Final pt 1

As a nurse manager and the leader of the unit, you are aware of multiple avenues for learning leadership traits. Which avenues would you pursue for learning leadership traits? (Select all that apply.) • Attending professional conferences • Reading books on leadership • Joining professional organizations • Connecting with other leaders in the organization • Experiences from new nurses

Attending professional conferences Reading books on leadership Joining professional organizations Connecting with other leaders in the organization

A Magnet® hospital surveys the staff about job satisfaction. This type of environment, in which nurses have authority and 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.

The chief nursing officer plans a series of staff development workshops for the nurse managers to help them deal with conflicts. The first workshop introduces the four stages of conflict, which are: • frustration, competition, negotiation, and action. • frustration, conceptualization, action, and outcomes. • frustration, cooperation, collaboration, and action outcomes. • frustration, conceptualization, negotiation, and action outcomes.

frustration, conceptualization, action, and outcomes.

The nurse manager decides to use a mediator to help resolve the staff's conflict. A basic strategy for truly addressing this conflict is to: • identify the conflicting facts. • be determined to resolve the conflict. • schedule a meeting time for resolution. • have a clear understanding of the differences between the parties in conflict.

have a clear understanding of the differences between the parties in conflict.

In helping nurse managers to manage their time, the chief nursing officer suggests that they: • maintain a perfectionistic attitude. • set up a complaint list. • have good negotiation skills. • have good information literacy skills.

have good information literacy skills.

The education consultant at St. Joseph Hospital is giving a workshop on cognitive reframing. The consultant explains that cognitive reframing reduces stress by: • aiding individuals in identifying positive stressors. • helping people realize that negative thinking causes emotional distress. • eliminating negative stressors. • replacing positive self-statements with negative irrational beliefs.

helping people realize that negative thinking causes emotional distress.

A staff nurse is taking leadership classes in an advanced degree program as the nurse wants to become a manager. The instructor requires the students to create a journal and make notes of their feelings when they experience conflicts at work over the next few weeks. The assignment calls for the use of reflection. What is the purpose of this assignment? • Log of conflicts which occur • Reflection for self-awareness in conflict situations • Assess the students conflict management skills • Analysis of student lead conflicts

Reflection for self-awareness in conflict situations

The manager of a nursing unit is having difficulty working with a new graduate nurse. The new graduate nurse is excited and full of ideas she wants to try. The manager decides to journal her feelings regarding the new nurse and her feelings. What is the nurse manager practicing in this situation? • Leadership • Reflection • Knowledge • Action

Reflection

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.

Two staff nurses are arguing about whose turn it is to work on the upcoming holiday. In trying to resolve this conflict, the nurse manager understands that interpersonal conflict arises when: • risk taking seems to be unavoidable. • people see events differently. • personal and professional priorities do not match. • the ways in which people should act do not match the ways in which they do act.

people see events differently.

During staff-development programs, staff nurses verbalize their frustration about their workloads and having to delegate so many tasks to others. One of the main reasons that delegation has emerged as an issue is because of: • the amount of paperwork required to complete care. • the complexity of care required by patients. • earlier discharge practices. • the numbers of other disciplines present on a given unit.

• the complexity of care required by patients.

During a fire drill, the nurse manager becomes very assertive and directive in her communications with staff. This type of situational leadership depends on: • supportive behavior by the leader and immature followers. • the development level of the followers and the behavior based on the situation. • well-developed followers combined with a strong leader who acts quickly. • the leader's ability to evaluate personnel and communicate that evaluation.

• the development level of the followers and the behavior based on the situation.

Sally (RN) and Melissa (RN) have shared an ongoing conflict since the first day that Melissa worked on the unit. Sally has confided to another colleague that she doesn't even know why the conflict started or what it was about. This is an example of: • how expectations and objectives need to be made clear in team situations. • the need to encourage open discussion of disagreements in opinions. • the importance of involving all staff in discussions in group settings. • the enduring nature of first impressions.

• the enduring nature of first impressions.

Resistance is most likely when change: • is not well understood. • involves many layers in an organization. • involves nonprofessional workers. • threatens personal security.

• threatens personal security.

A staff nurse approaches the unit manager and indicates to her that because of her father's death in the previous month, she is now finding it very difficult to do her work effectively. This would be considered a(n) ________ stress. • internal source • familial • burnout • external

external

As a new nurse manager who has "inherited" a unit with high nurse turnover and complaints of patient 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.

Time management is very essential for the nurse manager. Which of the following is a good time-management technique? Select all that apply. • Decide what not to do. • Learn to say "No." • Learn to delegate. • Break down your workload into smaller, manageable tasks.

Decide what not to do. Learn to say "No." Learn to delegate. Break down your workload into smaller, manageable tasks.

Nurses entering the work force today are faced with which of the following relationships that could create organizational conflict? (Select all that apply.) • Nurse-physician relationship • Nurse-nurse relationship • Nurse-patient relationship • Nurse-chief nursing officer relationship • Nurse-auxiliary personnel relationships

Nurse-physician relationship Nurse-nurse relationship Nurse-patient relationship Nurse-chief nursing officer relationship Nurse-auxiliary personnel relationships

The Emergency Department 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.

You have hired a new RN to replace a well-respected and experienced nurse in your outpatient department. The new RN recently graduated and is nervous about stepping into a role that was previously filled by someone who was so competent. You recognize anxiety and set up regular, frequent meetings during which you explore how she is dealing with her anxiety, provide feedback, and discuss strategies/ideas that will enhance her performance. What development approach are you using? a. Performance appraisal b. Counseling c. Empowerment d. Coaching

d. Coaching

On your unit, despite efforts to build a strong sense of team, conflict between some of the staff is ongoing. Nonetheless, you want to proceed with developing a systematic and effective performance appraisal system. Which of the following approaches would be most appropriate for you to implement? a. Peer review b. A combination of tools c. Anecdotal notes d. Rating scale

b. A combination of tools

The turnover rate for RNs in the ICU is high. You discuss this situation with existing staff and you find out that because of the rapid turnover, new staff are frequently required to assume full responsibilities soon into the position and before training is completed. In considering approaches that will reduce turnover rates, the staff and you decide to implement: a. an employee recognition program. b. coaching for new staff. c. a new performance appraisal system. d. a committed orientation and training program.

d. a committed orientation and training program.

John notes that the next section is specific to the organizational philosophy and has a 4-point ordinal scale that describes performance from "always meets expectations" to "does not meet expectations." This type of evaluation is most commonly known as: a. a behavior-anchored rating scale. b. management by objectives/learning goals. c. the forced distribution scale. d. a graphic rating scale.

d. a graphic rating scale.

Jill is the charge nurse on a unit in a large hospital. Two of the staff nurses are constantly arguing and blaming each other, and a resolution has not occurred in months. To solve the existing conflict, which is the most creative conflict resolution? • Avoiding • Competing • Compromising • Collaborating

Collaborating

What is the primary role of the followers on the unit, as defined in nursing? • Direct care provider • Implements leader's policy unquestioned • Passive role on unit • Devalued staff member

Direct care provider

In nursing theory, one theorist developed the theory of self-care of patients. In the theory, the nursing action of providing care and educating the patients can be interpreted in the form of followership for the patient. Who was their theorist? • Dorothea Orem • Patricia Benner • Ida Jean Orlando • Robert E. Kelley

Dorothea Orem

At the end of a shift, the charge nurse shares with the new nurse she had done an excellent job with a difficult patient that day. The new nurse was upset by the way the family of the patient had treated her. She shared her feeling with the charge nurse. The charge nurse offered to change the assignment the following day. What is the charge nurse displaying? • Emotional intelligence • Comportment • Compassion • Management of conflict

Emotional intelligence

The charge nurse of a unit is asking the staff what patients they had the day before to make assignments for the day. A new nurse complains about having the same patients every day. The charge nurse considers the new nurse request at an assigned to different patient for today. What type of leadership is the charge nurse displaying? • Informal leadership • Formal leadership • Favoritism • No leadership displayed

Formal leadership

Staff at Valley Hospital are concerned that recent staffing cuts will affect their ability to provide quality patient care, and they express their concerns to senior management. The CEO of Valley Hospital makes the following statement: "We need to contain costs because our funding has been decreased." This is a good example of which of the following conditions that propel a situation toward conflict? • Incompatible goals • Role conflicts • Structural conflict • Competition for resources

Incompatible goals

To engage your staff in awareness of their current practice and how it is affirmed or not by evidence, you plan a short series of learning presentations on evidence and use of heparin and saline to maintain IV patency. You meet with the educator to plan out the goals for each session with the overall purpose of increasing knowledge and awareness of staff in readiness to consider questions related to the IV practice. Staff nurses who gain information on current IV therapy practices are engaging in which phase of Rogers' decision-making process (p.326)? Persuasion • Knowledge • Confirmation • Decision

Knowledge

In nursing theory, one theorist developed the idea of new nurses progressing to experienced nurses and playing an important role in patient care in all stages. The new nurses follow their role and progress through stages to advanced nurse. Who was this theorist? • Dorothea Orem • Patricia Benner • Ida Jean Orlando • Robert E. Kelley

Patricia Benner

As a new nurse manager, you are aware of leadership, management, and followership principles. The concept of followership is rather new as relating to leadership. What is the role of the follower in followership? • Leading the group in task • Submission position in organization • Person who may influence team • Negative meaning for worker

Person who may influence team

The manager of a nursing unit is having difficulty working with a new graduate nurse. The new graduate nurse is excited and full of ideas she wants to try keeps pushing the manager to make changes. The manager decides to provide the new nurse with an opportunity to present an idea to the staff at the next meeting. What is the manager providing the new nurse? • Leadership opportunity • Working to improve patient care • Input to the unit • All of the above

All of the above

Which of the following would not be a characteristic of an effective team nurse leader? • An autocratic perspective • Excellent communication skills • Awareness of everyone's abilities • A genuine interest in team members

An autocratic perspective

The chief nursing officer (CNO) is appointed for the local hospital in a rural area. The nursing committee agreed with the appointment of the new CNO offered the position. What is this type of leadership position considered? • Formal leadership • Informal leadership • Director leadership • Personal leadership

Formal leadership

In trying to achieve Magnet® status, the chief nursing officer establishes a shared governance model to help nurses experience job satisfaction. However, some nurses who have enjoyed working with less autonomy resist this change and begin to criticize and make rude comments about managers who embrace this model, as well as colleagues who support it. The comments are not brought to an issue because those who are making them are well established nurses who are often vocal about their displeasure with the organization. Organizational conflict is arising from which of the following? • Staffing practices • Increased participation in decision making • Allocation of resources • Tolerance of incivility

Tolerance of incivility

A new graduate nurse has accepted a position in an intensive care unit. The nurse is assigned to a preceptor with several years of experience. The new nurse also notices the other staff seek this nurse out for answers to questions and as a resource to the unit. What does the new nurse consider the role of the mentor nurse? • A formal leader • A positional leader • An official leader • An informal leader

An informal leader

After several months of heavy patient loads in the Emergency Department and inability to secure sufficient and experienced staff, the department is especially taxed by a train accident that brings in many seriously injured individuals. You observe that Rama ignores the requests of several of the injured, even when time is available to care for them and is rude to two older adult patients. You are concerned that Rama is evidencing which state? • Hardiness • Depression • Role ambiguity • Depersonalization

Depersonalization

The manager is using self-reflection to gain insight into improving the leadership skills. By using self-awareness what does a leader develop? • New knowledge • Personal growth • Improved self esteem • Management skills

New knowledge

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.

Elizabeth is an example of a(n): • early adopter. • late majority. • laggard. • resister.

• laggard

A group of staff nurses is dissatisfied with the new ideas presented by the newly hired nurse manager. The staff wants to keep their old procedures, and they resist the changes. Conflict arises from: • group decision-making options. • perceptions of incompatibility. • increases in group cohesiveness. • debates, negotiations, and compromises.

perceptions of incompatibility.

The chief nursing officer listens to nurse managers verbalize their feelings of internal stress. One common source of internal stress seems to be: • the death of a loved one. • perfectionism. • getting married. • losing a job.

perfectionism

The nurse manager of a unit has lost many staff members, and the unit is now staffed with a large number of agency and traveling nurses. She knows that the agency and traveling nurses are all contracted to stay on the unit for the next 3 months. One way to improve morale and decrease stress in the unit would be to: • plan a social event and include the agency and traveling nurse staff members. • plan unit-based social events for your remaining permanent staff members. • request hospital-based "floating" nurses to substitute for the temporary staff. • implement team nursing.

plan a social event and include the agency and traveling nurse staff members.

As a nurse manager, the one activity you should not overlook is: • posting the yearly rotation schedule. • reviewing vacation requests. • scheduling staffing for holidays 6 months in advance. • anticipating staff sick days.

reviewing vacation requests.

A hospice nurse has been feeling very stressed at work because of both the physical strain and the emotional drain of working with clients with AIDS. She tries to walk 1 to 2 miles three times a week and to talk regularly with her husband about her work-related feelings. One reasonable stress-management strategy would be to: • start taking yoga lessons. • make an appointment to meet with a psychiatrist. • start jogging 5 to 6 miles every day. • plan to go out for a drink with fellow nurses after work every day.

start taking yoga lessons.

An example of role stress occurs when: • the director of the ICU and the manager of the surgical unit wish to hire the same new employee. • two part-time staff members are hired to work in a unit, but the job expectations for them are not clear, and the charge nurse expresses disappointment in their performance. • the nurse manager for the ICU wants to advocate for more staff and finds it difficult to find data to substantiate his proposal. • line managers believe that supporting staff to use their technical knowledge is to intrude on their authority.

two part-time staff members are hired to work in a unit, but the job expectations for them are not clear, and the charge nurse expresses disappointment in their performance.

An RN colleague, who is a long-standing and collaborative member of your team, is performing a complex dressing with new orders written for the first time for the assigned patient. Which of the following would be the most appropriate communication with her? • "How do you usually do this kind of dressing?" • "The dressing needs to be done today and tomorrow with the supplies on this cart." • "Here is what you need for the dressing, and I will show you what needs to be done." • "I know you know what you are doing. Let me know if you have any problems."

• "Here is what you need for the dressing, and I will show you what needs to be done."

Sarah, RN, is one of your most enthusiastic staff members and has been to a workshop on preparing educational materials for patients. On the basis of this workshop, she would like to develop an information website for patients who are being admitted to the ward. An appropriate response to Sarah's suggestion would be: • "That is a great suggestion, but we have no resources for such an expensive undertaking right now." • "Perhaps you can keep that in mind as we redesign our charting system." • "We have too many seniors as patients, and you know that they don't use technology." • "There is a great group here that meets to look at technology pilots. Let's see if you can join them and discuss your idea further."

• "There is a great group here that meets to look at technology pilots. Let's see if you can join them and discuss your idea further."

Mobilizing others to accomplish extraordinary things requires what leadership behaviors? (Select all that apply.) • Celebrating the successes of others • Demonstrating exceptional technical skills • Imagining possibilities • Establishing a sense of "being in this together"

• Celebrating the successes of others • Imagining possibilities • Establishing a sense of "being in this together"

The staff development educator developed strategies to help nurse managers actively listen. Guidelines for active listening include which of the following? • Speed up your internal processes so that you can process more data. • Realize that the first words of the sender are the most important. • Be prepared to make an effective judgment of the communication sender. • Cultivate a desire to learn about the other person.

• Cultivate a desire to learn about the other person.

The state of being emotionally impelled, demonstrated by a sense of passion and dedication to a project or event, describes: • commitment. • control. • willingness to cooperate. • communication.

• commitment

Complex change situations require that the change leader promote ongoing visioning among staff members. One strategy is to: • consciously evaluate invisible mental models. • allow for individual outcomes. • encourage cooperative activities. • operate between order and disorder.

• consciously evaluate invisible mental models.

The mediator asked each staff member to reflect on his or her communication style. Which of the following best describes communication? Communication: • is a reflection of self-analysis. • is a result of thoughtful consideration. • consists of thoughts, ideas, opinions, emotions, and feelings. • focuses on the sender of the message.

• consists of thoughts, ideas, opinions, emotions, and feelings.

An example of one strategy to improve participation in the change process by staff fitting the behavioral descriptions of laggards, early majority, late majority, and rejecters is to: • encourage teamwork. • transfer to a different unit. • require attendance at staff meetings. • delegate the roles and tasks of change.

• delegate the roles and tasks of change.

The mediator suggested to the unit staff that a group agreement needed to be made so meetings could become productive. For example, the group agreement, "We will speak supportively," prevents: • expression of opposing ideas. • gossip and making negative comments about absent team members. • efforts to ensure that everyone thinks alike. • votes that oppose motions.

• gossip and making negative comments about absent team members.

As the unit manager on the unit that is leading changes on heparin locks, you find that Elizabeth is very valuable in terms of her observations about other units and her knowledge of organizational processes, and now in discussing the new procedure with others. Elizabeth might be considered an: • engager. • innovator. • informal change agent. • informant.

• informal change agent.

Which of the following exemplifies accountability? Karen, the nurse manager on 5E: • consistently submits her budgets on time. • gets along well with her staff and with other managers. • outlines her rationale for reduction of RN coverage on nights to the Nursing Practice Committee after serious patient injury. • actively solicits ideas regarding scheduling from her staff.

• outlines her rationale for reduction of RN coverage on nights to the Nursing Practice Committee after serious patient injury.

The wound care nurse decided to involve those to be affected by change early in the change management process. This can positively result in: • coordination. • resistance. • anticipation. • participation.

• participation

Functions such as "delegates tasks to assistive personnel" that are outlined in a position description for an RN Team Leader would be considered: • active delegation. • passive delegation. • passive accountability. • active responsibility.

• passive delegation.

An example of one strategy used to improve participation in the change process by staff fitting the behavioral description of innovators and early adopters is to: • repeat the benefits of the change. • share change experiences early in the process. • initiate frequent interactions among staff. • provide select information to the staff.

• share change experiences early in the process.

To effectively achieve a change goal/outcome in a change situation, the wound care specialist will: • preserve the status quo. • diminish facilitators and reinforce barriers. • weigh the strength of forces. • strengthen facilitating forces.

• strengthen facilitating forces.

A key advantage that a charge nurse has in terms of delegating is that: • clients receive less attention because too many staff make it difficult to coordinate care. • nurses report less pressure to perform necessary tasks themselves. • administration can predict overtime more accurately. • team skills can be used more effectively.

• team skills can be used more effectively.

"I really wish that my supervisor would realize and acknowledge all the things I do well." In nursing, this has been identified as a problem. Which statement is part of the solution? Focus on: • new staff. • care assignments with which the individual is not familiar. • making corrections. • the strengths of the individual rather than the weaknesses.

• the strengths of the individual rather than the weaknesses.

The mediator noticed that tension was still evident between the nurse manager and staff members. He informed the chief nursing officer that to begin team building, it would be important that everyone: • work together in a respectful, civil manner. • use avoidance techniques when confronted with a conflict. • develop a personal friendship with each other. • socialize frequently outside of work.

• work together in a respectful, civil manner.

Jane has transferred from the ICU to the CCU. She is very set in the way she makes assignments and encourages her new peers to adopt this method without sharing the rationale for why it is better. This is a good example of a process and procedure that creates which type of conflict? • Organizational • Intrapersonal • Interpersonal • Disruptive

Interpersonal

Sarah, a staff nurse on your unit, witnesses another nurse striking a patient. Sarah wants to remain friends with her colleague and worries that confrontation with her colleague or reporting her colleague will destroy their relationship. Sarah is experiencing which type of conflict? • Intrapersonal • Interpersonal • Organizational • Professional

Intrapersonal

Nurses in an Emergency Department, 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.

The nurse manager is implementing a shared governance model to help with communication and decision making. Although staff members like the concept, change is difficult because staff nurses feel: • more empowered. • more communicative. • less stressed. • more powerless and devalued.

more powerless and devalued.

The nurse manager was upset with the staff nurse and said, "You did not understand what I said." Which element in the communication process was she referring to? • Feedback between receiver and sender • A message channel • A receiver who decodes the message • A set of barriers that may occur between sender and receiver

• A set of barriers that may occur between sender and receiver

Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effects." According to Havelock (1973), this comment may originate from failure in which phase of the six phases of planned change (p.326)? • Generating self-renewal • Choosing the solution • Diagnosing the problem • Building a relationship

• Building a relationship

When goals/outcomes are somewhat unclear in early preparation for a complex change, the manager and the change management team develop several acceptable goals/outcomes. This change in management approach is termed: • unfreezing. • nonlinear. • cybernetic. • linear.

• nonlinear.

As a unit manager, you chair the unit meetings. For each meeting, you consider and establish the purpose of the meeting. Second, you prepare an agenda. Arranging the following steps in an order would make the meetings productive and successful. 1. Distribute an agenda. 2. Distribute minutes. 3. Select team members. 4. Start on time. 5. Keep the meeting focused and directed toward accomplishing the set objectives. Select the correct order from the following options: • 1, 2, 4, 5, 3 • 4, 1, 2, 5, 3 • 3, 1, 4, 5, 2 • 3, 4, 2, 1, 5

3, 1, 4, 5, 2

Factors that influence the ease with which conflict is resolved include all except which of the following? • Level of interdependence of the parties • Interprofessional collaboration • Expression of one's own needs and ideas • Avoidance of the issue or concern

Avoidance of the issue or concern

In a job interview for a nursing position, Marley can be assured that which of the following will occur? • Both eustress and distress • Only eustress • Only distress • Neither eustress nor distress

Both eustress and distress

Excellent leaders need to have or develop the skills of empathy and expressiveness when dealing with others in the workplace. This is also known as understanding and managing own feelings and emotions as well as discerning the emotions of others. What is this an example of required by good leaders? • Social awareness • Self-awareness • Emotional intelligence • Intellectual ability

Emotional intelligence

Which one of the following statements has been proven to be true? • Recent research has found that women do not have a unique physiologic response to stress. • Both men and women interpret the same stressor in the same manner without regard to past experiences. • Stress influences the immune system in one complex manner. • Identical stressor does not necessarily have similar effects on each individual.

Identical stressor does not necessarily have similar effects on each individual.

A staff nurse wants to become a charge nurse. What is one of the most effective methods for the staff nurse to incorporate to effectively transition to charge nurse? • Read a book on charge position. • Integrate prior experience to new role. • Do things the way always done. • Change units to be a charge on different unit.

Integrate prior experience to new role.

High levels of work-related stress affect which of the followings? (Select all that apply.) • Job satisfaction • Absenteeism and turnover • Nurses' health • Client welfare

Job satisfaction Absenteeism and turnover Nurses' health Client welfare

A staff nurse is taking leadership classes in an advanced degree program with a goal to become a nurse manager. The nurse is studying the leader-follower relationship. What has the nurse discovered as accurate part of the leader-follower relationship? • Leaders are also followers. • Followers need to linear structures. • Followers are submissive in nature. • Leaders should dictate to the group.

Leaders are also followers.

Kala, a unit manager, in discussing a role the CEO would like her to perform, makes the following statement, "I will sit on the hospital task force on improving morale if you send me to the hospital's leadership training classes next week, so I can further develop my skills and thus be more effective." Which of the following conflict management styles is Kala using? • Collaborating • Avoiding • Negotiating • Accommodating

Negotiating

The definition of follower has historically referred to a person who is subservient and submissive. The new principles of followership offer a different perspective. What is NOT considered an attribute of followership in nursing? • Independent decision making • Critical thinking • Patient advocate • No influence over leaders

No influence over leaders

The core of nursing leadership incorporates integration of unique qualities to include us as individuals. Which is not considered part of leadership integration? • Person • Leader • Nurse • Position

Position

Social stressors are considered a major factor in the stress nurses experience in the healthcare system. Which of the following is not considered to be a social stressor? • High amounts of stress in the nursing home environment • Changes in the current healthcare system such as nursing strategies • Disruptive behavior coming from physicians and other healthcare workers • Stress such as self-criticism and overanalyzing

Stress such as self-criticism and overanalyzing

The core of leadership is awareness. The text by Don Miguel, The Four Agreements, presents a set of agreements to enhance personal growth and awareness. What is not one of the four agreements? • Be impeccable with your word. • Take things personally. • Do not make assumptions. • Always do your best.

Take things personally.

Jeff, an RN in his 30s, has lost a parent, just purchased a new home, and is laid off with 6 months' severance pay. At the same time, Jerry, an RN in his 50s, is financially secure and is asked to take early retirement with a buyout. How will the two men react to the emotional and physical influences and the sequence of stress? • The younger man will feel more stress. • The two men may or may not feel the same amount of stress. • The older man will feel more stress. • Neither man will experience any stress.

The two men may or may not feel the same amount of stress.

The definition of leader refers to a person who has ability to guide people. In nursing, the leader does more. What is NOT a role of a leader in nursing? • Active listening • Open communication • Accountability in decisions • Tight control of decisions

Tight control of decisions

Which of the following is an example of a formal leadership position on a nursing unit? • Staff nurse • Unit secretary • Unit manager • Nursing assistant

Unit manager

Which of the following statements would best define stress? Stress is: • the comfortable gap between how we like our life to be and how it actually is. • everyday life, both the highs and the lows. • a consequence or response to an event or stimulus that can be positive or negative. • identical to distress.

a consequence or response to an event or stimulus that can be positive or negative.

John, a new graduate, reviews the employee evaluation for his new position. The first section requires that he list his own specific objectives to be accomplished. This is an example of: a. the traditional rating scale. b. learning goals, or management by objectives. c. a forced distribution scale. d. a behavior-anchored rating scale.

b. learning goals, or management by objectives.

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.

A nursing instructor is teaching a class on conflict and conflict resolution. She relates to the class that conflict in an organization is important, and that an optimal level of conflict will generate: • creativity, a problem-solving atmosphere, a weak team spirit, and motivation of its workers. • creativity, a staid atmosphere, a weak team spirit, and motivation of its workers. • creativity, a problem-solving atmosphere, a strong team spirit, and motivation for its workers. • a bureaucratic atmosphere, a strong team spirit, and motivation for its workers.

creativity, a problem-solving atmosphere, a strong team spirit, and motivation for its workers.

The final section of a performance appraisal is a rating scale. This scale is very detailed and relates to competency standards specific to surgical clients. The scale is a summary of performance directly observed or documentation reviewed and is specific to client care situations in which the employee has been involved. This type of evaluation is most commonly known as: a. a traditional rating scale. b. management by objectives/learning goals. c. a forced distribution scale. d. a behaviorally anchored rating scale.

d. a behaviorally anchored rating scale.

As part of orientation to your unit, you decide to administer Kolb's Learning Style Inventory (LSI) to new staff. The most likely reason for your decision is that the use of Kolb LSI: a. reduces the cost of orientation. b. determines if there is fit between learner and organizational values. c. develops the strengths of the new staff member. d. enables individualization of learning to the learner's needs.

d. enables individualization of learning to the learner's needs.

(Box19.4) The SBAR system of communications is one of the most used communication systems in health care because: • it deals with all aspects of communications in patient care except communication with the physician. • the nurse is on the same communication level as administration. • it honors a familiar, structured transfer of information among health professionals. • it honors an unstructured transfer of information.

it honors a familiar, structured transfer of information among health professionals.

After using a mediator to resolve a conflict between the nurse manager and two staff nurses, the chief nursing officer decides to: • observe to make sure the conflict has been resolved. • fire both staff nurses. • reassign both staff nurses. • reassign the nurse manager.

observe to make sure the conflict has been resolved.

Mrs. Hill, aged 68, was hospitalized after a stroke. The speech therapist recommended that oral feeding be stopped because of her dysphagia. During visiting hours, Mr. Hill fed his wife some noodles. The nurse noticed this and stopped Mr. Hill from feeding his wife, telling him it was the doctor's decision. An hour later, the nurse returned and found Mr. Hill feeding his wife again. The nurse tried to stop him again. Mr. Hill refused and claimed that the clinical staff was trying to starve his wife; he also threatened to get violent with the nurse. The nurse decided to walk away and documented the event in Mrs. Hill's chart. According to Thomas' four stages of conflict, in which stage could the nurse have been more effective? • Frustration • Conceptualizing • Action • Outcomes

Action

A new graduate nurse is working in an outpatient surgical center with the circulating nurse. The nurse is reviewing the patient's chart and orders. The patient has been in pre-op receiving eye drops in her right eye as preparation for cataract removal surgery. The pre-operative orders indicate a marking has been made above the right eyebrow by the pre-operative nurse for surgery. The pre-operative nurse has been instilling the medicated eye drops to dilate the right eye for surgery. Upon further review of surgical consent, the consent was for surgery on the left eye and the history and physical by the surgeon indicate the patient is supposed to have surgery on her left eye. What action by the new nurse is considered appropriate followership? (SATA) • Alert the pre-operative nurse to the chart discrepancy. • Ask the charge nurse to double check the chart together. • Notify the surgeon to the issue for further orders. • Complete a hospital incident report. • Do nothing; assume the nurse was correct.

Alert the pre-operative nurse to the chart discrepancy. Ask the charge nurse to double check the chart together. Notify the surgeon to the issue for further orders. Complete a hospital incident report.

As a new nurse manager, you are aware of leadership, management, and followership principles. What is the first step to becoming an effective leader? • Being an effective follower • Taking a class on leadership • Taking a class on management • Getting an advanced degree

Being an effective follower

As a leader in nursing, one must seek new insights and establish personal tools to improve their lifelong learning. Which behavior by manager would be a concern for a chief nursing executive? • Journaling for self-reflection • Authentic relationships • Complacent behavior • Improved knowledge of staff

Complacent behavior

Two nurses on a psychiatric unit come from different backgrounds and have graduated from different universities. They are given a set of new orders from the unit manager. Each nurse displays different emotions in response to the orders. Nurse A indicates that the new orders include too many changes; Nurse B disagrees and verbally indicates why. This step in the process is which of the following in Thomas' stages of conflict? • Frustration • Conceptualization • Action • Outcomes

Conceptualization

The chief nursing officer understands that a nurse manager can exhibit stress that is related to trying to keep up with the number of electronic messages that arrive, as well as trying to remain accessible to staff. What is a strategy that would assist the manager to manage the information overload effectively? • Ignore messages unless they are labeled as important. • Determine who is most likely to send useful or important information or requests. • Check e-mail messages once a day. • Encourage face-to-face meetings rather than e-mail.

Determine who is most likely to send useful or important information or requests.

As a nurse manager, you are a leader in health care and on the unit you manage. Looking at the larger picture of health care and patient environment on the unit, what is your primary role when evaluating the care provided on your nursing unit? • Focus on cost outcomes. • Assess staff for contentment on unit. • Ensure quality patient care on unit. • Provide education to the staff of the unit.

Ensure quality patient care on unit.

In developing leadership skills, one should focus on authentic leadership. The theory of authentic leadership focuses on various factors. What is the top priority in development of authentic leadership? • Honest relationships • Organizational task • Accomplishment of goals • Exploring others

Honest relationships

A staff nurse is the person on the unit everyone seeks for input and asks questions. What type of leadership position is the staff nurse displaying? • Position leadership • Informal leadership • Personal leadership • Formal leadership

Informal leadership

A nurse manager attempts to translate the picture or vision of her facility across for the staff nurses. The manager is faced with a staff who is resistant to the vision of the facility. What is the theory the manger needs to incorporate to be effective? • Model the Way • Inspire a Shared Vision • Challenge the Process • The Four Agreements

Inspire a Shared Vision

The nurse manager is working with a group of new nurses. The new nurses ask questions about leadership and the role of a manager in leading nursing. The manager shares she has incorporated her core values and beliefs into her role and responsibilities as a nurse manager. What type of leadership has she described? • Positional leadership • Personal leadership • Formal leadership • Information leadership

Personal leadership

A new nurse leader wants to be the best leader. The nurse takes classes, finds leadership mentor, seeks input from her unit, and employs other strategies for leadership development. What is another strategy for the leader to develop and improve leadership skills? • Proactive learning • Ignoring feedback • Being in charge • Authoritative position

Proactive learning

The nurse manager is aware that conflict is occurring on her unit; however, she is focused on preparing for a state health department visit, so she ignores the problem. What factor can increase stress and escalate conflict? • The use of avoidance • An enhanced nursing work force • Accepting that some conflict is normal • Managing the effects of fatigue and error

The use of avoidance

As a manager, you are interested in developing behavioral questions for an interview. Knowing that there is team conflict at times on your unit, which of the following questions would satisfy your interest in behavioral questions? a. "Tell me about a time you were involved in a conflict related to a project. What was your role in the conflict? In the resolution of the conflict?" b. "If you were to employ one strategy for managing conflict, what would it be?" c. "What is your preferred style of conflict resolution?" d. "How effective are you in working in a group? In dealing with conflict?"

a. "Tell me about a time you were involved in a conflict related to a project. What was your role in the conflict? In the resolution of the conflict?"

Sandra, an RN on the surgery unit, is assisting with a procedure in the patient examination room. The physician orders a medication to be given through IV. Sandra questions the order, based on her knowledge of the patient's history and of other medications that the patient 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.

A survey of staff satisfaction is conducted. The survey indicates that staff members are satisfied, are loyal to the organization, and feel that they have reasonable control in their individual responsibilities. The findings best exemplify: a. clarity in roles and valuing of contributions. b. satisfaction but not empowerment. c. effective coaching of new staff. d. role attachment

a. clarity in roles and valuing of contributions

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.

The biggest challenge in the recruitment of staff is: a. finding well-qualified candidates who can function well within your particular work culture. b. recruiting individuals with the appropriate qualifications and experience. c. screening out candidates who are unable to function well within a team. d. determining if candidates have had previous negative experiences in a work environment

a. finding well-qualified candidates who can function well within your particular work culture.

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.

During the performance appraisal session, the manager should: (Select all that apply.) a. maintain a relaxed and professional manner. b. inquire about the employee's personal life and how it is affecting performance. c. allow the employee to express opinions orally and in writing. d. plan to give specific examples only for poor performance.

a. maintain a relaxed and professional manner. c. allow the employee to express opinions orally and in writing.

The validity of comments and ratings related to performance is enhanced by: a. maintenance of anecdotal notes over the entire evaluation period. b. quantity of information gathered for appraisal purposes. c. agreement of the employee with the ratings and comments. d. whether or not other individuals have contributed to the observations.

a. maintenance of anecdotal notes over the entire evaluation period.

The nurse manager schedules evaluations of staff members using a newly developed performance appraisal tool. The development of a performance appraisal tool should include: a. organizational mission, philosophy, and position requirements. b. a generalized overview of the duties of a position. c. a skills checklist and accreditation requirements. d. an ordinal scale that ranks all employees.

a. organizational mission, philosophy, and position requirements.

An outpatient clinic advertised for RN positions. Before authorizing an open position, the nurse manager should: a. review the position description and performance expectations for the opening. b. place an ad in the local newspaper and on the telephone job line. c. review all current applications on file. d. look for employees within the system who might best fill the position.

a. review the position description and performance expectations for the opening.

You have hired Chelsea as a new staff member on your unit. Although she is an experienced ICU nurse, this is her first educator role. A month into her new position, she confides that she feels really incompetent in her new position and bursts into tears. Your response is based on application of your understanding of: a. role acquisition. b. role conflict. c. role complexity. d. performance appraisal.

a. role acquisition

As a nurse manager, you observe a staff nurse who over the past few weeks has become withdrawn and has had several absences due to minor ailments. Your best action would be to: • ask the nurse if she is okay during report. • refer the nurse to the employee assistance program. • ask the nurse to meet with you for a few minutes before she leaves for the day. • write a note to the nurse advising her that her work attendance must improve.

ask the nurse to meet with you for a few minutes before she leaves for the day

Lee, the charge nurse in ER, has attempted to meet Jillian, one of her staff RNs, for several days to discuss concerns about Jillian's relationships with her team members. Lee hopes to offer Jillian coaching so that Jillian's relationships can be more satisfying for Jillian and her team members. Each time Lee and Jillian set a time to meet, Jillian calls in sick. In this situation, Lee and Jillian are demonstrating: • similar conflict management strategies. • escalation of conflict. • avoidance and compromise strategies. • competing and compromise strategies.

avoidance and compromise strategies.

Which of the following strategies might be effective in empowering staff? a. Communication book in which new information on policies and processes is communicated and mistakes are highlighted. b. Monthly staff meetings during which a portion of the agenda is devoted to sharing ideas and presentations on best practices for implementation on the unit. c. Once-yearly summative evaluations based on what the manager best likes about the individual. d. Focus on discussion of errors in care with direction as to how errors are to be prevented in the future.

b. Monthly staff meetings during which a portion of the agenda is devoted to sharing ideas and presentations on best practices for implementation on the unit.

Sue, a nurse manager, discusses her concerns about the hospital's employee appraisal system with her work group, noting that it includes only one rating scale and that it means nothing unless the manager has effective relationship skills. Sue's concerns reflect which best practices associated with performance appraisal? a. Rating scales are too generalized to be considered valid or reliable. b. The effectiveness of appraisal is enhanced by a combination of methods and effective communication skills. c. BARS is considered superior to simple rating scales in terms of performance appraisal. d. Rating scales need to be designed by users to be well accepted.

b. The effectiveness of appraisal is enhanced by a combination of methods and effective communication skills.

ohn's performance was satisfactory during the first month, but after that time, he was found to be very inconsistent in the provision of nursing care. One month before the end of the rating period, he cared for a very wealthy and influential client, who is best friends with the clinical manager. This client donated new furniture for the staff lounge in John's name to show appreciation for his care. John's subsequent performance appraisal resulted in outstanding ratings in all areas. This is an example of: a. a performance rating based on justifiable evidence. b. a bias related to recent events. c. the impact of personality on the appraisal of performance. d. the effective use of a behaviorally anchored rating scale.

b. a bias related to recent events.

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.

Anecdotal notes: a. should be completed only when there are performance concerns. b. can be used to support and justify fairness in termination discussions. c. are unnecessary if the evaluation instrument is thorough. d. need to be completed at the end of a performance period.

b. can be used to support and justify fairness in termination discussions.

The Emergency Department 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.

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 consider 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 consider changes that can be made at the local level and those that need system intervention.

The chief nursing officer utilizes the hospital's workplace advocacy to help the overwhelmed Emergency Department 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.

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.

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.

Joanne, a new nurse manager, writes certain assumptions regarding the organization's objectives into her budget. Her supervisor tells her that the objectives implied in her assumptions are not entirely consistent with the organization, and that she needs to clarify these objectives with her supervisor. Joanne apologizes and says she had more latitude with the budget where she previously worked. This is an example of: a. role complexity. b. role ambiguity. c. role conflict. d. time-dependent roles.

b. role ambiguity

The chief nursing officer establishes a shared governance model to help empower the nursing staff, thus empowering the organization. Common characteristics of empowered organizations are: a. shared values, high salaries, and a human focus. b. shared values, flexibility, and a human-capital focus. c. commitment to communication, high salaries, and flexibility for evaluations. d. creation of community and of effective stress management in the midst of divergent goals.

b. shared values, flexibility, and a human-capital focus.

During a performance appraisal, Joanne, the nurse manager, indicates that Alysha has difficulty mentoring students on the unit. Alysha responds that this is not her responsibility. In responding to Alysha, Joanne needs to consider: a. Alysha's level of confidence. b. whether mentoring is included in the position description. c. whether mentoring is an essential component of the position description. d. whether mentoring can be accurately observed and measured.

b. whether mentoring is included in the position description.

Mr. T. Jones and Mr. R. Smith are both going to become residents in Sunny Haven Lodge. Mr. Jones views it as an opportunity to socialize and meet new friends. Mr. Smith views this as abandonment by his family and is worried that the care will be inadequate. Each senior perceives the situation differently. This is a good example of stress that is: • both a positive stressor and a negative stressor. • occurring only because of age. • positive in both cases. • harmful in both cases.

both a positive stressor and a negative stressor.

The charge nurse and a staff nurse are having a conflict over how to use and apply a new procedure for dressings in the medical/surgical area. The staff nurse wishes to use the new procedure based on newly released nursing research. The charge nurse wishes to use a protocol that has been used in the department for a number of years. The head nurse later makes comments to other staff on her unit about the credibility of the staff nurse. This behavior is associated with: • lateral violence. • horizontal violence. • confrontation. • bullying.

bullying

Which of the following might best conclude an interview? a. "Thank you for your interest. Someone will be in touch with you soon." b. "Before you go, we will make sure that we have your contact information. Thank you for coming." c. "I will be in contact with all candidates by telephone by next Friday. It has been a pleasure to meet you." d. "We have several excellent candidates so I am not sure about the outcome of the interview, but I will let you know. Thank you for coming."

c. "I will be in contact with all candidates by telephone by next Friday. It has been a pleasure to meet you."

In determining the fit of a candidate with the culture on your unit, which of the following interview questions might be asked? a. "Could you review your résumé for us, highlighting your certifications and experience?" b. "If we were to ask your references, what would they list as your strengths? Weaknesses?" c. "We have a number of older adult patients on this unit. If you noticed another staff member addressing one of these patients impatiently, how would you respond?" d. "Tell us about your work and academic experiences and qualifications."

c. "We have a number of older adult patients on this unit. If you noticed another staff member addressing one of these patients impatiently, how would you respond?"

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.

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.

From the information presented in this chapter, which of the following statements best defines an accomplished team? Effective teams: • can create a form of synergism in which the outcome is greater than the sum of the individual performances. • do not necessarily need goals, objectives, vision, and a clearly stated purpose. • do not always have effective communication patterns. • may or may not have a clear plan that is followed and revisited and has an ongoing evaluation scheme.

can create a form of synergism in which the outcome is greater than the sum of the individual performances.

The staff development educator presents a series of programs on stress management to the nurse managers. Research has indicated that an individual's ability to deal with stress is moderated by psychological hardiness. Psychological hardiness (resilience) is a composite of: • commitment, control, and challenge. • commitment, powerlessness, and passivity. • commitment, control, and passivity. • decreased isolation, challenge, and passivity.

commitment, control, and challenge.

A nurse manager in the ICU works with his staff to develop an appraisal instrument that includes quantitative data and respects standards for an RN working on that unit. This type of appraisal is a: a. rating scale. b. collaboratively based appraisal system. c. narrative instrument. d. behaviorally anchored rating scale.

d) behaviorally anchored rating scale

Awareness and use of power have been challenging for nurses in general because 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.

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.

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 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.

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.

Sarah is a nurse manager in a surgical unit. She is concerned about a conflict between Lucy (a staff nurse) and one of the maintenance personnel. Sarah explains to Lucy that unsatisfactory resolution of the conflict is typically destructive and will result in: • decreased frustration between the maintenance worker and her. • a good relationship with the maintenance department. • eventual resolution of the problem without further intervention. • decreased productivity on her part.

decreased productivity on her part.

Mrs. Hill, aged 68, was hospitalized after a stroke. The speech therapist recommended that oral feeding be stopped because of her dysphagia. During visiting hours, Mr. Hill fed his wife some noodles. The nurse noticed this and stopped Mr. Hill from feeding his wife, telling him it was the doctor's decision. An hour later, the nurse returned and found Mr. Hill feeding his wife again. The nurse tried to stop him again. Mr. Hill refused and claimed that the clinical staff was trying to starve his wife; he also threatened to get violent with the nurse. The nurse decided to walk away and documented the event in Mrs. Hill's chart. The outcome as depicted by Thomas' conflict stages can be considered to be: • compromising. • confronting. • constructive. • destructive.

destructive

A nurse manager has decided that she must institute some personal time-management steps to survive work and home life. Her first step should be to: • determine what takes up so much of her time and energy. • organize her personal and work spaces. • purchase a handheld personal digital assistant to help remind her of important meetings. • determine her personal and professional goals.

determine her personal and professional goals.

"Stress-buffering" behaviors can be elicited to reduce stress. All of the following behavioral coping responses can be used by nurse managers to reduce and manage stress except: • distancing oneself from work. • using cognitive reframing to change irrational thoughts. • refusing a request to sit on a committee to evaluate scheduling software. • exercising regularly.

distancing oneself from work.

Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effects." You follow up with Elizabeth and discover that she is really quite angry about the information sessions because she feels that you are implying that "what she has been doing all these years means that she is incompetent and doesn't care about her patients." Which of the following would be the most effective response to Elizabeth? • "I understand how you feel, but you are going to have to change." • "It is unfortunate that you feel this way. Others seem quite excited about the new information." • "It is difficult sometimes to change what we know very well. Sometimes it can be frightening." • "Perhaps I can arrange some more information sessions for you, so you can see just how important this change is to patient safety."

• "It is difficult sometimes to change what we know very well. Sometimes it can be frightening."

In delegating to a UNP in a home health setting, which of the following represents the most appropriate delegation communication? • "You will be taking care of Mrs. S., who needs assistance with her bath." • "You will need to help Mrs. S. get into and out of her shower. Ensure that you check the condition of her feet, and let me know if you have any concerns when you check in." • "I am not sure that you know how to do this, but I am giving you Mrs. S. She is quite obese and needs skin care." • "Mrs. S. needs help to get into and out of her bathtub. Her bath will need to be completed by 10:00. When you are helping her to dry, please check between her toes and toenails, and call me by 10:30 if you notice nail discoloration or redness."

• "Mrs. S. needs help to get into and out of her bathtub. Her bath will need to be completed by 10:00. When you are helping her to dry, please check between her toes and toenails, and call me by 10:30 if you notice nail discoloration or redness."

As the nurse manager on a rehab unit, you are asked to come to the tub room immediately because two nursing assistants are having a loud disagreement in front of a patient. You ask the nursing assistants to meet you outside and after ensuring that a third nursing assistant is able to care for the patient, you speak with the two nursing assistants. Which of the following would you ask first? • "How long have you two been working together?" • "Have you experienced disagreements like this before?" • "How do you think this patient's perception of her care has been changed?" • "What happened to bring on this disagreement today?"

• "What happened to bring on this disagreement today?"

Which of the following are examples of application of the Leadership Rounding Tool? (Select all that apply.) • "What is working well for you during bedside reporting?" • "What has not worked for you today?" • "Is there someone on your team who deserves special recognition for her efforts in the implementation?" • "Did you have a good vacation?"

• "What is working well for you during bedside reporting?" • "What has not worked for you today?" • "Is there someone on your team who deserves special recognition for her efforts in the implementation?" • "Did you have a good vacation?"

Which of the following indicates safe delegation? • The nurse supervisor for a large urban acute care department asks the unit manager to accept two new acutely ill patients. The unit is short two staff, and the replacement is inexperienced. • A unit manager agrees to release a staff from her unit to Unit B. The staff member she agrees to release is experienced on Unit B and is agreeable to the change. The unit manager's unit is fully staffed and patients are stable. • The nurse supervisor asks the charge nurse for Unit A not to replace an ill staff member because Unit A was originally overstaffed anyway. Patient acuity levels are very high on Unit A and two staff are orientating. • The nurse supervisor asks the charge nurse on Unit B to cover Unit F, which is two floors up, because the charge nurse for Unit F is ill. The charge nurse for Unit B is an experienced manager but has no experience with the nursing care required on Unit F.

• A unit manager agrees to release a staff from her unit to Unit B. The staff member she agrees to release is experienced on Unit B and is agreeable to the change. The unit manager's unit is fully staffed and patients are stable.

Sally is an experienced nurse on the unit and is very experienced with ICP monitoring. She is assigned to David, a patient who has been admitted with a severe head injury. In communicating with Sally, what is an appropriate action by the charge nurse? • Provide a detailed explanation of what she needs to do with ICP monitoring. • Tell her when she needs to provide an update about David's status. • Ask her to tell you what she knows about ICP monitoring and share expectations about reporting. • Advise her that you are available if she needs you.

• Advise her that you are available if she needs you.

The charge nurse is making patient assignments for the next shift on the unit. There is one critical patient on the unit, who is going to require more care than the other patients. Before delegating this patient in an assignment, what is the appropriate action by the charge nurse? • Delegate the admission assessment to the LPN. • Review the employee's performance assessment for the most recent period. • Assess the amount of guidance and support needed for the nursing care of the patient. • Create a task analysis of critical behaviors for the individual.

• Assess the amount of guidance and support needed for the nursing care of the patient.

The day shift nurse asks an LPN/LVN to complete a task for a patient. The day shift nurse is engaging in what function? • Delegating • Assigning • Sharing • Authorizing

• Assigning

The unit manager was addressing nursing students in the lounge area and was discussing team leadership and team effectiveness. She stated, "One can agree or disagree with another team member's perspective even when one doesn't necessarily see that perspective as being the correct one." In being creative, what did she mean? • Championing one's own opinion • Being compassionate • Being flexible • Committing to resolution

• Being flexible

To engage your staff in awareness of their current practice and how it is affirmed or not by evidence, you plan a short series of learning presentations on evidence and use of heparin and saline to maintain IV patency. You meet with the educator to plan out the goals for each session with the overall purpose of increasing knowledge and awareness of staff in readiness to consider questions related to the IV practice. This learning approach is an example of which change management approach? • Linear • Nonlinear • Second-order • Unplanned

• Linear

In the cardiac intensive care unit, there has been simmering discontent about the new nurse manager, who avoids any discussion about her scheduling and practice decisions. The staff have begun to sort into "different camps" depending on how they feel about the manager or the decisions. Which of the following statements MOST accurately describes this situation? • The tension that has been generated will result in creative solutions. • Staff will become a cohesive group that takes a stand against the manager. • The conflict will result in increased dialogue about practice and scheduling options. • Patient care may suffer because attention and energy is being diverted toward the unit relationships.

• Patient care may suffer because attention and energy is being diverted toward the unit relationships.

As a new manager, you are shocked to learn that your unit is still using heparin in heparin locks. You are aware of evidence related to this practice and want to change this practice as quickly as possible on your unit. You are in which stage of Lewin's stages of change? • Unfreezing • Experiencing the change • Moving • Refreezing

• Unfreezing

As a nurse manager, you notice that one of your new nurses has provided exceptional care for a patient with especially complex needs. What would be the MOST effective way of recognizing the nurse's performance? • At the next performance review, note specifically what the nurse did to make the patient comfortable. • To avoid embarrassing the nurse in front of others, find a way to compliment the nurse in private. • When the nurse comes out of the room, tell the nurse specifically what you appreciated about the care that was provided. • Encourage the patient to note the care on the patient feedback form so that the institution can recognize the nurse's efforts.

• When the nurse comes out of the room, tell the nurse specifically what you appreciated about the care that was provided.

The nurse on the 7-7 shift is assigning a specific component of care to an unlicensed nursing personnel (UNP) employee. The night nurse would remain: • accountable. • responsible. • authoritative and liable. • responsible and task-oriented.

• accountable.

County Hospital has position descriptions for all staff, including RN Team Leaders. Sarah, a team leader on the rehab unit, assesses the needs of the patients in her area, assesses the skills and backgrounds of each of the individuals on her team, and then assigns and delegates the appropriate care provider to each patient and task. Sarah's activity in the example described is termed: • passive delegation. • passive accountability. • active delegation. • active responsibility.

• active delegation.

By following a shared leadership model, the nurse manager believes that staff members will learn to function synergistically. Some teams function synergistically because members: • do not volunteer unwanted information. • actively listen to each other. • listen to the person who believes he or she is an expert. • do not speak unless they are absolutely sure they are correct in their views.

• actively listen to each other.

The clinical coordinator expects the position description of the new wound care specialist to change nurses' responsibilities in caring for clients with skin integrity problems. The best approach to address this need for change, yet to have the best outcomes for clients, staff nurses, and the organization, is to: • select one of the change models. • use Lewin's model and principles of change. • apply both planned and complexity theory approaches. • form a task force of nursing staff and wound care specialists.

• apply both planned and complexity theory approaches.

A nurse manager is experiencing conflicts between herself and staff members. She had tried to develop a team by using a shared leadership model to empower the staff. Staff members are functioning: • as a team. • independently. • interdependently. • as a group.

• as a group

You ask Evelyn, a new home health UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. Before assigning Evelyn to Mrs. N.'s care, the most appropriate action of the care coordinator would have been to: • determine Evelyn's educational background and preparation for this role. • ask Evelyn if she has worked with inhalers before and to describe what she knows about them. • advise that if Evelyn has any questions about what to do with the inhaler, she should come to the coordinator. • advise Evelyn that working the inhaler is not really complicated and that she should ask the patient how to check medication levels in the inhaler.

• ask Evelyn if she has worked with inhalers before and to describe what she knows about them.

County Hospital has position descriptions for all staff, including RN Team Leaders. Sarah, a team leader on the rehab unit, assesses the needs of the patients in her area, assesses the skills and backgrounds of each of the individuals on her team, and then assigns and delegates the appropriate care provider to each patient and task. Sarah provides Colleen, her RN colleague with details regarding the patients to whom Colleen has been assigned on the day shift. This is an example of: • accountability. • responsibility. • assignment. • delegation.

• assignment

You ask Evelyn, a new home health UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. Determination of Evelyn's educational preparation and certification is related to the concept of: • accountability. • authority. • role performance. • assignment.

• authority.

Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effects." You follow up with Elizabeth and discover that she is really quite angry about the information sessions because she feels that you are implying that "what she has been doing all these years means that she is incompetent and doesn't care about her patients." Your response to her indicates that: • Elizabeth will never adopt the change. • Elizabeth is insecure in her practice. • Elizabeth requires more information about the practice. • change involves emotions.

• change involves emotions.

The nurse manager used a mediator to help resolve conflicts on the unit. During the mediation process, the nurse manager saw signs of potential team building. One key concept of an effective team is: • conflict. • task clarity. • commitment. • a designated leader.

• commitment

The night nurse understands that certain factors need to be considered before delegating tasks to others. These factors include the: • complexity of the task and the age of the delegatee. • potential for benefit and the complexity of the task. • potential for benefit and the number of staff. • complexity of the task and the potential for harm.

• complexity of the task and the potential for harm.

As the unit manager, you spend a day performing direct patient care and work with a new system that is designed to capture patient documentation at the bedside. During discussions with staff while giving care, you discover that the number of screens that need to be opened during documentation makes charting more complex and time consuming than traditional manual charting approaches. On the basis of this feedback, you: • assume that the system is doing what it needs to do. • provide reassurance to staff that the unit has achieved its goals in implementation of the system. • ask some of the staff if they have had similar experiences with the system. • consult chart audit data and end user consultation reports to determine if errors and problems are occurring.

• consult chart audit data and end user consultation reports to determine if errors and problems are occurring.

The home health agency hired an expert in financial management to evaluate and propose a plan for reversing growing expenses and decreasing revenues. The expert is well respected, both personally and professionally, by members living in this small community. To be effective, staff will need to perceive this change agent as: • trusted, quiet. • flexible, informal. • credible, enthusiastic • communicative, personable.

• credible, enthusiastic

You anticipate that your region will soon move toward an e-health record (EHR) system. You begin to discuss this with your staff and are disappointed that you receive little positive response from the staff about this possibility. One staff member, in particular, seems to sum it up by saying "e-health? Won't happen in my working life! There are too many problems with it, like privacy issues." This response is most likely motivated by: • lack of urgency regarding the need to change. • lack of evidence to support importance of technology. • deficits in education and experience. • lack of organizational support for change.

• deficits in education and experience.

The nurse manager frequently interacts with staff and other hospice facility employees. Communication is purposeful because the manager assesses current issues, such as specific satisfactions and dissatisfactions with the newly implemented computerized documentation system. Informally, the manager gathers available staff members to address similar learning needs. Many times, staff members are found coaching other staff about improving use of the new system. According to Senge (1990), the activities demonstrated in this example are: • dialogue, team learning. • resilience, personal mastery. • shared vision, systems thinking. • mental models, teachable moments.

• dialogue, team learning

Team Member A and Team Member B engage in heated disagreements on a frequent basis in team meetings. Their behavior is characterized by insistence on their points of view and refusal to back down or to negotiate alternative solutions once their ideas have been expressed. This behavior is characteristic of: • autocratic leadership. • constructive conflict. • dualism. • creativity.

• dualism

You ask Evelyn, a new home health UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. This incident is an example of: • incompetence of the UNP. • failure to follow-through. • skills but no motivation. • lack of accountability.

• failure to follow-through.

The chief nursing officer decided that the nurse managers need a series of staff-development programs on team building through communication and partnerships. She understood that the nurse managers needed to build confidence in ways of handling various situations. The greatest deterrent to confidence is: • lack of clarity in the mission. • lack of control of the environment. • fear that one can't handle the consequences. • fear that the boss will not like one's work.

• fear that one can't handle the consequences.

. A mediator suggested that the nurse manager and staff members decide on a method to resolve conflicts. It is important to have agreements about how team members will work together because: • if there are no agreements, each member will make up rules about how to handle disagreements and relationships. • people are naturally difficult and will not work well together without such agreements. • people will naturally ask for agreements about how to be together. • a way to eliminate nonproductive team members must be available.

• if there are no agreements, each member will make up rules about how to handle disagreements and relationships.

The oncology clinical manager and the educational coordinator asked nursing staff to complete a brief written survey to assess their attitudes and knowledge related to having used the new infusion equipment for 6 weeks. The stage of change in this situation is: • developing awareness. • experiencing the change. • integrating the change. • perceiving awareness.

• integrating the change.

Trust is an important aspect of helping relationships, therapeutic communications, and the positive communications model. Which statement does not involve or define trust? Trust: • involves decisions to manipulate situations to gain advantage over another. • is the basis by which leaders facilitate the activities and progress of a team. • is low among members and leaders in poorly performing teams. • involves what we do and not necessarily what we say.

• involves decisions to manipulate situations to gain advantage over another.

The unit manager is working in a large metropolitan facility and is told that two UNPs are to be assigned to work with her. Delegation begins with: • acknowledging the arrival of the second UNP on the unit. • providing clear directions to both UNPs. • matching tasks with qualified persons. • receiving reports from the prior shift.

• matching tasks with qualified persons.

You are working in a home health service and have three unlicensed nursing personnel (UNPs) assigned to your team. You have worked with two of them for 2 years; the third is new. The two experienced UNPs have patients with complex illnesses for whom they provide basic care. The third member of the team has been assigned to patients with less complex illnesses. Your best approach to supervising their care is to: • remain in the office and ask each UNP to check in with you upon arrival at their first patient care site. • ask another RN to supervise the two experienced assistants so you can be with the new person full time. • meet the new staff member at the first patient care site and ask the others to call if anything is unusual. • meet the new staff member at the first patient care site and call the others with questions to determine whether anything is unusual.

• meet the new staff member at the first patient care site and call the others with questions to determine whether anything is unusual.

Based on Elizabeth's insights and suggestions, you involve pharmacy, only to discover that the change in practice involves practice committees, a medical practice committee, and concerns from administration about potential costs and safety of the proposed change to the IV protocols. The change process at this point is: • linear. • nonlinear. • sabotaged. • neutralized.

• nonlinear

With delegation, responsibility and accountability remain with the: • physician. • professional who delegates. • individual who receives the delegation. • individual who previously performed the task.

• professional who delegates.

You are a member of a team assigned to care for 15 general medical/surgical clients. You have all worked well together in the past in this same type of care. If you are assigned to coordinate this team's work, your best strategy, based on the Hersey model, would be to: • have a list of tasks to be accomplished and tell each member of the team what he or she must do. • encourage people to discuss their frustrations in providing this care. • ignore them—they've done it before. • provide minimal direction and let them come to you with questions.

• provide minimal direction and let them come to you with questions

Leslie, a UNP, transfers a patient while using improper technique. The patient is injured, and as a result, a suit is launched in which both Sarah (the delegator) and Leslie (the delegatee) are named. Sarah is named in the suit because she: • retains accountability for the care of the patient. • worked the same shift as Leslie. • has passive accountability for delegation. • retains accountability for the outcomes of care for the patient.

• retains accountability for the outcomes of care for the patient.

Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effects." You follow up with Elizabeth and discover that she is really quite angry about the information sessions because she feels that you are implying that "what she has been doing all these years means that she is incompetent and doesn't care about her patients." After speaking with Elizabeth, a few days later you discover that she is now fine with the change but is concerned that other areas of the organization might resist the change because of perceptions related to patient safety and cost. She suggests that it is important to bring pharmacy on board as they have had previous concerns about the use of heparin. In relation to change theory, this is indicative of: • systems level thinking. • linear thinking. • interprofessional collaboration. • first-order change.

• systems level thinking.

An example of a nursing care activity that would not be delegated by an RN to a UNP is: (Select all that apply.) • teaching self-catheterization to a patient with paraplegia who has limited English. • basic care for a patient with a head injury who is rapidly deteriorating. • one-to-one observation with a suicidal patient. • assessment of patients being admitted through the Emergency Department. • basic hygienic care for a patient who is post MI and stable.

• teaching self-catheterization to a patient with paraplegia who has limited English. • basic care for a patient with a head injury who is rapidly deteriorating. • assessment of patients being admitted through the Emergency Department.