Leadership Exam 2: Ch. 4, 8, 9, 10, 11, 12, 13 ,14

The nurse manager for a unit's culturally diverse staff creates a staff-development program so the professional nursing staff members can enhance their understanding of cultures on the basis of published literature. The literature reveals that the following characteristic is inherent in a culture. It: a. Develops over time.b. Maintains a strong work ethic.c. Changes easily.d. Develops quickly.

A

At Health Center XYZ, staff members on the rehab unit have a head nurse who is intolerant of error and publicly chides anyone who makes a mistake. Over time, the rules on the unit dictate that mistakes are hidden and that areas of concern related to the functioning of the unit are discussed in tub rooms and are never openly discussed during periodic meetings. New staff members are quickly made to realize that silence is expected. The situation described is an example of: a. Ethnicity.b. Work environment.c. Work culture.d. Marginalization.

C

Sarah, one of your RNs, tells you that she can't understand why Jim, an Aboriginal patient, wants to do a smudge. In coaching Sara, you suggest which of the following? a. "Explain to Jim that there is no smoking in the hospital."b. "Inform Jim that fires are not allowed in the hospital."c. "Insist that he give you his tobacco because it is unhealthy for him."d. "Ask him what he means by a smudge and what meaning it has for him."

D

The nurse manager of a unit is asked by a family member of a dying Native American patient if it is possible to have the patient's eight-member family recite the rosary by the bedside. The manager responds affirmatively. The nurse manager is most likely exhibiting behavior related to: a. Acculturation. b. Ethnocentricity. c. Cultural diversity. d. Cultural sensitivity.

D

After using a mediator to resolve a conflict between the nurse manager and two staff nurses, the chief nursing officer decides to: a. Observe to make sure the conflict has been resolved.b. Fire both staff nurses.c. Reassign both staff nurses.d. Reassign the nurse manager.

a. Observe to make sure the conflict has been resolved The nurse leader should follow up to determine if the conflict has been resolved because, in professional practice environments, unresolved conflict among nurses is a significant issue that results in job dissatisfaction, absenteeism, and turnover, as well as in decreased patient satisfaction and poorer quality in patient care.

The workgroup on NU 23 is marked by apathy toward the ward's patients, high absenteeism, open conflict among team members, and high turnover of personnel, including managers. The underlying behavior in this situation may be characterized as: a. Powerlessnessb. Angerc. Apathyd. Oppression

a. Powerlessness Emotions such as anger and apathy result from a workplace in which powerlessness is exhibited.

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

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

"At Thoroughcare, we provide health care for women and children in transition" is an example of a: a. Vision statement.b. Mission statement.c. Goal statement.d. Statement of philosophy.

b. Mission statement Mission statements provide a reason or rationale for the existence of the organization and are indicative of the structure of the organization and of who consumes the services provided.

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? a. Organizationalb. Intrapersonalc. Interpersonald. Disruptive

c. Interpersonal Interpersonal conflict transpires between and among nurses, physicians, members of other departments, and patients.

One day, at coffee, your co-worker suggests that you and she sit with unit members of the hospital research committee. She suggests that this would be an excellent way to get to know people who share her interest in research. Her actions are an example of: a. Mentorship.b. Politics.c. Networking.d. Empowerment.

c. Networking Meeting individuals outside the normal workgroup to share ideas and gain support and encouragement is an example of networking.

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

d) Education and expertise Differentiated nursing practice - models of clinical nursing practice defined or differentiated by: - level of education - expected clinical skills or competencies - job descriptions - pay scales - participation in decision making

Jill is the head 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? a. Avoidingb. Competingc. Compromisingd. Collaborating

d. Collaborating Collaboration, although time-consuming, is the most creative stance. The collaboration technique involves both sides in the conflict working together to develop an optimal outcome. This results in a win-win solution.

Which of the following best exemplifies the predominant style of conflict management for staff nurses? a. Sarah and Jonas, two RNs, disagree about the best approach to assisting a family that has complex needs. They decide that they will consult with family and together will decide what is best. b. Jennifer needs to switch a shift to attend a family function. She arranges to trade with Nancy, who wants a day off next to a 3-day break. c. Lindsay asks Melody to stay late for the third day in a row. Melody refuses, stating that she has already helped out for two days by staying late for Lindsay. d. Lara asks Stacey to switch shifts with her because Lara wants to attend a concert. Stacey would prefer not to but does to enable Lara, who is new in town, to be with her friends.

d. Lara asks Stacey to switch shifts with her because Lara wants to attend a concert. Stacey would prefer not to but does to enable Lara, who is new in town, to be with her friends Avoidance and accommodation are the predominant conflict management styles of nurses. Accommodating involves neglecting one's own needs while trying to satisfy the needs of another.

As a nurse manager, you have to be effective in managing a culturally diverse staff. Which of the following nurse manager attributes would assist you in addressing the cultural needs of your staff (select all that apply)?a. Stereotyping of othersb. Respecting othersc. Understanding the importance of languaged. Encouragement of potential in all staffe. Age biasf. Disrespect for others

B, C, D

Cultural diversity is the term used to describe a vast range of cultural differences. Events have symbolic meanings for the nurse manager and the staff. The event that would be most likely to provide symbolic meaning to a nurse manager and staff is a: a. Task force formed to commemorate a New Year's celebration in the Western tradition. b. Project to provide Christmas gifts to the children in a daycare program. c. Celebration of National Nurses Week with the focus on cultural care. d. Task force to develop a poster for the unit depicting religions of the world.

C

Maintaining a culturally diverse staff and working with a culturally diverse patient population is an important function of a nurse manager who works in the hospital of a large medical center. On your palliative care unit, you have recently received complaints from families about ineffective pain management for their family members and you determine this occurs primarily when certain nurses are working. What approach might you take to resolve the concerns of the families, patients, and potentially, the staff? a. Reinforce to staff that practice guidelines support as-needed analgesia for the terminally ill.b. Ask staff input on the development of stricter guidelines to ensure that all terminally patients are given sufficient analgesia.c. Encourage conversation with patients and among staff that facilitates learning about cultural beliefs and priorities in dying.d. Advise families that the administration of analgesia is based on the expert clinical judgment of nurses who are familiar with care of patients in palliative care.

C

Mary joins 5W nursing unit. Mary is a new graduate who is anxious to fit in. She soon learns that some of her "book learning" is being criticized by her colleagues, so she adapts her practice to what others on the unit are doing. She is demonstrating: a. Cultural awareness.b. Cultural sensitivity.c. Acculturation.d. Cultural marginality.

C

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

a) can be effective in recognizing individual strengths and backgrounds of staff Team nursing delivers care to a small group of patients, using a mix of licensed and unlicensed personnel. Team nursing uses the strengths of each caregiver.

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

a) it is the role of the primary nurse to make alterations based on assessment data and input The primary nursing model assumes that the primary nurse is accountable for patient care, even while off duty. The primary nurse is responsible for establishing the patient plan of care and therefore for altering it with the input of an associate. The associate is responsible for implementation of the established care plan when the primary nurse is off duty.

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

a) minimizing costs in high resource consumption areas Case managed care is not revenue generating but rather revenue protecting in that better coordination of care enables efficient achievement of patient outcomes, can result in shorter length of stay, and can prevent readmission.

Taylor Hospital has well-defined organizational units that provide maintenance, financial services, care for cardiac patients, care for surgical patients, and so on. The organizational chart indicates that surgical units report to a surgical manager and all nursing units report to a vice president of nursing; financial services to an accountant and then to a business executive; and so on. The primary disadvantage of this organizational structure is: a. Breakdown in function and communication across specialties. b. Lack of congruence in culture and organizational values. c. Highly centralized decision making and authority. d. Wide span of control.

a. Breakdown in function and communication across specialties In a functional organizational structure, departments and services function according to specialty. This model supports professional expertise but can lead to silos in communication and decision making and discontinuity in patient services.

A nurse educator is giving a workshop on conflict. During the sessions, he makes various statements regarding conflict. All of the statements are true except: a. Conflict can decrease creativity, thus acting as a deterrent for the development of new ideas.b. Horizontal violence involves those with similar status but little power in the larger context.c. Interprofessional collaboration reduces unresolved conflicts.d. All conflicts involve some level of disagreement.

a. Conflict can decrease creativity, thus acting as a deterrent for the development of new ideas The opposite is true because research has shown that conflict, like change, increases creativity and allows for the development of new ideas.

With revenue reductions and cost-saving measures, the number of managers has been reduced, which has increased the number of team leaders supervised by managers by as many as three. This change may result in: a. Decreased patient satisfaction. b. Increased efficiency in costs. c. A more positive perception of managers. d. Little change to manager-staff relationships.

a. Decreased patient satisfaction When a span of control becomes too large, supervision can become less effective, which can have a negative effect on staff-manager relationships and on the overall quality of patient care.

A nurse manager must implement a 2% budget cut on the nursing unit. Which approach should the manager use to most effectively empower the staff of the unit? a. Discuss the guidelines for the budget cuts with the staff, making the decisions with those who participate.b. Inform the staff of the budget cuts in a series of small group meetings and accept their ideas in writing only.c. Provide the staff with handouts about the budget cuts and let them make recommendations in writing.d. Hold a series of mandatory meetings on the budget cuts, asking staff for ideas on the cuts.

a. Discuss the guidelines for the budget cuts with the staff, making the decisions with those who participate Empowerment is the process of exercising one's own power to facilitate the participation of others in decision making and taking action so they are free to exercise power It means releasing authority and enabling others to have accountability, for participation and decisions.

During orientation of new nurse managers, the chief nursing officer stresses strategies that help nurse managers to achieve a powerful image. Which groups of behaviors best contribute to a powerful image for the nurse manager? a. Greeting patients, families, and colleagues with a handshake and a smile; listening carefully when problems ariseb. For men, no facial hair, always wearing a suit and tie; for women, always wearing a suit and high-heeled shoesc. Maintaining a soft voice during times of conflict; making unbroken eye contact during interactionsd. Smiling all the time; always wearing a suit, carrying a briefcase, and, if a woman, wearing no jewelry

a. Greeting patients, families, and colleagues with a handshake and a smile; listening carefully when problems arise A powerful and positive approach is communicated through confident behaviors such as greeting others, smiling, and showing respect for the opinions of others through listening. Grooming and dress need to be clean, neat, and appropriate to the situation. Speech needs to be firm and confident.

As a nurse manager in a for-profit hospital, you are interested in promoting teaching programs for physicians, because evidence suggests that hospitals with teaching programs tend to promote better care for patients. Your administration indicates that it cannot support your ideas or proposal because of: (select all that apply) a. Increased salary costs. b. Duplication of tests and procedures. c. Graduate medical education. d. Potential damage to reputation through learner error.

a. Increased salary costs b. Duplication of tests and procedures c. Graduate medical education Teaching hospitals tend to incur higher costs because of the salaries required for supervision of physicians, duplication of tests and procedures through the learning process, longer times required to process patients, costs of state-of-the art technology, biomedical research, and stand-by capacity of specialized care. Because of the additional costs, few for-profit agencies and organizations support teaching programs.

A nurse manager in a for-profit environment finds it difficult to recruit staff. This difficulty may be most related to aggressive profit goals and: a. Lower salary compensation for staff.b. Rising expectations of impoverished and indigent individuals for services.c. Poor orientation and retention practices for staff.d. An overwhelming emphasis on accepting learners from health disciplines.

a. Lower salary compensation for staff For-profit hospitals tend to have lower wage and salary costs that are most likely connected to aggressive goals for profit.

Organizational culture includes: (select all that apply) a. Norms b. Traditions c. Behaviors d. Values

a. Norms b. Traditions c. Behaviors d. Values Organizational culture, the reflection of the norms or traditions of the organization, is exemplified in behaviors that illustrate values and beliefs.

Nurses entering into the workforce today are faced with which of the following relationships that could create organizational conflict? (Select all that apply) a. Nurse-physician relationshipb. Nurse-nurse relationshipc. Nurse-patient relationshipd. Nurse-chief nursing officer relationshipe. Nurse-auxiliary personnel relationships

a. Nurse-physician relationshipb. Nurse-nurse relationshipc. Nurse-patient relationshipd. Nurse-chief nursing officer relationshipe. Nurse-auxiliary personnel relationships By nature, conflict is potentially present in all interpersonal situations. The nurse manager should create an environment that recognizes and values differences in staff, physicians, patients, and communities.

6. In opening a new dialysis unit, the nurse manager has to develop a philosophy for the unit. This philosophy needs to: a. Reflect the culture of the unit and its values. b. Be developed by the nursing manager on the unit. c. Identify the clients that will be served on the unit. d. Replicate the organization's philosophy.

a. Reflect the culture of the unit and its values A philosophy expresses the values and beliefs that members of the organization hold about the nature of their work, about the people to whom they provide service, and about themselves and others providing the services.

Which of the following is an outcome of managed care? a. Shift of patients to outpatient and home health servicesb. Less complexity in funding sourcesc. Less complexity in rules for consumers to followd. Greater consistency in the quality of care

a. Shift of patients to outpatient & home health services A goal of managed care is to reduce the cost of expensive acute hospital care by focusing on out-of-hospital preventive care & illness follow-up care, which has led to shifts in where health care is delivered.

The chief nursing officer is given the task of reviewing and revising the organization's mission, philosophy, and technology. In reviewing them, the chief nursing officer understands that they should be reflected in: a. The organizational structure. b. Line and staff responsibilities. c. The policies and procedures. d. Government regulations.

a. The organizational structure The mission statement is an important foundation for the organizational structure and defines technology and human resources required for the organization.

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? a. The use of avoidance.b. An enhanced nursing workforce.c. Accepting that some conflict is normal.d. Managing the effects of fatigue and error.

a. The use of avoidance Avoidance as a conflict-management style prolongs conflict and has a tendency to escalate conflict.

A staff nurse asks the nurse manager for a few days off for personal reasons. The nurse manager turns in the request to the human resources office with a note indicating that the staff nurse has demonstrated excellent working skills and is a valued employee. The nurse manager has used the influence of her position to help this staff member. Influence is the process of: a. Using power b. Empowering others c. Understanding power d. Moving past apathy

a. Using power Influence involves the use of power to effect certain outcomes—in this situation, to arrange days off for a valued employee.

"Georgia Hospital will provide care that is a national example of consumer service" is a: a. Vision statement.b. Statement of philosophy.c. Mission statement.d. Rationale for care.

a. Vision statement A vision statement is an articulated goal that provides an inspirational target to which the organization aspires at some future time. A statement of philosophy expresses values and beliefs, and a mission statement provides the reason for the existence of the organization.

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

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

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

b) Functional nursing Functional model of nursing - method of providing pt care by which each licensed & unlicensed staff member performs specific tasks for a large group of pts

John is a circulating nurse in the operating room. He is usually assigned to general surgery, but on this day he is assigned to the orthopedic room. He is unfamiliar with the routines and studies the doctor's preference cards before each patient. The fourth patient comes into the room and John prepares a site for a biopsy using a Betadine solution. The surgeon prefers another solution. He notices what John has done and immediately corrects him by rudely insulting John. Which of the following is the most appropriate approach to conflict resolution in this example? a. Collaboration b. Compromising c. Avoiding d. Withdraw

b. Compromising Compromise involves negotiation or an exchange of concessions and supports a balance of power.

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? a. Frustration b. Conceptualization c. Action d. Outcomes

b. Conceptualization Thomas' Stages of Conflict include conceptualization, which involves different ideas and emphasis on what is important or not or about what should occur.

Amy has worked in the dialysis unit on staff for about 12 years. She is frequently consulted by other nursing staff regarding protocols and policies on the unit. What type of power is Amy using? a. Position powerb. Expert powerc. Personal powerd. Competency power

b. Expert power According to the types of power outlined in the text, Amy is most likely evidencing expert power in that she is being consulted regarding areas of knowledge and competency on the unit and is at the same level, potentially, in the hierarchy as her colleagues.

The local health department nurse manager has developed and implemented a disaster readiness plan as part of a community service. Community services: a. Care for the specific needs of individual families in the community.b. Focus on the treatment of community-wide problems rather than on individual health problems.c. Do not include services provided by public health departments.d. Provide personal health follow-up for all acute care hospitalizations.

b. Focus on the treatment of community-wide problems rather than on individual health problems Community services, including public health departments, are focused on the treatment of the community rather than that of the individual. These funds provide personal health services, care for communicable diseases, services for children with birth defects, mental health care, investigation of epidemiology, and treatment of bioterrorism threats and attacks. Monies are allocated also for environmental services and for health resources.

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: a. Frustration, competition, negotiation, and action.b. Frustration, conceptualization, action, and outcomes.c. Frustration, cooperation, collaboration, and action outcomes.d. Frustration, conceptualization, negotiation, and action outcomes.

b. Frustration, conceptualization, action, & outcomes Thomas (1992) determined that conflict proceeds through these four stages in this particular order.

A local hospital has formed a corporate partnership with a reputable HMO (health maintenance organization). The nurse manager has had to educate staff and personnel about the financial implications of this partnership. A Health Maintenance Organization (HMO): a. Provides more expensive care than other types of insurance plans. b. Has a centralized administration that directs and compensates physician services. c. Pays physicians on a fee-for-service basis. d. Does not pay as much for acute care as other practice plans.

b. Has a centralized administration that directs and compensates physician services The HMO is a configuration of healthcare agencies that provide basic and supplemental health maintenance and treatment services to voluntary enrollees who prepay a fixed periodic fee without regard to the amount of services used. HMOs have a centralized administration that directs and pays salaries for physician practice (e.g., HMOs).

In matrix organizational structures, a nurse manager understands that this type of structure: a. Is a simplified organizational structure.b. Has both a functional manager and a service or product-line manager.c. Arranges departments strictly according to function.d. Promotes harmony in organizational decision making.

b. Has both a functional manager and a service or product-line manager Matrix structures are complex, integrated organizational structures that involve both functional and service or product-line managers. In this structure, team members or teams from various functional departments may combine to complete a project or program, thereby becoming responsible to both their functional department manager and their product-line manager.

Two nurses approach their manager about a conflict regarding the next month's schedule. The nurses are talking loudly and at the same time. The manager most effectively uses communication skills to resolve the conflict by: a. Taking both nurses aside, separately and then together, and charging them with resolving the problem without her direct intervention. b. Listening to each nurse speak to the other without interruption and asking clarifying questions to help them resolve the issue themselves. c. Separating the nurses, instructing each to decide how the problem can be resolved, and meeting with them the next day. d. Calling an emergency scheduling committee meeting and asking volunteers to resolve the conflict between the two nurses.

b. Listening to each nurse speak to the other without interruption and asking clarifying questions to help them resolve the issue themselves Negotiation involves the presentation of an opening position with each party, then moving on until they achieve a mutually agreeable result or until one or both move away from a failed negotiation. Negotiation occurs when one party has something that the other party values, such as a desired schedule.

Tracy is an RN case manager who interfaces between the Centers for Medicare and Medicaid. Tracy's responsibilities most likely would include: a. Managing physician-led research.b. Monitoring physician documentation of the need for medical care.c. Determining which services are designated fee-for-service.d. Identifying errors in physician diagnoses.

b. Monitoring physician documentation of the need for medical care Nurse case managers serve as interfaces for the Centers for Medicare & Medicaid Services (CMS) and are key in monitoring compliance with Conditions of Participation (CoP) elements. The case managers routinely monitor for appropriate physician documentation of medical necessity and other required CoP elements.

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: a. Risk taking seems to be unavoidable.b. People see events differently.c. Personal and professional priorities do not match.d. The ways in which people should act do not match the ways in which they do act.

b. People see events differently By definition, conflict involves a difference in perception between two or more individuals.

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: a. Group decision-making options.b. Perceptions of incompatibility.c. Increases in group cohesiveness.d. Debates, negotiations, and compromises.

b. Perceptions of incompatibilityConflict involves disagreement in values or beliefs within oneself or between people that causes harm or has the potential to cause harm. Folger, Poole, and Stutman (2012) add that conflict results from the interaction of interdependent people who perceive incompatibility and the potential for interference.

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

c) Critical pathway Critical pathway - outlines outcomes, clinical standards, & interventions for a pt in each phase of treatment. - Goal = effective coordination of care across various staff & levels of care.

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

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

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

c) Pediatric intensive care unit that heavily involves families as well as patients This model is especially useful in the care of complex pts who need active symptom management provided by an RN, such as the care of the pt in a hospice setting or an ICU. This method would be justifiable delivery in the pediatric intensive care unit, where the status of pts can change rapidly & where complex functions of care involve both pts & families.

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

c) RN and medication assistants The partnership care delivery model is a variation of primary nursing in which an RN works with a consistent assistant, who performs basic nursing functions consistent with state delegation rules

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

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

Lee, the head 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 phones in sick. In this situation, Lee & Jillian are demonstrating: a. Similar conflict management strategies.b. Escalation of conflict.c. Avoidance and compromise strategies.d. Competing and compromise strategies.

c. Avoidance and compromise strategies Jillian is demonstrating avoidance by staying away from meetings to discuss her team relationships, and Lee is demonstrating compromise by offering coaching in return for Jillian's being able to engage in more satisfying relationships.

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: a. Creativity, a problem-solving atmosphere, a weak team spirit, and motivation of its workers.b. Creativity, a staid atmosphere, a weak team spirit, and motivation of its workers.c. Creativity, a problem-solving atmosphere, a strong team spirit, and motivation for its workers.d. A bureaucratic atmosphere, a strong team spirit, and motivation for its workers.

c. Creativity, a problem-solving atmosphere, a strong team spirit, and motivation for its workers. Differences in ideas, perceptions, and approaches, when managed well, can lead to creative solutions and deepened human relationships. Work on conflict suggests that complete resolution of conflict is counterproductive to the achievement of organizational goals, organizational change, and cohesiveness of employees.

Collaborative partnerships between hospitals and schools of nursing are examples of hybrid organizational structures. A hybrid organizational structure: a. Has many divisions of labor. b. Best fits long-term care units. c. Has a mixture of the characteristics of various organizational types. d. Places the authority for decision making closest to the places where workers perform.

c. Has a mixture of the characteristics of various organizational types Hybrid structures include characteristics of various organizational types and reflect the needs of the situation and the environment.

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 taskforce 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? a. Collaboratingb. Avoidingc. Negotiatingd. Accommodating

c. Negotiating Negotiation involves an exchange of concessions (membership on a committee in return for attendance at a workshop) or trading. This strategy supports a balance of power.

A new CEO has been hired at Valley Hospital who proposes to change the centralized organizational structure that was put in place ten years ago, based on widespread consultation with staff. The proposed structure involves substantial flattening of the organizational structure, with significant decision making being made at the point-of-care and an emphasis on interprofessional collaboration. There is a great deal of discussion about the balance between hospital-wide budget decision making and unit-based decision making. This discussion represents: a. Chaos theory. b. Organizational redesign. c. Organizational reengineering. d. Restructuring.

c. Organizational reengineering Reengineering involves a total overhaul of an organizational structure. It is a radical reorganization of the totality of an organization's structure and work processes. In reengineering, fundamentally new organizational expectations and relationships are created. Redesign is a technique to analyze tasks to improve efficiency, and restructuring is a technique to enhance organizational productivity.

In which of the following situations would you expect low morale and frustration? a. Statement of philosophy indicates "We value our staff." When staff members leave, careful evaluation is done to determine whether staff should be replaced by full- or part-time employees. b. Practices include annual staff recognition celebrations. During times of change, staff members are actively included in issue identification and solution finding. c. Recruitment ads promise opportunities for advancement for everyone. Promotions are given only to individuals with long-standing service and entrenched relationships. d. The vision indicates that there is strong commitment to lead in research. The organization has tried to implement a strong campaign to attract leading nurse researchers but has experienced difficulty in doing so.

c. Recruitment ads promise opportunities for advancement for everyone. Promotions are given only to individuals with long-standing service and entrenched relationships Although frustration may occur with external factors that affect ability to act on values and aspirations, lack of congruence between what is espoused as a value within the organization (such as promising advancement as an incentive to join the organization) and what is actually done (such as restricting advancement to internal candidates with much organizational history) can cause low morale and confusion.

The nurse manager is comparing functional nursing & primary nursing for potential adoption. The nurse manager determines that patient & nurse satisfaction in primary nursing are: a) similar to those in functional nursing b) not of significance in either model c) low by comparison with functional nursing d) high when compared with functional nursing

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

In an acute care unit, the nurse manager utilizes the functional nursing method as the care delivery model. The nurse manager's main responsibility is the needs of the: a) department b) unit c) staff d) patient

d) patient In a functional nursing model, where other team members are focused on performing specific tasks, the nurse manager assumes primary responsibility for patient outcome

Which of the following exemplifies the predominant conflict management style of nurse managers? a. Elizabeth, the head nurse on neurology, finds that Tom, the RN nurse on nights, is irritable in relation to any suggestions or new ideas, and so she comes in to work after Tom leaves the unit b. The technology committee has recommended a clinical system for implementation on the nursing unit. Staff is anxious about the change. Tim, the head nurse, asks staff for ideas on how to meet the technology goals and to meet staff needs c. During management meetings, George, the head nurse on nephrology, dominates meetings and decisions. Lee, the head nurse on the cardiac step-down unit, begins to miss the management meetings d. Ann, RN, asks her head nurse if she can go on the permanent evening shift. The head nurse, Rajib, agrees, as long as Ann agrees to be involved in assisting to mentor evening staff in the use of the new clinical information system.

d. Ann, RN, asks her head nurse if she can go on the permanent evening shift. The head nurse, Rajib, agrees, as long as Ann agrees to be involved in assisting to mentor evening staff in the use of the new clinical information system Compromise involves trading and negotiation and is the predominant conflict management style of managers.

The head 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 head 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: a. Lateral violenceb. Horizontal violencec. Confrontationd. Bullying

d. Bullying Bullying involves aggressive or destructive behavior or psychological harassment of a recipient who is in a position of power differential with the perpetrator (the head nurse). Bullying is closely related to lateral or horizontal violence and involves such behaviors as incivility or intimidation.

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: a. Decreased frustration between the maintenance worker and her. b. A good relationship with the maintenance department. c. Eventual resolution of the problem without further intervention. d. Decreased productivity on her part.

d. Decreased productivity on her part Research by Saltman et al. (2006) determined that productivity decreases with destructive conflict, whereas constructive conflict strengthens relationships

A new director of nursing in a small rural hospital wants to make changes from the traditional model of governance to a shared-governance model. Select the characteristic below that best describes the traditional organizational structure in which a staff nurse is assigned to carry out nursing tasks for clients but is not given the chance to provide input into forming the policies and procedures by which care is delivered or the standards by which care is evaluated: a. Bureaucratic b. Decentralized c. Delegated authority and responsibility d. Delegated responsibility but no authority

d. Delegated responsibility but no authority In traditional structures, decision-making authority (right to act) is held by a centralized decision-making body, so that staff members have responsibility for certain functions but do not participate in decisions related to those functions.

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: a. Identify the conflicting facts.b. Be determined to resolve the conflict.c. Schedule a meeting time for resolution.d. Have a clear understanding of the differences between the parties in conflict.

d. Have a clear understanding of the differences between the parties in conflict It is important for each person in the conflict to clarify the conflict as "I see it" and how "it makes me respond" before all the persons involved in the conflict can define the conflict, develop a shared conceptualization, and resolve their differences.

Sondra, a new graduate, recently began a position as a registered nurse in a rural hospital, where she is the youngest and newest staff member. Although she has limited experience, she has a strong knowledge base, is confident, and was considered to have strong entry-level skills on graduation. Sondra meets with her former instructor and confides that she is very frustrated that others do not seem to accept her leadership. What might you suggest that would help Sondra to understand what is happening in terms of power and influence? a. As a new graduate, it is unlikely that she has acquired the experience and knowledge of other staff, including aides and practical nurses.b. Rural settings tend to be closed systems and therefore are, not welcoming of those who are not from their community.c. Morale on her unit can be improved by engaging in shared decision making.d. Identify the informal leaders on her unit and how they affect care decisions.

d. Identify the informal leaders on her unit and how they affect care decisions Developing organizational savvy includes identifying the real decision makers and those persons who have a high level of influence with the decision makers. Recognize the informal leaders within any organization may have more power than the formal leader because of more knowledge of the organization, more informational power, or more expertise.

Which of the following interactions is MOST consistent with the idea of networking? a. Meet with the same colleagues daily to have coffee and share concerns about the workplace and stories about colleagues.b. Join an online workplace forum to gain ideas about how to handle workplace conflict.c. Suggest that you and a new team member meet after work for coffee to review unit guidelines.d. Join a nurse executive interest group to meet other executives for support and for sharing ideas of expertise.

d. Join a nurse executive interest group to meet other executives for support and for sharing ideas of expertise Networking is the result of identifying, valuing, and maintaining relationships with a system of individuals who are sources of information, advice, and support. Many nurses have relatively limited networks within the organizations where they are employed. Active participation in nursing organizations is the most effective method of establishing a professional network outside one's place of employment. Successful networking involves sharing similar ideas and maintaining relationships within a system of individuals who serve as sources of information, advice, and support

A nursing informatics specialist hired by Blue Cross/Blue Shield (a form of third-party payers benefit packages that uses specific standards to approve a period of time for the use of inpatient & community health services) is participating in: a. Critical pathwaysb. Healthcare networksc. Health maintenance organizationsd. Managed care

d. Managed care Managed care strives to contain costs (e.g., through limitation of time in care) while maintaining quality. Managed care combines care delivery with financing and provides comprehensive services for a fixed prepaid fee. Group practice plans take various forms. One form has a centralized administration that directs and pays salaries for physician practice (e.g., HMOs).

A nurse manager working for a not-for-profit organization should be familiar with the regulations that impact the organization. Not-for-profit organizations: a. Pay dividends to stockholdersb. Have funds that are redirected to the organization for maintenance and growthc. Have no paid employeesd. Pay no taxes

d. Pay no taxes Not-for-profit organizations, often referred to as voluntary organizations, are controlled by voluntary boards and provide services to both paying and charity clients. Funds are redirected toward maintenance and growth as opposed to profit shares for stockholders. Historically, non-profit organizations have been exempt from paying taxes as they commit to providing an important community service.

To prepare for the orientation of newly hired nurses, the nurse manager plans a presentation outlining the concept of healthcare networks. Healthcare networks are: a. Units that provide only primary care services.b. Owned by the institutions.c. A feature of all public institutions.d. Units that provide a full spectrum of services.

d. Units that provide a full spectrum of services Healthcare networks are interconnected units. Their aim is serving large regional populations.

Despite repeated invitations by his colleagues to become involved in regional and state nursing practice committees, Tom refuses. His reason is that "nursing committees rarely get anything worthwhile done because of politics and conflicts." According to the text, Tom's view of involvement:a. Is rare in nursing today.b. Reflects a fear of power.c. Reflects the essential process of power.d. Reflects empowerment and capacity to make his own decisions.

*c. Reflects the essential process of power Tom's response reflects a distancing from other nurses related to discomfort with conflict associated with human interactions. The text defines human interactions within organizations as politics, a component of which is the essential process of power

A 66-year-old native Chinese patient, hospitalized for a myocardial infarction, asks the nurse manager about seeing his "acupuncture doctor" for treatment of his migraine headache. The best response to this patient would be: a. "How long have you been using acupuncture treatment?" b. "Do you think acupuncture relieves your pain satisfactorily?" c. "What have you told your heart specialist about your migraines and treatment?" d. "Have you tried nonprescription pain medication or been given a prescription drug for your headaches?"

A

As a nurse manager, you have hired two new staff members who have recently come to the United States from other countries. Which of the following strategies might indicate your efforts to assist these staff members with acculturation to your unit? a. Analyze a recent situation with them in which an order with a physician was not clarified and explore their beliefs about nurse-physician relationships. b. Expect them to behave in ways that are expected of staff who have grown up and been educated in the United States. c. Stress to these new staff that your unit is a "family" and that staff members take pride in saying that they are from Unit 4. d. Recognize that culture develops over time and leave them alone to figure out differences between their culture and that of the unit.

A

Because an increasing number of Hispanic patients are being admitted, a nurse manager designs a staff-development program to help her staff understand the Hispanic culture. A nurse should understand that culture is determined by which of the following? a. Behaviorb. Love for peoplec. Shared visiond. Genetic predisposition

A

During a unit meeting, you notice that Vivian listens attentively when Mary is speaking and offers support and advice when Mary presents ideas to the group. You are surprised because Vivian has often confided that she does not like Mary. Vivian's behavior is best described as: a. Insincereb. Networkingc. Politically sophisticated d. Collegial

d. Collegial Collegial behavior requires respect, not friendship

According to Leininger, "cultural imposition" is a major concern in nursing because nurses have a tendency to impose their values, beliefs, and practices on patients of other cultures. The discussion topic most likely to be without cultural imposition would be: a. Abortion b. Wound management c. Blood transfusion d. Advance directives

B

During performance appraisal, you praise Xia for her attention and care to nursing details. You suggest that her care would be further enhanced by greater acknowledgment of patients' feelings. Xia bursts into tears and leaves the office. Later, you learn that criticism is perceived as akin to failure in Xia's culture. You reflect on how you could modify your approach in the future to acknowledge different cultural interpretations of feedback. Your response is indicative of: a. Bias.b. Cultural awareness.c. Cultural diversity.d. Ethnocentricity.

B

As a nurse manager, you have been asked to be part of a design team for health services that have vertical integration. In planning for these services, your team will design a proposal that will: A) cluster like services together, such as outpatient clinics for the care of children with various developmental and medical needs.B) plan for the smooth transition of patients from the emergency services department to other units in the hospital.C) ensure that funding follows the patient from acute care to long-term care services.D) bring together acute care, ambulatory, home care, and palliative care services for the management of patients diagnosed with cancer.

D) bring together acute care, ambulatory, home care, & palliative care services for the management of pts diagnosed with cancer When organizations align to provide a full array or continuum of services, the arrangement is referred to as vertical integration. Benefits attributed to vertical integration include enhanced coordination of services, efficiency, and customer services.

"Power in nursing" refers to the nurse's ability to: A) protest unfair working conditions through walkouts and strikes. B) demonstrate knowledge about organizational behavior. C) act on issues that influence nursing licensure but not patient care. D) use one's influence to create change in pursuit of goals.

D) use one's influence to create change in pursuit of goals Power is the use of one's influence. Nurses use power to create change related to their goals for patient care, organizational effectiveness, development of the profession of nursing, access to health care for the nation, and other arenas or issues that involve nurses.

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

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

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

a) Baccalaureate Bc of the breadth of nursing knowledge required, baccalaureate education is preferred for primary nurses.

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

a) Case method The case method may involve total pt care provided by a RN, which, in today's costly healthcare economy, is very expensive. In times of nursing shortages, there may not be enough resources or nurses to use this model.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

To maintain patient safety, studies suggest that scheduling should avoid: a. Rotating shiftsb. Weekendsc. 8-hour shiftsd. Mandatory overtime

a. Rotating shifts Rotating shifts & overtime past 12 hours are shown to increase nurse error & jeopardize pt safety

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

b. 85% Occupancy (%) = daily pt count / # of beds on unit [34/40, or 85%]

To project staffing needs & avoid understaffing, it is important that nurse managers consider which of the following? a. Maximum productive hoursb. Average non-productive hoursc. Minimum benefit hoursd. Maximum vacation time

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

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

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

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

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

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

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

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

b. Participate in databases that compare the outcomes and staffing levels versus those of institutions similar to yours Staff morale suffers both when acuity models indicate a gap between staffing and acuity and when there is no model but perceived acuity that is not being addressed. A truer approach is to monitor patient outcomes and participate in national databases that measure staffing levels through comparison with like institutions.

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

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

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

b. Trends in acuity on the unit Acuity levels are determined through classification systems, which determine the nursing resources required.

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

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

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

c. Combines interventions and time required for interventions to determine levels of care required A factor evaluation system considers tasks, thought processes, and patient care activities and gives them a time or rating. These are then used to determine the number of patient care hours required.

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

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

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

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

To prepare staffing schedules, a nurse manager needs to calculate paid nonproductive time. When calculating paid nonproductive time, the nurse manager considers: a. Work time, educational time, and holiday time. b. Paid hours minus worked hours. c. Vacation time, holiday time, and sick time. d. Paid hours minus meeting time.

c. Vacation time, holiday time, & sick time Nonproductive hours = hours of benefit time (include vacation, holiday, & personal/sick time)

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

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

A strategy to increase RN staff retention at Valley Hospital includes: a. Better compensation and benefitsb. Clearer position descriptionsc. Lay-offs of nursing assistantsd. Adequate staffing to meet acuity levels

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

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

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

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

d. Department of Health licensing standards Licensing regulations of the state can determine staffing models. Staffing regulations can dictate the number of professional nurses required on a unit at any given time.

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

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

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

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

As a manager, you are responsible for two separate units: a CCU and a cardiac step-down unit. The organization and relationships on these units are distinct and very different from one another. Your decision has been to support the uniqueness of these units because each is effective in different ways in providing patient care. This approach is consistent with which principle? a. Transculturalismb. Cross-culturalismc. Multiculturalismd. Acculturation

C

One of the staff nurses on your unit makes the comment, "All this time I thought Mary was black. She says she is Jamaican." The best response would be to say: a. "Who cares what she is?"b. "What did you think when you learned she was Jamaican?"c. "Why did you assume she was black?"d. "We have never had a Jamaican on this unit."

B

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? a. Intrapersonalb. Interpersonalc. Organizationald. Professional

a. Intrapersonal Intrapersonal conflict occurs within a person when confronted with the need to think or act in a way that seems at odds with that person's sense of self. Questions often arise that create a conflict over priorities, ethical standards, and values. Some issues present a conflict over comfortably maintaining the status quo and taking risks to confront people when needed, which can lead to interpersonal conflict.

A facility that provides care for patients whose average length of stay is less than 30 days and to patients whose average length of stay is longer than 30 days, and who require inpatient and ambulatory care for addictions, through a spectrum of wellness and illness services and providers, would be considered: a. A healthcare networkb. A tertiary care institutionc. Rehabilitatived. Long-term care

a. A healthcare network Healthcare networks embrace and provide wellness and illness services, including primary, secondary, and tertiary care, through a network of providers.

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

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

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

b) significant changes in the physical structure of units This particular model includes a focus on patient care that includes multidisciplinary teams & assistants at the bedside. Services, including laboratories & pharmacies, are decentralized to bring them closer to where care is delivered

The institution where you are a nurse manager has resisted the adoption of a new document management software, citing cost as a concern. You meet with other nurse managers who are in favor of the software and prepare a proposal to take to the senior executive with the goal of persuading the executive to adopt the software. This is an example of: a. Collaborationb. A coalitionc. Networkingd. Policy building

b. A coalition The formation of temporary groups to achieve particular goals involves the development of coalitions.

As a nurse manager, you have been offered a position at a Veterans Administration hospital. In accepting the position, it is important for you to understand that veterans' hospitals provide: a. Primary care and are privately fundedb. A range of services and are responsible to government and taxpayersc. Secondary care only and are publicly administered and fundedd. Services to veterans under an HMO

b. A range of services and are responsible to government & taxpayers Veterans Administration hospitals provide a range of services to Veterans and are responsible to government and thus to taxpayers, who support the hospitals.

As a new manager in the ED, you meet with each of the staff to ask about their priorities and what they think is going well in the department or what is of concern to them. Almost all of the staff express frustration & distress at being treated rudely or disrespectfully by pts, staff from other departments, and physicians and complain that they feel that nurses in the ED are not valued. With the staff, you brainstorm to raise the profile of nurses. Which of the following strategies would be most effective? (select all that apply) a. Requesting increased compensation b. Speaking positively about one's work c. Dressing and grooming in a clean and neat manner d. Using titles (e.g., Mr., Mrs., Ms.) and last namese. Submitting a written complaint to senior administration regarding rude behaviors f. Developing a code of conduct for the ED staff.

b. Speaking positively about one's work c. Dressing and grooming in a clean and neat manner d. Using titles (e.g., Mr., Mrs., Ms.) and last names f. Developing a code of conduct for the ED staff Demonstrating a positive and professional attitude about being a nurse to nursing colleagues, patients and their families, other colleagues in the workplace, and the public facilitates the exercise of power among colleagues while educating others about nurses and nursing. A powerful image is an important aspect of demonstrating this positive professional attitude and includes how we identify ourselves, how we dress, whether we are punctual for commitments, and whether we speak positively about our work. Bullying and incivility are negative expressions of power that can affect patient outcomes. The Joint Commission standard demands that leaders ensure that a code of conduct is implemented to ensure patient safety and a culture of quality.

Susan, an RN in the ED, would like to pursue leadership roles in her career. She is frustrated that others in her working environment seem to pay little attention to her creative ideas or place her in informal leadership positions. As her colleague, you want to provide her with helpful feedback. Which of the following statements will provide feedback as to how she might communicate power and demonstrate that she is capable of handling other leadership responsibilities? a. "I find your soft voice and manners very reassuring and calming to patients." b. "Try using a wider vocabulary and big words so that people will think that you are knowledgeable." c. "At times, you tend to slump and avoid eye contact when you are talking with colleagues and families." d. "Don't worry about what others think of you. If you feel like saying something, say it, even if it hurts other people's feelings."

c. "At times, you tend to slump and avoid eye contact when you are talking with colleagues and families A powerful image comes from thinking of oneself as powerful and effective, and this is communicated through posture, maintaining eye contact, treating others with courtesy and respect, and using a firm, confident voice with vocabulary that is appropriate (which does not necessarily involve using big-sounding words)

Mrs. Hill, aged 68, was hospitalized after a stroke. The speech therapist recommended that oral feeding be stopped because of her dysplasia. 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? a. Frustrationb. Conceptualizingc. Actiond. Outcomes

c. Action By walking away, the nurse is engaged in an action or a behavioral response, which is the action stage of conflict that is outlined in the four stages of conflict (Thomas, 1992). In this stage, the nurse might have used more effective strategies, such as clarifying Mr. Hill's views on feeding his wife and engaging in dialogue with Mr. Hill to clarify his concerns and attempt to reach a common goal.

Healthcare organization XYZ provides women's health services on an inpatient basis (average stay of less than 30 days). This facility would likely be considered: a. Primary care, specializedb. Tertiary care, long-termc. Acute care, specializedd. Public care, specialized

c. Acute care, specialized The AHA defines an acute care hospital as a facility in which the average length of stay is less than 30 days. Because of the focus on women's health services, it would also be considered specialized.

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

d) prevent additional hospitalizations resulting from complications of the client's disease The goals and outcomes established in a critical pathway are designed to support the aims of case management, which are shortened hospital stays and prevention of hospital readmissions.

Which of the following would be the most appropriate mission statement for a nursing center? a. "At Plentyville, we provide rehabilitative services for addicted adolescents." b. "Georgiatown provides treatment and prevention services for county residents." c. "At Heart, our aim is to provide services that lead the nation in health education and research." d. "At Coeur, we strive to achieve optimal pain management with patients who are experiencing chronic pain."

d. "At Coeur, we strive to achieve optimal pain management with patients who are experiencing chronic pain" The mission statements of nursing centers are oriented toward achieving optimal health status for a defined group of patients or consumers rather than being treatment or maintenance or social-support oriented.

At Orangetown Hospital, the nursing department is developing a mission statement for nursing. Which would be a suitable mission statement? a. "Nursing provides services for patients admitted to Orangetown Hospital." b. "To participate fully in the professional services offered by Orangetown Hospital." c. "To lead by the lamp; services for seniors." d. "At Orangetown, the nursing department provides caring services that recognize the diversity of clients and promote optimal health with clients through partnership, education, and interprofessional collaboration."

d. "At Orangetown, the nursing department provides caring services that recognize the diversity of clients and promote optimal health with clients through partnership, education, and interprofessional collaboration" A nursing mission statement within an organization needs to establish the reason for nursing within the organization and lays out relationships with clients, the community, and other disciplines.

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

d. Number of RNs and number of RNs with experience on the unit Studies show that adverse events such as falls & pressure ulcers can be reduced by increasing the number of RNs on a unit (relative to other personnel) and utilizing experienced RNs. Overtime and 12-hour shifts are linked to greater incidence of errors.

Lucy, head nurse on the surgical unit, works with her staff to find ways in which they can work together with other disciplines to provide more effective care for patients on the unit. Lucy likely knows her power is: a. Limited, thereby necessitating involvement of others in implementing ideas.b. Restricted, which necessitates finding alternative means to achieve strong patient outcomes.c. Directed primarily toward those who are subordinate to her.d. Of unlimited capacity when shared with others.

d. Of unlimited capacity when shared with others Those like Lucy, who share power, tend to be the strong collaborators and see power as an unlimited quantity when shared. Empowered nurses make professional practice possible, creating a culture that satisfies all nurses.

Which of the following is an example of an HMO? a. Nurse practitioners are paid promptly at discounted fees for each service rendered at a women's health clinic.b. Physicians in a large urban center are reimbursed for visits made to their clients.c. Physicians are paid for each service delivered to enrolled patients through a prepaid plan.d. Patients pay fixed annual fees for ambulatory care services, regardless of actual utilization of health services.

d. Patients pay fixed annual fees for ambulatory care services, regardless of actual utilization of health services Fee-for-service systems provide compensation to healthcare providers in group practices based on fee-for-service, which in PPQs means that fees are paid promptly but at a discounted rate. HMOs are configurations of healthcare agencies that provide health maintenance and services for enrolled patients for a fee that is preestablished regardless of utilization of service.