Leadership Final

The nurse manager in the Emergency Department needs to implement new staffing patterns. As a transformational leader, the nurse manager should: a. Explain in detail how well the new idea will work. b. Reinforce how this change will respond to the ideas and solutions generated by staff members. c. Reason with staff members that the new idea will save money and allow more free time. d. Imply that raises will be smaller than anticipated if the new idea is not accepted.

ANS: B Transformational leadership inspires and motivates others through influence and persuasion rather than through rewards (e.g., free time) and punishment (e.g., smaller raises). This type of leader listens to the views of others (such as those of the staff members), empowers others to lead (such as in generating solutions for staffing problems), finds ways to remove barriers, and serves as an advocate for those who care for patients.

As a result of Amy's coaching, Sarah, a nursing graduate of 5 years, completes a ROLES assessment. This assessment is helpful in (select all that apply): a. Identifying her clinical knowledge. b. Role development. c. Areas of conflict in expectations. d. Expected work time commitments.

ANS: B, C, D b. Role development. c. Areas of conflict in expectations. d. Expected work time commitments.

John is interested in leadership positions within his nursing organization. Al-though he has been on the same unit for 10 years, he has attended two workshops during that time and has steadfastly refused opportunities to engage in leadership development opportunities or other learning offered as part of the hospital's succession planning strategy. He says that he is interested in a leadership role primarily because it will give him a more stable work schedule and will enable him to spend more time with his family. In coaching John, it would be important to: a. Affirm that his years of service and stability on the unit are the most important attributes for assumption of a leadership role. b. Reinforce that his concern with maintaining balance outside work would be a key factor in selecting him for a leadership position. c. Encourage him to consider the financial rewards of the position, as well as the positive effect on his work schedule. d. Encourage him to seek out new experiences and learning that will complement his existing strengths derived from experience and his interest in life-work balance.

ANS: D According to Covey, effective leaders continually engage in learning and self-renewal, as well as in maintaining a balanced life, radiating positive energy, believing in other people, being concerned with the common good, and being synergistic.

The most important approach that a nurse manager can take with an emotionally troubled employee is to:

Assist the employee in obtaining professional help.

Nurses who engage in in-fighting, seek physician support against nursing colleagues, and avoid membership in nursing organizations: a. Refuse to believe that they are acting like members of groups that suffer socioeconomic oppression. b. Do not understand how their failure to exercise power can limit the power of the whole profession. c. Purposefully choose to exercise their power in the workplace through indirect means. d. Suffer from learned helplessness as a result of abuse by powerful nurse executives.

B

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. Collaboration. b. A coalition. c. Networking. d. Policy building.

B

Your colleague, Mary, a recent graduate announces one day that she intends to leave nursing in 3 to 4 months to pursue a position in marketing. While at your agency, she plans to give patients excellent care and to learn as much as she can, because "Who knows? Nursing is a great job with a great pay and I may return someday." Mary's statements most accurately exemplify which orientation to the concept of nursing? Nursing as a(n): a. Profession. b. Occupation. c. Flexible discipline. d. Career with off and on ramps.

B

Which of the generations is challenged by sharing leadership with other generations? a. Baby Boomers b. Generation Y c. Generation X d. Generation Z

Baby Boomers

A nurse manager recognizes the need to expand her professional network as she begins a job search for a middle-management position. Which of the following actions is least likely to expand her job-searching network? a. Reviewing her address book or card file for names and phone numbers of former colleagues who are now in middle-management positions b. Making an appointment to meet with a former instructor from her graduate program in nursing administration c. Making a long overdue return call to a former colleague who is now a chief nurse executive d. Attending a state-level conference for nurse managers and executives and attending informal luncheons and receptions

C

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

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

Politics is usually: a. Confined to legislatures. b. Seen in dysfunctional workplaces. c. Found in all social organizations. d. A representation of self-interest.

C

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

Incivility is a disruptive behavior or communication that creates a negative environment and interferes with quality patient care and safety. The manager can implement the following steps that help to alleviate uncivil behavior on a unit.

C) Providing verbal admonishment, B) Providing written admonishment that is discussed and placed in the employee's file, A) Suspending the staff member from work, D) Terminating the staff member

Nurses generally experience difficulty in identifying behaviors and actions that could signal chemical dependency in a co-worker. Which of the following is not a behavioral change that occurs with chemical dependency?

Changes in educational involvement and pursuit

A nurse belongs to several professional organizations, serving on a state-level committee of one group and on two task forces at work. The nurse is committed to a range of health issues. This nurse exemplifies which level of political activism in nursing? a. Gladiator b. Buy-in c. Self-interest d. Political sophistication

D

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. Insincere. b. Networking. c. Politically sophisticated. d. Collegial.

D

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. Directly primarily toward those who are subordinate to her. d. Of unlimited capacity when shared with others.

D

Which of the following accurately represents the concept of political activism? a. Meghan, an ER supervisor, encourages staff to write letters to the local health board, protesting closure of the ER and loss of 30 full-time jobs. b. Sarah refuses involvement in her professional organization but is heavily involved in the Little League organization to which her son belongs. c. Because of her influential contributions to position papers on health care, Roberta is asked to let her name stand for election as chair of the local organization of gerontology nurse practitioners, who are lobbying for increased certification standards. d. Sondra volunteers to run for office in her state nursing organization because of her concern about the underrepresentation of expertise from her area of nursing practice.

D

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 informal lunch meeting to meet other executives for support and for sharing ideas of expertise.

D

Which of the following is the best example of skilled negotiation? a. Linda, the manager on pediatrics, takes a proposal to her supervisor, outlining the benefits of a walk-in preoperative area for children. b. Kim, RN, asks for leave to pursue a semester of full-time study in her graduate program. She proposes to accept less popular rotations during peak vacation time, in return. c. George, the head nurse in ER, asks for additional staff for his department and points out the benefits of being able to keep patients longer. d. Jerry speaks with his supervisor about his supervisor's concerns related to bedside reporting before presenting a proposal to change this process.

D

During unit staff meetings, you observe that Marg rolls her eyes and snorts whenever Julia makes a comment. Your first response as a unit manager is to:

Discuss what you have observed with Marg.

The unit manager is concerned about Jean, a staff nurse. She is not involved directly with Jean, so she has not been able to determine whether the problem is one of motivation, ability, or both. If Jean lacks ability, which of the following strategies might the head nurse use?

Document all problem areas and then discuss them with Jean.

A nurse manager must be familiar with the agency's policies regarding termination. Termination procedures include which of the following?

Having adequate written documentation to support the action

In keeping with guidelines of the organization, the nurse manager documents staff problems. Documentation of disciplinary problems should:

Include a plan to correct them and to prevent future occurrences.

Nathan has been on the cardiac unit for 6 months and has found it difficult to adjust to the expectations of his team. Which of the following behaviors would most likely signal that Nathan is intending to resign from his position on the unit?

Increased absenteeism over the past month

Which of the following represents outcomes of transformational leadership? a. Deadlines are met. b. Work is completed according to the rules. c. Increased job satisfaction d. Pay tends to be higher.

Increased job satisfaction

Which of the following is not a rule of leadership? a. Maintain a positive attitude. b. Listen to people. c. Maintain balance. d. Maintain like-ability.

Maintain like-ability.

A nurse manager understands that the typical first step in handling an employee with a disciplinary problem is a:

Reminder of employment standards.

In assisting new graduates to make the role transition to graduate nurse, Ted, the unit manager initiates which of the following? a. Self-check list to assess competencies that have been strengthened b. Discussions that focus on what the new graduates have yet to learn c. Fixed target dates for acquisition of competency and transition to RN role d. Frequent formal meetings to provide feedback on performance and areas to be strengthened

a. Self-check list to assess competencies that have been strengthened

An interviewee for a nurse manager position asks for a copy of the organizational chart. Organizational charts provide information about the role component of: a. Expectations. b. Opportunities. c. Responsibilities. d. Lines of communication

d. Lines of communication

Seth is hired as the nurse manager for a surgical unit. After a year, the hospital reorganizes, and his position is lost. In leaving the unit, it is important for Seth to: a. Engage in clarifying why the hospital did not state its expectations for the unit at the time of hiring. b. Hire a lawyer to represent his interests during this unexpected role transition. c. Seek counseling to deal with his shock and anger. d. Negotiate a reasonable settlement.

d. Negotiate a reasonable settlement

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage. Sarah finds a mentor, Amy, who has been in the role of unit manager for 3 years and has a similar interest in clinical excellence. During their frequent meetings, Amy provides assistance with learning aspects of the manager's role, including technical aspects, such as how to interpret budget printouts and to achieve budget outcomes. The success of Amy's coaching depends on: a. Clarity of Amy's information. b. Organizational support for the mentor relationship. c. The congruence of Amy's beliefs with Sarah's beliefs. d. Willingness of Sarah to receive feedback.

d. Willingness of Sarah to receive feedback.

Clinical incompetence is a problem facing a nurse manager. Joyce, the nurse manager, is not aware of the problems of Sarah, a novice nurse. After she investigates, it is obvious that Sarah's peers are covering for her. Which of the following might Joyce include in her meeting with the nurses?

"It is a nurse's professional responsibility to... "All instances of clinical incompetence... "It is not considered being disloyal when... "Patient care is the number one concern...

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 and distress at being treated rudely or disrespectfully by patients, 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.)

*Speaking positively about one's work *Dressing and grooming in a clean and neat manner *Using titles (e.g., Mr., Mrs., Ms.) and last names *Submitting a written complaint to senior *Developing a code of conduct for the ED staff.

The unit manager discusses absenteeism with the unit clerk. She indicates that it is a serious problem on the unit. Which of the following points would they have likely discussed?

1.Care will suffer and standards will be lowered. 2.Unit costs have increased because of staff replacements and overtime.

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

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

A unit manager watches a new RN graduate interacting with a patient. When the RN comes out of the room, the unit manager says, "I don't know what they taught you in your nursing program, but if I see you do that again, I will write you up." This example demonstrates: a. Coercive use of power. b. Appropriate application of control. c. Use of informatory power. d. Use of power to provide coaching.

A

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 arise b. For men, no facial hair, always wearing a suit and tie; for women, always wearing a suit and high-heeled shoes c. Maintaining a soft voice during times of conflict; making unbroken eye contact during interactions d. Smiling all the time; always wearing a suit and carrying a briefcase; women should wear no jewelry

A

Literature on oppression in nursing has: a. Verified the presence of behaviors associated with oppression within nursing. b. Suggested that nurses are oppressed because of the actions of other groups. c. Failed to establish that oppression is present in nursing groups. d. Indicated that nurses use oppression negatively.

A

The workgroup on NU 23 is marked by apathy to 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. Powerlessness. b. Anger. c. Apathy. d. Oppression.

A

Becky graduated five years ago and is keenly interested in pursuing leadership opportunities. She has been active in learning about leadership through workshops and Internet research and recently began a graduate degree program with a focus on nursing administration. She has excellent clinical skills and eagerly accepts responsibility for various projects on the unit. Her sarcastic and sometimes aggressive behavior tends to alienate other staff members on the unit. In coaching Becky, you: a. Suggest that she reflect on situations in which she has had a positive influence and consider how her interactions contributed to the situation. b. Suggest that she not consider leadership roles because her interaction skills are more suited to roles in which she has limited opportunities to work with others. c. Ask staff members on the unit with whom she works to provide her feedback about ways in which her behavior irritates or turns them away. d. Encourage her to continue her graduate courses, as information about strategies and technical aspects of the role will compensate for negative interactions.

ANS: A Leadership involves radiating positive energy and the ability to inspire and motivate others. Management can be taught through formal instruction, but leadership is attained through reflection on rich personal experience.

The adage "leaders are born and not made" reflects which of the following ideas around leadership? a. Management can be taught; leadership depends on abilities. b. Mentorship is important in developing innate skills of leaders. c. Leadership is a natural skill that cannot be refined or developed. d. Succession planning and formal education related to leadership are ineffective.

ANS: A Leadership is an abilities role that is reflective of rich personal experience. It can be developed and refined through such strategies as coaching, mentorship, and reflection. Management can be taught and learned.

During a discussion of concern about approaches used with aggressive patients in the Emergency Department, several staff members express concern for their safety. As a leader, the nurse manager should: a. Look directly at speakers and acknowledge their comments. b. Promise to implement each suggestion that is made. c. Implement the idea that receives the most discussion. d. Listen but implement the plan that she had in mind before the discussion began.

ANS: A One of the five rules for leaders is to listen to the constituents—in this instance, the staff members who have safety concerns. Active listening in the United States means establishing direct eye contact and asking probing questions. Listening does not obligate the leader to any one course of action. Action will be based on what is best for the group.

After being interviewed for the unit manager position, the staff nurse reflects on the interview process. The staff nurse is aware that leadership begins: a. Within. b. Through a relationship with a mentor. c. With the job description. d. With the chief nursing officer of the organization.

ANS: A People notice differences in workplaces and tend to choose those that evidence a high degree of trust between leaders and followers. Stephen M.R. Covey suggests that trust begins with self and that leaders must focus first on developing character and confidence, which is their credibility. Credibility enables leaders to trust themselves and gives others someone or something that they can trust.

A nurse executive is hired to restore a unit's productivity, which has decreased as the result of low staff morale. The nurse executive utilizes which of the following leadership principles? a. The leader declares the intent and goals to enhance productivity and assumes that the unit also wishes to increase productivity, which allows nurses to feel in control of the environment. b. If staff members increase productivity, then they are given opportunity to engage in learning events such as workshops and conferences. If the staff members are not satisfied, they will insist on a different leader, who will get them what they want. c. Leaders at the national level who are seeking relief for nurses in the workplace are seen as the solution to the nursing shortage. d. Workplace satisfaction depends on staffing ratios, adequate pay, and tuition reimbursement, and these are things the leader can control.

ANS: A Stephen M.R. Covey suggests that Smart Trust is a method for restoring trust in organizations. Smart Trust Actions include declaration of the leader's intent and assumption by the leader that others also have positive intentions. Building trust involves signaling goals and intended actions in advance. Actions such as promising external rewards such as additional learning opportunities, workload relief, and compensation are consistent with transactional leadership, which leads to low to stable commitment and limited satisfaction.

A group of managers is meeting to discuss ideas related to the successful implementation of evidence-based practice on their units. Susan has been asked by the director of care to assume leadership of these discussion groups. After two such sessions, Susan expresses disappointment to her mentor that the group seems disinterested in her ideas and that they are listening to Ken, who has much less experience with leadership. In discussing this with Susan, the mentor understands that leadership: a. Is a designated role. b. Must be earned. c. Is more likely to be taken by someone who is more talkative. d. Rarely is taken over by someone with less experience.

ANS: B A person can have an impressive title, but title or designation does not make the person a leader. A leader must have the ability to inspire others to follow.

Recruiting among the emerging workforce (18- to 35-year-olds) is a challenge for healthcare agencies. Marketing brochures should address the leadership and vision of the healthcare agency. Which of the following workplace environments will attract applicants in the emerging workforce? a. A highly professional environment b. A nurturing and receptive environment c. An environment highlighted by lots of meetings, so staff members can have lots of input d. A totally online environment, so staff members will not have to interface with uncaring colleagues

ANS: B A study of student nurses who represent this age group indicates that they want a leader who is receptive, approachable, a team player, and motivating.

A nurse executive who considers herself a Baby Boomer will have the challenge of convincing the emerging workforce of the necessity of committee meetings. One of the primary reasons that the Baby Boom generation appears to have so many meetings in the work environment is that: a. They feel more comfortable in a group. b. They find that the journey to the solution is as important as the solution itself. c. They were deprived of collective action opportunities in the past and now feel that solutions are better when many people have input. d. Baby Boomers are aging and need the respite from work that meetings offer, so they can recuperate from the physical demands of the work environment.

ANS: B Baby Boomers mistrust authority and trust in collective action, based on successes with social movements in their formative years.

The new head nurse on G Unit has been the subject of a great deal of discussion and complaining during breaks. She is a competent nurse of tremendous integrity with approximately 30 years' experience. Her predominant method of problem solving and communication is through meetings, which can go over the allotted time. The staff may: a. Be represented by a high number of Baby Boomers. b. Be presenting different generational values and attitudes than the head nurse. c. Be unresponsive to her transactional leadership style. d. Want a leader rather than a manager.

ANS: B Leaders who come out of the Baby Boomer generation may be more comfortable with collective action than followers who come out of the Emerging Workforce generation, who are more comfortable with interactions if they are seen as having value for them and with activities if they are seen as having benefit. A group that is highly weighted toward the Emerging Workforce generation may find the approach of a leader who is part of the Baby Boomer generation frustrating and may not understand the meaning or value of the meetings.

The Sunny Long-Term Care Facility has experienced numerous difficulties with staff relationships, despite its success in maintaining financial viability and judicious use of resources. Staff members complain that the primary concerns of the facility include applying policy, saving money, and ensuring that lawsuits are avoided. There is little trust in, and involvement of, staff members. This facility may be: a. Well managed and well led. b. Overly managed and not well led. c. Poorly managed and well led. d. Overly led and overly managed.

ANS: B This organization is concerned primarily with coordination of resources, application of current policy, and economic issues connected to the present. These behaviors are consistent with the management role. There is little evidence that the organization displays leadership, which involves trust, belief, hope, and vision.

Which of the following nurses is MOST likely to inspire others to do their best? a. Nancy, RN, is an individual who enjoys details and organization. She regularly leaves notes for the next shift about what has been done incorrectly or omitted. b. Jim, RN, has been involved in nursing for several years and is well liked by patients and families. He continually searches for new knowledge and skills, and his sense of humor and optimism are infectious. c. Clara has been the head nurse on Unit 3Y for years. She is quiet but enjoys patients and their families. She has not been to a conference in years because the unit is her entire life. d. Karen is a team leader. She is extraordinarily vigilant about ensuring that everyone is treated fairly in assignments. She is also very conscientious about care and regularly checks up on what everyone is doing to ensure that it is done correctly.

ANS: B To be inspired, people must have a positive leader who radiates energy, a zest for learning, and an interest in the common good, and is engaged in self-renewal. This leader is hopeful and optimistic. Leaders, not managers, inspire others to work to their highest level.

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

ANS: B Transactional leaders tend to rely on position and power, and they tend to reward and punish according to performance and conformity with expectations.

The style of leadership that Kari is exhibiting is likely to: a. Ensure that the organization is financially stable. b. Stifle innovative thinking about ways to move out of financial jeopardy. c. Lead to apathy and disinterest in the organizational goals. d. Lead to decreased attrition of staff on her unit.

ANS: B Whether or not the organization achieves financial stability is a function of financial envisioning and planning, but the style of leadership (transactional) that Kari is demonstrating is likely maintaining the status quo within the organization, without generating creative and innovative ideas to address the financial issues. Staff commitment is low to stable, and conformity to organizational goals is motivated by external rewards.

As a senior executive, you are keen to develop your hospital as a learning organization. Part of your purpose in translating this vision into practice is to (select all that apply): a. Retain funding from third-party payers. b. Develop leaders. c. Maintain and/or improve quality of care. d. Stay abreast of new knowledge and evidence.

ANS: B, C, D Learning organizations are concerned with providing opportunities and incentives for individuals and groups to engage in lifelong learning, in recognition of the positive impact that learning has on patient outcomes and staying abreast of new knowledge. Lifelong learning and reflection are also characteristics of leaders.

The hospital administration is discussing the possibility of closing hospital beds in your unit because of a nursing shortage and the increased amount of overtime required to care for patients. As the leader on the unit, which of the following examples best demonstrates your transformational leadership style? a. Your entire staff walks out on strike. b. Your staff sends an ultimatum to the clinic director demanding higher pay. c. A group of your staff members goes to the administration to propose closing of a different unit. d. A group of your staff members goes to the administration to request that they be allowed to work the overtime hours.

ANS: C Commitment to the vision that has been created is seen in the ability of the leader to influence, motivate, and persuade others. The transformational leader can motivate employees by encouragement of novel, innovative thinking. Drenkard (2013) describes true transformational leadership as occurring when the leader "created an environment that brought leaders and followers together to solve problems, create new ways of doing work, and manage change together" (p. 57).

In working with Cheryl, her mentor suggests that it is really important for Cheryl to engage in self-appraisal and to know her strengths. This observation is based on an understanding that: a. Self-confidence comes automatically out of leading. b. Self-confidence requires constant self-affirmation of strengths. c. There is little external motivation and affirmation in leadership. d. Supervisors of leaders rarely provide feedback.

ANS: C Followers usually hold opinions about decisions that are made; these opinions can be favorable or not, which means that external motivation and affirmation are rare. Leaders have to be confident in their own abilities and enthused about the vision that they have created.

To retain supervisory staff members, the director of nursing develops a mentoring program. The best person to be a mentor for a new supervisor in a leadership position is someone who has: a. Been in exactly the same position and can relate to the new supervisor's problems. b. Had vast leadership opportunities and likes to talk about his or her past experiences. c. Leadership experience and time to spend communicating with the new supervisor about his or her experiences. d. People who can help the new supervisor get what he or she needs to make the organization grow quickly and prosper in the process.

ANS: C Mentors need to have experience and some success in the leadership area of interest, as well as interest in the future development of the novice. The mentor can be geographically distant or close and able to provide advice and feedback.

As the clinical director of 24 employees, you have been asked to explain to staff members why they are not getting a raise this year, even though they have been working short-handed for many months and patient satisfaction scores have never been higher. Because you believe yourself to be a transformational leader, you will approach this problem by: a. Telling the assistant clinical director and asking her to share the bad news with the other staff members. b. Posting a note on the bulletin board that includes the phone number of the chief nursing officer, so anyone who has complaints may express them. c. Showing staff members the budget and asking for input about how to cut costs so that raises will be possible in the future. d. Meeting with a small group of seasoned staff members and asking them how to break the news.

ANS: C Transformational leadership involves engaging those being led and inspiring shared vision in moving toward a goal that all will accept as desirable. This involves enabling and empowering others to believe that their input and effort will make a difference in solving problems.

The senior executive praises John for the positive patient evaluations that his unit has received. As an effective leader, John: a. Thanks the senior executive for having confidence in him and celebrates by going out to a special restaurant. b. Points out the impact that the changes he has initiated have had on the unit. c. Advises the senior executive that the mission statement and goals are important to him. d. Points out the contributions of his staff to the outcomes and shares the praise with his staff.

ANS: D An effective leader is eager to share the glory with those who have worked with him or her to achieve outcomes and success. The act of acknowledging the achievement to the senior executive and of sharing the positive feedback with his staff empowers the staff and builds a support base for the leader.

After a newly hired director of nursing has reviewed the hospital's strategic plans, she develops a timeline for achieving those plans. The new leader is: a. Not expecting that novice leaders will have a vision. b. Demonstrating mistrust of the abilities of her staff to implement the plans. c. Instituting deadlines against which the performance of staff will be evaluated. d. Translating a global document into realistic plans for nursing.

ANS: D Followers need three things from leaders: direction, trust, and hope. Developing timelines for the strategic plan involves translating a vision into reality and being able to communicate a vision meaningfully, which is an example of a leader's influencing behavior.

Susan, a new graduate on the dialysis unit, appears to take Kari's remarks very seriously and works even harder, often volunteering for extra assignments. She also is often in Kari's office, advising of successes with her patients and of the extra effort that she is committing. This behavior suggests that Susan: a. Is fearful of losing her job. b. Lacks understanding of Kari's leadership style. c. Is not intimidated by Kari's leadership style. d. Knows how to "play the game."

ANS: D Followers under transactional leadership feel secure about what will happen next or what is needed to be rewarded; therefore, they learn to "play the game."

The director of nursing has been observing staff interactions in a 20-bed coronary care unit. Based on her observations, which of the following staff members is an obvious leader? a. The unit secretary who knows everyone's business b. The chief nursing officer who is in charge and is responsible for nursing services c. The chief cardiologist who admits the largest number of patients and brings in more revenue than any other physician d. The staff nurse who persuades other staff members to practice by making evidence-based decisions

ANS: D Leaders are those who do the best job of sharing their vision of where the followers want to be and how to get there. It is the ability to inspire others to bring a vision (such as evidence-based decision making) to reality and is not necessarily tied to status or information flow.

While explaining the importance of developing leadership skills among nurses to a group of first-year nursing students, Natalie, a nursing unit manager, emphasizes that: a. Most nurses are not expected to assume leadership roles. b. The role of nurse leadership is only at the bedside, ensuring that patient care is performed according to established standards. c. Only individuals in formal leadership roles are expected to be leaders. d. The public depends on nurses to assume leadership in moving consumer advocacy concerns forward.

ANS: D The complexity of nursing and the healthcare environment demands that all nurses assume roles of manager, leader, and follower, depending on the situation. Nurses are involved in providing leadership in direct patient care, in leading others at a unit or organizational level, in moving the profession forward, and in participating in legislative and policy arenas. Consumers depend on nursing leadership to carry the healthcare agenda forward.

How can a leader deal fairly with employees who fail to meet established standards of care? a. Determine if the employee issue is a will or skill issue. b. Conduct a chart review that reflects the care issue. c. Ask questions of the employee that can reflect the employee's knowledge base. d. Ask other staff to document concerns to use for discharging.

Ask questions of the employee that can reflect the employee's knowledge base.

The charge nurse observes a specific employee has a significant increase in errors and may have some emotional problems from personal issues at home. What is the appropriate response by the charge nurse? a. Schedule a series of meetings with the employee to support and assist the employee in addressing the problem. b. Ask the employee some questions ending with a suggestion that Employee Assistance might be an option. c. Put the employee on the first steps of disciplinary action. d. Send the employee to the mental health center and ask for documentation before returning to work.

Ask the employee some questions ending with a suggestion that Employee Assistance might be an option.

A nurse manager is experiencing poor staff morale on her unit. While participating in a baccalaureate course, the nurse manager had learned that one of the reasons nurses lack power today is probably because of the past. In the early decades of the profession, nurses lacked power because: a. Nurses freely chose to defer to physicians and administrators with more education. b. Women lacked legal, social, and political power because of legal and cultural barriers. c. The first nursing licensure laws prohibited nurses from making most decisions. d. Nurses astutely recognized the risks of grabbing too much power too soon.

B

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 power b. Expert power c. Personal power d. Competency power

B

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

You have been offered a position as a head nurse in the ED. You understand that: a. You have stature and power by accepting the position. b. You have stature but no power at this point in your position. c. As a result of your position, you will need to keep much knowledge to yourself. d. Knowledge is assumed as a result of your position.

B

A manager relies on his director (immediate supervisor) for advice about enrolling in graduate school to prepare for a career as a nurse executive. The director may exercise what kinds of power in the relationship with the manager in this advisory situation? a. Expert, coercive, and referent b. Reward, connection, and information c. Referent, expert, and information d. Reward, referent, and information

C

What is the most important component of role transition? a. Clear delineation of role expectations and accountabilities b. A supportive manager c. A detailed position description d. Orientation

Clear delineation of role expectations and accountabilities

A nurse is participating in a baccalaureate course. For the class, she has to attend the legislative session regarding the new role of medication assistants. Nurses should be involved in shaping public policy primarily because: a. Involvement will enable nurses to take over the healthcare system at some point in the future. b. Other healthcare professions are less concerned about the essential needs of clients. c. Such activities are important career builders for nurses who seek top-level executive positions. d. They are closest to the front line of health care and see how it affects clients and families.

D

Ellen is a novice nurse on your unit. as her supervisor, you have noticed some knowledge and skill deficiencies. These have been noticed by her peers as well, who cover for her. Which of the following is likely to be the greatest asset to Ellen in improving her performance?

Encourage staff to report every behavior of Ellen's that is different from theirs.

All of the following are grounds for immediate dismissal except:

Failing to pursue further medical help for a patient; patient dies.

Before terminating an employee, a nurse manager must:

Follow the organization's specific policies for addressing disciplinary problems and termination.

The chief nursing officer understands that clinical incompetence is best prevented by a

Formalized competency program with established standards for practice.

Susan, a new graduate, is upset that so many staff have been absent lately from the unit. She declares to you that all absenteeism could be eliminated with proper management. Your response is based on understanding that:

Not all absenteeism is voluntary.

A nurse manager understands that the second step in handling an employee with a disciplinary problem is to document the incident. Which of the following is best for documentation of personnel problems?

Notes made immediately after an incident that include a description of the incident, actions taken, plans, and follow-up

The education consultant for the hospital is presenting a workshop titled "Documentation: A Manager's Responsibility." Which of the following points would she not include in her PowerPoint presentation? Documentation:

Should avoid discussion of the problem.

the director is very concerned about a report of substance abuse on the manager's unit, and she reviews the procedures involved in dealing with chemically dependent staff. Which of the following statements would NOT be included in the discussion? "As a manager, you:

Should realize that the nurse is a professional embarrassment and should be kept out of sight of other staff."

The chief nursing officer reviews the policy about "progressive discipline process." The progressive discipline process includes which of the following? The manager:

Should terminate the employee if the problem persists.

Which of the following is a professional role transition? a. Purchasing a car b. Marriage c. Starting a new job d. Retirement

Starting a new job

When progressive discipline is used, the steps are followed progressively only for repeated infractions of the same rule. On some occasions, rules that are broken are so serious that the employee is:

Terminated after the first infraction.

Incivility is a disruptive behavior or communication that creates a negative environment and interferes with quality patient care and safety. The manager can implement steps that help to alleviate uncivil behavior on a unit. Which of the following would not be an appropriate first step?

Terminating the staff member

The nurse manager places a staff member on probation because of reports of chemical dependency. The nurse manager should be aware that which of the following statements is true regarding chemical dependency?

The chemically impaired nurse affects the entire healthcare organization.

Nurse Stacey is a self-admitted drug addict and has been a heavy abuser of codeine. Stacey and the unit manager decide that changes have to occur. Stacey enrolls in an addiction program, and the manager has her transferred to a drug-free area. What other strategies might be appropriate?

The manager could assist in monitoring Stacey's progress.

The nurse manager knows that the most serious effect that absenteeism has on the nursing unit is that:

Unacceptable patient care may result.

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage. Sarah's actions are important in avoiding role: a. Ambiguity. b. Transition. c. Development. d. Negotiation.

a. Ambiguity.

A nurse manager notices that Nathan, an RN who has been on the unit for approximately 3 years, has a particular interest in technology and seems to be very enthused about working with software and hardware at home. She speaks with Nathan and asks him if he would lead investigation of software applications on the unit. This is an example of: a. Opportunity. b. Delegation. c. Role negotiation. d. Role transition.

a. Opportunity.

The chief nursing officer develops a mentoring program to help new staff members adjust to their new jobs. The main purpose of mentoring is: a. Promoting staff retention. b. Promoting staff attrition. c. Developing new role expectations. d. Promoting staff supervision.

a. Promoting staff retention.

A nurse manager in one hospital values a colleague who is a few years older and has more experience in nursing management. The colleague works in another hospital, but they meet for lunch once a month. In these meetings, they share their feelings about nursing management and their lives. The function of a mentor that is missing in the relationship is: a. Sponsorship. b. Role modeling. c. Social interaction. d. Mutual positive regard.

a. Sponsorship.

Nurses were long viewed by physicians, legislators, the media, and others as powerless because nurses a. declined to participate in political activities in the earliest years of the profession in the United States. b. as women were subject to control by medicine and other paternalistic groups; women had limited legal rights in late 19th-century America. c. and nursing leaders in the mid-20th century did not wish to be viewed by those outside of nursing as pushy or demanding. d. were subject to nursing practice acts that limited their ability to take political action.

as women were subject to control by medicine and other paternalistic groups; women had limited legal rights in late 19th-century America.

As a new manager, you reflect on what professional development would be most valuable to assist you in taking on this role. Which of the following would you most likely identify? a. Opportunities to hone clinical skills that are used most often on the unit that you will manage. b. A workshop on conflict management and communication skills. c. Attendance at a conference on global health care economics. d. Attendance at a workshop on survey tool development and statistical measurement

b. A workshop on conflict management and communication skills.

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage. Sarah finds that she has begun to think negatively about the way nursing care is delivered on her nursing unit. She often wishes that she was back on her old unit and in her familiar staff nurse role. This behavior: a. Is natural when assuming a new position. b. Diverts energy from internalization of Sarah's new role. c. Is justified if practices are deficient on the new unit. d. Reflects Sarah's astuteness as a clinician.

b. Diverts energy from internalization of Sarah's new role.

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage. After a year, Sarah successfully transitions into the nurse manager role and considers taking the examination to become a certified nurse executive. Amy advises her that this is not possible because Sarah will need: a. A graduate degree. b. At least a nursing diploma. c. 24 months of experience. d. 5 years of successful experience.

c. 24 months of experience.

The nurse manager of a unit was demoted to staff nurse 6 months ago. Because of being near retirement, the former nurse manager wanted to be employed at the hospital and was offered a position on the same unit. The former nurse manager complains often about how infrequently the current nurse manager is available on the unit and argues with physicians and co-workers. Clients have complained about the attitude of the nurse. The behavior of the former nurse manager can be best explained as being caused by: a. Overwork in the staff nurse position. b. Inadequate mentoring in the new role. c. Anger as a stage of the grieving process. d. Demotion as a threat to personal identity.

c. Anger as a stage of the grieving process.

In addition to providing coaching, a nurse mentor may provide counseling to the mentee. For counseling to be successful, the mentor must: a. Provide a quiet environment away from the unit. b. Keep the focus on technical and management responsibilities. c. Assure confidentiality. d. Present assignments that stretch the intellectual and technical ability of the mentee.

c. Assure confidentiality.

Who of the following might be the BEST mentor for Becky, a new nurse manager on the cardiac unit who has 4 years of previous clinical experience? a. Sam, near retirement. He has 20 years of clinical nursing and recently assumed role of head nurse in an interim capacity because of the incumbent's illness. b. Leslie, who has been a clinical educator at the institution for a number of years. She has tired of her role and aspires to become a nurse manager. She looks at mentorship as an opportunity to understand the role better. c. Courtney, who has been a nurse manager for 3 years. Her staff and supervisor value her skills and her leadership acumen and championship of innovation. d. Ben, who was nurse manager for 3 years, soon after graduation. He left the role because he was uncomfortable with the expectations and has been a team leader on surgery for 15 years.

c. Courtney, who has been a nurse manager for 3 years. Her staff and supervisor value her skills and her leadership acumen and championship of innovation.

The unit leader on an inpatient psychiatric unit of a large hospital has been in the position for 3 months. The unit leader is frustrated by how little time is available to work with clients and how few changes have been implemented in that time. The phase of role transition being experienced is the role of: a. Acceptance. b. Negotiation. c. Discrepancy. d. Internalization.

c. Discrepancy

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage. After beginning her new position, Sarah finds that she spends a great deal of time in direct patient care. Her staff begins to complain that they are never able to find her when they need her, and that some aspects of her responsibilities fall behind, such as scheduling. Sarah is most likely: a. Lacking an understanding of the nurse management role. b. Attempting to prove her clinical skills to the nursing staff. c. Experiencing difficulty in unlearning old roles. d. Lacking enjoyment in her new role.

c. Experiencing difficulty in unlearning old roles.

The new nurse manager feels pulled between the expectations of staff, the demands of hospital administrators, and family obligations. According to Hardy (1978), unrelieved role stress and strain will lead to: a. Frustration and anger. b. Alienation of family and friends. c. Low productivity and performance. d. Physical symptoms and acute illness.

c. Low productivity and performance

John, a new nurse manager, complains to his colleague that he feels very uncomfortable with the conflict between what he thinks he should be doing as the manager and what his supervisor thinks he should be doing. According to Hardy's role theory, John is experiencing: a. Stress. b. Role stress. c. Role strain. d. Role exploration.

c. Role strain.

A nurse is interviewing for a manager's position. Which of the following actions is considered a role preview? a. Formal commitment of the employment contract b. Improving role performance c. Touring the unit d. Disillusionment about the expectations of the job

c. Touring the unit

After several months in the role of manager of a dialysis unit, Maryanne finds herself still questioning the gap in expectations between her and her staff and management and is also questioning if she can reconcile her concerns about quality care with the strong cost containment orientation of the facility. At this point, Maryanne is in which stage of role transition? a. Internalization b. Acceptance c. Development d. Discrepancy

d. Discrepancy

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage. Sarah finds that she is comfortable with the expectations of staff and her supervisor regarding her management role and responsibilities and has been able to effect a strong commitment to quality clinical care on the unit. At this point, Sarah has likely attained this role: a. Development. b. Acceptance. c. Symmetry. d. Internalization.

d. Internalization.

During an employment interview for the manager's position in a home health agency, the applicant asks questions about the medical director and about retention of staff. The nurse executive assures the applicant that the agency has few personnel problems and receives excellent support from the medical director. The applicant knows that the agency has a 50% turnover rate and has had three medical directors in the past year. The nurse executive is: a. Unaware of the turnover rate and difficulties with the medical director. b. Lying about the problems and hoping to resolve them by hiring the applicant. c. Denying that the agency has a turnover problem with staff or medical directors. d. Minimizing the challenges of the position to make a positive impression on the applicant.

d. Minimizing the challenges of the position to make a positive impression on the applicant.

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage. A strategy that may help to make the transition to her management role and to respond to relationships and situations in her new position is: a. Avoiding discussion of her personal beliefs with staff until she is ready to do so. b. Finding a network of clinicians with interests similar to her own. c. Researching clinical literature to maintain her clinical assessment skills for the unit. d. Recognizing her strong commitment to care in the management process through journaling.

d. Recognizing her strong commitment to care in the management process through journaling

The new head nurse on telemetry has been in the position for 3 months. The head nurse and the administrator disagree on how much time the head nurse should allot to various aspects of the role. Staff members on the unit complain that the head nurse is unavailable for clinical concerns because of being off the unit while attending meetings. To facilitate the process of role transition, the head nurse should: a. Develop policies consistent with the head nurse's prior workplace. b. Attend a workshop on how to deal with difficult people. c. Decide to give the position 3 more months and then leave if things do not improve. d. Schedule a series of meetings with staff and the administrator to clarify expectations.

d. Schedule a series of meetings with staff and the administrator to clarify expectations.

"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.

use one's influence to create change in pursuit of goals.