Leadership exam 2 part 2 (ch. 13 rest, 14,16,17)

Mandatory minimum staffing ratios are being considered in the jurisdiction where a nurse-manager works. Based on experiences of other states, the nurse should identify what possible result of this legislation? a. There may be a backlash from clients and families. b. Predicted cost savings may take many years to realize. c. Health-care organizations may be more reluctant to hire new graduates. d. Increased numbers of staff may not necessarily improve client care.

D Feedback: Critics of mandatory staffing ratios identify the fact that increased numbers of staff do not necessarily translate into improved care. Legislation of this type tends to be supported by clients and families and it is recognized that this increases staffing costs. Mandatory staffing ratios have not been noted to reduce new graduates' employment opportunities.

The nurse-manager is developing an educational program for an organization. What action should the manager perform first? a. Identifying the facilities available to meet the needs b. Identifying the desired skills or knowledge the staff should have c. Explaining to the team the benefits that will result from the program d. Assessing the staff who is willing to learn new skills

B Feedback: Identifying the desired skills or knowledge the staff should have is the first step in developing an educational program. Although the other options are relevant, they should be done after the requisite skills and knowledge are identified.

What is the most fiscally responsible method for determining staffing needs for a hospital unit? a. Maximum patient load capacity of the unit b. Numbers of patients present for an upcoming shift c. An agreed-upon staffing formula based on client acuity d. Total beds on the unit

C Feedback: A staffing formula is the best way to determine staffing needs, provided it is based on an accurate patient classification system (PCS). A robust formula considers the other variables listed, none of which can be used in isolation to determine staffing needs accurately.

What was the first generational work group that tended to value work hour flexibility and opportunities for time off? a. Veteran generation b. Baby boomer c. Generation X d. Generation Y

C Feedback: Generation Xers may lack the interest in lifetime employment at one place that prior generations have valued, instead valuing greater work hour flexibility and opportunities for time off.

What is the emphasis for the manager in the coaching role? a. Solving problems for the employee b. Showing employees how to work within the system c. Helping employees reach an optimum level of performance d. Redirecting employees to meet organizational goals

C Feedback: In coaching, the emphasis is on assisting the employee to recognize greater options, to clarify statements, and to grow. The other options are focused on doing for the learner rather than encouraging the learner to do for themselves

An experienced nurse has accepted a half-time management position on the unit. As well, the nurse works half-time providing direct client care on the unit. This nurse's immediate supervisor should identify the nurse's risk of: a. exhaustion. b. negative sanctions. c. role overload. d. role ambiguity

D Feedback: A nurse who provides client care half of the time and who is in a management role half of the time will have a high risk for role ambiguity. These simultaneous and dual roles may or may not lead to exhaustion and role overload, depending on the number of responsibilities. Role ambiguity does not necessarily lead to negative sanctions.

A hospital unit has an exceptionally high census for several weeks and mandatory overtime is being routinely required. What is the priority consequence of this practice? a. Ethics violations b. Increased continuity of care c. Temporary cost savings d. Decreased client safety

D Feedback: Frequent use of overtime creates a safety risk because exhausted nurses are much more likely to commit and error. This practice is costly but does not have a major bearing on continuity of care. Ethics violations can occur in any staffing situation and are not necessarily more common when overtime is used.

The integrated leader-manager has recognized a need to promote evidence-based practice on the unit. What action is most appropriate? a. Requiring staff to research the evidence base for each of their nursing actions b. Supporting staff who are trying to change old practices that are not evidence-based c. Implementing the principles of andragogy whenever possible d. Expanding the role of mentors within the organization

: B Feedback: Organizational cultures often do not support the nurse who seeks out and uses research to change long-standing practices rooted in tradition. The leader-manager must support efforts to change practices. It is impractical and unrealistic to expect nurses to research every action they perform. Mentorship and andragogy affect socialization and education on a unit, but are not directly related to implementation of EBP

A patient who has just been diagnosed with lung cancer has been assigned a nurse navigator. What task should the nurse prioritize in this role? a. Providing evidence-based guidance on treatment options and treatment decisions b. Providing clinical leadership and ensuring quality for the patient's care c. Guiding the patient in an effort to provide high-quality managed care d. Guiding the patient and family through their various interactions with the health-care system

: D Feedback: The primary role of a nurse navigator is to help the patient and the family navigate the complex health-care system by providing information and support. The navigator would not provide direct guidance on choosing treatment options, which are normally beyond the nurse's scope of practice. Clinical leadership is the role of the clinical nurse-leader. The role of the nurse navigator is not synonymous with managed care.

The manager of a hospital unit is frustrated that the centralized staffing department does not understand the unique staffing needs of the unit. What is the manager's best action? a. Advocate for a change to decentralized staffing. b. Introduce a self-scheduling system. c. Temporarily increase the use of agency nurses. d. Increase the use of overtime to meet the unit's staffing needs

A Feedback: Advantages of decentralized staffing are that the unit manager understands the needs of the unit and staff intimately, which leads to the increased likelihood that sound staffing decisions will be made. The increased use of overtime and agency nurses should not be considered as long-term solutions due to cost. A self-scheduling system is unlikely to address the fact that the centralized staffing department does not understand the unit's needs.

A nurse-manager has organized a 1-day workshop that is open to all the staff members on the unit. What characteristic of the workshop would most clearly suggest that it is an educational workshop rather than a training workshop? a. The workshop is focused on the broad intellectual development of the participants. b. Participants will be able to apply the material from the workshop immediately after completing it. c. The workshop provides skills for performing a specific task. d. The workshop specifically addresses a common deficiency in the work performance of participants.

A Feedback: Although training has an immediate use for a specific task or function, education is designed to develop the person in a broader sense. The results of training can often be applied more immediately.

The majority of patients whose care is organized by case management have contact with the health-care system in what acute care setting? a. Emergency department b. Ambulatory clinics c. Primary care provider offices d. Perioperative settings

A Feedback: Because 50% to 80% of admissions in most hospitals enter via th

A nurse-manager has recently learned that the health-care facility will be moving toward a case management approach. What factor is most likely driving this change? a. The need to address cost-effective options for care b. The need to provide challenging work for nurses and other members of the care team c. The need to enhance professionalism throughout the organization d. The need to obtain magnet designation

A Feedback: Case management addresses each client individually, identifying the most cost-effective providers, treatments, and care settings possible. It is not an explicit requirement of magnet designation and it is not primarily motivated by a need to stimulate nurses or increase professionalism

What is the primary focus of case management in prioritizing client care? a. Assessing each client's needs individually b. Minimizing costs to the organization c. Minimizing costs to the patient d. Applying the principles of team nursing

A Feedback: Case management is largely dependent on individualized assessments of each patient's specific needs. The patient's needs supersede costs, even though cost containment is an important consideration. Case nursing does not necessarily entail a team nursing care delivery model.

Which action by the nurse-leader best demonstrates the leadership role to the socialization and education of new nursing staff during their orientation? a. Discusses organizational values and unit culture b. Addresses all questions regarding the responsibilities of the RN c. Schedules orientation sessions at times when client acuity is at its lowest d. Applies sanctions appropriately so new staff become socialized

A Feedback: Discussing organizational values and unit culture is primarily a leadership responsibility; the remaining options are appropriate management responsibilities

It is 2 PM and the nurse-manager is calculating the nursing care hours for the 3 to 11 PM shift. There are three RNs, three nursing assistants, and one ward clerk scheduled and there are 22 clients with the following acuity and nursing care hours allotted for the evening shift: Category I, 4 clients at 2.0 hours Category II, 2 clients at 2.3 hours Category III, 10 clients at 2.8 hours Category IV, 6 clients at 3.4 hours What are the needed hours of nursing care? a. 61 hours b. 52.6 hours c. 68.4 hours d. 48.4 hours

A Feedback: Four category I clients require 8 hours of care; 2 category II clients require 4.6 hours of care; 10 category III clients require 28 hours; 6 category IV clients require 20.4 hours; total nursing care hours equal 61.

A group of nurses have formed an action group that has the goal of increasing professional power of the nursing profession. What strategy should the group adopt? a. Seek formal positions where members can influence public policy. b. Make a formal commitment to providing family-centered care. c. Increase interactions with recent nursing students and recent nursing graduates. d. Ask clients and families to publicize the high-quality care they have received.

A Feedback: Increasing professional power in nursing requires the placement of more nurses in influential positions of public policy. Family-centered care ensures good outcomes for clients but does not necessarily translate into enhanced professional power. Similarly, engagement with students and recent graduates reduces attrition but does not necessarily increase the profession's power. It is ethically questionable to ask clients to publicize the care they receive, and this obligation should not be placed on clients and families.

A nurse can directly address one of the Institute of Medicine's recommendations to improve practice environment by: a. facilitating open communication and shared decision making. b. advocating for caps on the maximum allowable nurse-patient ratio. c. adopting a functional nursing model whenever the setting allows. d. becoming a nurse navigator who is centered on patients' needs.

A Feedback: Interdisciplinary teamwork is accomplished through interdependent collaboration, open communication, and shared decision making. The Institutes of Medicine future of nursing has expand opportunities for nurses to lead and diffuse collaborative improvement efforts with physicians and other members of the health-care team to improve practice environments.

The nurses and managers of a clinic have agreed on a commitment to becoming a learning organization. What change in practice would suggest progress toward this goal? a. Recognizing that mistakes are an inevitable part of the learning process b. Exclusively hiring RNs with baccalaureate degrees c. Encouraging a variety of individual visions among the nursing staff d. Stressing the need for individual learning

A Feedback: Learning organizations have a shared vision and promote team learning. A common feature of learning organizations is their tolerance for mistakes as an inevitable part of the learning process. An organization does not need to limit itself to baccalaureate educated nurses in order to be a learning organization

A nurse with more than 15 years of experience in an adult medical setting has just transitioned to a job in the day surgery department. What should the manager of this department do to aid the resocialization of this experienced nurse? a. Avoid making assumptions about the nurse's ability to perform the job roles. b. Encourage the nurse to mentor new graduates as a gesture of respect for the nurse's experience. c. Emphasize the importance of evidence-based practice in the culture of the unit. d. Arrange for a nurse residency to help the nurse transition to a new site.

A Feedback: Managers must avoid making assumptions about an experienced nurse's ability to transition to a new location with new roles. It would be premature to assign a mentorship role to the nurse while he or she is in this transition period. Emphasizing EBP is important, but this action does not ease the nurse's resocialization. Nurse residencies are normally provided to new graduates, not experienced nurses who are changing sites.

A large health-care organization is reconsidering the model of patient care delivery. What factor should be prioritized in this decision? a. Patient needs b. Staff expertise c. Cost d. Physical layout of the facility

A Feedback: Many factors need to be considered when a change in care delivery is being selected. Central among these, however, is the interests of patients. Costs, staffing, and facilities must be considered, but the needs of patients are paramount.

The emergency room nurse is assessing a patient who has presented with an exacerbation of recently diagnosed irritable bowel syndrome. The patient states that he is "overwhelmed" and "bewildered" by the mix of diagnostic tests, appointments, and consultations since he was diagnosed. What is the nurse's best action? a. Acknowledge the difficulty of the patient's circumstances and arrange for a nurse navigator. b. Validate the patient's concerns and liaise with the clinical nurse-leader (CNL). c. Offer to mediate between the patient and the case manager. d. Offer to accompany the patient to any upcoming appointments

A Feedback: Nurse navigators help patients and families navigate the complex health-care system by providing information and support. It would not be possible for the ED nurse to perform this role on an ad hoc basis. A CNL focuses on quality of care in a specific setting and less on helping patients navigate the larger health-care system. Offering to mediate between the patient and the case manager does not address the patient's expressed concern

A new manager is confused why nurses are not heeding her directions in the workplace. What strategy is most appropriate when attempting to resolve this problem? a. Assure the nurses that she has their best interests in mind. b. Ignore the issue and reintroduce the directions in 6 to 8 weeks. c. Hold a meeting to remind staff that they are under the manager's authority. d. Bring in an outside consultant to have one-on-one conversations with staff.

A Feedback: One effective strategy for bridging the authority-power gap is to assure subordinates that the manager cares about them and has their best interests in mind. It would be inappropriate to ignore this issue, and overt displays of authority should be avoided whenever possible. Bringing in an outside consultant would be considered an action of last resort and is not a usual response to the authority-power gap.

Primary care nursing is organized so that the patient is at the center of the structure. How many nurses have 24-hour responsibility for care planning and coordination for the patient? a. One b. Two c. Three d. Four

A Feedback: Primary care nursing is organized so that the patient is at the center of the structure. One nurse has 24-hour responsibility for care planning and coordination.

Before starting an educational session, the nurse-manager has determined that participants possess readiness to learn. What does this imply about the participants? a. They have acquired the skills necessary for what is to be learned. b. They are motivated to learn the necessary material. c. The participants are contributing to a positive atmosphere. d. The participants are mature individuals with much experience.

A Feedback: Readiness means that the individual has the prerequisites to move to the next stage of learning. The prerequisites could be behavior or prior learning. This is not synonymous with motivation to learn, which involves "buy in" to the benefits of learning. A positive atmosphere does not necessarily mean that there is readiness to learn. Maturity and experience are components of adult learning theory but not necessarily a readiness to learn.

A nurse at a community health clinic has no formal position of authority but exercises great influence over staff because many of them perceive the nurse as being powerful. What type of power does this nurse possess? a. Referent power b. Legitimate power c. Personality power d. Coercive power

A Feedback: Referent power exists because others perceive a person as powerful, even if that person does not possess formal authority. Coercive power is based on the threat of punishment. This nurse lacks legitimate (position) power and there is not a category of "personality power."

What is a leadership role associated with staffing and scheduling? a. Role models the use of evidence in making appropriate staffing and scheduling decisions b. Uses patient classification tools to minimize understaffing c. Periodically examines the unit standard of productivity to determine if changes are needed d. Evaluates scheduling and staffing procedures and policies on a regular basis

A Feedback: Role modeling is classified as a leadership responsibility. The other options are recognized management responsibilities associated with staffing and scheduling.

A self-scheduling system has been proposed at a health-care facility. What potential benefit of this system should the manager recognize? a. Self-scheduling increases employees' autonomy over their work lives. b. The manager no longer has to participate directly in staff scheduling. c. Self-scheduling ensures an equitable distribution of benefits to employees who participate. d. Self-scheduling can be more easily implemented and sustained than other alternative systems

A Feedback: Self-scheduling can increase worker satisfaction by giving employees more control over their work life. This form of scheduling does not absolve the manager from participation, and there is a possibility that the advantages and disadvantages may be distributed unequally. This system is challenging to implement effectively and fairly.

The nurse-manager can begin to promote the needs of a culturally diverse staff by: a. viewing diversity as an opportunity rather than a threat. b. clustering staff members according to their culture whenever possible. c. focusing educational activities on the needs of staff from minority groups. d. adopting a neutral teaching style that is equally accessible to all cultures.

A Feedback: The nurse-manager should aim to see diversity as an opportunity that can be leveraged rather than a problem that must be managed. There is no such thing as "neutral" practice that is devoid of cultural content. Clustering staff by culture likely reinforces differences and separation. The manager should aim to meet the needs of all staff, not only those from minority backgrounds

A nurse-manager's immediate supervisor is a member of the veteran generation. What generational characteristic is the supervisor most likely to possess? a. Strong loyalty to the employer b. A high value on workplace flexibility c. High individualism d. Social consciousness

A Feedback: The veteran generation is typically recognized as those nurses born between 1925 and 1942. Members of this generation are often noted to possess a high level of loyalty to employers. Flexibility was valued more by subsequent generations. Individualism is noted as a particular characteristic of later generations, and social consciousness is associated with millennials.

An experienced registered nurse has begun a position as a clinical nurse-leader (CNL). In this role, what tasks should the nurse perform? Select all that apply. a. Collaborating with the interdisciplinary team b. Guiding patients and families through the health-care system at various sites c. Coaching nurses to provide evidence-based care d. Introducing quality improvement initiatives e. Preceptoring senior nursing students

A, C, D Feedback: The CNL role involves close collaboration with the interdisciplinary care team, leading nurses on the unit to ensure high-quality care and introducing quality improvement measures. Guiding patients and families through the health-care system at various sites is more congruent with a nurse navigator role. A CNL focuses on high-level leadership at the clinical site and would be less likely to be a preceptor because that role focuses on direct patient care.

A nurse-manager's interactions with a staff member suggest that the person is experiencing difficulties with resocialization. What potential causes should the manager consider? Select all that apply. a. Role ambiguity b. Lack of a dedicated coach, mentor, and preceptor simultaneously c. Inability to meet job demands d. Role overload e. Lack of motivation

A, C, D, E Feedback: Difficulties with resocialization usually center on unclear role expectations (role ambiguity), an inability to meet job demands, or deficiencies in motivation. Role strain and role overload contribute to the problem. Individuals do not normally have an assigned mentor, coach, and preceptor at the same time.

New mechanical lifts for client transfers are being introduced at a health-care facility. The manager plans to implement the principles of social learning theory in the necessary training. What actions should the manager facilitate? Select all that apply. a. Having an expert demonstrate the correct use of the mechanical lift b. Uploading a video for staff to watch on their own time c. Providing opportunities for hands-on practice d. Distributing an information packet to staff 1 week before education sessions e. Encouraging staff to work in groups during education sessions

A, C, E Feedback: Key components of social learning theory include group work, demonstration (modeling), and hands-on practice. Written information and online materials that learners complete on their own would be less indicative of social learning theory, even though they may benefit some learners.

A nurse-manager has begun in a new position and has quickly perceived that the nurses in the organization need to be empowered. How can the nurse empower the nurses? Select all that apply. a. Role model the way that an empowered nurse behaves. b. Delegate as many management tasks as possible. c. Minimize the amount of scrutiny and supervision that the manager provides. d. Teach nurses strategies for increasing their personal power. e. Seek nurses' input into proposed changes.

A, D, E Feedback: Strategies for empowering employees include teaching them about building their personal power, seeking their input in decision making, and role modeling what empowerment looks like. Empowerment does not entail excessive delegation or failing to give sufficient oversight to the care that nurses provide

The manager has been experiencing challenges working with a nurse who has a history of making unsympathetic comments about clients to other nurses. The manager has tried various strategies for changing the nurse's behavior with little effect. The manager feels that an application of coercive power is now appropriate. What action will the manager most likely take? a. Change the nurse's client care assignment. b. Implement disciplinary action. c. Offer sensitivity training to the nurse. d. Dialogue with the nurse about the effects of these comments

B Feedback: Coercive power is based on fear and punishment. Workplace discipline could be an example of this type of power. Coercive power foregoes more collaborative and indirect methods of changing behavior, such as training, dialoguing, or changing the nurse's work assignment

New intravenous pumps are being introduced in a health-care organization. How can educators best implement social learning theory into the necessary education and training? a. Encouraging each learner to give feedback about other learners' performance b. Demonstrating the use of the pump to groups of learners and then letting them practice c. Organizing an informal teaching session that allows learners to socialize with each other d. Maximizing the size of the group that attends each teaching session

B Feedback: Demonstration and practice in a group setting is central to social learning theory. This may or may not involve extensive feedback between participants. This theory does not imply casual learning and an emphasis on socialization. Social learning theory does not mandate a large size for the group.

Which statement demonstrates an intervention focused on the primary disadvantage of team nursing? a. "We are working with one fewer team member today." b. "The team will be meeting for a care report update in 5 minutes." c. "Our patient assignment is comprised of both males and females." d. "We will be having a member of the float pool on our team today."

B Feedback: Disadvantages to team nursing are associated primarily with improper implementation rather than with the philosophy itself. Frequently, insufficient time is allowed for team care planning and communication. This can lead to blurred lines of responsibility, errors, and fragmented patient care. None of the other options address a known disadvantage of team nursing.

Which patient would be most likely to benefit from a disease management approach within the context of case management? a. A client who is being treated for a ruptured tympanic membrane b. A client who has chronic obstructive pulmonary disease (COPD) c. A client who has been diagnosed with a postpartum hemorrhage (PPH) d. A client being treated for a transfusion reaction after receiving packed red blood cells

B Feedback: Disease management is most often focused on the management of long-term, chronic diseases rather than acute health problems

A nurse has accepted a position as a staff nurse and will practice primary care nursing. The nurse will be the only RN on the team. What is an appropriate role expectation for role fulfillment? a. Planning nursing care independently of others b. Assigning work according to the expertise of group members c. Being responsible for care planning only during the shift when he or she works d. Carrying out the majority of personal care for assigned patients

B Feedback: In the primary nursing, during work hours, the primary nurse provides total direct care for that client. When the primary nurse is not on duty, associate nurses, who follow the care plan established by the primary nurse, provide care. In primary nursing, the sole RN would not plan the care without others' input. The nurse is responsible for care planning for 24 hours per day. The RN leads the planning of care but may not carry out the majority of personal care.

A new nurse-manager has set a goal of building a personal power base. What strategy should the manager choose? a. Exercise overt displays of power to subordinates whenever possible. b. Seek to become highly visible in the organization. c. Take every opportunity to collaborate with physicians. d. Initiate dialogues with colleagues about the relationship between gender and power.

B Feedback: Increasing visibility and voice is a key strategy for managers who wish to expand their power base. Overt displays of power should be avoided whenever possible. Collaboration at all levels is beneficial, but there is no reason to prioritize collaboration with physicians in particular. Talking about gender and power with colleagues is not likely to cause an increase in the manager's power base.

The manager overheard an experienced nurse say to a new nurse, "Sorry you won't be able to join us for our weekly get-together at the yogurt shop. I see you are going to be here charting for a while yet." How should the manager best interpret this nurse's statement? a. The experienced nurse's positive sanction has the ability to affect the new nurse's behavior. b. The experienced nurse has applied a negative sanction regarding group norms. c. The experienced nurse is giving constructive feedback about expected group norms. d. Desired behavior is being role modeled for the new nurse.

B Feedback: Negative sanctions provide cues that enable people to evaluate their performance and modify behavior when needed. In this case, the experienced nurse is letting the new nurse know that the group's weekly outing is important, and on that day the staff makes sure they finish their work on time. Missing out on the social event is a form of negative, not positive, sanction. The experienced nurse is not overtly providing feedback or modeling a different behavior.

A nurse-manager has been overseeing the care at a clinic for several weeks and has noted that staff members are reluctant to follow instructions. How should the manager attempt to resolve this problem? a. Consult with the person who previously managed the clinic. b. Make more of an effort to get to know each of the employees individually. c. Reduce expectations on the employees in order to improve compliance. d. Remind the nurse about their obligation to follow standards of practice.

B Feedback: One way for a leader to bridge the authority-power gap is to make a genuine effort to know and care about each subordinate as a unique individual. It is unlikely that the ex-manager will be able to solve this problem for the new manager. Reducing expectations sets a dangerous precedent of acquiescing to the employees' reluctance to follow. Standards of practice do not address specific areas of followership

Which statement best demonstrates understanding of the concept of knowledge of results? a. "These are the goals for today's lecture." b. "Today you clearly demonstrated an understanding of client focused care." c. "As RNs on this unit, you will need to be proficient in assessing for depression." d. "There will be a short quiz on today's material at the end of the session."

B Feedback: Research has demonstrated that people learn faster when they are informed of their progress. The knowledge of results must be automatic, immediate, and meaningful to the task at hand. People need to experience a feeling of progress, and they need to know how they are doing when measured against expected outcomes. The other options failed to demonstrate an understanding of that need.

A clinical site has a diverse skill mix that includes registered nurses, practical nurses, and UAPs. Senior management is proposing a shift from team nursing to primary nursing. What effect will the skills mix have on this transition? a. Implementation of primary nursing will likely require hiring more UAPs and laying off some RNs. b. Implementation of primary nursing will likely require hiring more RNs, and laying off some UAPs. c. With adequate resources, primary nursing can be successfully implemented with the existing skills mix. d. Primary nursing is most successful if every member of the team providing direct patient care is an RN.

B Feedback: Shifting from a team approach to a primary care nursing approach would typically necessitate an increased number of licensed RNs and a reduction in UAP.

What goal should the nurse-manager prioritize when organizing staffing and scheduling? a. Schedule staff so there is a minimum of overtime. b. Ensure that there is adequate staff to meet the needs of each client. c. Develop trust in staff by seeing that staffing is carried out in a fair manner. d. Ensure that staff members achieve a healthy work-life balance.

B Feedback: The manager is tasked with seeing that client care needs are met first and foremost. Although the other options are relevant and appropriate, they are not the priority goal of the manager.

A nurse-manager is part of a committee that has been commissioned to change the care delivery model at a health-care facility. When planning this change, the nurse and the other committee members should be aware that this process will: a. be difficult to implement without hiring staff who have experience with the new model. b. affect social relationships and group functioning in the workforce. c. require equal input from every staff member during the planning stage. d. be best conducted by objective consultants from outside the organization.

B Feedback: The nurse-leader-manager needs to be aware that redesigning work that disrupts group cohesiveness may result in increased levels of job dissatisfaction. Reorganizing care does not necessarily require individuals from outside the organization. Often, the existing staff and skills mix can be used to implement a change; hiring may not be necessary. Input from staff and other stakeholders should be sought, but it is unrealistic to expect equal input from everyone.

A nurse-manager is working with a team of colleagues to update the organization's staffing and scheduling policies. What principle should the manager follow during this process? a. It is more important to communicate policies verbally than in writing. b. Policies should be written in a way that allows some flexibility. c. Each employee should be given the right to opt into the type of system that he or she wishes. d. Each unit manager should be granted full control over scheduling and staffing.

B Feedback: To retain employees, the staffing policies must allow some flexibility, which could include job sharing, flextime, a part-time staffing pool for weekends, or allowing employees to exchange hours of work among themselves. Policies must be written, not only verbal. Having individual employees adopt different systems would result in chaos. Even in a decentralized system, individual managers do not have absolute autonomy of staffing issues.

What term identifies a system that allows employees to select among variations in work start-time and end-time schedules to meet their personal needs? a. Self-scheduling b. Flextime c. Decentralized staffing d. Cyclical staffing

B Feedback: When a hospital uses flextime, employees arrive at the unit and leave at many different times. The other options are not associated with the system described.

What is one of the most important differences between case management and disease management? a. Disease management referrals begin in the hospital inpatient setting. b. Disease management is a collaborative process to meet patient needs. c. High-cost population groups are specifically targeted in disease management. d. Disease management treatment is episodic.

C Feedback: Although there are many similarities between disease management and case management, the primary goal of disease management is to target high-cost disease populations. Disease management referrals may originate in the community rather than from inpatient settings. Both models are collaborative. Disease management is designed to be ongoing rather than episodic.

The nurse-manager is applying the principles of andragogy during an educational offering. What is the manager's most appropriate action? a. Competition is prioritized over collaboration during learning activities. b. The manager seeks to establish a highly structured learning environment. c. The manager openly values participants' life experiences. d. The manager leads the majority of learning activities.

C Feedback: Andragogy works well with those who have had life experiences because they are mature and can take part in their own learning experiences. In this type of learning, the learner is self-directed rather than dependent. Collaboration, student-directedness, and a less-structured learning environment are also associated with adult learning

A nurse-manager sits on the hospital's board of directors and there has been repeated discussion about the possibility of changing the care delivery model. What action should be performed first? a. Elicit support from internal and external stakeholders. b. Perform a cost-benefit analysis of the major alternatives for care delivery. c. Assess the strengths and weaknesses of the current delivery model. d. Plan a pilot project where the delivery model will be changed on one subacute unit

C Feedback: Assessment of the current delivery system must precede any decision to change the delivery model. Consequently, it would be premature to start building support from stakeholders, introducing a pilot project or doing cost-benefit analysis of alternatives.

Which aspect of care at a long-term care facility most clearly suggests that a functional model of care delivery is being used? a. One nurse is assigned to provide all of a resident's care during a shift. b. Unlicensed assistive personnels (UAPs) coordinate each resident's care and occasionally delegate to practical nurses. c. Registered nurses perform all assessments while UAPs provide all feeding and hygiene. d. A pairing of one registered nurse and one practical nurse provides all the care for a designated pool of residents.

C Feedback: Functional nursing is task focused with specific tasks assigned to specific members of the care team. Having one nurse provide all of a resident's care is indicative of total patient care. No model of care ascribes a coordination role for UAP. Pairings suggest team or modular nursing

A health-care organization is transitioning from a centralized staffing system to a decentralized staffing system. A nurse-manager should anticipate what outcome of this change? a. Increased fairness to employees through consistent, objective, and impartial application b. Increased cost-effectiveness through better use of resources c. Greater manager autonomy, resulting in an increase in self-esteem and teamwork d. Increased availability of data for monitoring the effect of staffing size and composition, quality of care, and costs

C Feedback: In an institution that has no human resources department and no nurse recruiters, the unit manager does the hiring and has greater autonomy in personnel matters. Centralized staffing is more closely associated with increased impartiality, cost-effectiveness, and availability of data

In order to minimize the potentially negative effects of organizational politics in the workplace, the nurse-manager should: a. limit interpersonal interactions to people the manager can trust. b. role model being an empowered nurse to subordinates. c. develop skills in handling information and communication. d. ensure that overt displays of power are visible to colleagues

C Feedback: In order to mitigate the possible threats of organizational politics, the nurse-manager should seek to become an expert in handling communication and information. Overt displays of power should be used only as a last resort, not as a tool for managing politics. It is unrealistic to limit interactions to only those people that the manager can trust. Role modeling what an empowered nurse looks like is beneficial to subordinates but does not necessarily prevent political conflict.

A nurse-manager is helping a newly graduated RN adjust to the professional nursing role. What is the manager's most appropriate action? a. Advise the new RN to avoid confrontations with health-care providers whenever possible. b. Advise the new RN that the "real world" of nursing is fundamentally different from the one described in textbooks. c. Be alert to signs and symptoms of the shock phase of the nurse's role transition. d. Be alert to signs that the new RN has not shed nursing school values.

C Feedback: Managers should be alert to signs and symptoms of the shock phase of role transition. Managers should also ensure that some of the new nurse's values are supported and encouraged so that work and academic values can blend, rather than being rejected. The nurse should learn to manage conflict appropriately, not avoid it at all costs

A registered nurse is paired with a practical nurse and the two nurses are working together to provide all the needs for a group of patients. What type of nursing care delivery are these nurses demonstrating? a. Total patient care b. Functional nursing c. Modular nursing d. Primary care nursing

C Feedback: Modular nursing uses mini-teams, typically an RN and unlicensed health-care worker(s), to provide care to a small group of patients, centralized geographically. None of the other options provide this particular staffing format.

A nurse-manager is advocating for a switch from team nursing to primary nursing care. What characteristic of primary nursing care should the manager describe to decision makers? a. It requires minimal RN staffing. b. It is comparatively easy to implement. c. Many nurses find it stimulating and challenging. d. It eliminates the need for UAP or practical nurses.

C Feedback: Primary care provides challenging work for nurses; however, it is not easy to implement and it can succeed with a diverse skills mix (i.e., not all RNs). It requires a comparatively large cohort of RNs.

A nurse-manager is applying the facility's patient classification system (PCS) to the unit's staffing needs before the beginning of a shift. What task should the manager perform first? a. Identify the number of staff members scheduled for the shift. b. Create a preliminary work assignment based on the unit norms. c. Appraise the care needs of each client. d. Assign three clients to each nurse and then adjust according to client needs

C Feedback: Regardless of the specifics of a PCS, the starting point is the needs of each client. Other variables such as the mix and number of staff are accommodated to this priority consideration. It is simplistic to presume a baseline of three clients per nurse across all care settings.

The responsibilities for staff development have recently been decentralized in a large health-care organization. The nurse-manager should take action to prevent what possible consequence of this change? a. Poor staff retention b. Deficient nursing care c. Increased role ambiguity d. Decreased nursing autonomy

C Feedback: Some difficulties associated with decentralized staff development include the conflict created by role ambiguity whenever two people share responsibility. Role ambiguity is sometimes reduced when staff development personnel and managers delineate the difference between training and education. Decentralization of staff development is less likely to have a direct impact on retention, nursing care, or the autonomy of nurses.

The nurse-manager stresses the benefits of learning a new skill to achieving the unit's goal of client satisfaction. The manager will break the skill down into its component parts and teach the subskills in sequence. This demonstrates understanding of which concept of education? a. Readiness b. Motivation c. Task learning d. Transfer of learning

C Feedback: Task learning usually entails taking a big task and breaking it down into smaller components. None of the other options demonstrates association with this concept of learning

The nurse is providing care in a setting that uses a team nursing approach. What should be integrated into the routines in the health-care facility? a. Inclusion of the patient and family as members of the team b. Opportunities for UAP and practical nurses to increase their education level c. Frequent communication between team members d. Use of multidisciplinary action plans (MAPs)

C Feedback: Team nursing is wholly dependent on close, frequent communication between the team members. Through extensive team communication, comprehensive care can be provided for clients despite a relatively high proportion of ancillary staff. The client's and family's input is vital, and frequently sought, but they are not formal members of the care team. MAPs are associated with case management, which may or may not utilize team nursing. Educational opportunities for practical nurses or UAPs are not the drivers behind team nursing

Which statement is true regarding legislated minimum staffing ratios? a. They are mandated by federal law. b. They are required by 28 states. c. They are proposed to improve client care. d. They are necessary to reduce costs.

C Feedback: The intent of mandatory staffing ratios for the purpose of improving patient care, although there is no guarantee improved care will result from such legislation. Legislation is at the state, not federal, level. California is the only state that has legislated minimum staffing ratios. Their focus is quality of care and working conditions, not cost

A registered nurse is providing care in a setting that uses modular nursing. What task should the nurse perform during a shift? a. Providing every aspect of care to one half to one third of the mini-team's assigned patients b. Collaborating with another registered nurse to plan the care of all the mini-team's assigned patients c. Confirming that each member of the mini-team is completing his or her assigned tasks d. Providing total patient care to the most acutely ill patients that the mini-team is assigned

C Feedback: The modular team leader should check the work of team members. Care is divided among the mini-team members, so the RN does not provide every aspect of care to some of the patients, even those who are acutely ill. Modular nursing does not usually involve collaboration between two RNs; it is more common for each team to have only one RN.

An experienced nurse has been hired to manage an inpatient unit at a hospital in a different city. What is an appropriate activity for building the manager's personal power base when beginning this new job? a. Take every opportunity to describe personal accomplishments. b. Offer to lead a high-visibility committee within the hospital. c. Determine which people are most powerful in the hospital. d. Seek to openly display authority when colleagues are present

C Feedback: The nurse can build his or her personal power base by first determining which people in the organization possess power. This is especially important when beginning in a new organization. Although the manager is new, it is best to avoid vying for high-level leadership. Overt displays of authority should be minimized and used as a last resort, not used as a means of building power. Talking about accomplishments could be interpreted as prideful by colleagues and could potentially harm the nurse's transition

A change in the patient care delivery system has been mandated on a hospital unit. The manager can best ensure the successful introduction of a new delivery system by: a. assigning a senior registered nurse to lead the implementation. b. explaining the implications of the proposed change to patients and families. c. carefully studying the best method for implementing the planned change. d. hiring nurses who have experience in providing the new delivery system.

C Feedback: Thorough preparation is essential to the successful implementation of a new patient care delivery system. This does not necessarily require hiring new nurses who have experience with the new system; existing staff can be adequately prepared if there are sufficient time and resources. The manager should collaborate with staff but it would be an inappropriate delegation if the manager assigned a nurse to lead the transition. Explaining internal changes to patients and families is not normally necessary and would not significantly increase the chances of success.

One year ago, a hospital implemented a 6-month internship program for new hires who are recent graduates. When evaluating the success of this transition to practice program, what piece of data should leaders and managers prioritize? a. Rates of absenteeism in participants compared with more experienced staff b. The incidence of sentinel events (safety violations) in periods before and after the program c. Retention rates among participants of the program compared with nonparticipants d. Response rates to the personnel department's recruitment campaigns

C Feedback: Transition-to-practice (TTP) programs can improve outcomes for new nurses in their first year of practice and increase their retention. This is one of the ultimate goals of TTP programs, so data related to absenteeism, safety violations and recruitment would be secondary, even though these data are relevant.

. A staff member asks the manager for a particular day off on the next schedule. Which response demonstrates the concept of underpromising and help the manager retain the staff's trust? a. "I'd like to, but that would be unfair to the other nurses." b. "Be sure to get the written request in early." c. "I can't guarantee it right now but I will try to find a solution for you." d. "If you don't take any sick time before then, I'll give it to you."

C Feedback: Underpromising helps preserve trust by making it less likely that a manager will have to go back on his or her word. This can be done by not promising to honor a request at the time it is made but then making efforts to meet the request. Underpromising does not involve outright refusal or requiring a favor in return.

A centralized staffing department is being created at a health-care facility. What attributes of this system should the nurse-manager expect? Select all that apply. a. Increased individual flexibility b. Improved client care c. Cost savings d. Increased consistency in staffing practices e. Increased impartiality in staffing decisions

C, D, E Feedback: Centralized staffing is generally fairer to all employees because policies tend to be employed more consistently and impartially. Centralized staffing also allows for the most efficient (cost-effective) use of resources because the more units that can be considered together, the easier it is to deal with variations in patient census and staffing needs. Centralized staffing, however, does not provide as much flexibility for the worker, nor can it account as well for a worker's desires or special needs. Neither system is noted to have a direct effect on the quality of care.

A nurse is following a multidisciplinary action plan (MAP) when caring for a new patient. The nurse should identify what components within the MAP? Select all that apply. a. Cost analysis of major interventions b. Identity of the nurse navigator c. Critical path d. Nursing care plan

C, D, E Feedback: The care MAP is a combination of a critical path and a nursing care plan that shows times when nursing interventions should occur as well as variances. All health-care providers follow the care MAP to facilitate expected outcomes. It does not include cost analysis and does not necessarily involve a role for a nurse navigator.

A health-care organization has achieved a decrease in RN hours in the total nursing care hours per patient-day (NCH/PPD). What is a potential outcome of this change? a. Increased interprofessional collaboration b. Decreased numbers of errors c. Decreased client fall rate d. Decreased client satisfaction

D Feedback: A review of current literature suggests that as RN hours decrease in NCH/PPD, adverse patient outcomes generally increase, including increased errors and patient falls as well as decreased patient satisfaction. There is no evidence that such a change increases interprofessional collaboration.

A health-care organization is changing from a functional nursing model to a team nursing model. How should the nurse-manager best address the impact on staffing and scheduling? a. More unlicensed assistive personnel will need to be hired. b. A self-scheduling system will need to be adopted. c. No changes in scheduling policies will likely be necessary. d. The client assignment method will need to be adjusted.

D Feedback: As new practice models are introduced, there must be a simultaneous examination of the existing staff mix and patient care assessments to ensure that appropriate changes are made to the staffing and scheduling policies. This change does not necessarily create a need for self-scheduling or more UAPs.

The nurse is assigned to administer medications to all patients throughout the shift. What is this an example of? a. Team nursing b. Case method nursing c. Primary care delivery d. Functional nursing care

D Feedback: Being assigned a specific task to do is part of functional nursing. None of the other options identify that connection.

The manager is organizing a class to prepare nurses to function in the neonatal ICU. What is the manager's initial action? a. Identify available learning resources that will assist with role transition. b. Evaluate the professional attributes of the nurses who already work on the unit. c. Evaluate the educational background and credentials of the new nurses. d. Identify the learning needs of the new nurses.

D Feedback: Developing a training program starts with identifying the knowledge or skill needed. There may or may not be a correlation between these learning needs and the educational background of the nurses. The attributes of the existing nurses and the available resources are not priorities over the orientees' learning needs.

The nurse-manager has just begun a new assignment in a new health-care organization. What action should the manager prioritize in order to be seen as credible by subordinates? a. Share her doubts about her abilities with the employees. b. Maintain an open-door office policy. c. Ask for input from staff on decision making. d. Avoid any and all forms of dishonesty.

D Feedback: Dishonesty is absolutely fatal to the manager's credibility and must be avoided at all costs. Having an open-door policy may enhance rapport but will not necessarily affect the manager's credibility. Seeking staff input on decisions can empower staff but would have less of an effect on credibility. Although the manager should be honest with staff, sharing internal doubts about her abilities may harm the perception of competence that employees have

Which statement about patient classification systems is accurate? a. Classification systems are able to solve staffing problems if applied consistently. b. Nursing care hours assigned to a classification system should remain constant. c. A good classification system can resolve all staffing challenges. d. Internal and external forces may affect classification systems.

D Feedback: Examples of internal and external forces that may affect a PCS are a sudden increase in nursing or medical students using the unit, a lower skill level of new graduates, or cultural or language difficulties of recently hired foreign nurses. PCSs are not able to independently solve staffing challenges and cannot resolve every staffing challenge. Care hours will be constantly changing due to the interplay of numerous variables

A nurse manager is in charge of a unit that consists of a generationally diverse group of staff nurses. The nurse manager knows that this type of staffing arrangement will: a. require the baby boomer nurses have more flexibility in scheduling and time off as compared to the generation X nurses. b. create a nursing environment that will be more structured and focused on the use of technology to provide the best care. c. allow generation Y and Z nurses to create a secure and stable work environment. d. establish a diverse working environment based on experience and technology.

D Feedback: Generational diversity allows clients to receive care from both the most experienced nurses as well as those with the most recent education and likely greater technology expertise. Managers must be alert to how generational diversity may impact staffing needs. Up to five generations of nurses are now working together. In previous years, earlier retirement from nursing and shorter life spans kept the workforce typically to three generations. Some researchers suggest that the different generations represented in nursing today have different value systems that may impact staffing. For example, most experts now identify five generational groups in today's workforce: the veteran generation (also called the silent generation or the traditionalist), the baby boomers, generation X, generation Y (also called the millennials), and generation Z

What goal is most congruent with being a learning organization? a. Staff development is the main priority in the organization. b. The organization employs a dedicated staff member for providing in-house education. c. There is dedicated time on each shift for staff to pursue education. d. Continuing education for staff exceeds the requirements for licensure

D Feedback: In a learning organization, staff members' educational activities exceed the minimum standards that are needed for licensure. Being an LO does not necessarily require dedicated staff members whose exclusive role is to provide education. Client care, not staff development, should be the main priority in any health-care organization. Opportunities for education should be provided regularly, but it is not realistic or necessary to provide opportunities during every shift for every staff member.

. A nurse has joined a group that has a goal of increasing the power base of the nursing profession. What is the nurse's best initial action to help achieve the group's goals? a. Recruit nursing students to join the group as auxiliary members. b. Present a powerful picture to others in the group. c. Recruit among the nurse's peers and colleagues. d. Become familiarized with relevant public policy issues

D Feedback: Increasing the professional power of nursing must begin with becoming knowledgeable and familiar with the issues that are relevant to the profession. This baseline knowledge should precede recruitment efforts. Presenting a powerful image may build the nurse's power base within the group but does little to accomplish the group's goals

The nurse-manager needs to determine the effectiveness of a staff workshop on establishing IV access. What is the manager's best method for determining this? a. Having class participants evaluate the instructor and the class b. Giving participants an examination or test at the conclusion of the course c. Having a documented decrease in the unit's IV site infections d. Observing staff perform and document the practice

D Feedback: Instructor evaluation supports effective teaching but not learning of the new skills. Testing someone at the end of educational training does not confirm that the learning changed behavior, which is the primary goal of staff development. There needs to be some method of follow-up to observe whether a behavior change occurred, showing that the education was effective. Observation of the staff will fulfill this need. Having a decrease in IV site infections may or may not be the result of the staff implementing the educational program.

Which historical event is known that have had a major effect on the delivery model of nursing care? a. Emergence of antibiotic-resistant microorganisms in the 1990s b. Increases in patient empowerment during the 1970s and 1980s c. High rates of infection, death, and disability during the Civil War d. Shifts from home-based care to hospital-based care during the 1930s

D Feedback: Major shifts in the location of care from the home to the hospital underlie many of the shifts in care delivery in the early decades of the 20th century. Patient empowerment, antibiotic resistance and the Civil War are not identified as having such sweeping effects on the delivery of nursing care

Training and education are important parts of staff development. Responsibility for these activities lies with: a. preceptors. b. the education department. c. the manager and preceptor. d. the manager and the education department.

D Feedback: Managers and education department staff have a shared responsibility for the education and training of staff. It is not the responsibility of the other options.

Which statement best describes the manager's main role in socialization of a new nurse? a. Providing the employee with organizational rules and regulations b. Providing the new employee with a good preceptor c. Ensuring that there are sufficient numbers of good role models d. Sharing organizational values, expected attitudes, and behaviors

D Feedback: New group members must be socialized into the group, and these socialization efforts should be led and modeled by the manager.

The nurse-manager is attempting to promote closer adherence to the principles of evidence-based practice. What is the manager's best action? a. Stress the need to base practice on research findings during orientation of new graduates. b. Include a statement of the need for evidence-based practice in the unit vision statement. c. Impose sanctions on nurses who do not use research during the annual evaluations. d. Arrange for easy online access to academic databases

D Feedback: Providing available research for the staff is the most concrete action an organization could take to encourage nurses to incorporate research in practice. None of the remaining options provides the staff with the tools to actually implement evidence-based practice

Which nurse is experiencing the effects of coercive power? a. A nurse who has been granted an extra vacation day after willingly working overtime for several days b. A nurse who has completed a master's degree in nursing c. A nurse who has great influence from being "well-connected" d. A nurse who was terminated after assaulting a client

D Feedback: Punishment and discipline are examples of the effects of coercive power. Getting an extra vacation day is an example of reward power. Completing a graduate degree enhances expert power. Personal connections build referent power

The leadership of a health-care organization has declared their intention to make the facility a learning organization (LO). What action is most likely to achieve this goal? a. Assigning mentors to each new employee and to employees who have relocated in the organization b. Requiring each employee to prove that he or she has met the continuing education requirements for license renewal c. Offering the facility to university researchers as a site for conducting health-care research d. Acknowledging and rewarding employees who participate in continuous learning

D Feedback: Recognizing and incentivizing education is one step that an organization can make toward become a true LO. Mentorship is an important tool for new and relocated employees, but it does not directly promote the establishment of a learning organization. Establishing an LO requires more than just the minimum requirements for licensure. Having researchers present on the unit may or may not promote the development of an LO, because there is no guarantee that there would be close collaboration between researchers and staff members.

An experienced nurse is applying for a position as a clinical nurse-leader (CNL). In addition to the nurse's clinical experience, what characteristic best qualifies the nurse for this position? a. The nurse currently sits on the hospital's ethics board. b. The nurse has consistently adhered to the standards of practice. c. Specialty certification in a specific area of practice. d. The nurse has a master of science in nursing degree.

D Feedback: The CNL, as an advanced generalist with a master's degree in nursing, is expected to provide clinical leadership at the point of care. CNLs have advanced knowledge and education in general practice as opposed to specialization in one primary discipline, like clinical nurse specialists. Adherence to standards of practice is a minimum requirement for nursing practice, not a specific qualifier for a CNL role. Similarly, sitting on an ethics board is a useful aspect of experience but not a specific qualifier for a CNL role.

A manager has issued a directive to nursing staff about improving the timeliness of their documentation. Most nurses have failed to make a change in their practice, however. The manager should consider what potential cause of this failure to act? a. Leadership-subordinate conflict b. Manager-subordinate gap c. Administrator-power differential d. Authority-power gap

D Feedback: The gap that sometimes exists between a position of authority and subordinate response is called the authority-power gap. None of other options is the term used to identify the described power gap

A primary health-care teams (PHCT) has been established to coordinate the care of a patient with complex health-care needs. What should be the nurse's primary role in this team? a. Communicate the wishes of the patient to the other team members. b. Weigh the benefits of suggested interventions with their costs. c. Provide the patient's direct bedside care, whenever possible. d. Emphasize improved quality of life and patient-centered care.

D Feedback: The nurse can perform several tasks in the context of a PHCT, but advocating for the patient and promoting patient-centered care is a priority role that encompasses many smaller tasks (such as communicating the patient's wishes, when necessary). The nurse does not focus on financial concerns in this setting, and it is not necessary for the nurse on the PHCT to be the one to provide the majority of the patient's actual care.

A busy medical unit has been increasing the use of agency nurses. The nurse-manager should anticipate what consequence of this staffing alternative? a. Increased reliance on unlicensed assistive personnel by nurses b. A need for 8-hour rather than 12-hour shifts c. Short-term cost savings d. Decreased continuity of nursing care

D Feedback: The use of agency nurses can increase costs and decrease continuity of care. There is no obvious need to change the length of shifts or for nurses to become more reliant on UAPs with the use of agency nurses

A nurse is practicing in a case management context and a patient has been following a multidisciplinary action plan (MAP). In the last 24 hours, it has become clear that the patient's health status is not improving as quickly as expected and the patient is deviating from the MAP. What is the nurse's best action? a. Cancel the patient's current MAP and call a meeting to select a new one. b. Document the presence of a variance in the MAP. c. Collaborate with the care team to arrange a transfer to a new setting. d. Cancel the current MAP and adopt customized, rather than standardized care.

: B Feedback: In care MAPs, it is necessary to provide variances when there are patient deviations, because this is a major component to case management. Deviations do not warrant a wholesale rejection of the existing MAP or case management principles. A transfer to another site may or may not be necessary, and this does not address the need to change the patient's MAP

A nurse-manager works on a unit that has a decentralized self-scheduling system. When managing with this scheduling option, the manager should: a. oversee the system carefully to ensure sufficient staff coverage at all times. b. avoid becoming involved with the system so that staff remain autonomous. c. advocate for the most senior staff to receive the most desirable shifts. d. refer any disputes to the organization's personnel department.

A Feedback: Although self-scheduling offers nurses greater control over their work environment, it is not easy to implement. Success depends on the leadership skills of the manager to support the staff and demonstrate patience and perseverance throughout the implementation. The manager cannot afford to take a fully hands-off approach. It is more likely that junior staff would need advocacy than senior staff. Because the organization's staffing is decentralized, it would not likely be possible for the nurse-manager to refer disputes to a personnel department.

Which statements demonstrate an understanding of the factors that should be considered when a change in the care delivery system is being proposed? Select all that apply. a. "We have determined that our level of care would improve if we provided it differently." b. "It's questionable whether our current nursing staff is large enough to support the proposed change." c. "We will discuss our proposed change with the multidisciplinary team members." d. "Administration has been supportive of the planned change in our care delivery system." e. "We're going to make our decision based on which option is newest in the literature."

A, B, C, D Feedback: If evaluation of the present system reveals deficiencies, leaders and managers need to examine available resources and compare those with resources needed for the change. Therefore, openness to change and a willingness to examine available resources are necessary. Interdisciplinary collaboration is essential and support from high-level administration is needed as well. Decisions should not be based simply on which model is newest or most innovative

A nurse-manager is in charge of a unit that has a large proportion of recent graduates, most of whom are members of Generation Y (millennials). The manager should anticipate that many of these nurses will have what characteristics? Select all that apply. a. Technologically savvy b. Adept at teamwork c. Loyal to a single, long-term employer d. Comfortable with multiculturalism e. Committed to environmental issues

A, B, D, E Feedback: Millennials tend to be technologically savvy, eco-aware, comfortable with multiculturalism, and skilled at working in teams. Long-term loyalty to a single employer is more closely associated with the veteran generation, which changes jobs much less frequently

A flextime system has been introduced at a health-care facility. The nurse-manager should take what action to address the consequences of this staffing system? a. Limiting flextime to those staff members who have at least 2 years experience on the unit b. Ensuring that overtime can be used to fill times when there is insufficient staffing c. Providing incentives to ensure daytime weekday shifts are sufficiently staffed d. Working to promote continuity of care when there are multiple start times and end times for staff

D Feedback: Flextime entails staff having their shifts begin and end at varied times. This can affect continuity of care if the manager does not take action. It would be unfair to limit the benefits of flextime to only those nurses who have multiple years of experience. Overtime should be used as an action of last resort, not a structured approach to meeting staffing needs. In most cases, weekday shifts are easier to fill than night shifts, holidays, and weekends.

A community health unit is transitioning from centralized staffing to decentralized staffing. The manager should recognize what possible consequence of this change? a. It carries risks that employees may be treated unequally or inconsistently. b. One individual or a computer will perform the staffing functions. c. The manager's role is that of making minor adjustments or providing input. d. The change will increase control over personnel by the organization.

A Feedback: A manager being perceived as granting special treatment to some employees is a risk of decentralized staffing. A single individual or department is responsible in a centralized, not decentralized, system. Similarly, a manager plays a lesser role in a centralized system and the organization possesses more control

A manager is implementing a patient classification system (PCS). Which external and internal variables should the manager address when implementing the PCS? Select all that apply. a. The presence of nursing students on the unit b. The hiring of two graduates as staff c. The increase of scheduled medical students d. Language barriers presented by nursing staff e. The hospital's accreditation status

A, B, C, D Feedback: Regarding PCS, the middle-level manager must be alert to internal or external forces affecting unit needs that may not be reflected in the organization's patient care classification system. Examples of such forces could be a sudden increase in nursing or medical students using the unit, a lower skill level of new graduates, or cultural and language difficulties of recently hired foreign nurses. The hospital's accreditation status should not influence the use of the PCS.

The increased use of agency nurses has been proposed by a health-care organization's personnel department. What implications of this practice should be considered? Select all that apply. a. Increased costs b. Consequences of unfamiliarity with the unit c. Liability from the use of unlicensed nurses d. Decreased continuity of client care e. Increased need for overtime

A, B, D Feedback: The use of agency nurses is expensive and can result in poor continuity of nursing care. As well, agency nurses are often unfamiliar with the unit, which can negatively affect care. The use of agency nurses does not directly increase the need for overtime. Agency nurses are fully licensed.

A health-care facility is considering whether to move from 8-hour shifts to 12-hour shifts. What potential consequences of this change should be considered? Select all that apply. a. Increased overtime pay b. Increased nurse satisfaction c. Decreased cost d. Increased judgment errors e. Increased need for continuing education

A, B, D Feedback: Twelve-hour shifts have become commonplace in acute care hospitals even though there continues to be debate about whether extending the length of shifts results in increased judgment errors related to fatigue. Because extending the workday with 10- or 12-hour shifts may require overtime pay, the resultant nurse satisfaction must be weighed against the increased costs. There is no notable increase in the need for continuing education with 12-hour shifts

Which statement best describes a characteristic of mentorship? a. The intensity and duration of relationships are similar in mentorship and preceptorship. b. Staff cannot be assigned to become mentors. It is a role voluntarily chosen by the mentor. c. Mentees must be willing to put aside their personal goals and beliefs in an effort to identify more closely with their mentor. d. Most nurses will have the opportunity for many mentor relationships during their careers.

B Feedback: The mentor makes a conscious decision to assist the protégé in career development, with the relationship usually lasting several years. Mentorship and preceptorship differ in purpose and duration. Mentorship does not necessitate putting aside one's personal goals and beliefs. Mentorship relationships are intended to have a longer duration; most nurses do not have several mentors during their career

The unit supervisor is working with an RN who has just been promoted to charge nurse. What action by the supervisor will best help the RN adjust to this new role? a. Take the RN out to lunch to congratulate the nurse on the promotion. b. Arrange for the RN to meet with staff peers in the organization. c. Explain to the RN on the need for underling respect. d. Inform the RN of the past performance of employees that he or she will manage.

B Feedback: There should be a management group in the organization with which the new manager can consult. The new manager should be encouraged to use the group as a resource. Congratulating the nurse will not help the adjustment to the new role. Similarly, emphasizing the need for respect and telling the nurse about subordinates' performance does not facilitate role adjustment.

Which statements support the manager's commitment to staff empowerment? Select all that apply. a. "I need you to know that I won't accept any substandard nursing care." b. "A staff committee will be formed to address that unit issue." c. "We can arrange for you to spend 2 months working on another unit to expand your skills." d. "I've got funding to support staff who are interested in earning certifications." e. "There's talk of acquiring new mechanical lifts, but I'd like to get your input."

B, C, D, E Feedback: Empowerment occurs when leaders communicate their vision; employees are given the opportunity to make the most of their talents; and learning, creativity, and exploration are encouraged. Rejecting substandard practice may be necessary, but this action does not necessarily empower nurses.

The policies around scheduling and staffing are being amended in a health-care facility. Managers must ensure that the policies to not violate which of the following? Select all that apply. a. Local laws b. Labor laws c. State laws d. Union contracts e. Federal laws f. Local norms

B, C, D, E Feedback: Staffing and scheduling policies must not violate labor laws, state or national laws, or union contracts. There is no prohibition against violating local norms and traditions. There are not normally local laws that address work scheduling

Which statements are true regarding float pool nurses? Select all that apply. a. They are classified as per diem staff. b. The nurse trades increased personal flexibility for less pay. c. Float pool nurses do not receive usual staff benefits. d. They are crossed-trained on multiple units. e. They are internal, not external, employees.

D, E Feedback: Float pools are generally composed of employees who agree to cross-train on multiple units so that they can work additional hours during periods of high census or worker shortages. They are not necessarily hired on a per diem basis and do not receive less pay. Float nurses receive benefits

The staff at a community health clinic will require training on the use of the new electronic health record system. How should the nurse-manager organize the necessary education in order to enhance learning? a. Schedule a long, uninterrupted session. b. Explain the most complicated part of the system first. c. Use a dynamic lecture technique. d. Teach in several short, frequent sessions.

D Feedback: When learning motor skills, spaced practice is more effective than massed practice. Simpler concepts should precede more complex concepts. Lectures are generally less effective than more interactive learning techniques.