Chapter 12
Upon entering a patient's room, the nurse notes that the patient is unresponsive. The nurse takes control and begins to direct other members of the health care team during this crisis. This style of leadership is: a. autocratic. b. democratic. c. laissez-faire. d. bureaucratic.
A
The nurse manager of a unit is sharing the most recent results of a patient satisfaction survey to motivate staff. This nurse manager is a _________________leader. a. Transformational b. Transactional c. Situational d. Autocratic
A
The nurse manager is considered a "great communicator." She can be found on the unit talking with staff, keeping them informed and asking their opinions. She believes that her nurses are motivated by internal means and that they want to participate in making decisions about the unit although the final decision always rests with her. This nurse manager is what type of leader? a. Autocratic b. Democratic c. Bureaucratic d. Laissez-faire
B
The terms leadership and management are often used interchangeably. Although these concepts are related, they are different in definition and in practice. Leadership behaviors and management skills complement each other. However, a. managers focus on relationships. b. a manager may not possess leadership traits. c.leadership focuses on coordinating and directing others. d. a manager is a visionary who sets the direction for a group.
B
A patient is found unresponsive and pulseless. The nurse begins cardiopulmonary resuscitation (CPR) and calls for help. When help arrives, the nurse should take on the role of: a. autocratic leader. b. democratic leader. c. laissez-faire leader. d. bureaucratic leader.
A
The nurse leader is conducting a staff meeting. During the meeting, staff members have verbalized dissatisfaction with the staffing pattern created by the nurse leader. The nurse listens intently as the staff come up with other options. The nurse leader is demonstrating: a. openness. b. integrity. c. dedication. d. magnanimity.
A Openness refers to the leader's ability to listen to other points of view without prejudging or discouraging them. An effective leader considers others' opinions with an open mind because a wider variety of solutions to problems is offered. Openness by the nurse leader encourages creative solutions by providing an environment in which people feel comfortable "thinking outside the box." Integrity is the quality of having clear ethical principles and aligning one's actions with the stated values. Dedication is the ability to spend the time necessary to accomplish a task. Magnanimity means giving credit where credit is due. Good leaders reflect the work and success of accomplishing a goal by crediting those who helped reach it
A nurse does not have to be a manager to be a leader. Even at the bedside, nurses use leadership skills, although possibly in different ways than a nurse manager. The nurse who plans, organizes, delivers, and evaluates nursing care for patients is functioning as a: a. patient care provider. b. patient advocate. c. case manager. d. clinical nurse leader.
ANS: A A nurse does not have to be a manager to be a leader. Even at the bedside, nurses use leadership skills, although possibly in different ways than a nurse manager. The patient care provider must be able to plan, organize, deliver, and evaluate nursing care for patients. An advocate is someone who supports and promotes the interests of others. The RN acts as a patient advocate during the course of treatment. Although many health care organizations have case managers to aid in moving the patient through the health care system, the bedside nurse also acts as a case manager. One important way a nurse can do this is by beginning discharge planning on admission. The clinical nurse leader (CNL) has a master's degree and certification from the American Association of Colleges of Nursing (AACN) Commission on Nurse Certification.
Hiscock and Shuldham state that, in order to deliver quality care, it is important for nurse leaders to be focused on the: a. patient. b. self. c. staff. d. physician.
ANS: A Hiscock and Shuldham state that it is important for nurse leaders to be focused on the patients rather than themselves to deliver quality, patient-focused care. The patient is the center and purpose of the process. All others (self, staff, physician) exist to provide service to the patient.
The nurse is acting as a leader in the role of charge nurse and notes that the unlicensed assistive personnel (UAP) on the floor are stressed related to their increased workload. The nurse changes the original planned approach based on the presenting situation. What theory of leadership is being implemented? a. Situational b. Transactional c. Transformational d. Autocratic
ANS: A Situational theories suggest that leaders change their approach depending on the situation. Transactional leaders use reward and punishment to gain the cooperation of followers. Transformational leaders use methods that inspire people to follow their lead. Transformational leaders work toward transforming an organization with the help of others. The authoritarian or autocratic leader exercises strong control over subordinates.
According to Fayol, controlling is a function of management. Controlling compares to what phase of the nursing process? a. Evaluation b. Diagnosis c. Assessment d. Implementation
ANS: A The act of controlling involves comparing expected results of the planned work with the actual results. In the nursing process, evaluation is comparable to controlling. The planning function of a manager is comparable to the assessment, diagnosis, and planning portions of the nursing process
Which of the following has been done improperly? a. The UAP re-delegates vital signs to the student nurse. b. The RN delegates assistance with bathing to the student nurse. c. The RN delegates monitoring of intake and output to the UAP. d. The RN delegates assistance with mobility to the UAP.
ANS: A The person to whom the assignment was delegated cannot delegate that assignment to someone else. If the person cannot carry out the assignment, the individual needs to notify the delegating RN so that the task may be reassigned or completed by the RN. The RN must remember to delegate tasks that do not require nursing judgment. Only tasks that are routine such as bathing, monitoring intake and output, and assisting with mobility, and do not require variation from a standardized procedure should be delegated.
The leadership theory that assumes that leaders are born with certain leadership skill that few people possess is known as: a. trait theory. b. behavioral theory. c. situational theory. d. transformational theory.
ANS: A Trait theories assume that leaders are born with the personality traits necessary for leadership, which few people are thought to possess. Behavioral theories assume that leaders learn certain behaviors. These theories focus on what leaders do, rather than on what characteristics they innately possess. Situational theories suggest that leaders change their approach depending on the situation. Transformational leaders use methods that inspire people to follow their lead. Transformational leaders work toward transforming an organization with the help of others.
When delegating to other health care providers, the nurse understands that the task: (Select all that apply.) a. must be within the scope of the person to whom it is being delegated. b. is one that can be delegated to other health care providers. c. can be delegated whenever assessments are required. d. may be re-delegated by the person to whom it was first delegated. e. may require the nurse to procure resources to complete the task.
ANS: A, B, E Through quality improvement, the nurse appreciates the value of what each team member can do to improve patient care. When delegating to other health care providers, the nurse understands that the task must be within the scope and abilities of the person to whom it is being delegated. The nurse must know if the task is something that can be delegated. The RN is responsible for assessment of patients even if certain tasks are delegated to others. The person to whom the assignment was delegated cannot delegate that assignment to someone else. Adequate resources must be made available to the delegatee to complete the task
An effective manager must: (Select all that apply.) a. understand the concepts of budgeting. b. run a unit efficiently without regard to cost. c. be able to staff the unit effectively. d. be adept at information management. e. achieve desired outcomes in any way possible.
ANS: A, C, D An effective manager must have business skills and a business sense. Part of quality care is ensuring that the care the patient receives is cost effective. The nurse manager must understand concepts of budgeting, staffing, marketing, and information management. An understanding of human resource management is equally important. The skillful nurse manager understands the way these elements interact and their influence in achieving expected outcomes in an economically responsible manner.
The nurse has a question regarding scope of practice and delegation. Where should the nurse seek clarification? (Select all that apply.) a. The state's Nurse Practice Act b. Theory X management c. Nurse's Code of Ethics d. The NCSBN website e. NCSBN journal articles
ANS: A, D, E Nurses must have knowledge of the nurse practice act in the state where they are licensed. Each state's nurse practice act defines the RN scope of practice and discusses appropriate delegation. A second resource in delegation is the use of the organization's policy and procedure manual. Employers must have job descriptions for each job class that outline the responsibilities and limitations of each position. The National Council of State Boards of Nursing (NCSBN) website and journal articles are other resources for understanding delegation. Nurses are expected to follow personal and professional ethics, as outlined in the American Nurses Association (ANA) Code of Ethics for Nurses to maintain integrity. Theory X-style managers believe that the average person dislikes work and will avoid it if given the opportunity to do so.
The nurse correctly defines leadership when stating: a. "Leadership is coordinating others toward a common goal." b. "Leadership is the ability to influence others." c. "Leadership focuses on the task at hand." d. "Leadership is based in formal authority."
ANS: B Leaders have the ability to influence and motivate others while maintaining relationships to accomplish a goal. Management is the process of coordinating others and directing them toward a common goal. Management is focused on the task at hand. A manager holds a formal position of authority in an organization; that position includes accountability and responsibility for accomplishing the tasks within the work environment. Managers demonstrate accountability when they are answerable for their own actions and the actions of those under their direction.
For patient care to be completed in a safe and timely manner, it is sometimes necessary for the nurse to delegate tasks to other health care providers. The ANA describes delegation as: a. a transfer of authority to a less-qualified individual. b. the nurse transferring accountability to the delegate. c. the transfer of tasks by the nurse while retaining accountability. d. transferring responsibility for assessments and planning.
ANS: C For patient care to be completed in a safe and timely manner, it is sometimes necessary for the nurse to delegate tasks to other health care providers. The National Council of State Boards of Nursing (NCSBN) offers support in this process. In their joint statement (ANA and NCSBN, 2005), the ANA describes delegation as the transfer of responsibility, and the NCSBN calls it a transfer of authority. This transfer gives a competent individual the authority to perform a selected nursing task in a selected situation. The nurse retains accountability for the delegation. Any significant findings during the care such as alterations in skin integrity, shortness of breath, or changes in a patient's condition should be reported to the nurse. The nurse is then responsible for assessing the alterations and addressing them in the plan of care.
The unit charge nurse uses reward and punishment to gain the cooperation of the nurses assigned to the unit. What type of leader is this charge nurse? a. Transformation b. Autocratic c. Transactional d. Situational
ANS: C Transactional leaders use reward and punishment to gain the cooperation of followers. Transformational leaders use methods that inspire people to follow their lead. Transformational leaders work toward transforming an organization with the help of others. The authoritarian or autocratic leader exercises strong control over subordinates. Situational theories suggest that leaders change their approach depending on the situation.
Mintzberg described management in terms of behaviors. Mintzberg's decisional roles include: (Select all that apply.) a. figurehead. b. spokesperson. c. entrepreneur. d. resource allocator. e. negotiator.
ANS: C, D, E Mintzberg described management in terms of behaviors. Underlying his descriptions were two assumptions: much of a manager's time is spent in human relations, and managers are more reactive than proactive. These assumptions provided the basis for three categories of behaviors: interpersonal roles, informational roles, and decisional roles. Mintzberg described three interpersonal roles: figurehead, leader, and liaison. The three informational roles he described are monitor, disseminator, and spokesperson. The third category of Mintzberg's behavioral roles comprises the four decisional roles: entrepreneur, disturbance handler, resource allocator, and negotiator.
The nurse has made patient care assignments and expects all team members to set their own goals for the day and manage their time to meet their goals. The nurse is implementing what style of leadership? a. Autocratic b. Democratic c. Bureaucratic d. Laissez-faire
ANS: D Like the democratic leader, the permissive or laissez-faire leader thinks that employees are motivated by their own desire to do well. The laissez-faire leader provides little or no direction to followers, who develop their own goals and make their own. The authoritarian orautocratic leader exercises strong control over subordinates. The participative or democratic leader believes that employees are motivated by internal means and want to participate in decision making. The primary function of the leader in this situation is to foster communication and develop relationships with followers. Like the autocratic leader, the bureaucratic leader assumes that employees are motivated by external forces. This type of leader relies on policies and procedures to direct goals and work processes. The nurse using bureaucratic leadership tends to relate impersonally to staff and exercises power on the basis of established rules
Which of the following was delegated inappropriately? a. Personal hygiene by the UAP b. Assistance with eating breakfast by the UAP c. Assistance with toileting by the UAP d. Interpretation of abnormal vital signs by the UAP
ANS: D The RN must remember to delegate tasks that do not require nursing judgment. Interpretation of abnormal vital signs requires assessment skills possessed by the RN only. Only tasks that are routine and do not require variation from a standardized procedure, such as providing hygiene, assisting with eating, and toileting, should be delegated.
The nurse manager of the emergency room believes that efficiency is the expected standard for her department. She also believes that efficiency lies in following established rules, policies, and guidelines. The only way to change procedures is to changes rules, policies, and guidelines. In order to run the emergency room with this philosophy, the nurse manager must take on the role of: a. laissez-faire leader. b. democratic leader. c. bureaucratic leader. d. autocratic leader.
C
Communication skills are most essential for the nurse: a. when they become nurse managers. b. except when delegation is required. c. to decrease nurse-family interaction. d. to obtain information from patients.
D Communication is the foundation of nursing practice. Communication skills are essential for the work of the nurse manager and every nurse. By developing excellent communication skills, the nurse can obtain information, relay a plan, delegate, and evaluate a plan of care. The nurse develops relationships—with patients, families, co-workers, and other health care professionals and managers—that are necessary for functioning in the work environment.
The nurse is acting in the planning function as a manager. Which of the following stages should be completed first? a. Set the plan b. Assess the situation and future trends c. Convert plan into action statement d. Set the goals
D The planning function of a manager is comparable to the assessment, diagnosis, and planning portions of the nursing process. It includes four stages: (1) Setting goals, (2) assessing the current situation and future trends, (3) setting the plan, and (4) converting the plan into an action statement.
