Leadership Exam 1

As a nurse manager, you observe a staff nurse who over the past few weeks has become withdrawn and has had several absences due to minor ailments.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 to meet with you for a few minutes before she leaves for the day.

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.

Leadership

-understanding conflict resolution and ability to negotiate and manage for resolution of issues and concerns -Providing engaged, collaborative guidance and decision making in a complex situation where there is no standardized solution -an individual who works w others to develop a clear vision of the preferred future and to make that vision happen - The use of individual traits and abilities to interpret an emerging situation and to address the situation in the absence of a script or defined plan - Required when the unknown presents itself, necessitating the use of principles to improvise solutions and help others cope, thrive, and function in the situation

The hospital administration is discussing the possibility of closing hospital beds in your unit because of a nursing shortage and the increased amount of overtime required to care for patients. As the leader on the unit, which of the following examples best demonstrates your transformational leadership style?

A group of your staff members goes to the administration to propose closing of a different unit.

Which of the following indicates safe delegation?

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 manager has been asked to implement an evidence-based approach to teach ostomy patients self-management skills postoperatively. The program is to be implemented across the entire facility. What illustrates effective leadership in this situation?

An RN who is already familiar with the new approach of volunteers to take the lead in mentoring and teaching others how to implement it.

A grievance brought by a staff nurse against the unit manager requires mediation. At the first mediation session, the staff nurse repeatedly calls the unit manager's actions unfair, and the unit manager continues to reiterate the reasons for the actions. What would be the best course of action at this time?

Ask each party to examine their own motives and issues in the conflict.

A new graduate nurse wonders about the directions that her preceptor has given her regarding management of incontinent, confused patients. The new nurse brings the preceptor evidence-based information she located regarding incontinence interventions for confused patients and asks to talk about the guidance that given after the preceptor reviews the information in the article. What is the new nurse demonstrating in this situation? (Select all that apply.)

Assertiveness, Followership

Nancy is a staff nurse who works on a rehabilitation unit. Nancy tells you that the assistants are experiencing difficulty with the new lift and wonders what your thoughts are on organizing an in-service training. Nancy is exhibiting which trait of a follower?

Assumes responsibility for identifying a safety concern and concedes authority for solution to you.

Being able to think systematically involves:

Being able to consider the "Big Picture" beyond the needs of your unit.

Examples of thinking systematically

Being able to consider the "big picture" beyond the needs of your unit A systems thinker has the big picture by looking beyond what is going on during a shift or events of the nursing unit Balancing short-term and long-term objectives - recognizes long-term consequences of actions Recognizing the dynamic, complex, and interdependent nature of systems - all things are connected using measurable vs nonmeasurable data systems - this thinking triggers a "tendency to 'see' only what we measure"

Time management is very essential for the nurse manager. Which of the following is not a good time-management technique?

Break down your workload into smaller, manageable tasks.

Which of the following is NOT important in a positive work environment, as defined by the AONE?

Challenge and striving for excellence

delegation vs. assigning

Delegation refers to transfer of responsibility for work; the day shift nurse retains accountability for the outcomes of patient care therefore is using assigning of the task rather than delegation. EX: The day shift nurse asks an LPN/LVN to complete a task for a patient. The day shift nurse is engaging in what function? assigning When an RN assigns care to another RN, it is termed an assignment and not delegation, because both accountability and responsibility are transferred.

Electronic health records (EHRs) are being instituted at Pleasant Valley Hospital. Some of the staff on Unit 4 complain to the manager that acquiring the technologic skills required is too time consuming. They question its value in patient care. The manager responds that:

EHRs will increase effectiveness of care by enhancing coordination and improving patient outcomes.

Examples that demonstrate the concept of followership

Each group member contributes optimally in tandem with other group members to achieve clinical or organizational outcomes Nurses serving on committees (reviewing minutes from previous meetings and completing readings) Preparing for a meeting so that they can be active participant rather than arriving at the meeting unprepared to contribute to the group activities

At a second negotiation session, the unit manager and staff nurse are unable to reach a resolution. What is the appropriate next step?

Elevate the next negation session to the next manager, one level above.

A nurse manager of a 20-bed medical unit finds that 80% of the patients are older adults. She is asked to assess and adapt the unit to better meet the unique needs of the older adult patient. Using complexity principles, what would be the best approach to take for implementation of this change?

Engage involved staff at all levels in the decision-making process.

The manager of a surgical area has a vision for the future that requires the addition of RN assistants or unlicensed persons to feed, bathe, and ambulate patients. The RNs on the staff have always practiced in a primary nursing-delivery system and are very resistant to this idea. What would be the best initial strategy for implementation of this change?

Exploring the values and feelings of the RN group in relationship to this change

The chief nursing officer has asked the staff development coordinator to facilitate the development of a clinical competency program for the facility. While making rounds on the units, the staff development coordinator overhears RN staff complaining that they feel it is insulting to be required to participate in a competency program. What behavior by the staff development coordinator is most appropriate in this situation?

Facilitate a meeting so nurses can articulate their values and concerns about a competency program.

The nurse manager wants to increase motivation by providing motivating factors for the nurse on the unit. What action would be appropriate to motivate the staff?

Implement a model of shared governance.

Which of the following represent outcomes of Transformational Leadership?

Increased job satisfaction

rules of leadership

Maintain balance Generate self-motivation Build self-confidence Listen to constituents Maintain a positive attitude

The adage "leaders are born and not made" reflects which of the following ideas around leadership?

Management can be taught; leadership depends on abilities.

Which of the following statements is true regarding complexity theory?

Nurses can understand the dynamic nature of healthcare processes using complexity theory.

In developing an orientation program, the hospital educator breaks essential organizational information down into chunks, which she develops as online modules. This is an application of which of Drucker's functions of management?

Organization of activities into manageable tasks

Which of the following best demonstrates the concept of Followership?

Preparing for a committee meeting by reviewing the agenda and supplemental materials, so that you can be an active participant in the meeting.

A charge nurse on a busy 40-bed medical/surgical unit is approached by a family member who begins to complain loudly about the quality of care his mother is receiving. His behavior is so disruptive that it is overheard by staff, physicians, and other visitors. The family member leaves the unit abruptly, and the nurse is left feeling frustrated. Which behavior by the charge nurse best illustrates refined leadership skills in an emotionally intelligent practitioner?

Reflect to gain insight into how the situation could be handled differently in the future.

management

The act of any individual who guides others through a series of routines, procedures, or practice guidelines Requires determining routines and practices that offer structure and stability to others

You overhear a new graduate RN telling a nurse colleague that leadership and management belong to the unit manager, not to her. As a nursing colleague, what do you know to be true in regard to the statement?

The new graduate would benefit from further understanding of her role as a professional, whose influence may affect the decision making of patients, colleagues, and other professionals.

The director of nursing has been observing staff interactions in a 20-bed coronary care unit. Based on her observations, which of the following staff members is an obvious leader?

The staff nurse who persuades other staff members to practice by making evidence-based decisions

A unit manager of a 25-bed medical/surgical area receives a phone call from a nurse who has called in sick five times in the past month. He tells the manager that he very much wants to come to work when scheduled but must often care for his wife, who is undergoing treatment for breast cancer. According to Maslow's need hierarchy theory, what would be the best approach to satisfying the needs of this nurse, other staff, and patients?

Work with the nurse, staffing office, and other nurses to arrange his scheduled days off around his wife's treatments.

Which of the following statements would best define stress? Stress is:

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

stress

a gap between how we would like our lives to be and how they actually are and as a consequence or response to an event or stimulus.

During a staff meeting held to discuss developing a mission statement for the unit, the idea of placing patient needs first is discussed. What is considered when the suggestion by the manager is for the unit mission to be derived from the organization mission?

a leadership tag

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

To solve a problem, the nurse manager understands that the most important problem-solving step is:

accurate identification of the problem.

The unit is shifting from primary nursing to a team model in an effort to contain costs. Staff members are upset about the change and ask for a meeting to discuss the new model. After hearing their concerns related to reduction in professional autonomy, what is the initial response by the manager to address the concerns?

acknowledge the loss

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:

active delegation

Which of the generations is challenged by sharing leadership with other generations?

baby boomers

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 potential for harm.

As a leader on a rehab unit, the manager encourages all staff members to see themselves as having a role in decision making and quality care. The manager sees their role as involving particular responsibilities in decision making but not as a hierarchal role. What is this view of the role consistent with in this situation?

complexity theory

The hospital administrator approves a case management position for a new rehabilitation unit to help reduce costs. In developing the job description, the nurse manager understands that a key element of case management is:

coordination of resources for effective outcomes.

During a fire drill, several psychiatric patients become agitated. The nurse manager quickly assigns a staff member to each patient. This autocratic decision style is most appropriate for:

crisis situations.

Select the statement that best defines the difference between problem solving and decision making:

decision making is a goal-directed effort; problem solving is focused on solving an immediate problem.

A manager who is concerned with ensuring that patients on her surgical unit have the necessary information to make informed choices is:

demonstrating respect for patient rights.

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?

depersonalization

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 her personal and professional goals.

The manager of a unit is finding it difficult to work with a new graduate nurse. The new nurse has many ideas; however, his manner of presenting them irritates the manager. After reflection and discussion with others, the manager recognizes that she feels threatened by his behavior. She comes to understand that the new nurse is trying to establish his own role on the unit; is not trying to challenge her; and needs guidance, coaching, and affirmation. What is the nurse manager demonstrating in this situation?

developing self-awareness

A staff nurse has been recently promoted to unit manager. During the time on the unit, the nurse formed a strong social network among staff, has promoted the development of relationships between staff and workers in other areas of the organization, and has formed relationships that generate ideas from patient organizations and the local nursing education program. According to complexity theory, what principle is being engaged?

development of networks

"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

emotional intelligence

empathy handling relationships deepening self-awareness in self and others motivating others managing emotions **self awareness, self regulation, empathy, social skills

After the nurses who work on an adolescent psychiatric unit have had a brainstorming session, they are ready to resolve the problem of unmanageable teenage patients. To maximize group effectiveness in decision making and problem solving, the nurse manager has:

encouraged equal participation among members.

After assessing an older adult patient in long-term care who has been slowly deteriorating for weeks, the nurse manager calls the family and asks them to come in, as the patient is dying. What is the most likely basis for the nurse manager's request?

experience

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.

external

A nurse manager is experiencing considerable conflict among staff members because of weekend staffing coverage. During a called staff meeting, the nurse manager asks the disgruntled staff to meet as a group and determine the best staffing practices. In doing this, the nurse manager is using the concept of collaboration to:

focus all energies of staff members on a best possible strategy.

A family is keeping vigil at a critically ill patient's bedside. The nurse approaches the unit manager with concern over the family dynamics for the patient concerned there are patient-family conflicts based on patient's wishes. The nurse suggests that the patient's provider may need to discuss the treatment plan with the family. The unit manager states he will arrange a discussion with the patient's provider and ask the nurse to support the provider's decisions. What is the role of the nurse in this situation?

follower

Several nurses on an adolescent psychiatric unit complain that the teens are becoming unmanageable on the 0700-1900 shift. To resolve this problem, the nurse manager decides that the staff should have a brainstorming session. The goal of brainstorming is to:

generate as many solutions as possible.

The nurse manager is anticipating changes on the unit because of managed care. It is up to the manager to "sell" the staff on this care concept. A goal of managed care that the staff must understand is that managed care is:

grounded in business theory

The risk manager informs the nurse manager of an orthopedic unit that her unit has had an increase in incident reports related to patients falling during the 11-7 shift. The nurse manager knows that the best way to resolve the problem is to:

identify the problem.

The risk manager wants to evaluate the reasons for an increased number of falls on the rehab unit. The risk manager devises a fishbone diagram. A fishbone diagram is a useful tool to:

identify the root causes of problems.

The nurse manager of a rehab unit wants to purchase a new antiembolic stocking for use with patients. To make a high-quality decision, the nurse manager would:

involve the rehab staff in the decision.

quantum theory

leaders act as change catalysts and innovators

The manager calls the staff together to assess a situation in which the family of a seriously ill patient is anxious and is absorbing a great deal of staff time in consultation, discussion, and questioning of treatment decisions. Staff members are becoming distanced from the family. After inviting the concerns of staff, the manager explains that the organization values patient-centered care and that evidence supports that acting as an advocate and a listener is helpful to families. The manager asks the staff for ideas and strategies that are effectively patient-centered in dealing with families in similar situations. What is the role of the nurse manager in this situation?

leadership

external stressors

losing a job death of a loved one getting married

which of the following is NOT a rule of leadership?

maintain likability

Chart audits have revealed significant omissions of data that could have legal and financial guideline ramifications. The unit manager meets with the staff to discuss audit findings and to find approaches that will address the gaps in charting and achieve desired goals. What is the manager demonstrating?

management

A family is keeping vigil at a critically ill patient's bedside. Distant family members call the unit continuously asking for updates and expressing concern. The nurse speaks with the distant family members and states she is referring them to the hospital social worker, whose role is to work with family in this situation. What role is the nurse assuming through this action?

manager

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:

matching tasks with qualified persons.

The nurse manager plays a unique role in institutional management in that the nurse manager:

models professional nursing behavior.

Which of the following exemplifies accountability? Karen, the nurse manager on 5E:

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

Functions such as "delegates tasks to assistive personnel" that are outlined in a position description for an RN Team Leader would be considered:

passive delegation

The chief nursing officer listens to nurse managers verbalize their feelings of internal stress. One common source of internal stress seems to be:

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.

With delegation, responsibility and accountability remain with the:

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:

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

The nurse manager in the Emergency Department needs to implement new staffing patterns. As a transformational leader, the nurse manager would:

reinforce how this change will respond to the ideas and solutions generated by staff members.

In a rural hospital, the unit for which you are charge nurse has a particularly busy morning. A 52-year-old patient is complaining of left-sided chest pain and a multiparous patient is about to deliver. A child with asthma is experiencing early signs of an attack. The other RN on the unit is a recent graduate who has not yet been orientated to the labor room and has limited cardiac nursing experience. An unlicensed assistant is available to assist. You must decide which patient situation you will take and where the new graduate RN's skills can best be used. Given the limitations in skills and experience, number of staff available, and time constraints, you must make a decision that involves:

satisficing

The nurse manager, as the leader of the unit's "customer (client) first" initiative, has asked the staff nurses to develop and administer a survey to every client before discharge. In asking the staff nurses to accomplish this task, the nurse manager is demonstrating:

shared leadership

As the clinical director of 24 employees, you have been asked to explain to staff members why they are not getting a raise this year, even though they have been working short-handed for many months and patient satisfaction scores have never been higher. Because you believe yourself to be a transformational leader, you will approach this problem by:

showing staff members the budget and asking for input about how to cut costs so that raises will be possible in the future.

According to the complexity theory, what would be the focus of measurement?

staff morale and budgets

complexity theory

systems interact and adapt and that decision making occurs throughout the systems, as opposed to being held in a hierarchy. In complexity theory, every voice counts, and therefore, all levels of staff would be involved in decision making. Nontraditional theory emerged over time from works of physical and social sciences; examines how systems adapt and function, where co-creation of ideas and actions unfold in a non-prescriptive manner Can be used by leadership/management to understand an organization and planning and executing changes within an organization The complex nature of health systems and related processes can be best understood using complexity theory

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. basic hygienic care for a patient who is post MI and stable.

A key advantage that a charge nurse has in terms of delegating is that:

team skills can be used more effectively.

Kari, a head nurse on the dialysis unit, has been informed during budget planning meetings that budget cuts are likely. She discusses this at the next unit meeting and tells staff members that unless they do their jobs well, their positions may be terminated, and there will be no replacement. Kari is enacting which management style?

transactional

As the head of a nursing program, you consistently invite the ideas of your team about innovations in teaching, community partnerships, and curriculum design and invite participation in decisions. Many of these ideas have been implemented successfully, and your staff members are keen to try on other ideas. What is the leadership you are employing?

transofmational

characteristics of a healthy/positive work environment

Clear and open communication accountability and clarity of roles participatory decision making

Knowing when to have the entire team participate in the decision-making process or when to have only the team leader make the decisions depends on the situation and the desired outcomes. The autocratic process is used in which of the following situations?

The task and the outcome are relatively simple and defined.

Which of the following would be most in line with Hersey model and concepts?

The team of caregivers on day shift are familiar with their roles and with the patients. The nurse manager decides to work on the unit budget in her office.