A primary difference is that nurses in the total care model assume accountability while on shift, whereas primary nurses assume responsibility from time of admission to discharge and 24 hours a day.

A nurse manager questions the true difference between primary nursing and total patient care. After careful consideration of both models, the nurse manager concludes that primary nursing differs significantly from total patient care in: a. Breadth of nursing knowledge and expertise required. b. Intention to provide holistic nursing. c. Degree of task orientation. d. Levels and types of assessment.

When organizations are in dynamic and uncertain environments, their effectiveness depends on being able to adapt quickly to changing customer tastes and preferences, which requires a more _________ design. A. Adaptive B. Mechanistic C. Organic D. Customer-centric

C. Organic

ANS: C Functional team nursing involves licensed and unlicensed personnel who perform specific tasks for a large number of patients. A disadvantage of functional team nursing is the fragmentation of care. The physical and technical aspects of care may be met, but the psychological and spiritual needs may be overlooked. Patients become confused with so many different care providers per shift. These different staff members may be so busy with their assigned tasks that they may not have time to communicate with each other about the patient's progress.

A patient complains to you that she has no idea who "her nurse" is on any given day. "I ask one nurse for my pills and she says, 'That's not my job.' I ask the pill nurse about my lab tests and she says that I should ask another nurse." The nursing care delivery model most likely employed in this situation is: a. Differentiated practice. b. Team nursing. c. Functional nursing. d. Case management.

ANS: D An advantage of functional nursing is that both unskilled assistive personnel and skilled staff are involved in performance of specific tasks, and the repeated performance of tasks enables staff to become very efficient in specific functions. Disadvantages of the model include difficulty in being able to assess the patient's nonphysical needs effectively and the potential for ineffective communication because of the focus on specific tasks.

A patient complains to you that she has no idea who "her nurse" is on any given day. "I ask one nurse for my pills and she says, 'That's not my job.' I ask the pill nurse about my lab tests and she says that I should ask another nurse." This nursing care delivery model employed in this situation might be particularly effective in: a. Promoting communication among diverse team members. b. Facilitating multiple perspectives on the total care of a patient. c. Avoiding patient-provider conflict. d. Developing competence and confidence in unskilled workers.

ANS: A Because of the breadth of nursing knowledge required, baccalaureate education is preferred for primary nurses.

A patient is admitted to a medical unit with pulmonary edema. His primary nurse admits him and then provides a written plan of care. What type of educational preparation best fits the role of primary nurse? a. Baccalaureate b. Associate c. Diploma d. LPN/LVN

During times of crisis or restructuring, it is likely that organizations like Yahoo! Will maintain strong control over decision making by top managers, also known as A. Centralization B. Decentralization C. Matrix D. Departmental

A. Centralization

Marissa Mayer's ban on working remotely (telecommuting) policy could impact the concept of employee _________, or letting others make decisions and exercise discretion in getting things done. A. Empowerment B. Delegation C. Performance D. Structures

A. Empowerment

Which of the following is an advantage of a divisional structure? A. Expertise focused on specific customers, products, and regions B. Economies of scale with efficient use of resources C. Reduced costs because of common resources and efforts across divisions D. Emphasis on the goals of the organization as a whole E. No scope for unhealthy rivalries within the organization

A. Expertise focused on specific customers, products, and regions

Slice-It Inc., a fast food organization operating in many countries, varies its menus in different countries according to local tastes and preferences. It groups together employees and tasks working in the same location. Which of the following structures is Slice-It Inc. using? A. Geographical structure B. Functional structure C. Product structure D. Customer structure E. Process structure

A. Geographical structure

Behind every formal structure typically lies a(n) __________, which is the set of unofficial relationships among an organization's members. A. Informal structure B. Divisional structure C. Functional structure D. Matrix structure E. Template structure

A. Informal structure

Adzen Inc., an advertising firm, has a horizontal structure with simple rules and procedures. It achieves targets by having personal means of coordination. The firm values the existence of informal groups and does not believe in division of labor. Which of the following designs is being used by Adzen Inc.? A. Organic B. Centralized C. Authoritative D. Nonadaptive E. Bureaucratic

A. Organic

Which of the following is true of adaptive organizations? A. They are built on a foundation of trust that people will do the right things on their own initiative. B. They are characterized by vertical structures with a clear-cut division of labor and a hierarchy of authority C. They operate with a distinguished feature of promotion based on competency D. They work best for organizations doing routine tasks in stable environments E. They work with narrow spans of control and formal coordination

A. They are built on a foundation of trust that people will do the right things on their own initiative

To reduce reliance on overtime hours, an organization develops a strategy for floating nurses during staff shortages. To maximize patient safety and reduce costs, the healthcare organization: a. develops a centralized pool of float nurses. b. assigns nurses from less busy units to ones with increased acuity levels. c. floats nurses only between units on which the nurses have been cross-trained. d. assigns float nurses to basic care only.

ANS: A A centralized pool usually includes experienced nurses who maintain a broad range of competencies. Other approaches are less satisfying for nurses, are less efficient, and may be less safe.

A busy neurologic ICU and step-down unit most likely would use which patient-classification system? a. Factor evaluation b. Prototype evaluation c. Hybrid system d. AHRQ system

ANS: A A factor evaluation system is considered more objective than a prototype evaluation system. It gives each task, thought process, and patient care activity a time or rating. Some patient types with a single healthcare focus, such as maternal deliveries or outpatient surgical patients, would be appropriately classified with a prototype system. Patients with more complex care needs and a less predictable disease course, such as those with pneumonia or stroke, are more appropriately evaluated with a factor system.

As the unit manager, you post the staffing plan and compliance reports. This initiative is aimed at: a. maintaining unit morale. b. complying with national requirements. c. demonstrating patient outcomes. d. inviting staff participation in decision making

ANS: A Hospitals are responsible for monitoring the extent to which actual staffing matches the staffing plans, making revisions as necessary. The Joint Commission accreditation reviews staffing plans against any obvious staffing deficiencies and patient care concerns. Posting of the staffing plan is required in some states so that staff may view it. Adequate staffing, as demonstrated through a staffing plan, and compliance reports contribute to staff morale.

The difference between staffing and scheduling is that staffing: a. puts the right person in the right position. b. puts the right person in the right time and place. c. refers to the number of nursing hours per patient per day. d. looks after interpretation of benefits and compensation.

ANS: A Nursing staffing involves planning for hiring and deploying qualified human resources to meet the needs of a group of patients. Scheduling, on the other hand, is a function of implementing the staffing plan by assigning unit personnel to work specific hours and days of the week.

To maintain patient safety, studies suggest that scheduling should avoid: a. rotating shifts. b. weekends. c. 8-hour shifts. d. mandatory overtime.

ANS: A Rotating shifts and overtime past 12 hours (mandatory or not) are being shown to increase nurse error and jeopardize patient safety.

A nurse manager must also consider a number of internal variables that will affect staffing patterns. An internal variable to be considered is: a. organizational staffing policies. b. state licensing standards. c. American Nurses Association. d. consumer expectations.

ANS: A State licensing standards outline what a nurse can do. Internal policies determine what a nurse may do in a particular setting as well as the amount of flexibility that is allowed to manage times of high and low volumes, as well as changes in acuity. Organizational policies can put the nurse manager in a situation where patient safety cannot be maintained or financial obligations met.

In reviewing the job description of a nurse manager, the staff becomes aware that a nurse manager's role is complex. Which of the following duties are required of a nurse manager? (Select all that apply.) a. Ensure unit productivity reports. b. Develop policy and legislation to protect nurses' well-being. c. Plan staffing of UNPs only. d. Prepare a unit budget that reflects unit staffing needs. e. Monitor nurse-sensitive indicators such as falls and incidence of infections

ANS: A, D, E A nurse manager manages financial resources by developing business and staffing plans.

A small rural hospital has been designated as a critical access hospital. It has 40 beds and an average occupancy of 34 beds. To prepare the staffing, the chief nursing officer computes the occupancy as being: a. 90%. b. 85%. c. 75%. d. 60%.

ANS: B A way to assess a unit's activity level is to calculate the percentage of occupancy. Formula: daily patient census (rounded) divided by the number of beds in the unit The occupancy level is calculated as 34/40, or 85%.

A nurse manager uses many sources of data when planning the unit's workload for the year. Which of the following data must be considered in the planning? a. Hours of operation of the unit b. Trends in acuity on the unit c. Maximum work stretch for each employee d. Weekend requirements

ANS: B Acuity levels are determined through classification systems, which determine the nursing resources required.

A nurse staffing plan takes into account: a. specific nurse-to-patient ratios per shift. b. participation of nurses in projecting staffing needs. c. compensation and benefits for each level of staff. d. the occupancy load of a unit.

ANS: B Nurse staffing plans employ nursing judgment and flexibility that is based on acuity, nurse experience, and unit configuration rather than set nurse-to-patient ratios. The American Nurses Association has opted to support the nurse staffing committee as the approach to ensure safe staffing. In 2013, national legislation was introduced that requires all acute care hospitals to establish a committee made up of 55% direct care RNs.

Staff members on your unit raise concern that there is rising acuity on the unit and lack of responsiveness in addressing these needs through appropriate staffing. They point to increased incidences of adverse and sentinel events on the unit. To address this concern, your hospital organization would do best to: a. implement a patient-classification system immediately. b. participate in databases that compare the outcomes and staffing levels versus those of similar institutions. c. provide increased numbers of staff to the unit. d. ignore such concerns because acuity is variable.

ANS: B Staff morale suffers both when acuity models indicate a gap between staffing and acuity and when there is no model but perceived acuity that is not being addressed. A truer approach is to monitor patient outcomes and participate in national databases that measure staffing levels through comparison with like institutions.

To project staffing needs and to avoid understaffing, it is important that nurse managers consider which of the following? a. Maximum productive hours b. Average non-productive hours c. Minimum benefit hours d. Maximum vacation time

ANS: B To avoid understaffing, average non-productive or benefit hours need to be taken into account, so the unit is properly staffed when staff members are off.

A particular classification system assigns revenue according to the functional capacity of patients and the progression of patients during their stay in rehabilitation units. More independent patient activities, such as prompted voiding, require higher staff utilization than dependent activities but do not result in increased staff resources. This is an example of: a. bureaucracy. b. concern related to the validity of classification systems. c. inadequate reliability of classification systems. d. inappropriate subjectivity in making judgments about staffing.

ANS: B Validity of categories and implications for staffing levels are in question in this situation because staffing levels are not reflective of the levels of activity required for patient care.

A factor evaluation system: a. utilizes financial data to determine number of staff-to-patient ratios. b. utilizes DRGs to determine acuity on a unit. c. combines interventions and time required for interventions to determine levels of care required. d. combines financial resources and nursing interventions to determine patient contact hours.

ANS: C A factor evaluation system considers tasks, thought processes, and patient care activities and gives them a time or rating. These are then used to determine the number of patient care hours required.

An important aspect of managing the costs on a unit is to plan accurately for staffing needs. Nurse managers use staffing plans to: a. assign staff on the unit on a daily basis. b. ensure that days off are planned for the staff. c. outline the number of individuals by classification on a per-shift basis. d. predict the numbers and classifications of float staff needed to augment regular staff

ANS: C A nurse manager needs to manage financial resources by developing staffing plans. Staffing plans plan for minimum number of professional nurses required on a unit at a given time or to the amount of minimum staffing in an extended-care facility or prison, based on regulatory guidelines.

Scheduling is a function of implementing the staffing plan by assigning unit personnel to work specific hours and specific days of the week. To retain nursing staff, the nurse manager must incorporate into the schedule plan: a. all weekends off. b. all holidays off. c. a variety of scheduling options. d. rotating shifts.

ANS: C Creating a flexible schedule with a variety of scheduling options that leads to work schedule stability for each employee is one mechanism likely to retain staff, which is within the control of nurse managers.

To prepare staffing schedules, a nurse manager needs to calculate paid non-productive time. When calculating paid non-productive time, the nurse manager considers: a. work time, educational time, and holiday time. b. paid hours minus worked hours. c. vacation time, holiday time, and sick time. d. paid hours minus meeting time.

ANS: C Non-productive hours are hours of benefit time and include vacation, holiday, and personal or sick time.

In a job interview for a staff position, which of the following indicates your knowledge of patient safety? a. "Will I be able to get overtime hours on your unit?" b. "If there is an opportunity to work extra shifts, I would really like that." c. "Is there a strategy in place to reduce the number of overtime hours on the unit?" d. "I see no reason why I wouldn't be able to work overtime."

ANS: C Overtime, whether voluntary or mandatory, to fill staff vacancies is seen as a risk to both patients and nurses because it is more likely to lead to compromised decision making and technical skills because of fatigue.

In evaluating weekend mortality rates, the head nurse on the cardiac unit is surprised to find that they are higher than on weekdays. In exploring the reasons for this apparent anomaly, the head nurse focuses on: a. availability of diagnostic personnel. b. availability of physicians. c. communication with on-call providers. d. acuity level of patients.

ANS: C Studies to date of off-peak hours (weekends and nights) are limited, but those that have been done indicate increased mortality during weekends and nights, when staff work with fewer and often less experienced staff and when there may be strained communication among on-call healthcare providers.

Structures with wider spans of control and fewer levels of management are called _________; those with narrow spans of control and many levels of management are known as _________. A. Tall, short B. Large; small C. Tall, flat D. Short, tall E. Flat, tall

E. Flat, tall

The number of adverse events such as falls and pressure ulcers on the unit is increasing. An ideal staffing plan to address this issue would include which of the following? Increasing the: a. total number of staff on the unit. b. staff and RN hours per patient. c. total number of staff and implementing 12-hour shifts. d. number of RNs and number of RNs with experience on the unit.

ANS: D A number of studies have identified that adverse events such as falls and pressure ulcers can be reduced by increasing the number of RNs on a unit (relative to other personnel) and utilizing experienced RNs. Overtime and 12-hour shifts are linked to greater incidence of errors

The American Nurses Association has advocated for the Registered Nurse Safe Staffing Act. This legislation is based on ANA Safe Staffing Principles and takes what factors into consideration for planning staffing on a nursing unit? a. Patient acuity and complexity b. Education and training of the nurses c. Technology available and use on the unit d. All factors listed are to be considered

ANS: D ANA has opted to support the nurse staffing committee as the approach to ensure safe staffing. For the last decade, the ANA has advocated for a Registered Nurse Safe Staffing Act. The legislation is based upon the ANA Safe Staffing Principles (Box 13-2) and considers the following: RN educational preparation, professional certification, and level of clinical experience The number and capacity of available healthcare personnel Geography of the unit Available technology Intensity, complexity, and stability of patients

Your healthcare organization has a decentralized system for scheduling. As part of this process, after you have developed a draft schedule, you may need to: a. seek budgetary approval. b. balance personal schedules against institutional needs. c. negotiate the schedule with unit staff. d. submit the schedule to a centralized staffing office for review.

ANS: D In a decentralized model, you may be completely responsible for approving all schedule changes and for development of the schedule, or you may need to submit a draft to a centralized office for review and determination of supplemental staff. Balancing personal schedules and negotiation describes staff self-scheduling models.

A nurse manager must consider a number of external variables when preparing the personnel budget and projecting the unit's staffing needs. An external variable to be considered is: a. organizational staffing policies. b. staffing models. c. changes in services that will be offered. d. department of Health licensing standards.

ANS: D Licensing regulations of the state can determine staffing models. Staffing regulations can dictate the number of professional nurses required on a unit at any given time.

In the past year, you have noticed an increase in patient falls on your unit. In reading studies related to staffing and patient outcomes, you realize that you will need to plan for: a. higher patient care hours. b. safer facilities. c. institution of a patient-classification system. d. an increased number of RN positions.

ANS: D Lower fall rates are shown to be related to higher total nursing hours and a higher percentage of nursing hours supplied by RNs.

A strategy to increase RN staff retention at Valley Hospital includes: a. better compensation and benefits. b. clearer position descriptions. c. lay-offs of nursing assistants. d. adequate staffing to meet acuity levels.

ANS: D Over the past decade, a significant amount of research has been done in the United States to evaluate links among nursing staffing, workloads, skills mix, and patient outcomes. An analysis of this research demonstrates that ensuring adequate staffing levels has been shown, among other things, to improve nurse retention and job satisfaction.

Which of the following is not a possible type of divisional structure? A. Groups based on working on the same processes B. All of these are types of divisional structures C. Groups are based on working on the same product D. Groups based on working in the same area E. Groups based on working with similar customers

B. All of these are types of divisional structures

LMZ Inc. functions with systematic order and a hierarchical system of management. It is characterized by formal channels of communication. The employees of the firm are required to strictly abide by the formal rules of the company. LMZ Inc. is a(n) _________ A. Adaptive organization B. Bureaucracy C. Decentralized organization D. Boundaryless organization E. Autocracy

B. Bureaucracy

Which of the following is an advantage of a network structure? A. A network structure is characterized by technology that enables the organization to have control over activities contracted out B. Network structures are lean and streamlined C. Network structures have a relatively large central core that gives them stability D. If one part of the network breaks down or fails to deliver, the other parts of the network will continue working E. A network structure has an efficient vertical management system

B. Network structures are lean and streamlined

Which of the following is used to describe a diagram that shows reporting relationships and the formal arrangement of work positions within an organization? A. Informal chart B. Organization chart C. National culture D. Informal structure E. Organizational culture

B. Organization chart

What do we call boundaryless organizations that use IT and the Internet to engage a shifting network of strategic alliances? A. Matrix structure B. Virtual organizations C. Boundaryless organizations D. Organizational cultures E. IT departments

B. Virtual organizations

The best organizational design is the one that: A. Emphasizes a vertical structure, hierarchy of authority, and promotion based on competency B. Is centralized, with many rules and procedures, a clear-cut division of labor, narrow spans of control, and formal coordination C. Achieves a good match between structure and situational contingencies D. Has narrow spans of control and strcutures of the pyramid form E. Emphasizes formal authority, order, fairness, and efficiency

C. Achieves a good match between structure and situational contingencies

Which type of organization operates with a minimum of bureaucratic features and encourages worker empowerment and teamwork? A. Virtual organizations B. Coercive organizations C. Adaptive organizations D. Mechanistic organizations E. Bureaucratic organizations

C. Adaptive organizations

Which of the following are included in the basics of a formal organizational structure? A. Friendship cliques B. Social relationships C. Communication channels D. Sources of emotional support E. Grapevine structures

C. Communication channels

Which of the following is an advantage of a functional structure? A. Establishment of a sense of common purpose B. Improved coordination across functional departments C. Economies of scale with efficient use of resources D. Clear points of responsibility for product or service delivery E. Expertise focused on specific customers, products, and regions

C. Economies of scale with efficient use of resources

Potential advantages of matrix structures include all of the following except: A. Better cooperation across functions B. Improved strategic management, since top managers are freed from unnecessary problem solving to focus time on strategic issues. C. Less performance accountability through the program, product or project managers D. Imrpoved decision making as problem solving takes place at the team level, where the best information is available E. Increased flexibility in adding, removing, and/or changing operations to meet changing demands.

C. Less performance accountability through the program, product or project managers

ANS: A Case managed care is not revenue generating but rather revenue protecting in that better coordination of care enables efficient achievement of patient outcomes, can result in shorter length of stay, and can prevent readmission.

Case managed care may enhance profit in a for-profit health organization by: a. Minimizing costs in high resource consumption areas. b. Combining licensed and non-licensed care providers in delivering patient care. c. Increasing reimbursement from third-party payers. d. Reducing the amount of technology used to support clinical decision making.

ANS: D Differentiated nursing practice models are models of clinical nursing practice that are defined or differentiated by level of education, expected clinical skills or competencies, job descriptions, pay scales, and participation in decision making.

Complex care of acutely ill patients is required on a surgical unit, which utilizes differentiated nursing practice as its model of care delivery. The concept of differentiated nursing practice is based on: a. Licensure status. b. Experience in the agency. c. Leadership capabilities. d. Education and expertise.

Marissa Mayer's ban on telecommuting was put in place to increase: A. Face time B. Teamwork C. Collaboration D. All of the choices are correct

D. All of the choices are correct

Which of the following is true about a network structure? A. It does everything for itself with full-time employees B. It consists of networks that are composed of full-time employees C. It consists of a relatively small central core that results in an increase in costs D. It employs a minimum staff and contracts out as much work as possible E. It groups jobs and activities that are part of the same processes

D. It employs a minimum staff and contracts out as much work as possible

The two-boss system is susceptible to power struggles and can be frustrating if it creates task confusion and conflicting work priorities. This two-boss system is a characteristic of which type of organization structure? A. Virtual B. Functional C. Customer D. Matrix E. Process

D. Matrix

A(n) _______ convenes for a particular task and disbands once a project is completed. A. Boundaryless team B. Process team C. Cross-functional team D. Project team E. Functional team

D. Project team

The line of authority that vertically links each position with successively higher levels of management is called: A. The span of control B. Organizational culture C. The division of labor D. The chain of command E. Organizational design

D. The chain of command

At ZNC Bank, all operational decisions regarding promotional measures, interest rates, benefits, and customers are made completely by the top management. This implies that ZNC Bank has a(n) ___________ A. Boundaryless structure B. Informal structure C. Organic design D. Decentralized system E. Centralized system

E. Centralized system

ANS: A The case method may involve total patient care provided by a registered nurse, which, in today's costly healthcare economy, is very expensive. In times of nursing shortages, there may not be enough resources or nurses to use this model.

During times of nursing shortages and increased nursing costs in health care, which of the following nursing care delivery models might come under greatest scrutiny? a. Case method b. Team nursing c. Functional nursing d. Nurse case management

The chain of command: A. Horizontally links all positions of an organization's management B. Is the number of subordinates directly reporting to a manager C. Operates with a minimum of bureaucratic features D. Is the process of distributing and entrusting work to other persons E. Links all persons with successively higher levels of authority

E. Links all persons with successively higher levels of authority

Which of the following types of structure combines the functional and divisional structures? A. Process structure B. Customer structure C. Network structure D. Virtual organization E. Matrix structure

E. Matrix structure

The major advantages of a functional structure inside all of the following EXCEPT: A. Economies of scale with efficient use of resources B. Clear career paths within functions C. High-quality technical problem solving D. Task assignments consistent with expertise and training E. Minimized need of communication

E. Minimized need of communication

Which type of structure uses IT to link with networks of outside suppliers and service contractors? A. Process structure B. Functional structure C. Team structure D. Matrix structure E. Network structure

E. Network structure

The process of choosing and implementing structures that best arrange resources to accomplish the organization's mission and objectives is called: A. Using a bureaucracy B. Mechanistic design C. Organization culture D. Boundaryism E. Organizational design

E. Organizational design

Which of the following is a disadvantage of a matrix structure? A. Matrix structures are associated with very poor customer service B. A matrix structure results in reduced performance accountability through the program, product, or project managers C. A matrix structure stresses that top managers must engage in both lower-level problem as well as more strategic issues D. Matrix structures lead to reduced flexibility in adding, removing, or changing operations to meet changing demands E. The requirement of adding the team leaders to a matrix structure can result in higher costs

E. The requirement of adding the tem leaders to a matrix structure can result in higher costs

Which of the following is true regarding the process of delegation? A. A manager is allowed to provide the subordinate with responsibility but not the authority to perform B. When a subordinate takes an assignment, he does not have an obligation to the manager to complete the job as agreed C. In the process of delegation, a manager does not have the power to create accountability D. The manager seldom gives the right to the subordinate to take necessary actions along with the assigned task E. The responsibility given by the manager is an expectation for the subordinate to perform assigned tasks

E. The responsibility given by the manager is an expectation for the subordinate to perform assigned tasks

Which of the following is a disadvantage of informal structures? A. They discourage informal learning as people work and interact together throughout the workday B. They are characterized by too many vertical layers of management C. They are typified by the presence of complex formal communication flows D. They have very centralized systems that restrict employee freedom E. They are characterized by the existence of "in" and "out" groups

E. They are charactarized by the existence of "in" and "out" groups

ANS: A Although repetition of tasks increases confidence and competence, it can also lead to boredom. Rotation of tasks can assist specifically in this model to reduce the boredom that is a potential disadvantage of this model.

For a nurse manager in the functional nursing model, an approach that will assist in maintaining staff satisfaction in this specific model is: a. Rotation of task assignments. b. Frequent opportunities for in-service education. c. Orientation to job responsibilities and performance expectations. d. Team social events in off hours.

ANS: C The partnership care delivery model is a variation of primary nursing in which an RN works with a consistent assistant, who performs basic nursing functions consistent with state delegation rules.

In a small rural nursing home, a director of nursing decides, because of a shortage of nurses, to implement a partnership model to help with basic tasks that comply with state rules regarding delegation. What type of design constitutes a partnership care delivery model? a. RN and LPN/LVN b. RN and RN c. RN and medication assistants d. RN and certified nurses' aides

ANS: D In a functional nursing model, where other team members are focused on performing specific tasks, the nurse manager assumes primary responsibility for patient outcomes.

In an acute care unit, the nurse manager utilizes the functional nursing method as the care delivery model. The nurse manager's main responsibility is the needs of the: a. Department. b. Unit. c. Staff. d. Patient.

ANS: A Team nursing delivers care to a small group of patients, using a mix of licensed and unlicensed personnel. Team nursing uses the strengths of each caregiver.

In comparing team and functional models of care, a nurse manager favors the team model. In particular, she finds that the team model: a. Can be effective in recognizing individual strengths and backgrounds of staff. b. Promotes autonomy and independence for the RN. c. Avoids conflict because of role clarity. d. Is efficient in delivering care to a large group of patients, utilizing a staffing mix.

ANS: C Magnet™ hospitals exemplify hospitals whose focus processes attract and retain nurses who value and promote quality care and excellence in nursing environments.

In considering whether or not to accept a job offer as a nurse manager at a Magnet™ hospital, you look at an environment that you might encounter as a head nurse at the hospital. You determine that you could expect to: a. Find it difficult to recruit new staff. b. See rapid turnover of staff on your unit. c. Find nurses who exemplify interest in quality care. d. Find limited interest in excellence in the nursing environment.

ANS: B Nurses who have less than 2 or 3 years' experience in primary nursing and/or less than 2 or 3 years of nursing experience will likely require more assistance than other nurses, which will put a greater demand on the unit during a time of transition.

In hiring nurses during the transition from team nursing to a primary nursing model, Benner's work would suggest that you give priority to nurses who are at least at which level of competency? a. Advanced beginner b. Competent c. Proficient d. Novice

ANS: B The nurse manager who is considering movement to primary nursing needs to consider how the role of the manager changes, as well as the roles of the staff. The role of decision making at the patient care level is relinquished to the primary nurse, and the role of manager becomes that of facilitator, coach, mentor, role model, and clinical resource.

In transitioning to a primary nursing model, it is important for a nurse manager who enjoys a high level of control over patient care to understand that his or her decision making at the patient care level: a. Is increased. b. Is decreased. c. Is relinquished. d. Remains the same.

ANS: C This model is especially useful in the care of complex patients who need active symptom management provided by an RN, such as the care of the patient in a hospice setting or an intensive care unit. This method would be justifiable delivery in the pediatric intensive care unit, where the status of patients can change rapidly and where complex functions of care involve both patients and families.

The case method of care delivery could be best justified in which of the following scenarios? a. Stable patient population with long-term care and family needs b. Acute care surgical unit with predictable postsurgical outcomes and many technical procedures c. Pediatric intensive care unit that heavily involves families as well as patients d. Home healthcare environment with patients at varying levels of acuity

ANS: D The goals and outcomes established in a critical pathway are designed to support the aims of case management, which are shortened hospital stays and prevention of hospital readmissions.

The nurse case manager is working with a client admitted for end-stage renal disease. The case manager's major goal during this hospitalization is to: a. Implement the care pathway on admission. b. Provide direct nursing care throughout the hospitalization. c. Supervise the nursing staff members who implement the care map. d. Prevent additional hospitalizations resulting from complications of the client's disease.

ANS: B Team nursing, functional nursing, and case management are all considered efficient, cost-effective methods of care delivery because they enable utilization of various types of healthcare providers (rather than baccalaureate nurses in direct care, which is the primary nursing method). Case management is considered particularly cost-effective in patient care settings because it maintains quality care while streamlining costs for high-risk, high-volume, high-cost patient populations and seeks the active involvement of the patient, the family, and diverse healthcare professionals.

The nurse manager at a cardiac rehabilitation unit was asked to select a care delivery model. Which of the following methods would be the most cost-effective? a. Functional method b. Case management method c. Primary care method d. Team method

ANS: A Because the basic education of baccalaureate-prepared RNs emphasizes critical-thinking, clinical reasoning, and leadership concepts, they are likely candidates for such roles. Benner (2001), however, identified five stages of clinical competence for nurses: novice, advanced beginner, competent, proficient, and expert. She suggests that competence is typified by a nurse who has been on the job in the same or similar situation 2 to 3 years. Nurses who are at the novice or advanced beginner stage would be less likely than their more experienced counterparts to implement any type of delivery model effectively and thus, this assignment overlooks the nurse's level of clinical expertise and leadership experience.

The relief charge nurse has assigned a newly licensed baccalaureate-prepared nurse to be one of the team leaders for the 3-11 shift. In making this decision, the charge nurse has overlooked this nurse's: a. Clinical expertise. b. Leadership ability. c. Communication style. d. Conflict-resolution skills.

ANS: C A particular challenge in team nursing is that staff mixes and staff may change daily because of individual schedules and shortages.

To effectively delegate in a team nursing environment, the RN team leader must be familiar with the legal and organizational roles of each group of personnel and must: a. Be able to effectively communicate with patients. b. Build relationships with physicians. c. Be able to adapt to daily changes in staffing. d. Adapt in communicating information to her supervisor.

ANS: D Although some studies suggest there is little difference between functional nursing and primary nursing, primary nursing tends to be more satisfying for RNs, who enjoy a high level of accountability and autonomy in decision making. Patient satisfaction is also high, as patients form close therapeutic relationships with the nurse because of the continuity of the relationship. Functional nursing is criticized for low patient satisfaction and potential staff dissatisfaction related to boredom and an autocratic approach to management.

When comparing functional nursing and primary nursing, a nurse manager, after evaluating particular models of nursing care for potential adoption, determines that patient and nurse satisfaction in primary nursing are: a. Similar to those in functional nursing. b. Not of significance in either model. c. Low by comparison with functional nursing. d. High when compared with functional nursing.

ANS: D Case managers can come from a variety of disciplines but should have advanced preparation with the particular at-risk population being served, be comfortable in an advocate role, and be outcome and patient focused.

When hiring a case manager for a rehabilitation setting, you would most likely consider a: a. Registered nurse with a master's degree. b. Physiotherapist with a background in stroke rehabilitation. c. Social worker with a background in counseling. d. Health professional with advanced background who is client and outcome focused.

ANS: B The functional model of nursing is a method of providing patient care by which each licensed and unlicensed staff member performs specific tasks for a large group of patients.

When interviewing an applicant for a position, the nurse manager describes the unit's care delivery system as one in which each nursing assistant is cross-trained to perform specific tasks, and the RNs do all treatment, medication administration, and discharge teaching. The nurse applicant knows this nursing care delivery strategy to be: a. The case method. b. Functional nursing. c. Primary nursing. d. Nurse case management.

ANS: B This particular model includes a focus on patient care that includes multidisciplinary teams and assistants at the bedside. Services, including laboratories and pharmacies, are decentralized to bring them closer to where care is delivered.

You are considering putting forward a proposal to move the model of care from team nursing to a primary nursing hybrid: patient-focused care model. In considering this proposal, you recognize that significant costs specific to operationalizing this model are related to: a. Implementation of an all-RN staff complement. b. Significant changes in the physical structure of units. c. Orientation of staff to new roles and responsibilities. d. Testing and piloting technology at the bedside.

ANS: C A critical pathway outlines outcomes, clinical standards, and interventions for a patient in each phase of treatment. The goal of critical pathways is effective coordination of care across various staff and levels of care.

You are the nurse manager of a nursing service organization that provides around-the-clock care to clients in their homes. To achieve maximum reimbursement for a client who is recovering from a hip replacement, the nursing staff most likely will follow the nursing care guidelines presented in the: a. Nursing care plan. b. Physician's orders. c. Critical pathway. d. Clinical practice guidelines.

ANS: A, B, E Transforming care at the bedside (TCAB) relies on active involvement of staff in the generation of innovative ideas to improve patient care. Staff are actively engaged in selecting innovation, planning, and evaluation of the innovations. Critical to practice changes, rapid cycle change is a process that encourages testing creative change on a small scale while determining potential impact.

Your organization has made a decision to implement TCAB in your hospital. As a manager, what strategies would you use to implement TCAB? (Select all that apply.) a. Encourage recognition among staff of their knowledge of the patient-care environment. b. With staff, select small changes for consideration. c. Select only projects that have widespread impact. d. Secure external advisors to evaluate innovation. e. Present ideas based on best practices and ask staff for advice on implementation.

Sarah determines, in partnership with her patient, that current medications are not enabling her patient, a married account executive with fibromyalgia, to continue with her employment and family responsibilities. After searching for additional information on fibromyalgia, Sarah finds nonpharmacologic interventions that are supported through credible evidence. Sarah suggests that the patient, her physician, and she meet to discuss the medications and possible options and a plan of care for the patient's discharge. This action exemplifies which of the four historical concepts? a. Authority b. Responsibility c. Communication of conflict d. Autonomy

a. Authority Authority refers to the use of professional status and power to act in the patient's best interests. In this example, Sarah is using her professional status and power to set up a conference in which her patient, the prescribing physician, and she can discuss what is not working for the patient and potential options.

Sandra, an RN on the surgery unit, is assisting with a procedure in the pt exam room. The physician orders a medication to be given through IV. Sandra questions the order, based on her knowledge of the pt's history & of other meds the pt has been given. The physician reiterates the order and Sandra refuses to give it. In this instance, Sandra is demonstrating: a. Autonomy b. Accountability c. Authority d. Best practice

a. Autonomy In this situation, Sandra is exemplifying autonomy, which is the act of making independent decisions in the best interests of the patient, based on her knowledge and experience. This is analogous to the example in the text where the workers on the manufacturing floor have the independence to say "Stop the line" when something is wrong. Key to the concept of autonomy is decision making and the level of independence that is given. Accountability refers to achievement of outcomes, and authority refers to the capacity to make decisions

A Magnet hospital surveys the staff about job satisfaction. This type of environment, in which nurses have authority & autonomy, is linked with: a. Client satisfaction with the healthcare organization b. Organizations with a limited number of nurse managers c. Private, specialty organizations in urban areas d. Sophisticated academic health sciences universities

a. Client satisfaction with the healthcare organization Autonomy & authority in decision making that is consistent with scope of practice are linked both to higher job satisfaction and to higher patient satisfaction with care. Job satisfaction is an important indicator of the quality of patient care

You are hired as a new manager. When the offer of employment is made, you agree to at-will employment. Later, you become very concerned about the policies and practices of your organization and their impact on patient care. You speak with your supervisor several times about your concerns, but no action is taken. In considering your next steps, you: a. Consider your increased vulnerability under the terms of your employment. b. Recognize that your supervisor is more vulnerable than you are because of her more senior position. c. Are more likely as a leader to take action because you are well protected from repercussions by federal and state regulations. d. Contact your union to discuss your concerns and review your options.

a. Consider your increased vulnerability under the terms of your employment Managers of at-will employees have greater latitude in selecting disciplinary measures for specific infractions. State and federal laws do provide a level of protection; however, an at-will employee may be terminated at any time for any reason except discrimination. At-will employees, in essence, work at the will of the employer. Nurses in these positions need to know their rights and accountability

As a new nurse manager who has "inherited" a unit with high nurse turnover & complaints of pt dissatisfaction, your first course of action would be to: a. Determine levels of nurse engagement on the unit. b. Review the personnel files of nurses who have resigned. c. Interview upper management about their vision for the unit. d. Meet with your staff to clarify your vision for the unit.

a. Determine levels of nurse engagement on the unit Multiple studies demonstrate that a healthcare organization that provides a climate in which nurses have authority and autonomy has better patient outcomes, retains nurses at a higher rate, is more cost-effective, and has evidence of greater patient satisfaction than an organization in which such a climate does not exist. Organizational assessment assists in identifying the reasons for high nurse turnover and patient complaints.

Nursing labor-management partnerships: a. Engage nurses at all levels in problem solving for better patient care. b. Require unions and management to negotiate in good faith regarding hours of work and wages. c. Have been shown to have negligible effects on nurse turnover and patient outcomes. d. Have typically resulted in increased polarization of nurses and management, leading to formation of collective bargaining units.

a. Engage nurses at all levels in problem solving for better patient care The development of a nursing labor management partnership is an approach that can be used in most professional nursing environments. This process recognizes nurses as leaders on all levels and provides formal and informal mechanisms for professional nurses to work together to achieve shared goals through collaboration and shared decision making or decentralized decision making. A study of a nursing labor management partnership suggested that nurse satisfaction was higher, turnover was lower, and more time was available for patient care.

Senior executives at Hospital A determine that the hospital will engage in a strategic planning process after changes in healthcare funding and concerns expressed in the community about care that is being delivered at the hospital. The senior executives decide on a participatory process in which staff are widely consulted regarding input about the organization and the external environment and are actively invited to be part of decisions related to the mission statement, goals, and objectives. For true shared governance to be seen as part of this approach: a. It must be evident in the outcomes of the process that staff and senior executives have partnered on the decisions. b. Stakeholders must be assured of the value of their input even though final decisions rest with senior executives. c. Publications must clearly outline how staff input was solicited and obtained. d. Staff must be reassured that significant concerns will be kept in mind even if they have not been addressed in planning documents.

a. It must be evident in the outcomes of the process that staff and senior executives have partnered on the decisions Shared governance demands participation in decision making. When partnership, equity, and ownership are not involved, then shared governance has not occurred, and publication and expressions of appreciation for input will not be seen as representative of shared governance

Martin, the unit manager, receives complaints from community agencies that patients who have been discharged from his unit seem to lack understanding about their disorder and immediate strategies for managing elements of their care. Martin checks the patient teaching sheets and notes that the sheets are initialed by staff. He calls the agencies and indicates that teaching has been done. Potential outcomes of Martin's actions include: (select all that apply) a. Poor morale on the unit b. Disruption in community relationships c. Corruption of patient-staff relationships d. Patient outcomes for quality care are met

a. Poor morale on the unit b. Disruption in community relationships c. Corruption of patient-staff relationships When management accountability for activities is not accepted, then relationships suffer, professional practice is diminished, and self-esteem suffers.

The ED staff decides to use a collective bargaining model for negotiation rather than a traditional trade union model. A traditional trade union model is characterized by: a. Positional conflict b. Management support of labor's initiatives c. A spirit of trust between management and labor d. An ability to resolve complaints

a. Positional conflict Collective bargaining encompasses management support of labor's initiative, a spirit of trust between labor and management, and resolution of problems. It replaces the positional conflict that has been associated with traditional trade unions. Models such as the interest-based problem solving (IBPS) model seek to avoid positional conflicts such as those between labor and management that do not take into account the opposing party in any way

Nurses in an ED, in an inner-city neighborhood characterized by high levels of violence, are concerned with low levels of security presence in their department. Security levels have recently been decreased and the nurses question why this has occurred. An appropriate action would be to: a. Provide nurses with information about rationale for recent changes in security staffing. b. Refer the matter to the head of security and let her deal with it. c. Provide mentors who can help nurses diffuse aggressiveness. d. Accept the security levels as a consequence of funding realities.

a. Provide nurses with information about rationale for recent changes in security staffing Workplace advocacy is an umbrella term encompassing activities within the practice setting. Workplace advocacy includes an array of activities undertaken to address the challenges faced by nurses in their practice settings. The focus of these activities is on career development, employment opportunities, terms and conditions of employment, employment rights and protections, control of practice, labor-management relations, occupational health and safety, and employee assistance. The objective of workplace advocacy is to equip nurses to practice in a rapidly changing environment. One manifestation of workplace advocacy is ensuring that relevant information is shared about decisions that affect practice so that further data gathering and decision making (in this instance about security levels and nurse safety) is informed.

Government and third-party payers announce reduction of compensation for the delivery of patient services. Hospital STV has a flat organizational structure. After the funding announcements, senior officials at the hospital meet and make decisions regarding cost containment of new revenue streams. This action is consistent with: a. The practice of leaving financial decisions with senior officials who understand the total context of funding. b. A tendency to concentrate decision making during economic downturns at the top administrative level. c. A need to make expedient decisions that are likely to be poorly received by staff. d. Ensuring that decisions with regard to cost are made equitably across all departments.

b. A tendency to concentrate decision making during economic downturns at the top administrative level During times of economic downturn, decisions tend to become very centralized to avoid risk. History demonstrates that increasing the breadth of input during these times is more effective than narrowing it.

The ED staff members are concerned that working long hours without rest puts patient safety at risk. One staff member decides that she will risk her job and become a whistleblower. Whistle-blowing is an appropriate recourse when management: a. Disregards due process when disciplining a nurse. b. Delays responding to repeated efforts to provide safe care. c. Hires nurses who are not a part of the union during a strike. d. Refuses to bargain in good faith with the elected bargaining agent.

b. Delays responding to repeated efforts to provide safe care Whistle-blowing is often a result of organizational failure, including failure of the organization to respond to serious danger or wrongdoing created within the environment, which, in this instance, involves conditions that put the patient at risk

Nurses on the dialysis unit notice that changes in labeling of fluids have meant several alarming near miss in terms of wrong administration of fluids. They take this concern to the unit manager. As an advocate of nurse autonomy, the most appropriate response in this situation would be to: a. Ensure that the nurses are aware of the reasons for the change and how the decision was made about the new labels. b. Discuss concerns about the labels and develop potential solutions that take into account changes that can be made at the local level and those that need system intervention. c. Suggest that the staff wait until they have become more familiar with the labels before taking further action. d. Tell the staff that you will notify the pharmacy about these concerns and leave it up to the pharmacy to decide what should be done.

b. Discuss concerns about the labels and develop potential solutions that take into account changes that can be made at the local level and those that need system intervention Participation in decision making regarding one's practice is an appropriate expectation for professional nurses, provides for greater autonomy and authority over practice decisions, contributes to supporting the professional nurse, and is a major component of job satisfaction. Autonomy is encouraged through supportive management and through unit-level support of changes without the need for complex, multilevel approval of changes that can be made locally.

The chief nursing officer utilizes the hospital's workplace advocacy to help the overwhelmed ED staff. Workplace Advocacy is designed to assist nurses by: a. Creating professional practice climates in their institutions b. Equipping them to practice in a rapidly changing environment c. Negotiating employment contracts d. Representing them in labor-management disputes

b. Equipping them to practice in a rapidly changing environment Workplace advocacy encompasses a number of activities that enable nurses to control the practice of nursing and to address challenges that they face in the practice setting. These activities include career development, employment rights, employment opportunities, and the labor-management relationship. The aim of workplace advocacy is to proactively equip nurses to practice within a rapidly changing environment, rather than to negotiate contracts or provide representation in employment disputes

In accomplishing the goal of breakfast for children in elementary school, Leanne is particularly effective in approaching businesses with the needs that the group has determined and articulating the ways that the group has found for businesses to participate. Leanne is exemplifying: a. Leadership b. Followership c. Professionalism d. Knowledge of context

b. Followership Effective followership involves active and loyal involvement in an agenda that has been established. In this role, Leanne is supporting and operationalizing the agenda and strategies that have been established within the group

Martin, the unit manager, receives complaints from community agencies that patients who have been discharged from his unit seem to lack understanding about their disorder and immediate strategies for managing elements of their care. Martin checks the patient teaching sheets and notes that the sheets are initialed by staff. He calls the agencies and indicates that teaching has been done. Martin's follow-up to complaints from the community is: a. Appropriate and indicates that he has assumed accountability for the actions of his staff. b. Indicative that he does not clearly understand the concept of accountability. c. Indicative of strong support for his staff and their autonomy. d. Important in clarifying the difference between his accountability and that of the community in patient care.

b. Indicative that he does not clearly understand the concept of accountability Accountability refers to the achievement of desired outcomes. If community agencies are noticing that limited or no change in patient behavior has occurred despite teaching on the unit, then the staff has not achieved accountability, and he is not holding his unit responsible for the outcomes. Martin is also demonstrating lack of accountability

On Unit 62, the nurses and the unit manager have been involved in shared decision making related to the model of nursing care delivery that the unit will adopt. All individuals have participated and been involved in decision making and implementation of changes. When issues arise during implementation, it is expected that: a. Accountability resides entirely with the unit manager. b. Individual expertise will be utilized to provide solutions, but that responsibility for the change is shared. c. No one really has any accountability or responsibility for the changes. d. This will contribute to widespread skepticism among the staff about the probability of success.

b. Individual expertise will be utilized to provide solutions, but that responsibility for the change is shared High-performing organizations provide for participation by all stakeholders, and each stakeholder shares responsibility and risk. This kind of environment is more satisfying for nurses and is characterized by optimism and trust

In an inner-city area, a group of nurses meet and develop a plan to negotiate with local businesses to support a breakfast program for young elementary schoolchildren. This is an example of: a. Community development b. Collective bargaining c. Collective action d. Shared governance

c. Collective action Collective action refers to activities undertaken by a group of people with common interests and, in this example, by a group of nurses who are interested in the welfare of children in their community

The Emergency Department nurses' decision to organize for the purpose of collective bargaining is being driven by a desire to: a. Establish the staffing pattern that will be used. b. Determine the hours that one is willing to work. c. Create a professional practice environment. d. Protect against arbitrary discipline and termination.

c. Create a professional practice environment Historically, nurses were reluctant to unionize. However, concern with safety of care and quality of care, especially when tension is present in a work environment, makes unionization more desirable. U.S. Supreme Court rulings have provided for RN-only units and protection to practice according to what the profession and licensure status require nurses to do

While making rounds, a night supervisor finds a unit with a low census and too many staff members. The night supervisor is performing as a statutory supervisor when he or she: a. Assigns nurses to care for specific clients b. Develops a protocol for unlicensed personnel c. Recommends transferring a nurse to another service d. Teaches a nurse to use a new piece of equipment

c. Recommends transferring a nurse to another service The night supervisor is acting in accordance with the National Labor Relations Act, which would enable the supervisor to assign nurses to care

In Hospital STV, senior administration is strongly oriented toward fiscal and social conservatism. The nursing department is deeply concerned with the provision of quality to the community, which includes a high number of poor and unemployed. To accomplish the goals of the nursing department, resources need to be allocated that administration is not able to allocate. Nursing and administration: a. Are engaged in shared governance b. Are involved in an irreconcilable conflict of interests c. Represent separate subcultures in the institution d. Represent union and nonunion conflict

c. Represent separate subcultures in the institution Institutions can have several subcultures, which are represented by unique features and distinct ideologies. Subcultures can be congruent and can support healthy relationships in the organization, or they may be separated and characterized by tensions that may be irreconcilable and destructive. From the information given in this scenario, it is not evident that shared governance, union presence, or irreconcilable differences are present

Awareness & use of power have been challenging for nurses in general bc of: a. Incidences of punishment by authority figures b. Too little time in the workplace to collectively develop power strategies c. Lack of cohesiveness and unity among nurses d. A tradition of obedience to authority

d. A tradition of obedience to authority Rituals and traditions such as the Nightingale Pledge have emphasized the need for the "good nurse" to be obedient to authority. This prevailing attitude has made it difficult for nurses, who typically spend considerable time in the workplace and who have opportunity through their work in teams to develop cohesiveness and unity, to develop awareness and use of power

Collective action is effective in: a. Ensuring that needs of nurses are placed ahead of other disciplines b. Defining nursing as a profession c. Advising patients of the needs of nurses d. Amplifying the influence of individuals

d. Amplifying the influence of individuals Individuals may have limited influence in achieving various purposes such as advancement of quality care or of the profession, whereas collective action helps to define and sustain individuals in achieving the desired purposes

In looking at an organizational chart for her institution, Jennifer notes that nursing is led at the senior level by a non-nurse executive. Jennifer expresses concern that this is a reflection of how nursing is viewed within the organization. Jennifer's comments reflect: a. A concern that resource allocation will be made on a business and not a professional model. b. The dissatisfaction that occurs when lack of autonomy is given to nurses. c. Concern with the nonadvancement of nursing practice in the institution. d. An awareness of how organizational culture is reflected in organizational structure.

d. An awareness of how organizational culture is reflected in organizational structure The organizational chart reflects the formal structure of the organization and can reflect predominant beliefs, values, and relationships in the organization. Exclusion at senior executive levels of nurse leaders may reflect institutional beliefs about how resources are allocated, the degree of autonomy given to staff, and involvement of key groups in decision making

The staff members in a local Emergency Department are experiencing stress and burnout as the result of excessive overtime. The staff decides to unionize to negotiate for better working conditions. The increase in unionization within health care may be attributed to the: a. Movement from being "blue-collar workers" to being "knowledge workers" b. Excess profits in health care c. Level of risk that exists for health care d. Number of people who are involved in health care

d. Number of people who are involved in health care As technology replaces unskilled workers, fewer workers are available for trade-union organizing, which has led to declines in union memberships. Nurses represent a large pool of workers who may be available for union organizing in the face of the declining pool available elsewhere.

In a nurse managers' meeting, strategies for ways to help retain staff are discussed. One strategy for assisting nurses in developing collective action skills is: a. Accepting the practice of "going along to get along" b. Attending as many workshops as practical c. Spending as much time as possible in clinical settings d. Taking the opportunity to work with a mentor

d. Taking the opportunity to work with a mentor Mentoring facilitates development and adoption of positive interaction and other skills that facilitate good decision making. Optimism, trust, and decision making are important in collective action and shared decision making and contribute to job satisfaction and lower turnover in staff