Leadership Questions

The _____ is a tool which is useful in assessing the readiness for organizational change. Organizational Change-Readiness Scale (OCRS) five-dimensional scale Rapid Cycle Change plan-do-study-act model

Organizational Change-Readiness Scale (OCRS) The OCRS is a 76-item inventory that is used to analyze the ability of an organization to manage change effectively. There are five dimensions that are a part of this assessment tool.

Which of the following behaviors build trust between leaders and employees in an organization (select all that apply)? Sharing relevant information Encouraging competition via winners and losers Reducing controls Meeting expectations Avoiding discussion of sensitive issues

Sharing relevant information reducing controls meeting expectations Leadership is founded on trust. Behaviors that build trust include sharing relevant information, reducing controls, and meeting expectations. Trust-destroying behaviors include being insensitive to beliefs and values, avoiding discussion of sensitive issues, and encouraging competition. Leadership is founded on trust. Behaviors that build trust include sharing relevant information, reducing controls, and meeting expectations. Trust-destroying behaviors include being insensitive to beliefs and values, avoiding discussion of sensitive issues, and encouraging competition.

Good leaders need to be able to demonstrate an intuitive skill of empathy and expressiveness when dealing with others in the workplace. This requires sensitivity and awareness of the emotions and moods of others and is known as: social awareness. self-awareness. self-management. relationship management.

Social Awareness Social awareness is an intuitive skill of empathy and expressiveness in being sensitive and aware of the emotions and moods of others.

Cultural diversity refers to the: acknowledgment of variation in thoughts, communication, values, and beliefs. belief that one's own culture is similar to another's culture. realization that all people in a particular culture have the same beliefs. view that individuals living in a country should speak the native language.

acknowledgment of variation in thoughts, communication, values, and beliefs. Cultural diversity refers to variations with respect to the thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups.

Cultural affiliation, health and care beliefs and practices, illness beliefs and customs, and spiritual practices best describe components of a: cultural assessment. data collection. health evaluation. medical history.

cultural assessment A cultural assessment consists of cultural affiliation, health and care beliefs and practices, illness beliefs and customs, interpersonal relations, spiritual practices, world view, and other social structure features.

An approach for decreasing nursing RN skill mix was implemented in a "one size fits all" approach across organizations in the 1990s. These changes in skill mix led to: decreases in RN workload. increased nursing satisfaction. decreased patient satisfaction. decreased patient safety concerns.

decreased patient satisfaction.

Clinicians tend to buy into the need for practice change when (select all that apply): there is a strong evidence base. the topic addresses an identified need. the practice change offers a relative advantage. the practice change is endorsed by organizational executive leadership. data demonstrate an opportunity for practice improvement within the clinical area.

there is a strong evidence base. the topic addresses an identified need. the practice change offers a relative advantage. data demonstrate an opportunity for practice improvement within the clinical area. (all except 4)

The total number of nurses who left a unit in 1 year divided by the total number of nurses employed on that unit is the _____ rate. actualized employable turnover vacancy

turnover

All of the following are true in regards to a high-performance organization except: A. Leaders communicate a strong and clear mission and vision to employees. B. There is a commitment to ongoing identification of problems and a preoccupation with preventing potential failures. C. The environment is highly structured. D. The organization is resilient.

Correct answer: C Rationale: Characteristics of a high-performance organization include flexibility; leaders who communicate a strong and clear mission and vision to employees; strategic thinking that anticipates customer needs and market changes; resiliency; and creative and improvisational problem solving to address failures or "near misses."

The registered nurse performs assessment, the licensed practical nurse administers medications, while the certified nursing assistant bathes the patient. This is an example of what type of nursing care delivery model? A. Private duty nursing B. Group nursing C. Functional nursing D. Primary nursing

Correct answer: C Rationale: In functional nursing the division of labor is assigned according to specific tasks and technical aspects of the job. Private duty nursing involves one nurse caring for one client. Group nursing is defined as nursing group practice. Primary nursing is an approach in which a nurse has responsibility and accountability for the continuous guidance of specific clients from hospital admission through discharge.

An experienced critical care nurse left a CCU staff nurse position to finish a master's degree. Periodically, he would return to work as a per diem nurse in the CCU. The staff was impressed with the nurse's performance; however, one staff member complained that he was unfamiliar with the new telemetry monitors when he first returned to work several months ago. This comment showed up in his evaluation, resulting in a poorer overall evaluation from the nurse manager compared with previous evaluations. This is an example of: a halo effect. a horn effect. recent behavior bias. similar-to-me effect.

a horn effect -- A horn effect occurs when a manager perceives one negative aspect about an employee or that employee's performance and generalizes it into an overall poor appraisal rating.

The future projected demand for nurses is related to the aging population and the increase in: acute illnesses. chronic illnesses. medication costs. primary prevention.

chronic illnesses

Evidence-based practice includes: collaborative practice dynamics between health care professionals. documentation of patient care as evidence of nursing practice. integration of research with clinical expertise and patient values. mutual goal setting and application in the clinical setting.

integration of research with clinical expertise and patient values.

There are two important elements associated with dealing with cultural diversity in the workplace. They are (select all that apply): increasing employee knowledge of other cultures. increasing employer pressure for nondiscriminating hiring practices. taking steps to eradicate ethnocentrism. taking steps to encourage egocentrism.

increasing employee knowledge of other cultures taking steps to eradicate ethnocentrism.

An executive leadership council makes practice decisions that affect nursing care delivery. Input from those affected by those decisions is rarely sought. This is an example of: A. Centralization B. Decentralization C. Selective decentralization D. Shared governance

Correct answer: b Rationale: Centralization means that decisions are made at the top levels. Decentralization means that decision making is diffused throughout the organization. Selective decentralization occurs when power for decision making is concentrated in the functional areas of staffing, purchasing, and operations, for example. Shared governance is an accountability-based system for professionals that empowers individuals within the decision-making system and increases nurses' authority and control over their practice.

Evidence shows that planned change is best carried out with the input of: A) Top leaders and managers only. B) Those affected by the change. C) Outside consultants. D) Anyone interested.

Correct answer: b Rationale: Evidence shows that change is best carried out with the input of those affected by change. Those who will be affected by the change likely have a different perspective on ramifications of and challenges related to the proposed change. Their input can be valuable in developing a plan for change. Top-down change is rarely successful as those in the top positions often view those affected by change as obstacles to that change. Although outside consultants can be valuable in the change process, consultants alone will likely not understand the affects of change on those involved. Again, "front-line" perspectives are needed. Those who do not have a vested interest in or are not affected by the change may add confusion to the change process, therefore input from anyone interested in the change is not an optimal strategy.

Empowerment and shared decision making are practices found in: A) Small organizations. B) Learning organizations. C) Innovative organizations. D) Stagnant organizations.

Correct answer: b Rationale: Learning organizations are organizations that learn to adapt to change. Porter-O'Grady and Malloch (2011) emphasized four practices that can be found in a learning organization: empowerment, shared decision making, self-direction, and shared governance. Any size organization can become a learning organization. Although an organization may espouse innovative practices and processes, staff may not be empowered or share in decision making. Stagnation implies a lack of movement or change. An organization such as this would likely not promote empowerment or shared decision making.

Nursing-sensitive indicators: A. Are used to make daily staffing decisions. B. Quantify nursing's contribution to quality and safety. C. Need to be developed to capture nursing's effect on care. D. Are only reported in the National Database for Nursing Quality Indicators.

Correct answer: b Rationale: Nursing-sensitive indicators are used to quantify nursing's contribution to quality and safety. Nursing-sensitive indicators are not used to make daily staffing decisions, although these data are used to support better nurse-to-patient ratios (e.g., evidence suggests poor staffing leads to poor outcomes). Several databases exist that have specific nursing indicators. These indicators are reported in these databases, like NDNQI, as well as organization-specific dashboards and scorecards.

Relationship management is a key leadership skill because: A) Being liked by staff makes it easier to get things done. B) Patient care requires a high degree of interdependence on other care providers. C) Transferring negative moods to staff can decrease productivity. D) Helping staff cope with change is important.

Correct answer: b Rationale: The definition of relationship management is the "use of effective communication with others to disarm conflict, and the ability to develop the emotional maturity of team members." Without effective communication, real or perceived conflict can take hold of a workgroup and disrupt the flow of communication between and among other staff and disciplines. This can seriously impact care coordination, quality, and safety. Relationship management is not related to being liked, transferring negative moods to staff (self-management), or helping staff cope with change (social awareness).

A nursing shortage is defined as: A. Understaffing of units. B. The discrepancy between supply and demand for RNs. C. A lack of graduating nursing students. D. A high turnover rate.

Correct answer: b Rationale: The hallmark of a nursing shortage is the discrepancy between the supply and demand for RNs. A nursing shortage is not just a matter of understaffing; in fact, understaffing can occur in conditions of shortage, equilibrium, or surplus, depending on local factors such as tight budgets or poor working conditions. A lack of graduating nursing students is one of the many causes that lead to a nursing shortage. A nursing shortage has been shown to have adverse effects, including decreased access to care, decreased job satisfaction, and increased turnover.

The aging of nursing faculty and inability of schools of nursing to meet education demands is an example of: A. A nursing shortage. B. A factor contributing to a nursing shortage. C. A recruitment strategy. D. Increased workload

Correct answer: b Rationale: The nursing shortage cycles over the past few decades have been primarily driven by six factors: Aging of current nurses in the workforce and their preparation for retirement; lower numbers of students entering nursing as a career and a shift in need for both BSN- and MSN/DNP-prepared nurses; aging of nursing faculty and inability of schools of nursing to meet education demands; aging of the American population and struggles to expand capacity to meet demand for care; and significant changes in health care delivery system as the nation moves into health care reform. The scenario in the question is not an example of a nursing shortage, a recruitment strategy, or increased workload.

Which of the following statements is not true about performance appraisal? A. Informing the staff about the specific impressions of their work helps improve their performance. B. A verbal appraisal is an acceptable substitute for a written report when performing an informal evaluation. C. Patients are the best source of information regarding personnel appraisal. D. One goal of performance appraisal is to identify learning needs.

Correct answer: c Rationale: Although patients can be a source for appraisal data, they are not necessarily the best source. Data should be gathered from a number of sources, including, but not limited to, patients, peers, and physicians. Performance appraisals help to improve performance and identify learning needs. An informal appraisal can be given in a verbal format.

All of the following are true about strategic management except: A. It involves establishing goals and setting targets. B. It allows an organization to obtain and maintain a competitive advantage. C. It includes only financial goals. D. It requires implementation and evaluation.

Correct answer: c Rationale: Although the strategic plan can include financial goals, it does not exclusively contain these items. Strategic management (Coulter, 2009; Dess et al., 2011; Pearce & Robinson, 2012; Sare & Ogilvie, 2009) involves conducting an environmental scan, knowing the competition, establishing goals, setting targets, developing an action plan, implementing the plan, and evaluating success. Organizations require strategic management to obtain and maintain a competitive advantage. Strategic planning involves developing a strategic mission or vision; setting objectives; developing strategies to achieve the objectives; implementing the strategies; and evaluating the results.

The statement "As a member of a progressive health care system, we deliver high-quality comprehensive services to the local and extended community with excellence, compassion and competence" is an example of which part of a strategic plan document: A. Executive summary B. Background C. Mission D. Goals and strategies

Correct answer: c Rationale: The mission, vision, and values statement should describe the philosophy of the organization. The executive summary is a two- to three-page encapsulation of the essence of the plan, written in language understandable by all potential readers, since many will not venture beyond the first few pages of the document. The background is a description of the institution, its history, and current state, including its accomplishments, as well as the situation that prompted the strategic planning process. Goals and strategies describe the target objectives and the strategies identified to ensure achievement of the objectives.

The staffing management plan: A. Is mandated by law. B. Does not include the use of hours per patient day. C. Is used to determine staffing through a forecasted workload and recommended care standard. D. Measures and predicts the demand for an institution's products and services.

Correct answer: c Rationale: The staffing management plan provides the structured processes to identify patient needs and then to deliver the staff resources as efficiently and effectively as possible. An effective plan first focuses on stabilizing the unit core staffing. A staffing pattern, or core coverage, is determined through a forecasted workload and a recommended care standard. Although over 25 states have various regulations related to staffing management, no legislation dictates every aspect of the staffing management plan. One care standard that can be used in determining staffing is hours per patient day. Demand management as a discipline focuses on (1) measuring, predicting, and understanding demand for an institution's products and services; and (2) deploying resources and management to ensure that demand is met in the way the consumer's wants and needs are satisfied.

Evidence-based practice: A. Encompasses critique of research studies, synthesis of findings, a determination of the applicability of findings, implementation of scientific findings in practice, an evaluation of the practice change, and dissemination of results to expand scientific knowledge. B. Is a statement designed to assist providers and clients in making decisions about appropriate health care for specific clinical circumstances. C. Includes testing the effect of interventions aimed at promoting the rate and extent of adoption of evidence-based practices by health care providers. D. Is a process of shared decision making in a partnership between patients and providers that involves the integration of research and other best evidence with clinical expertise and patient values and preferences in making health care decisions.

Correct answer: d Rationale: Evidence-based practice is a process of shared decision making in a partnership between patients and providers that involves the integration of research and other best evidence with clinical expertise and patient values and preferences in making health care decisions. Research utilization encompasses critique of research studies, synthesis of findings, a determination of the applicability of findings, review for application with implementation of scientific findings in practice, an evaluation of the practice change, and dissemination of results to expand scientific knowledge. The shift from research utilization to evidence-based practice reflects the realization that not all clinical questions have been answered through research; thus other forms of evidence may be required to guide practice. A clinical practice guideline is a statement designed to assist providers and clients in making decisions about appropriate health care for specific clinical circumstances. Translational research includes testing the effect of interventions aimed at promoting the rate and extent of adoption of evidence-based practices by nurses, physicians, and other health care providers and describing organizational, unit, and individual variables that affect the use of evidence in clinical and operational decision making.

Which statement regarding leadership and management is false? A) Leadership focuses on people while management focuses on systems and structures. B) Both leadership and management processes seek to accomplish goals. C) Strategies used to accomplish goals may be different in leadership and management. D) Leadership and management have discrete skill sets.

Correct answer: d Rationale: Leadership and management have several areas of overlap in regards to skill set. For example, both require excellent communication skills. Differences between leadership and management can be seen in regards to focus (people versus systems/structures) and strategies used to accomplish goals.

Workplace diversity: A) Is an interaction between patient/family, organization, co-worker, and clinician's own culture. B) Has a specific definition. C) Is likely to decrease with changes in health care. D) Is dependent on race

answer: a Rationale: Workplace diversity occurs as a result of the interaction between patient/family, organization, co-worker, and clinician's own culture. Many different definitions of workplace diversity exist. The key in any definition is to realize how various aspects of culture affect diversity. Workplace diversity is likely to increase as more patients from previously underserved and minority populations begin to seek care under the Affordable Care Act. Workplace diversity depends on many aspects of culture, which includes but is not limited to race

Which of the following statements regarding organizational culture is true? A) Staff are unaffected by organizational climate. B) Staff retention, workplace safety, and patient outcomes are directly affected by the organizational climate. C) Organizational leadership does not affect organizational culture. D) Working in an organizational culture that values continuous learning has been found to decrease nurses' job satisfaction.

answer: b Rationale: Research has shown that, among nurses, culture affects job satisfaction (Hart & Moore, 1989), intent to turnover (Hemingway & Smith, 1999), needlestick injuries and near misses, surgical outcomes, and patient mortality. Clearly staff are affected either positively or negatively by organizational culture. Organizational leadership typically defines the mission, vision, and values of an institution. Because of this, it is very likely the tone set in these statements will affect the culture of the organization. Organizational cultures that value continuous learning have been found to increase job satisfaction.

All of the following influence the shape of the organization except: A) Formal reporting relationship B) Span of control of managers C) Informal and formal power structures D) Number of management layers

answer: c Rationale: The shape of an organization structure can be described as relatively tall or flat. Several structural factors influence the shape of an organization. The formal reporting relationships among positions, which ensure the assignment of responsibility, authority, and accountability, result in hierarchical levels. The span of control of managers, which is the number of employees reporting directly to a management position, also influences organizational shape (Meyer, 2008). For instance, when managers on average have fewer direct-report staff, the organizational shape is relatively taller. Another structural factor involves decisions about the number of management layers in the hierarchy (i.e., scalar principle). Increased layers of management help the organization cope with increasing work complexity and extended time lines (Jaques, 1990). A tall organization structure assumes a pyramidal shape with multiple management layers (Figure 13-5). In contrast, a flat organization structure has minimal management layers.

The nurse manager calls a meeting of unit staff members to discuss ways to improve the timeliness of patient discharge. The nurse manager and group decide that the use of an admit/discharge nurse would help improve patient flow. This is an example of what kind of decision procedure? A) Autocratic B) Consultative C) Joint D) Delegated

answer: c Rationale: Since the manager and staff decided on a course of action together, this scenario is an example of a joint decision procedure. An autocratic decision procedure in which the leader makes all of the decisions. A consultative decision procedure occurs when decisions involve employee participation but the leader still makes the final decision alone. A delegated decision procedure occurs when the committee chair or leader allows participants to make the final decision.

Factors that affect supply include nursing education factors, work environment factors, and _____ factors. demographic geographic socioeconomic psychological

demographic -- Three factors that affect the supply of RNs are nursing education, work environment, and demographics.

Functional nursing: divided and distributed nursing tasks. enhanced client-oriented care. provided a smooth care delivery system. was expensive once implemented.

divided and distributed nursing tasks.

Shared governance is a model of organizational structure in which staff nurses are: employed to establish mutual goals with clients. empowered through autonomy and accountability. engaged in problem-solving strategies and techniques. equipped with evaluative thinking methodologies.

empowered through autonomy and accountability.

"To provide the best care to every patient every day through integrated clinical practice, education, and research" is an example of a(n): accountability agreement. mission statement. organizational standard. vision and value proposal.

mission statement

The workload standard commonly used in nursing when calculating staffing patterns is: patient days. patient acuity system. average length of stay. nursing care hours per patient day.

nursing care hours per patient day

Staffing management is one of the most critical activities for nurse leaders at every level of the health care organization today because it affects: delegation and supervision. unit leadership productivity. organizational outcomes. professional development and quality control.

organizational outcomes.

Decentralization occurs when: equipment is being purchased from approved vendors. hiring decisions are made at the executive level. power is distributed to those closest to the work of caregiving. supplies are distributed from one central supply area in the hospital.

power is distributed to those closest to the work of caregiving.

A situation in which the demand for employment of nurses (how many nurses employers would like to employ) exceeds the available supply of nurses willing to be employed at a given salary is known as a nursing: abundance. deficit. shortage. surplus.

shortage

Evaluation of the effect of nurse staffing on quality patient, financial, and organizational outcomes is known as: patient acuity. staffing effectiveness. nurse-to-patient ratio. nursing workload.

staffing effectiveness

Referring to a patient as Hispanic or Mexican can contribute to: stereotypes. cultural competency. spiritual competency. diversity.

stereotypes In patient care of a Mexican versus Hispanic person, the failure to identify differences not only perpetuates stereotypes evaluations but also can cause the clinician to fail in accurately assessing potential conflicts with the cultural values of the patient or important communication barriers.

A small number of people with complementary skills who are committed to a common purpose, performance goals, and approach for which they hold themselves mutually accountable and whose membership should be consistent is known as a: committee. group. team. unit.

team A team is a small number of people with complementary skills who are committed to a common purpose, performance goals, and approach for which they hold themselves mutually accountable and whose membership should be consistent (Katzenbach & Smith, 1993; Manion et al., 1996).