Chapter 14

A nurse manager is working on several projects and is stressed most of the time. This manager prefers working at the unit desk instead of in the office to be certain nothing on the unit is missed. Which would be the most effective method to decrease this manager's stress? 1. Keep a structured schedule for "work time" on each project in the office. 2. Elicit assistance from employees to help complete the projects. 3. Allow one project to fall behind while finishing up the others. 4. Take a sick day to work on the projects uninterrupted at home.

Correct Answer: 1 Rationale 1: Carving out work time for each project in the office with a clear place to work is the most effective method to decrease this manager's stress. Rationale 2: Eliciting help from employees is not the most helpful option provided. Rationale 3: Allowing one project to fall behind to work on others will not decrease stress in the long term. Rationale 4: Taking a sick day and working on projects at home is not an appropriate management behavior.

The nurse manager has planned a meeting that all staff nurses have to attend. Which method would most efficiently notify the staff members of the meeting time? 1. E-mail 2. Voice mail 3. Memo 4. Telephone call Correct Answer: 1

Correct Answer: 1 Rationale 1: E-mail minimizes time wasted trying to contact individuals and the urgency of the message can be coded. Rationale 2: Voice mail is time consuming because the caller must place the call. There is also the possibility the person will answer the call, which entails a greater investment of time. Rationale 3: There is a risk that the memo will be placed where it is not accessible to all staff members. Rationale 4: A telephone call may lead to socializing and small talk, which are time wasters.

A novice nurse manager is devising a schedule to meet the needs of the staff, clients, and other disciplines on the unit. Which is the most important method to counteract wasted time in nursing? 1. Delegate routine activities to concentrate on other tasks. 2. Assign a staff member to attend management meetings. 3. Redesign the position so that the nurse manager works when the unit is not busy. 4. Strictly adhere to a rule that the manager will see only staff members who make appointments.

Correct Answer: 1 Rationale 1: One of the most important time wasters in nursing at all levels is failing to delegate tasks that another lower level staff member could do. Rationale 2: Staff should not routinely attend management meetings. Rationale 3: The manager must be available during the busier times on the unit, especially in emergencies. Setting the manager's work schedule to avoid these busy times is not appropriate. Rationale 4: Seeing staff only by appointment does not fulfill the job responsibilities of a nurse manager.

The nurse manager has decided to work on personal time-management skills. What should this manager do first? 1. Review patterns of time use. 2. Purchase a new notebook system for time management. 3. Identify essential job activities. 4. Set a goal of prioritizing tasks every morning.

Correct Answer: 1 Rationale 1: The first step is always to assess, so reviewing patterns of time use is correct. Rationale 2: Deciding to purchase a new notebook system for time management is implementing a strategy and is not the first step of the process. Rationale 3: Identifying essential job activities would come second as a result of reviewing patterns of time use. Rationale 4: Setting a goal of prioritizing tasks every morning is a part of planning and is not the first step of the process

The nurse manager routinely experiences stress related to deadlines for projects. What should be the nurse's first action to control this stress? 1. Identify the actual stressor and the precipitating factors. 2. Plan activities to minimize time constraints to reduce stress. 3. Set aside a block of time each day for stress reduction. 4. Engage in distraction activities to minimize the stress.

Correct Answer: 1 Rationale 1: The first step of the nursing process is to assess the situation. Rationale 2: Before a plan can be made, the stressor must be assessed. Rationale 3: Implementation occurs after the stressor has been assessed and a plan developed. Rationale 4: Implementation occurs after the stressor has been assessed and a plan developed.

A nursing supervisor has a report due and just cannot seem to find the time to get it completed. One day before it is due, the supervisor turns it in. This situation best exemplifies which time waster? 1. The supervisor waited for the deadline pressure to increase the priority. 2. The report was one of the last tasks on the "to-do" list. 3. The supervisor has no interest in the topic of the report. 4. The report format is unfamiliar to the nursing supervisor.

Correct Answer: 1 Rationale 1: This is a classic example of procrastination, and the manager waited until it absolutely had to be done because of the looming deadline. Rationale 2: Being the last task on the "to-do" list is a plausible reason for the wait, but is not the most likely reason. Rationale 3: Lack of interest on the supervisor's part is a plausible reason for the wait, but is not the most likely reason. Rationale 4: The supervisor could be unfamiliar with the report format, but this is not the most likely reason for the delay.

How can a nurse who is consistently falling behind at work improve to become more organized and disciplined? 1. Use the same system every day to organize client care and required activities such as paperwork. 2. Ask the nurse manager to grant permission for fewer client assignments until more experience with organization is achieved. 3. Ask the unit secretary to do required paperwork to decrease the amount of time required. 4. Practice a shorter client assessment technique to minimize the time required for this activity.

Correct Answer: 1 Rationale 1: Using the same system consistently makes organization a habit. Rationale 2: Asking for a lighter load shifts the load onto other nurses and is not appropriate. Rationale 3: The unit secretary cannot legally do the nurse's paperwork. Shifting work onto the unit secretary is not appropriate. Rationale 4: Skimping on client assessment could cause a decrease in client care quality or legal consequences.

nurse manager has felt overwhelmed by work the last few months. After putting in many hours of unpaid overtime, the workload is beginning to stabilize. The nursing supervisor asks the manager to take on a new task that is exciting and stimulating. What should the manager do? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Consider how much work will be added to the current workload. 2. Tell the supervisor no. 3. Talk with the supervisor about decreasing another work responsibility if this project is accepted. 4. Accept the assignment and plan to continue to work very hard until it is completed. 5. Accept the assignment, but only if additional salary is offered.

Correct Answer: 1,2,3 Rationale 1: The manager must be realistic about how much work can be done. Rationale 2: If the project is too much for the manager to take on, the manager should say no. The manager must be aware of the consequences of declining the assignment. Rationale 3: If the manager would like to take on the new project, it may be necessary to decrease another job responsibility. The manager should discuss this possibility with the supervisor. Rationale 4: The manager should be aware of the consequences of overloading one's self. Accepting the assignment and continuing the current work pace may be dangerous to the manager and to others. Rationale 5: Additional salary does not make additional time. If the nurse does not have sufficient time to commit to the project, additional salary will not be helpful.

What are reasons that nurses fail to manage time effectively? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Nurses do tasks they enjoy doing before the ones they do not enjoy. 2. Nurses do things that bring the most immediate closure first. 3. Nurses respond on the basis of who wants something. 4. Nurses do uninteresting jobs before interesting jobs. 5. Nurses work on things in the order of their arrival.

Correct Answer: 1,2,3,5 Rationale 1: Nurses are like anyone else in that they tend to do things they enjoy before they do things they do not enjoy. Rationale 2: Nurses (and others) often do those things that they can get done most quickly first. They feel satisfaction with having one thing done and out of the way. Rationale 3: Nurses tend to prioritize based on who wants something done—for example, if a client wants something that is a priority over the nurse manager needing a report. Rationale 4: It is generally more time efficient to tackle uninteresting jobs first and get them completed before starting interesting jobs that may absorb more of the nurse's time. Uninteresting jobs are likely to be completed as quickly as possible. However, it is not human nature to do what is not interesting first.

A colleague frequently forwards funny e-mails to everyone on her contact list. The nurse manager does not have time to look at the e-mails and is aggravated when they appear. How should the manager handle this situation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Set the e-mail filter to divert the messages to a spam folder. 2. Tell the sender that the manager is not allowed to get personal e-mails at work. 3. Forward the e-mails back to the sender. 4. Send the colleague an e-mail that reads, "Stop wasting my time with these e-mails." 5. Delete the messages without opening them.

Correct Answer: 1,2,4,5 Rationale 1: If the e-mail can be filtered so that the recipient only has to look at them if desired, they are not as aggravating. Rationale 2: Using a corporate policy to explain reluctance to get these e-mails will save face for the sender and the recipient. Rationale 3: This action takes time and is rude. Rationale 4: Unless the colleague is a dear friend, this e-mail is confrontational and may unnecessarily embarrass the colleague. It may also damage a working relationship. Rationale 5: There is no rule that says that all messages have to be opened. When the message appears, delete it.

Which statements indicate that a nurse manager is using time reactively? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "We were so busy yesterday that I did not get the schedule completed." 2. "I knew that we would be busy over the holiday, so I ordered extra supplies." 3. "We have so many new graduates on our unit that our work is never caught up." 4. "I am putting a summary of a research article on the board each week since I realize many of the nurses do not read journals." 5. "I am really concerned about what the nursing supervisor said about our unit. I can't get it off my mind."

Correct Answer: 1,3,5 Rationale 1: Being too busy to get work done is reactive, not proactive. Rationale 2: The manager knew the unit would be busy and could control lack of supplies by ordering more. This is a proactive statement. Rationale 3: The manager should predict that new graduates require more time to complete tasks and should plan for that problem. Rationale 4: The nurse manager knows that nurses need to keep current and also knows that many of the nurses supervised do not read journals. A proactive solution to this problem has been proposed. Rationale 5: A proactive approach would be to ask the supervisor for clarification about the remark.

A nurse is participating in time-management education. This week's assignment is to compile a list of personal goals. Which of these goals should the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I will lose 10 pounds by Christmas." 2. "My family will have more fun." 3. "I will read for pleasure for 1 hour every day after work." 4. "I will not be late for work." 5. "We will save $200 monthly for the next 12 months for a car down payment."

Correct Answer: 1,3,5 Rationale 1: This is a measurable, time-defined goal. Rationale 2: This is not a measurable goal and has no time component. Rationale 3: Pleasure reading is a personal goal. This statement is measurable and has a time frame. Rationale 4: Not being late for work is a job-related goal. Rationale 5: Saving for a car down payment is a personal goal. This statement is measurable and has a time component.

A nurse manager must place a telephone call to a colleague who always wants to chat socially for several minutes. The manager does not have time for a social call. What is the best time for the manager to make this call? 1. At 9:00 a.m. after physician rounds are complete 2. A few minutes before the colleague usually goes to lunch 3. In the middle of the afternoon 4. First thing in the morning, just after shift report

Correct Answer: 2 Rationale 1: 9:00 a.m. is not the best time to make this call. Rationale 2: A call just before lunch is likely to be limited as the person who receives the call wants to leave the office. Rationale 3: In the middle of the afternoon, people are often looking for distractions from their work. If the nurse does not have time for a social chat, the middle of the afternoon is not a good time to call. Rationale 4: If this call is made first thing in the morning, the colleague is unlikely to have begun a project and may wish to delay starting the workday by chatting. If the colleague does not keep "shift" hours, he or she may not be at work that early.

When driving towards a meeting, the nursing supervisor gets a call explaining the meeting is to be delayed for about 30 minutes. Which activity is the best use of this supervisor's waiting time? 1. Listen to music on the radio. 2. Drive to the meeting place and read the minutes from the last meeting. 3. Stop by the closest store and get doughnuts to share with everyone. 4. Use the time to make some personal phone calls.

Correct Answer: 2 Rationale 1: Listening to music is relaxing but could be wasting time that could otherwise be used to prepare for the meeting. Rationale 2: Using the time to refresh memories from the last meeting is the most productive use of the time. Rationale 3: Getting doughnuts is a nice gesture but is not a productive one. Rationale 4: Using the phone to make personal calls is a waste of professional time.

A newly appointed nurse manager has just completed education on time-management skills. Which statement would the instructor evaluate as indicating this nurse understands the basic concepts of time management? 1. "My job as a nurse manager is so dynamic that I probably will not be able to attain true time management." 2. "The key to using time management is to respect my time as well as the time of others." 3. "If I am going to be able to manage time, the hospital will need to invest in a computer-based time-management system." 4. "The most important aspect of time management for me is to manage paperwork flow."

Correct Answer: 2 Rationale 1: Time management is achievable by nurse managers. Rationale 2: The most important aspect is the respect of one's own time, which results in others also respecting that time. Rationale 3: Time management is achievable without sophisticated computer-based time-management systems. Rationale 4: Managing paperwork flow is important, but not the most important aspect of time management.

A nursing supervisor warns the nurse manager, "Having access to electronic communication is not always a blessing." How should the manager interpret this warning? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Electronic communication wastes more time than it saves. 2. The manager does not have to be physically present in the facility for communication to take place. 3. If not used effectively, electronic communication can prevent the manager from getting rest. 4. Along with a flatter organization and easy access, the nurse manager's job responsibilities have increased. 5. In today's health care environment there is pressure to do more with less.

Correct Answer: 2,3,4,5 Rationale 1: Electronic communication can be a time waster, but if it is used effectively it save more time than it wastes. Rationale 2: The nurse manager is instantly available through cell phone or e-mail, but this is not always a positive. Easy availability allows nurses to avoid making decisions and the manager is never really "off call." Rationale 3: If nurses have instant contact with the manager and are not taught to solve problems, the manager may be called at all hours and on days off. This prevents the manager from getting needed rest. Rationale 4: Job enlargement has occurred, which means the nurse manager has greater responsibility and more employees to supervise. One reason this can occur is there is easier access to the manager during off-duty hours. Rationale 5: There is a need to do more with less in health care. Electronic communication makes the potential work place much bigger than it was previously.

During a job interview the nurse manager asks, "What are your short-term goals?" Which statement by the applicant addresses this question? 1. "I want to become a nurse anesthetist within 10 years." 2. "I will be available to come in for extra shifts if needed." 3. "My brother and I want to go to on a mission trip in the next year." 4. "I want to get this job so I can move on to the next part of my life."

Correct Answer: 3 Rationale 1: Becoming a nurse anesthetist in 10 years is a long-term goal. Rationale 2: Being available to come in for extra shifts is not measurable and is not a goal. A short-term goal statement would be, "I hope to work at least three extra shifts each month." Rationale 3: Going on a mission trip is a short-term goal because it involves a time frame of the next 6 months to a year. Rationale 4: Getting a job and moving on with life are not goals. A short-term goal statement would be, "I want to work and save $5,000 in the next year."

The nurse manager has several tasks that need to be accomplished. Which task is the manager likely to do first? 1. A large job that holds little interest to the manager 2. A difficult task that is going to require several days to complete 3. A task that has been assigned by the supervisor instead of a task that the manager thinks will benefit the unit 4. A task that will have little impact on the unit

Correct Answer: 3 Rationale 1: People tend to do small jobs before large jobs and to do interesting things first. Rationale 2: People tend to do easier things first, especially if they can be completed quickly. Rationale 3: People tend to respond to the demands of others before demands from themselves. Rationale 4: People work on the basis of consequences to the group.

The nurse manager is writing annual evaluations for each nurse. In order to promote professional development, it is vital for the nurse manager and nurse to become involved in which activity? 1. Personal organization 2. Priority setting 3. Goal setting 4. Limit setting

Correct Answer: 3 Rationale 1: Personal organization is the result of clearly defined priorities based on well-defined, measurable, and achievable objectives. Rationale 2: Goals must first be identified and set before priorities can be set. Rationale 3: Goal setting helps to relate current behavior, activities, or operations to the organization's or the individual's long-range goals. Rationale 4: Limit setting is trying to keep a person in line and trying to shape behavior.

As part of a new time management initiative, the nurse manager is creating a "to-do" list. How should the manger structure this list? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Focus on the events that are planned for each day. 2. Focus on the activities the manager expects for the day. 3. Block out time for the unexpected. 4. Be certain the list is flexible. 5. Do not create a "to-do" list for more than one day at a time.

Correct Answer: 3,4 Rationale 1: The focus should be on outcomes, not events. Rationale 2: The focus should be on outcomes, not activities. Rationale 3: The manager should leave enough uncommitted time to allow for unexpected occurrences to be handled. Rationale 4: Flexibility is of paramount importance in health care. Rationale 5: In some work environments, "to-do" lists may be better focused on what needs to be done each week. Adding a system to keep track of weekly or monthly standing meetings or appointments is also helpful.

The nurse manager must attend to several tasks this afternoon. Which tasks would the manager categorize as urgent? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Waiting for pharmacy to call back about a meeting time 2. Planning a staff meeting for next week 3. Assisting a family whose child is in the emergency department 4. Finding replacements for two staff members on the next shift who called in sick 5. Trying to organize the visitor take-out menus

Correct Answer: 3,4 Rationale 1: Waiting for a phone call is a time waster and would not be an urgent task. Rationale 2: Planning a staff meeting for next week in not urgent. Rationale 3: Assisting the family of a child in the ED is an urgent matter. Rationale 4: Finding replacement staff for the next shift is an urgent matter. Rationale 5: Organizing take-out menus is busy work.

A staff nurse frequently interrupts the nurse manager with problems that the staff nurse could solve. What should the manager say to correct this behavior? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I am no longer going to interrupt my work for you." 2. "Let me see what I can do about the problem you are having." 3. "Is this a problem you can handle yourself?" 4. "You have the skills to solve this issue." 5. "I trust you to solve this problem."

Correct Answer: 3,4,5 Rationale 1: The manager should be available for solving problems outside the staff nurse's scope of accountability. Telling the nurse that interruptions will not be tolerated may result in the nurse not notifying the supervisor of a situation that requires the manager's expertise. Rationale 2: The manager should not take responsibility for solving the problem. It is the nurse's responsibility. Rationale 3: Refocusing the nurse's ability to handle the problem may make the nurse reassess the need for the manager's intervention. Rationale 4: Reminding the nurse that he or she has the skills to solve the issue may give the nurse enough courage to attempt independent problem solving. Rationale 5: A statement of trust in the nurse's judgment may give the nurse enough courage to attempt independent problem solving.

A nurse manager has identified that a major time waster is the amount of time spent on the telephone each day. Which strategy would help reduce this time? 1. Answer the phone, "Hello, how are you?" 2. Send all calls to voice mail. 3. Use e-mail for potentially troublesome issues. 4. Set a specific block of time to return calls.

Correct Answer: 4 Rationale 1: Answering the phone this way encourages socializing and small talk. Rationale 2: There are situations in which issues must be dealt with immediately and face-to-face. Rationale 3: Troublesome issues should be addressed face-to-face. Rationale 4: The nurse manager should set time aside to handle routine phone calls and to return calls.

A nurse manager's week is filled with handling routine and repetitive issues. Which strategy should the manager employ to make handling these tasks most effective and efficient? 1. Ask those involved to leave voice mail messages about any routine matter. 2. Encourage those involved in routine matters to call between 10:00 a.m. and 12:00 p.m. each day. 3. Keep the office door open to be accessible to those dealing with these routine tasks. 4. Hold a meeting each week especially for dealing with routine and nonurgent matters.

Correct Answer: 4 Rationale 1: Having people leave voice mail messages is not efficient. The manager must then take time to retrieve, listen to, and respond to these messages. Voice mail also does not facilitate the face-to-face discussion often necessary to address routine issues. Rationale 2: Having a designated time for handling these issues is probably the second best option. However, spending 2 hours each day may be excessive. Also the hours between 10:00 a.m. and 12:00 p.m. are often extremely busy, both for the nurses handling routine issues and for the nurse manager. Rationale 3: Allowing unlimited access to the nurse manager encourages drop-in visits, which can be time wasters. Rationale 4: Having a regularly scheduled meeting encourages those with routine questions to hold their concerns for a specific time. Setting this time aside also allows time for thoughtful discussion of topics as necessary.

The nurse manager is significantly behind in the required paperwork for the job. How can the manager rectify this situation? 1. Make stacks of work on the corner of the desk so the work can be seen. 2. Use paper for all communication so a record is kept. 3. Discontinue subscriptions to all journals. 4. Set a goal to work on paperwork for a portion of every day.

Correct Answer: 4 Rationale 1: Stacking work around the desk can make work more difficult and overwhelming. It is better to file materials and keep a running "to-do" list of projects. Rationale 2: Using e-mail for communication reduces the amount of paper flow through the office, thereby reducing clutter. Rationale 3: The nurse manager must keep current on nursing issues, so the journal subscriptions are important and should be maintained. Rationale 4: The best of these options is to set a goal to work on paperwork for a portion of every day.

The nurse manager holds a regular Wednesday meeting with the charge nurses on the unit. There is no new information to discuss this Wednesday. What should the manager do? 1. Hold the meeting so that the charge nurses do not feel that the meetings are not important. 2. Hold the meeting, but only meet for 10 minutes instead of the usual 60 minutes. 3. Reschedule the meeting for Thursday. 4. Cancel the meeting.

Correct Answer: 4 Rationale 1: There is no reason to hold a meeting that is not necessary. Rationale 2: Holding a meeting that lasts only 10 minutes is a waste of the nurses' time. Rationale 3: There is no reason to reschedule a meeting if there is no information to discuss. Rationale 4: If there is no reason to hold a meeting, it should be canceled.

For the last several weeks, the nurse manager has felt as if there is not enough time in the day to accomplish all the required tasks. The manager goes home exhausted and does not look forward to going to work in the morning. What strategy may help alleviate some of this stress? 1. Do tasks as quickly as possible. 2. Hurry through work, hoping someone else will catch any mistakes that are made. 3. Do not start any new tasks after lunch. 4. Pick a simple task and complete it just before going home each day.

Correct Answer: 4 Rationale 1: Working faster is not likely to reduce this manager's stress. Rationale 2: Hurrying through work often results in mistakes. Hoping that someone else will catch the mistakes is not fair to others and can be dangerous. Rationale 3: The nature of nursing is unpredictable. The manager is unlikely to be able to stick to a plan of not starting any new projects after lunch. Rationale 4: Completing a task just before the end of the day helps the manager go home with a sense of accomplishmen

Which strategies would decrease the amount of time the nurse manager spends with "drop-in" visitors to the manager's office? Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Set office hours to eliminate those visits. 2. Keep the office door closed. 3. Arrange furniture so the desk faces the door. 4. Stand up to greet the visitor and remain standing. 5. Encourage appointments for routine matters.

Correct Answer: 4,5 Rationale 1: Office hours should be established to decrease drop-in visits, but the intent is not to totally eliminate them Rationale 2: Keeping the door closed is incorrect because a block of time when the door is open for accessibility and availability is needed. Rationale 3: If the desk faces the door, eye contact is made with passersby and anyone who is standing in the doorway, which invites interruption. Rationale 4: In order to redirect the drop-in visit, the nurse manager should stand up and remain standing throughout the encounter. This gesture is gracious yet obvious enough to encourage a short visit. Rationale 5: Encouraging appointments for routine matters is an effective solution. The manager should indicate that in order to have sufficient time to address the question, a block of time will be needed.

Which activities are similar enough that they could be grouped to better manage time? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Restocking the medication cart 2. Discussing a diet request with a new client 3. Calling for extra linen from laundry 4. Search the Internet for an unfamiliar client diagnosis 5. E-mailing a colleague a question about the schedule

Correct Answer: 4,5 Rationale 1: Restocking the medication cart takes attention to detail. This task should not be combined with other tasks. Rationale 2: The nurse should pay full attention to the client and not combine this with other activities. Rationale 3: Calling for extra linen is unlike any other task in this list and would not make a suitable fit for task combination. Rationale 4: While the nurse is logged into the computer, searching for a client diagnosis on the Internet would combine well with e-mailing a colleague. Rationale 5: The nurse could easily e-mail a colleague and search for information about a client diagnosis while logged into the computer in one session.

A nurse frequently has to work late and has no time to do required training while at work. She has to do it on her days off. Choose the work-related time waster that commonly puts nurses in this position. 1. Unscheduled tasks delaying those that are scheduled 2. An overwhelming amount of work to do 3. Taking longer-than-scheduled breaks 4. Volunteering for extra responsibilities

correct answer: 1