Chapter 10: Leadership, Managing and Delegating PrepU (WORK ON)
Which statement by a registered nurse (RN) represents appropriate delegation to a nursing assistant? -"Inspect the site for thrombophlebitis." -"Check the infusion rate." -"Dispose of the disconnected IV set." -"Discontinue the IV solution."
"Dispose of the disconnected IV set." Disposing of a disconnected IV set is a task that is within the scope of practice of a nursing assistant. Discontinuing an IV solution, inspecting an IV site for thrombophlebitis, and checking the IV infusion rate are not within the scope of practice of a nursing assistant and should be performed by the RN.
The charge nurse on the orthopedic unit believes in giving the staff as much power as possible. The nurses are allowed, among other things, to create their own work schedules, provide dates and times for unit meetings, and create the agendas, to which the charge nurse contributes. The charge nurse's style of leadership can be described as which? -Autocratic -Transformational -Democratic -Laissez-faire
Laissez-faire With laissez-faire leadership, the leader relinquishes power to the group. Autocratic leadership involves the leader assuming complete control. Democratic leadership displays a sense of equality among the leader and other participants. Transformational leaders create intellectually stimulating practice environments and challenge themselves and others to grow personally and professionally and to learn.
The new nurse is having difficulty managing the time required to care for a group of complex clients and is several hours behind in completing nursing interventions. Which intervention should the nurse complete first? -Complete a medication reconciliation form on a client who has recently been admitted to the hospital. -Perform a dressing change to an abdominal abscess that is three hours behind schedule. -Administer a dose of digoxin that is two hours behind schedule. -Obtain discharge orders for a client who is ready to be transferred to a long-term nursing facility.
Administer a dose of digoxin that is two hours behind schedule. The first step in time management is to determine which tasks are priority. Digoxin is a critical client medication and therefore takes priority over the other options. Dressing changes, discharge orders, and completing facility forms can be delayed until critical tasks are complete.
A staff nurse works on a medical unit where staff retention is very high. There is a sense of equality between the leader and the staff nurses. The unit decisions and activities are shared between the leader and the group. The designated nurse leader practices which leadership style? -Autocratic -Laissez-faire -Transformational -Democratic
Democratic The democratic leadership style is characterized by a sense of equality among the leader and other participants and shared decision making. The autocratic leader assumes complete control over the decisions and activities of the group. Transformational leaders create intellectually stimulating practice environments, and challenge themselves and others to grow personally, to grow professionally, and to learn. In laissez-faire leadership, also called nondirective leadership, the leader relinquishes power to the group, such that an outsider could not identify the leader in the group.
A nursing facility has recently implemented new policies regarding nurse-to-patient ratios. The nursing staff seems very resistant to the change. How can the nurse manager help the staff accept the change? -Use the laissez-faire leadership style to address staff concerns. -Institute the changes immediately and collectively to decrease anticipation anxiety. -Hold a unit meeting to discuss how the changes will benefit staff. -Challenge staff's beliefs and values regarding providing quality patient care.
Hold a unit meeting to discuss how the changes will benefit staff. Holding meetings allows open communication and opportunities for feedback. Listing the benefits of change to the individual and group also helps with buy-in. Laissez-faire leadership styles tend to increase conflicts and anxiety during times of change. Challenging staff beliefs will increase anxiety and create unpleasant work environments. Change should be instituted gradually, if possible.
The unit manager on a medical unit is trying to encourage the nursing staff to use a new protocol for documentation. To help with this, the nurse manager recruits one of the staff nurses to serve as a role model for many of the staff. Which type of power does the staff nurse exhibit? -Explicit -Coercive -Legitimate -Implied
Implied The staff nurse, as a role model for the rest of the staff and, therefore, influential with making change, would have implied power. Explicit or legitimate power is that power that is directly given, such as with the unit manager role; coercive power is a negative type of power that results from using threats or punishment to force people to do what they do not want to do.
A nurse manager best demonstrates effective leadership characteristic by which action? -Indicating an interest in becoming a role model -Being very structured and rigid with the unit flow -Knowing all information about the unit processes -Sharing a vision for the unit and enlisting support
Sharing a vision for the unit and enlisting support The nurse leader on a nursing unit should have a vision for the unit and be able to share this with the staff in order to enlist support and cooperation among the staff. The nurse leader should already be a role model, rather than just demonstrating interest. This would be related more to someone who was developing leadership qualities. The nurse leader should be flexible, not rigid, and does not have to know all information about the unit; rather, the nurse leader needs to know what resources are available among the staff and other leadership in helping reach expected goals and outcomes.
Which of these statements reflects the expected functioning at a hospital that has achieved Magnet status? -There is a decreased rate of retention among the nursing staff. -Most client outcomes have improved but are not at target range. -Staff nurses are developing innovative solutions to problems. -Nursing administration is in control of all decision-making.
Staff nurses are developing innovative solutions to problems. A hospital that has achieved Magnet status has recognition of quality client care that is provided by nursing staff who are professional and well-qualified. The staff nurses participate in self-governance and, therefore, work toward innovative solutions to problems. Having an increased turnover among staff nurses and a lack of quality client outcomes would not be characteristics of a Magnet hospital.
A charge nurse on a medical-surgical unit is asked by the nurse manager to serve as a mentor to another staff nurse who is less experienced. Which of these would best describe this role? -The staff nurse is orienting to the unit as a newly hired nurse. -The charge nurse is providing support for the staff nurse in new responsibilities. -The staff nurse is learning about all the hospital policies from the charge nurse. -The charge nurse is being paid to supervise the staff nurse.
The charge nurse is providing support for the staff nurse in new responsibilities. A mentor is not a paid position, but, instead, is a person who provides support and encouragement to a less experienced nurse who is learning new responsibilities for a current role or an expanded one. Preceptorship typically is a paid position, and is provided for a new or experienced nurse who is training for a new position on a unit. The preceptor would teach the new nurse about hospital policies and procedures, as well as supervise the nurse in daily assignments.
After a nurse manager implements a solution to the problem of delays in obtaining supplies, the first task for the manager is to: -plan to monitor the supply cabinets. -assess whether the desired results have occurred. -ask the staff members for other solutions. -make an appointment with the chief nursing officer.
assess whether the desired results have occurred. The nurse manager must evaluate the results of the efforts to determine whether the desired results have occurred. The nurse manager should solicit input from staff members about potential solutions before, not after, implementing a solution. Monitoring the supply cabinets would be more appropriate if the problem were suspected drug diversion by staff but would be unnecessary for evaluating for improvement in delays for obtaining supplies. Making an appointment with the chief nursing officer is not necessary and would not help the nurse manager evaluate the change in procedure related to obtaining supplies.
A nurse manager reviews an employee's contribution to the nursing division annually. This process is: -reward and development survey. -performance appraisal. -employee's job satisfaction survey. -interpreting quality indicators.
performance appraisal. Performance appraisal is typically conducted annually. Each organization determines a reward structure to define and to acknowledge success. Interpreting quality indicators pertains to evaluation of general client care, not of an individual nurse. An employee's job satisfaction survey is a tool that allows the employee to give feedback on the employee's satisfaction with work, not a review of the employee's contribution conducted by the nurse manager.
A client is received into the emergency department after getting shot in the chest. The client is hemorrhaging profusely and is in hypovolemic shock. The nurse calls a code blue. What type of leadership style will be most effective during the management of the code? -Laissez-faire leadership -Transactional leadership -Democratic leadership -Autocratic leadership
Autocratic leadership Autocratic leadership will be most effective in this scenario. Autocratic leadership involves the leader assuming control over the decision and activities of the group. During code blue, a leader is needed to direct the actions needed and make quick decisions to positively affect the client. Laissez-faire leadership would ultimately lead to the demise of the client. Democratic leadership could possibly delay the client receiving life-sustaining measures and would be less effective than autocratic leadership. Transactional leadership would involve a reward system which would be unethical in this situation.
The nurse has recently been promoted to nurse manager on a pediatric unit and has decided to accept input from staff regarding changes they would like to see on the unit. Which type of leadership style is the nurse embodying? -Quantum -Autocratic -Laissez-faire -Democratic
Democratic Democratic leadership style involves sharing the decision making process and activities with others who have an interest. Autocratic leadership style involves assuming control over the decisions and activities of the group. Laissez-faire leadership style involves the leader relinquishing power or control to the group. Quantum leadership style involves seeing an organization and members as interconnected and collaborative. This style involves change as continually unfolding, and frequently incorporates technology.
The registered nurse (RN) and unlicensed assistive personnel (UAP) are working together to admit a pediatric client to a nursing unit. Which task would be inappropriate for the RN to delegate to the UAP? -Gathering equipment needed for intravenous therapy -Soothing the client during the procedure -Securing the client on a papoose board -Initiating intravenous therapy
Initiating intravenous therapy When delegating, the RN must determine the skill level and education of the UAP, the client's condition and the complexity of that condition, and the potential for harm. Initiating intravenous therapy is reserved for the RN due to the potential for harm and the scope of the UAP. The UAP can assist the nurse by obtaining equipment, securing the client, and soothing the client.
Conflict has emerged on a nursing unit because new graduates have found that some of the more experienced nurses are manipulating the client assignment to ensure a lighter workload during night shifts. How should the manager of the unit best address this conflict? -Gather evidence over the next several weeks in order to determine if the practice is indeed happening. -Reassure the new graduates that the more experienced nurses are acting in the interests of both staff and clients. -Arrange for the newer nurses to organize the client assignment for a trial period. -Arrange a meeting where the issue can be discussed and addressed by as many of the nurses as possible.
Arrange a meeting where the issue can be discussed and addressed by as many of the nurses as possible. Open, explicit, and participatory conflict resolution that is based on collaboration is an effective strategy for the management of conflict. Gathering evidence does not directly address the conflict that currently exists and reassurance may be unwarranted and false. Allowing the new graduates to create the client assignment may perpetuate selfish practices and does not resolve animosity between the two camps.
A nurse manager informs the staff members during a meeting that unlicensed assistive personnel will no longer be allowed to check clients' blood glucose levels. The nurse manager informs the group that this is a new policy on the unit and that discussions will not change the enforcement of this policy. What type of leadership style is the nurse manager demonstrating? -Laissez-faire -Transformational -Democratic -Autocratic
Autocratic Autocratic leadership involves the leader assuming complete control of the decisions and activities of the group. An extremely autocratic leader might make all decisions for the workers or followers without considering their ideas or feelings. Democratic leadership is characterized by a sense of equality among the leader and the other participants. In laissez-faire leadership, the leader relinquishes power to the group. Transformational leadership can create a revolutionary change and may be directed by a charismatic leader who has a unique ability to inspire and motivate others.
A staff nurse is talking with a clinical nurse leader and asks, "What exactly do you do?" Which statement by the clinical nurse leader would be appropriate? -"I'm an administrator involved with client care." -"My position is one of management." -"I collaborate with health care teams to promote client care." -"I'm an advanced practice nurse with a specific specialty area."
"I collaborate with health care teams to promote client care." A clinical nurse leader is a master's-prepared nurse who has earned the certified CNL credential and works collaboratively with the health care team to facilitate, coordinate, and oversee care provided to clients. This role is not considered an administrative or management role, but rather one of leadership in all health care settings. Clinical nurse specialists are advanced practice nurses with specialist education in a defined area of practice.
A registered nurse is delegating activities to unlicensed assistive personnel (UAP) on a hospital unit. Which activities could this nurse normally delegate? Select all that apply. -Planning education for a client with a colostomy -Giving a bed bath to a client -Transferring a client to another floor -Taking routine vital signs -Administering medications to clients -The determination of a nursing diagnosis for a client with breast cancer
-Giving a bed bath to a client -Taking routine vital signs -Transferring a client to another floor The nurse should be familiar with guidelines for delegating nursing care. The nurse could delegate the following tasks to UAP: giving a bed bath to a client, taking routine vital signs, and transferring a client to another floor. The nurse could not delegate the administering of medications, planning client education for a client with a colostomy, or the determination of a nursing diagnosis.
A registered nurse checks the American Nurses Association (ANA) regulations prior to delegating tasks to unlicensed assistive personnel (UAP) on a burn unit. Which principles regarding the regulation, education, and use of UAP are recommended by the ANA? Select all that apply. -It is the role of the LPN to assign nursing duties to the UAP. -It is the LPN who supervises any assistant involved in providing direct client care. -It is the purpose of assistive personnel to work in a supportive role to the registered nurse. -It is the role of the assistive personnel to carry out tasks to enable the professional nurse to concentrate on nursing care for the client. -It is the health care institution that determines the scope of nursing practice. -It is the registered nurse who is responsible and accountable for nursing practice.
-It is the purpose of assistive personnel to work in a supportive role to the registered nurse. -It is the role of the assistive personnel to carry out tasks to enable the professional nurse to concentrate on nursing care for the client. -It is the registered nurse who is responsible and accountable for nursing practice. The nurse must be familiar with the delegation guidelines when working as a registered nurse. The purpose of assistive personnel is to work in a supportive role to the registered nurse. It is the role of the assistive personnel to carry out tasks to enable the professional nurse to concentrate on nursing care for the client. It is the registered nurse who is responsible and accountable for nursing practice. It is the nursing practice act of each state, not the health care institution, that determines the scope of nursing practice within a given state. The LPN does not supervise the assistant, the RN does. It is not the role of the LPN, rather the RN, to assign nursing duties.
The nurse is caring for an older adult client who states the need to use the restroom. Which safety intervention must the nurse perform first? -Assess the need for assistance with ambulation. -Arrange furniture so that the client has something to hold on to. -Apply socks to the client's feet. -Put the client's bedside rails up.
Assess the need for assistance with ambulation. The diverse physiologic and psychologic capabilities of people and encounters with various safety hazards across the lifespan put various age groups at risk for different safety concerns and potential injuries. Older adult clients are at a higher risk for falling. Thus, the nurse should assess the client's ability to ambulate independently before allowing the client to go to the restroom and to provide assistance, if needed. The nurse would lower, not raise, the bedside rails before having the client exit the bed. The nurse would put nonskid footwear like slippers, not socks, on the client to help prevent falls. Furniture should be arranged so that the client has a clear and easy path to the restroom.
A nurse is in charge of a large group of employees on a busy surgical floor. Today's care must be completed early due to a special event involving most of the employees. Which management style would work best in this situation? -Democratic -Laissez-faire -Coercive -Authoritarian
Authoritarian With authoritarian, or autocratic, leadership, the leader determines, dictates, and directs the activities of the group, with no input from the followers on decisions. It is particularly effective when decisions for a large group need to be made quickly and efficiently, as in this scenario. Coercion--involving forcing actions upon the staff--is not a recognized leadership style and, in any case, would not be an advisable approach as it would likely trigger resistance in the group and be counterproductive. Democratic leadership is appropriate when the task, or decision at hand, is not one that requires urgent action, when subordinates can be expected to make meaningful contributions, and when their input can be taken into account. Laissez-faire management provides little or no direction; coworkers develop their own goals, make their own decisions, and take responsibility for their own management.
The nurse manager for the psychiatric unit sees that there are major conflicts between the day and night shift staff. The nurse manager suggests that each shift put aside their differences for a time and determine a common major goal. Which conflict resolution style does the nurse manager display? -Collaborating -Avoiding -Smoothing -Competing
Collaborating With the collaborating approach to conflict resolution, there is a joint effort to resolve the conflict with a win-win solution. All parties set aside previously determined goals, determine a priority common goal, and accept mutual responsibility for achieving this goal. With avoiding there is awareness of the conflict situation, but the parties involved decide to either ignore the conflict or avoid or postpone its resolution. Competing is an approach that results in a win for one party at the expense of the other. Smoothing is an effort to complement the other party and focus on agreement rather than disagreement, thus reducing the emotion in the conflict. The original conflict is rarely resolved with this technique.
Two staff nurses on a unit disagree with one another over certain key aspects of providing client care. The nurse manager of the unit arranges a meeting with the charge nurse and the two staff nurses at a mutually agreed-upon time to discuss this situation. This activity is most accurately described as what? -Delegation -Problem solving -Conflict resolution -Client protection
Conflict resolution Nurse managers frequently encounter conflict between employees and between themselves and employees. Unresolved conflict can lower morale and threaten quality care. Conflict resolution, also known as conflict management, is a process to work through conflicts in a way that minimizes negative effects and promotes positive consequences. In this scenario, the nurse manager is practicing conflict resolution by bringing the parties involved in the conflict together to discuss possible solutions. Problem solving consists of using generic or ad hoc methods in an orderly manner to find solutions to problems. In a way, conflict resolution is a type of problem solving, in which the problem to be solved is the relational conflict between two or more people. Delegation is the assignment of any responsibility or authority to another person to carry out specific activities. Client protection refers to preventing harm to the client, such as when the nurse keeps client data private.
The nurse manager is concerned about the large number of teenage mothers being seen in the obstetrics clinic. How can the nurse manager use the transformational leadership style to address the concern? -Create a new policy that will limit the number of teenage mothers the clinic can treat. -Enlist volunteers to help develop a community outreach project that will educate teenagers on methods to prevent pregnancy. -Conduct community-based research into the number of teenagers who have become parents over the last five years. -Talk to each teenager who comes in to the clinic about ways to not get pregnant again.
Enlist volunteers to help develop a community outreach project that will educate teenagers on methods to prevent pregnancy. Transformational leaders create revolutionary change and inspire others to become involved with their cause or concern. Enlisting others to make a change in the community is an example of transformational leadership. Creating new policies to distract attention from the problem and talking individually to each teenager does not inspire others to become involved in the change. Conducting research may be a step taken when developing the community outreach project; however, conducting research does not involve others getting inspired to be a part of the change.
A nurse leader on a unit allows the staff to make all decisions and direct themselves, including filling out the work schedule. The nurse leader is practicing which leadership style? -Autocratic -Laissez-faire -Democratic -Transformational
Laissez-faire In laissez-faire leadership, also called nondirective leadership, the leader relinquishes power to the group, such that an outsider could not identify the leader in the group. The democratic leadership style is characterized by a sense of equality among the leader and other participants. The autocratic leader assumes complete control over the decisions and activities of the group. Transformational leaders create intellectually stimulating practice environments and challenge themselves and others to grow personally, to grow professionally, and to learn.
The nurse manager calls a staff into a unit meeting to discuss patient satisfaction. During the meeting, several staff members assume control. The nurse manager does not intervene to regain control of the group. Which type of leadership style is the nurse embodying? -Quantum -Laissez-faire -Autocratic -Democratic
Laissez-faire Laissez-faire leadership style involves the leader relinquishing power or control to the group. Democratic leadership style involves sharing the decision making process and activities with others who have an interest. Autocratic leadership style involves assuming control over the decisions and activities of the group. Quantum leadership style involves seeing an organization and members as interconnected and collaborative. This style involves change as continually unfolding, and frequently incorporates technology.
The nurse recognizes that a new mother is having difficulty breastfeeding. The nurse demonstrates various positions in which to hold the baby while feeding. The nurse also educates the mother on ways to ensure proper latching. The new mother attempts to breastfeed the baby again using the new techniques and is successful. Which statement in this scenario illustrates Lewin's stage of refreezing? -The new mother attempts to breastfeed the baby again using the new techniques and is successful. -The nurse recognizes that a new mother is having difficulty breastfeeding. -The nurse demonstrates various positions in which to hold the baby while feeding. -The nurse also educates the mother on ways to ensure proper latching.
The new mother attempts to breastfeed the baby again using the new techniques and is successful. Refreezing involves making a change operational, or a part of one's everyday life. The mother feeding the baby using new techniques is an example of refreezing. The nurse recognizing that a new mother is having difficulty breastfeeding is an example of unfreezing, in which the need for a change is recognized. The nurse educating the mother on ways to ensure proper latching and demonstrating various positions in which to hold the baby while feeding are examples of moving, in which change is initiated after a careful process of planning.
Two new nurses are requesting the same preceptor for unit orientation and say they will be unhappy if they do not receive their choice of preceptor. Which illustrates the nurses using an accommodating approach to conflict resolution? -The nurses agree for one nurse to obtain the preceptor for orientation in exchange for that nurse working each weekend. -The nurses allow the preceptor to decide which nurse to precept. -The nurses discuss the situation with the preceptor to come to an agreement mutually beneficial for both parties. -The nurses ignore each other's request for the preceptor.
The nurses agree for one nurse to obtain the preceptor for orientation in exchange for that nurse working each weekend. Accommodation involves one party deciding to let the other party win in exchange for something else of value, such as one nurse agreeing to let the other have the preceptor in exchange for the first nurse not having to work weekends. Each nurse ignoring the other's request illustrates avoidance. Allowing the preceptor to decide which nurse to precept encourages competition. Competition involves a win-lose approach to conflict. Collaborating is a joint effort to resolve the conflict with a win-win solution in which all parties set aside previously determined goals, determine a priority common goal, and accept mutual responsibility for achieving this goal.
Two new nurses are requesting the same preceptor for unit orientation. Both new nurses have been very vocal about being unhappy if they do not receive their choice of preceptor. Which illustrates the nurses using a compromise approach to conflict resolution? -The nurses ignore each other's request for the preceptor. -The nurses agree to allow the preceptor to decide which nurse to precept. -The nurses agree to have the preceptor precept one nurse at the beginning of the orientation and the other at the end. -The nurses agree that one nurse will obtain the preceptor for orientation in exchange for that nurse working each weekend.
The nurses agree to have the preceptor precept one nurse at the beginning of the orientation and the other at the end. Compromise involves both parties willingly relinquishing something of equal value. The nurses' decision to share the preceptor, with one having the preceptor at the beginning of the orientation and the other at the end, demonstrates compromise. The nurses ignoring each other's request illustrates avoidance. Allowing the preceptor to decide which nurse to precept encourages competition. Competition involves a win-lose approach to conflict. The nurses agreeing that one nurse will obtain the preceptor for orientation in exchange for that nurse working each weekend illustrates accommodation. Accommodation involves one party deciding to let the other party win in exchange for something else of value.
The registered nurse (RN) wants to delegate measuring a client's urinary output to an unlicensed assistive personnel (UAP). Which factors should the nurse consider before delegating the task? -Predictability of the UAP, the amount of time required for the task, and RN's skill level -The complexity of the activity, age of the UAP, and predictability of the outcome -The context of the other patient needs, the desired outcome, and autonomy of the patient -The stability of the patient's condition, potential for harm, and complexity of the activity
The stability of the patient's condition, potential for harm, and complexity of the activity RNs should consider the following when delegating tasks to UAPs: qualifications and capabilities of the UAP (not the age of the UAP or the RN's skill level), stability of the patient's condition (not the autonomy of the patient), complexity of the activity to be delegated (not the time required to complete the activity), potential for harm, predictability of the outcome (not the predictability of the UAP or the desired outcome), and overall context of other patient needs.
Which of these statements regarding a nurse manager role is accurate? -The nurse manager will decide on the financial targets for the nursing unit. -A healthy work environment is not within the scope of the nurse manager's role. -To effectively manage the nursing unit, the nurse manager should also be a leader. -The nurse manager's main role in the nursing unit is to manage the unit budget.
To effectively manage the nursing unit, the nurse manager should also be a leader. In order to be an effective nurse manager, the nurse manager must also be a leader. This is important with management of a healthy work environment, which is a responsibility of the nurse manager. This is done by helping ensure that interpersonal conflicts are resolved. The nurse manager is also accountable for client census, staffing, supplies, and budget, but is not responsible for setting financial targets for the budget; this is usually managed at the executive level.