Midterm (Chapters: 1,3,4,18,5,6,7,8,9,10,11,12,13,14,15)

As the nurse manager on a rehab unit, you are asked to come to the tub room immediately because two nursing assistants are having a loud disagreement in front of a patient. You ask the nursing assistants to meet you outside and after ensuring that a third nursing assistant is able to care for the patient, you speak with the two nursing assistants. Which of the following would you ask first?

"What happened to bring on this disagreement today?"

Sarah wonders about the direction that you have given regarding management of incontinent, confused patients. She brings you evidence that she has found regarding incontinence interventions and asks you if she and you could talk about the guidance that you have given after you have had an opportunity to read the articles she has given you. This is an example of (select all that apply):

-Assertiveness. -Followership.

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):

-Develop leaders. -Maintain and/or improve quality of care. -Stay abreast of new knowledge and evidence.

A nurse manager is discussing with unit staff the repeated lack of staff compliance in documenting exercise activity for post-cardiac surgery clients. The unit's licensed practical/vocational nurses are responsible for ensuring that clients carry out the prescribed exercise regimen and that the activity is documented. Using Drucker's five basic functions of a manager, identify appropriate functions for the nurse manager to use when addressing this situation (select all that apply):

-Divide the necessary activities into manageable tasks, so clients adhere to the exercise regimen. -Establish objectives and goals for each area and decide who is accountable for them. -Engage in activities that motivate the team, and communicate effectively with the responsible staff members. -Analyze, appraise, and interpret the performance of responsible staff, and communicate these findings to staff management.

Which of the following would not be a characteristic of an effective team nurse leader?

An autocratic perspective

As the manager, you have been asked to implement an evidence-based approach to teach ostomy patients self-management skills postoperatively that is being operationalized throughout your organization. Which of the following illustrates effective leadership?

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

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

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

During a staff meeting held to discuss developing a mission statement for the unit, the idea of placing patient needs first is:

A leadership tag.

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 nurturing and receptive environment

The nurse manager was upset with the staff nurse and said, "You did not understand what I said." Which element in the communication process was she referring to?

A set of barriers that may occur between sender and receiver

What is not a key concept in a well-functioning team?

Absence of disagreement or conflict

The unit is shifting from primary nursing to a team model in an effort to contain costs. Staff members are angry and ask for a meeting to discuss the change. After hearing their concerns related to reduction in professional autonomy and care quality, you:

Acknowledge the loss.

By following a shared leadership model, the nurse manager believes that staff members will learn to function synergistically. Some teams function synergistically because members:

Actively listen to each other.

As the RN charge nurse on the night shift in a small long-term care facility, you've found that there is little turnover among your LPN and nursing assistant (NA) staff members, but they are not very motivated to go beyond their job descriptions in their work. Which of the following strategies might motivate the staff and lead to greater job satisfaction?

Allow the LPNs and NAs greater decision-making power within the scope of their positions in the institution.

A nurse manager is experiencing conflicts between herself and staff members. She had tried to develop a team by using a shared leadership model to empower the staff. Staff members are functioning:

As a group.

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

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

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

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

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:

Be presenting different generational values and attitudes than the head nurse.

A nurse manager's responsibility for financial management involves making budgetary decisions. Budgets that allow the nurse manager to allocate resources at the unit level allow:

Budgetary decision making at the point-of-service (POS).

From the information presented in this chapter, which of the following statements best defines an accomplished team? Effective teams:

Can create a form of synergism in which the outcome is greater than the sum of the individual performances.

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

Challenge and striving for excellence

The nurse manager used a mediator to help resolve conflicts on the unit. During the mediation process, the nurse manager saw signs of potential team-building. One key concept of an effective team is:

Commitment.

The state of being emotionally impelled, demonstrated by a sense of passion and dedication to a project or event, describes:

Commitment.

The unit manager was addressing nursing students in the lounge area and was discussing team leadership and team effectiveness. She stated, "One can agree to disagree with another team member's perspective even when one doesn't necessarily see that perspective as being the correct one." In being creative, what did she mean?

Committing to resolution

As a leader on a rehab unit, you encourage all staff members to see themselves as having a role in decision making and quality care. You see your role as involving particular responsibilities in decision making but not as a hierarchal role. This view of decision making and leadership is consistent with:

Complexity theory.

The mediator asked each staff member to reflect on his or her communication style. Which of the following best describes communication? Communication:

Consists of thoughts, ideas, opinions, emotions, and feelings.

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

Coordination of resources for effective outcomes.

The staff development educator developed strategies to help nurse managers actively listen. Guidelines for active listening include which of the following?

Cultivate a desire to learn about the other person

Joan, the nursing unit manager, finds it difficult to work with Thomas, a new graduate. Thomas has many ideas, and his manner of presenting them irks Joan. After reflection and discussion with others, Joan recognizes that she also feels threatened by his behavior. She comes to understand that Thomas is trying to establish his own role on the unit, is not trying to challenge her, and needs guidance, coaching, and affirmation. Joan is demonstrating:

Deepening self-awareness.

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

Demonstrating respect for patient rights.

A nurse manager has worked rapidly to bring the staff to accept changes in the unit's mission, so that downsizing can be avoided. This nurse manager is using quantum leadership by:

Determining accurately the direction of change in the institution.

You recently acquired a position as a unit manager. During your time on the unit, you have formed a strong social network among your staff, have promoted the development of relationships between your staff and workers in other areas of the organization, and have formed relationships that generate ideas from patient organizations and the local nursing education program. According to complexity theory, you are engaging which principle?

Development of networks

Nurses on Unit 17 complain that their manager frequently "checks up on them" and encourages little involvement in decision making and yet, during performance reviews, praises them for their outstanding performance. Nurses on Unit 18 indicate that their experience is different from that of nurses on Unit 17. The manager on Unit 18 encourages active involvement in decision making and provides authentic, growth-promoting feedback. The practices on Units 17 and 18 reflect.

Differences in the managers' expectations of their role.

Team Member A and Team Member B engage in heated disagreements on a frequent basis in team meetings. Their behavior is characterized by insistence on their points of view and refusal to back down or to negotiate alternative solutions once their ideas have been expressed. This behavior is characteristic of:

Dualism.

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

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

You are charged with developing a new nursing curriculum and are committed to developing a curriculum that reflects the needs of the profession and of the workplace. To address deficits that may already be present in nursing curricula related to the workplace, you include more content and skills development related to:

Effective communication in the workplace.

In planning a new wing, the nurse manager complies with the workplace safety requirements of the Occupational Safety & Health Administration (OSHA). Which of the following groups is considered to be at high risk for violence in the workplace?

Emergency Department staff

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:

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.

As a nurse manager, you embrace the usefulness of resources such as Smart Bed. This behavior is important to:

Encouragement of staff utilization of technology.

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

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

A dispute arises between an RN staff member and an LPN over a patient issue. The tension between the two begins to affect other staff members, who are drawn into the conflict; eventually, the team becomes polarized toward either the RN or the LPN. This situation might have been prevented through:

Expediency in responding to the initial dispute, once it became apparent that it could not be resolved by the two parties themselves.

After assessing an older adult patient in long-term care who has been slowly deteriorating for weeks, the nurse manager calls the family and asks them to come in, as the patient is dying. The nurse manager's decision and actions are based on:

Experience.

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

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

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

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

The chief nursing officer decided that the nurse managers need a series of staff development programs on team-building through communication and partnerships. She understood that the nurse managers needed to build confidence in ways of handling various situations. The greatest deterrent to confidence is:

Fear that one can't handle the consequences.

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

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

A family is keeping vigil at a critically ill patient's bedside. Other, distant family members, not yet able to come, call the unit continuously, asking for updates and wanting to express concern. You speak with the distant family members and suggest that you are going to refer them to the hospital social worker, whose role is to work with people in such situations. In response to this situation, you approach the unit manager to apprise her of your concerns that the family dynamics of the patient involved may lead to staff-family and patient-family conflicts. You suggest that the physician may need to discuss the treatment plan with the family. The unit manager advises that he will arrange this discussion. If, after the meeting with family members, this is identified as a desired approach, you support the manager's decision. Your actions indicate that you are acting in what role?

Follower

The mediator suggested to the unit staff that a group agreement needed to be made so meetings could become productive. For example, the group agreement, "We will speak supportively," prevents:

Gossip and making negative comments about absent team members

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

Grounded in business theory.

As a nurse manager, you identify that a shift in nursing care models might increase patient and staff satisfaction and avoid downsizing. Administration is reluctant to adopt this approach because downsizing is seen as critical to reduction of costs. To leverage your ideas, you:

Identify influential members of your nurse manager group with similar ideas and request an opportunity to meet with administration to discuss options.

A mediator suggested that the nurse manager and staff members decide on a method to resolve conflicts. It is important to have agreements about how team members will work together because:

If there are no agreements, each member will make up rules about how to handle disagreements and relationships.

As the nurse manager who wants to increase motivation by providing motivating factors, which action would you select?

Implement a model of shared governance.

Trust is an important aspect of helping relationships, therapeutic communications, and the positive communications model. Which statement does not involve or define trust? Trust:

Involves decisions to manipulate situations to gain advantage over another.

The SBAR system of communications is one of the most used communication systems in health care because:

It honors a familiar, structured transfer of information among health professionals.

Which of the following nurses is MOST likely to inspire others to do their best?

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.

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:

Knows how to "play the game."

You pull staff together to assess a situation in which the family of a seriously ill patient is anxious and is absorbing a great deal of staff time in consultation, discussion, and questioning of treatment decisions. Staff members are becoming distanced from the family. After inviting the concerns of staff, you explain that the organization values patient-centered care and that evidence supports that acting as an advocate and a listener is helpful to families. You ask the staff for ideas as to strategies that are effectively patient-centered in these situations. In this situation, you are taking on which role?

Leadership

You walk into Mr. Smith's room and find him yelling at the LPN, Miss Jones. He is obviously very upset and after you speak with him regarding his behavior, you determine that he has not slept for three nights because of unrelieved pain levels. The LPN is very upset with Mr. Smith and calls him an "ugly, old man." You acknowledge her feelings and concerns and then suggest that Mr. Smith's behavior was aggressive but is related to lack of sleep and to pain. You say to Miss Jones, "Can you both, together with Mr. Smith, determine triggers for the pain and effective approaches to controlling his pain?" This approach demonstrates:

Leadership behavior.

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:

Leadership experience and time to spend communicating with the new supervisor about his or her experiences.

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:

Look directly at speakers and acknowledge their comments.

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

Management can be taught; leadership depends on abilities.

Budgeting and protection of revenues is a function of:

Management.

Chart audits have revealed significant omissions of data that could have legal and funding guidelines ramifications. As the unit manager, you meet with the staff to discuss audit findings and to find approaches that will address the gaps in charting and achieve desired goals. This is an example of:

Management.

A family is keeping vigil at a critically ill patient's bedside. Other, distant family members, not yet able to come, call the unit continuously, asking for updates and wanting to express concern. You speak with the distant family members and suggest that you are going to refer them to the hospital social worker, whose role is to work with people in such situations. What role are you assuming through this action?

Manager

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

Models professional nursing behavior.

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:

Must be earned.

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

Organization of activities into manageable tasks

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:

Overly managed and not well led.

In the cardiac intensive care unit, there has been simmering discontent about the new nurse manager, who avoids any discussion about her scheduling and practice decisions. The staff have begun to sort into "different camps" depending on how they feel about the manager or the decisions. Which of the following statements MOST accurately describes this situation?

Patient care may suffer because attention and energy is being diverted toward the unit relationships.

The senior executive praises John for the positive patient evaluations that his unit has received. As an effective leader, John:

Points out the contributions of his staff to the outcomes and shares the praise with his staff.

The successful integration of informatics into healthcare settings is key to:

Quality decision making related to management of resources and patient care.

Role theory has its underpinnings in management theory. Management theories influence managers' leadership styles. Which of the following theories would a nurse manager be most likely to follow when redesigning the staffing schedule?

Quantum

A nurse manager in a hospital is deeply concerned that senior administration makes decisions about budgetary directions that affect staffing and other resources without sharing the rationale for changes or demonstrating concern as to how these changes may affect patients or staff. She says she does not feel respected and is emotionally tired as a result. This situation represents:

Quantum leadership.

As a nurse manager on a urology unit, you note that there has been a marked increase in medication errors on the unit. Which of the following actions would be consistent with the National Database of Nursing Quality Indicators (NDNQI) measures?

Recent changes in staffing mixes are examined to determine if the timing of changes coincides with the increase in errors.

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

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

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

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

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

Shared leadership.

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

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

After staff meetings lately, Sharon, the head nurse, observes her staff in small groups, having animated discussions that end abruptly when she approaches. Sharon reflects on this observation and realizes that:

Staff members are very committed to the team and have strong opinions.

According to the complexity theory, which of the following should be the focus of measurement?

Staff morale and budgets

The style of leadership that Kari is exhibiting is likely to:

Stifle innovative thinking about ways to move out of financial jeopardy.

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:

Suggest that she reflect on situations in which she has had a positive influence and consider how her interactions contributed to the situation.

Sally (RN) and Melissa (RN) have shared an ongoing conflict since the first day that Melissa worked on the unit. Sally has confided to another colleague that she doesn't even know why the conflict started or what it was about. This is an example of:

The enduring nature of first impressions.

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?

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.

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:

The public depends on nurses to assume leadership in moving consumer advocacy concerns forward.

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

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

"I really wish that my supervisor would realize and acknowledge all the things I do well." In nursing, this has been identified as a problem. Which statement is part of the solution? Focus on:

The strengths of the individual rather than the weaknesses.

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:

There is little external motivation and affirmation in leadership.

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:

They find that the journey to the solution is as important as the solution itself.

While interviewing for a nurse manager position, Ann is asked to give an example of a situation in which she demonstrated leadership. Which of the following examples exemplifies leadership?

Through research and investigation of best practice and practice-based evidence, she proposed a change in the management of incontinence in elderly patients.

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

Transactional

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

Transformational

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:

Translating a global document into realistic plans for nursing.

At a second negotiation session, the unit manager and staff nurse are unable to reach a resolution. It would now be best to:

Turn the dispute over to the director of nursing.

Nurses in the CCU are unhappy and frustrated with their nurse manager. They complain that "nothing is ever good enough for him." These statements suggest that the nurse manager's goals may be:

Unrealistic.

As a nurse manager, you notice that one of your new nurses has provided exceptional care for a patient with especially complex needs. What would be the MOST effective way of recognizing the nurse's performance?

When the nurse comes out of the room, tell the nurse specifically what you appreciated about the care that was provided.

After being interviewed for the unit manager position, the staff nurse reflects on the interview process. The staff nurse is aware that leadership begins:

Within.

The mediator noticed that tension was still evident between the nurse manager and staff members. He informed the chief nursing officer that to begin team-building, it would be important that everyone:

Work together in a respectful, civil manner.

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

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

You overhear a newly graduated RN telling one of your colleagues that leadership and management belong to the unit manager and not to her. As a nursing colleague, you respond by demonstrating understanding that the perception of the new graduate:

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