Chapter 18: Motivating and Developing Staff
In an attempt to decrease tardiness, a hospital gives employees an extra hour's pay for each wage period that the employee has not been late for work. This incentive program is an example of which theory? 1. Expectancy 2. Shaping 3. Equity 4. Goal-setting
Answer: 1 Explanation: 1. Expectancy theory emphasizes the role of rewards to the employee in order to increase a desired behavior. 2. Shaping is a procedure that involves selectively reinforcing behaviors that are successively closer approximations to the desired behavior. 3. Equity theory is concerned with the conditions under which employees perceive their contribution to the job and the rewards obtained as fair and equitable. 4. Goal-setting theory suggests that it is not the reward or outcomes of task performance per se that causes an individual to expend effort, but rather the goal itself.
There is substantial unrest among the staff of an intensive care unit that has resulted in negative client outcomes. Which employee factors should the manager assess first? 1. Motivation and ability to be effective in the job 2. The age of employees and their social background 3. Gender and educational preparation of staff 4. Experience base of employees and their attitude toward the job
Answer: 1 Explanation: 1. Research has found an employee's ability and motivation to be the two major dimensions that most affect the employee's effectiveness. 2. The age of employees and their social background may influence job performance but are not as significant as other factors. 3. Educational preparation and gender may influence job performance but are not as significant as other factors. 4. The experience base of employees and their attitude toward the job may influence job performance but are not as significant as other factors.
A staff nurse is not meeting job expectations. The manager has followed some standard strategies such as counseling to try to motivate the nurse, but they have not been successful. When discussing the situation with the supervisor, the manager says, "I think I will try shaping strategies." What can the supervisor expect of the staff nurse's performance? 1. It should gradually move toward the expected behaviors. 2. The behaviors will likely get worse before they get better. 3. The nurse will probably get frustrated and resign. 4. Performance should be at expected levels within a week.
Answer: 1 Explanation: 1. Shaping consists of moving the individual toward desired behaviors a little at a time. 2. Shaping should not make behaviors worse. 3. Resignation is not the goal of shaping. 4. It may take weeks to get behaviors to their expected levels
A nurse has been asked to teach newly hired nurses how to operate some client care equipment that the unit has just received. The nurse says, "I'd love to do this, but someone else will need to take my clients today." How should the manager respond? 1. "You will need to work the education into your day as you take care of clients." 2. "This will be a good break for you." 3. "You can use the classroom in the hospital basement for your instruction." 4. "I will authorize your additional salary for the next pay period."
Answer: 1 Explanation: 1. The teaching assignment should not be seen as a chance to get away from caring for clients. 2. Teaching is not to be seen as a break from the "real" work of the unit. 3. On-the-job training is done on the unit in real time with real clients. 4. On-the-job instruction does not mean extra pay.
A nurse manager is investigating the application of the principles of equity theory to rewarding staff. Which options are rewards that the manager could influence? Select all that apply. 1. Job satisfaction 2. Prestige 3. Pay 4. Ability 5. Effort
Answer: 1, 2, 3 Explanation: 1. Job satisfaction is a reward that the manager could influence. 2. The prestige associated with a job is a reward the manager could influence. 3. Pay is a reward the manager could influence. 4. Ability is typically seen as a contribution to the job by the employee. 5. Effort is a job contribution by the employee.
A nurse executive is trying to convince the hospital management team that a clinical ladder system would work well in nursing. Which points should the nurse include in this argument? Select all that apply. 1. Clinical ladders keep very good nurses at the bedside. 2. These programs prove to be worth their cost. 3. These programs reveal substandard nurses quickly so they can be terminated. 4. Similar programs have been shown to improve nurse job satisfaction. 5. Quality of client care increases with these programs.
Answer: 1, 2, 4, 5 Explanation: 1. Nurses with excellent clinical skills are promoted, but not into management. They stay at the bedside. 2. Evaluation of established programs has shown substantial positive fiscal impact. 3. Terminating nurses is not the focus of the clinical ladder program. 4. Improvement of job satisfaction has been shown to be a result of clinical ladder programs. 5. The programs have been shown to increase quality of client care.
A nurse manager has scheduled several on-the-job instruction sessions. Why would the nurse choose this format? Select all that apply. 1. It is very cost-effective. 2. Travel expenses are minimized. 3. The professional educators used are experts in adult learning. 4. Transfer-of-learning issues are eliminated. 5. The learners are motivated to learn.
Answer: 1, 2, 4, 5 Explanation: 1. On-the-job instruction is one of the most cost-effective methods. 2. When training is on-the-job there is no need to leave the facility campus. 3. No professional educators are necessary. 4. Since the nurse is learning while doing the skill or procedure, there is no issue with transfer of learning. 5. Since the nurses are learning something they are actively doing, they are motivated to learn.
Which job behaviors would the nurse executive consider troublesome no matter which unit employed the nurse? Select all that apply. 1. The nurse made two medication errors today that resulted in poor client outcomes. 2. A nurse was tardy twice last month due to car trouble. 3. A manager reports that a nurse used a piece of equipment that had been taken out of service for malfunction. 4. A nurse did not report to work for 2 days and did not call in the absence. 5. A physician calls to complain that a nurse was rude.
Answer: 1, 3, 4 Explanation: 1. Medication errors are serious no matter where they occur. 2. This might or might not be a problem, depending on the unit. 3. Using malfunctioning equipment is a serious problem, no matter where it occurs. 4. Not calling to report intended absence is a serious problem. 5. This might or might not be a problem, depending on the situation.
In order to develop a succession-planning program as rapidly as possible, the management team has elected to divide the processes up among team members. Which assignments would be expected? Select all that apply. 1. "Identify the most important things that managers do." 2. "Find out how much managers in the local area hospitals are paid." 3. "Decide which current nurses would make good managers." 4. "Analyze management training opportunities." 5. "Research generational change theory."
Answer: 1, 3, 4 Explanation: 1. This is identification of core competencies and is the first step in designing a succession plan. 2. Salary determination is not part of the succession plan. 3. Identifying potential recruits is part of a succession plan. 4. Providing opportunities for development and growth is a key part of a succession plan. 5. This is not a part of succession planning.
A nurse manager often uses negative reinforcers as part of operant conditioning in order to inhibit undesirable behaviors. What often results from this action? Select all that apply. 1. The employee ducks into a client room each time the manager is seen. 2. The undesirable behavior vanishes permanently. 3. No improvement in the frequency of the undesired behavior is seen. 4. The employee calls in sick more often. 5. The manager must constantly monitor the situation.
Answer: 1, 3, 4, 5 Explanation: 1. Avoidance behavior can be a result of use of negative reinforcers. 2. The undesirable behavior may go away temporarily, but it often returns. 3. Often negative reinforcers, or punishment, do not result in a decrease in the undesired behavior. 4. Calling in sick is a way of avoiding the punishment. 5. If the manager stops monitoring the situation and does not consistently employ the negative reinforcer, the behavior resurfaces.
A newly licensed nurse is considering a job offer at a hospital that offers a residency program. The nurse should expect to be in this program for up to ________ months.
Answer: 12 to 18 months Explanation: Residency programs are 12- to 18-month programs designed to acclimate new graduates to the work environment.
The nursing administration has instituted a "horizontal promotion" system within the nursing department. What benefit is this program to the staff nurse? 1. The most competent nurses will rise to managerial positions. 2. It rewards the nurse's clinical excellence. 3. Over time the nurse will move steadily upward through the levels. 4. The process is practice based rather than research based.
Answer: 2 Explanation: 1. In horizontal promotion, the system rewards clinical excellence by moving clinically superb nurses upward on a clinical ladder, but they remain at the bedside. 2. Horizontal promotion is a reward for clinical excellence. 3. This promotion process is based upon the nurse's clinical excellence, not longevity. 4. The process is based on Patricia Benner's novice-to-expert concepts.
The nurse manager is reviewing the current staff to determine who should precept a newly licensed nurse. Which nurse is the most logical choice? 1. A nurse who needs the temporary pay increase that accompanies precepting 2. A nurse who is clinically competent and has the desire to assume the responsibility to train new staff 3. A nurse who has expressed the desire for additional training and unit responsibilities 4. The nurse who needs to work an 8-hour schedule for a few weeks while recovering from a work-related incident
Answer: 2 Explanation: 1. The preceptor role may offer a financial incentive, but this is not sufficient reason to choose this nurse. 2. Clinical competence and concern for effective orientation of new nurses are critical attributes for the preceptor. 3. While precepting will be an additional unit responsibility, the focus is on orienting the new nurse, not on increasing a staff nurse's skills. 4. Preceptorship may or may not be based on an 8-hour schedule. Also, a nurse recovering from a work-related incident may not have the focus and energy necessary for precepting.
A nurse manager wishes to use a model of job performance to help match employees and tasks to achieve the greatest effectiveness. What should the manager do first? 1. Evaluate each employee's educational and experiential background. 2. Establish the expectations of each task in writing. 3. Consider how much variation from standard is acceptable. 4. Review unit statistics for incidents, errors, and accidents.
Answer: 2 Explanation: 1. This evaluation is not the first step of this process. 2. In order to know which employee can do the task, a description of how the task looks when it is done correctly must be established. 3. Variation from standard cannot be assessed until the acceptable standard is established. 4. Using a job performance model focuses on specific individuals, not unit-wide statistics.
The nurse has expressed job dissatisfaction to the unit manager. The manager assigns another staff member as a coach for this nurse. What is the most important aspect of the coach's job? 1. Get the nurse to explain the cause of the dissatisfaction. 2. Conduct the relationship in a confidential manner. 3. Encourage the nurse to stay in the organization. 4. Help the nurse increase bedside skill competency.
Answer: 2 Explanation: 1. This is an important strategy, but is not the most important aspect of the relationship. 2. The relationship and the information divulged must be treated in a confidential manner. 3. While it is important to try to get the nurse to stay if possible, this is not the most important aspect of this relationship. 4. There may be nothing wrong with bedside skills. Even if that is the case, this is not the most important aspect.
A nurse manager is selecting nurses to serve as teachers in on-the-job instruction. What qualifications should these nurses hold? Select all that apply. 1. At least one nursing degree higher than those being taught 2. Willingness to teach new nurses 3. Ability to explain procedures accurately and clearly 4. Formal instruction in educational methodology 5. Experience as a clinical preceptor
Answer: 2, 3 Explanation: 1. On-the-job instruction is not formal education. There is no educational degree requirement. 2. Willingness to take on the role of teacher is essential. 3. Ability to teach is essential. 4. Instruction in methodology can be informal and provided by the manager. 5. The on-the-job instructor may or may not have experience as a clinical preceptor.
During strategic planning, the committee finds a need to develop a succession plan for the facility. What committee findings would draw attention to this need? Select all that apply. 1. More nurses are electing to move into management positions. 2. Many of the facility's senior nursing managers indicate they will likely retire within 5 years. 3. The nursing shortage in the area continues to worsen. 4. Salaries continue to rise, making profitability low. 5. Many of the nurses moved into leadership positions fail.
Answer: 2, 3 Explanation: 1. The issue with succession is not having enough nurses in place to effectively fill management positions. 2. In general, nursing is experiencing retirement of many experienced and excellent nurses, both from the bedside and from management. 3. As the nursing shortage worsens or continues, fewer nurses will be available to fill management openings. 4. Succession planning is not focused on salary or profitability. 5. Succession planning is not focused on why some nurses who are moved to leadership positions fail.
A nurse executive says, "I would really like to develop our current nurses so they can take a greater leadership role in the future." Why is this a good management plan? Select all that apply. 1. Employees with a long history at the facility are easier to control. 2. This method of developing leaders has proved to be cost-effective. 3. The leadership development can be varied according to the needs of the nurse. 4. When leaders are developed from within, management is already aware of their strengths and weaknesses. 5. The specific needs of the organization can be served.
Answer: 2, 3, 4, 5 Explanation: 1. Developing leaders from within is not a control strategy. 2. Cost-effectiveness comes from retaining high-performing nurses. 3. Many nurse leaders fail, not because they don't want to be a leader, but because they don't have the tools and skills they need. When a leader is developed from within, these tools and skills can be tailored to the individual. 4. When a nurse has worked at the hospital as a staff nurse, strengths and weaknesses are revealed. 5. Since the leaders are being developed from within, the organization can match strengths and interests to identified needs.
Reinforcement theory, commonly known as behavioral modification, views motivation as learning. Which of the following is true according to this theory of behavior? 1. An individual starts off as a blank slate, learning as time goes on. 2. An individual's response/consequence connection is strengthened over time. 3. Reinforcement is learned through a process called operant conditioning. 4. Learning is conditioned by the environment. 5. Behavior becomes associated with a particular consequence.
Answer: 2, 3, 5 Explanation: 1. Reinforcement theory behavior is learned through a process called operant conditioning. Response/consequence connection is strengthened over time and becomes associated with a particular consequence. 2. Reinforcement theory behavior is learned through a process called operant conditioning. Response/consequence connection is strengthened over time and becomes associated with a particular consequence. 3. Reinforcement theory behavior is learned through a process called operant conditioning. Response/consequence connection is strengthened over time and becomes associated with a particular consequence. 4. Reinforcement theory behavior is learned through a process called operant conditioning. Response/consequence connection is strengthened over time and becomes associated with a particular consequence. 5. Reinforcement theory behavior is learned through a process called operant conditioning. Response/consequence connection is strengthened over time and becomes associated with a particular consequence.
A unit secretary is chronically late returning from breaks. The rest of the secretary's work is excellent and he is always helpful and supportive of nurses and client families. The nurse manager has discussed the lateness with him, but it has not stopped. Thinking this might be an attention-seeking behavior, the manager decides to use extinction as a strategy. What should the manager do? Select all that apply. 1. Offer the secretary a free lunch if he can go 1 week without being late. 2. Ignore the behavior. 3. Place a large alarm clock in the break room and set it each time the secretary takes a break. 4. Plan to be away from the secretary's area during his break times. 5. Tell the secretary that one more late return will result in a written critical incident report.
Answer: 2, 4 Explanation: 1. This is a reward, not extinction. 2. Extinction occurs when the stimulus to continue the behavior is removed. In this case, the secretary will no longer get the manager's attention. 3. This is not the way an adult should be disciplined. 4. If the manager is not there to see the lateness and "reward" the employee with attention, perhaps the behavior will stop. 5. If the manager is correct and this is an attention-seeking behavior, a written critical incident is reinforcing the behavior.
Which findings associated with an employee are likely to be considered when discussing performance? Select all that apply. 1. The employee states, "I have to work so that we can have insurance coverage for our disabled child." 2. The employee has been tardy on one occasion when an unexpected snow fell just before shift change. 3. The employee was involved in a motor vehicle crash last fall. 4. The employee found a purse containing $200 in the cafeteria and turned it in to security. 5. The employee made two work errors requiring incident reports in the last year.
Answer: 2, 4, 5 Explanation: 1. This statement relates more to motivation rather than to performance. 2. Punctuality is a performance measure. 3. Personal accidents that occur when the employee is not on shift are not considered as part of performance. 4. Honesty and trustworthiness are considered performance measures. 5. Work errors are considered performance measures.
The hospital has initiated a new fall risk assessment tool. The nurse manager would like to reward those staff members who use the tool regularly. Which method of reinforcement would be most successful in getting long-term compliance? 1. A coupon for free lunch for staff members each time they use the tool 2. A counseling session with the nurse manager when the assessment tool has not been used 3. A coupon for a free lunch for staff members who, according to a medical record review of nursing documentation, consistently use the tool correctly 4. A pizza party for the staff when there is 100% compliance
Answer: 3 Explanation: 1. A reward on each instance of a behavior will change behavior but is not as effective for a lasting behavior change. Behaviors learned under a continuous schedule extinguish very quickly once the reinforcement stops. 2. Positive reinforcement is a better way to change behavior than punishment. 3. When giving reinforcement for desired behaviors, the reward should be seen as positive for the employee and based on continued performance. 4. To be most effective the staff member should have as much control as possible over the reward. This is not possible with a pizza party.
The nurse manager is concerned about the apparent lack of staff motivation to improve client care on a unit. How should this manager use motivational theories to help improve this situation? 1. Choose one theory that the manager thinks best suits the situation. 2. Review several theories but use no more than two. 3. Combine theories to develop a plan for this specific unit. 4. Review the motivational theories, but don't depend on any of them to work in "the real world."
Answer: 3 Explanation: 1. Limiting motivation to one theory will narrow the manager's influence. Different workers are motivated in different ways. 2. It is important for the manager to be aware of many theories. Using only two theories narrows the managers' ability to be influential. 3. The manager will encounter workers who are motivated in a variety of ways. The manager should learn about as many theories as possible and combine them to suit the specific population of the unit. 4. There is a significant amount of research that supports the use of these theories in "the real world."
The staff development nurse has elected to use coaching as a staff development technique. Which situation is an example of this technique? 1. Pairing a newly licensed nurse with a nurse who has worked on the unit for 5 years 2. Matching a newly hired male nurse with a newly hired female nurse 3. Pairing a nurse with conflict management experience with an employee who has expressed dissatisfaction with the job 4. Matching nurses who have similar educational and cultural backgrounds when selecting participants for an educational offering
Answer: 3 Explanation: 1. Pairing a newly licensed nurse with a nurse who has worked on the unit for 5 years more closely describes preceptorship. 2. Matching a new male nurse and a new female nurse does not describe coaching. 3. Coaching is a strategy suggested to address a nurse's job dissatisfaction. 4. Assigning educational offerings on the basis of similar educational and cultural backgrounds does not represent coaching.
A registered nurse is dissatisfied with the wages and health benefits available in his current position and decides to seek other employment. This employee's frustration is most linked to which motivational theory? 1. Reinforcement theory 2. Process theory 3. Content theory 4. Equity theory
Answer: 3 Explanation: 1. Reinforcement theory deals with behavioral modification and the individual's response to positive or negative reinforcement. 2. Process theories emphasize how the motivation process works to direct an individual's effort into performance. 3. Content theories explain why an individual behaves in a particular manner, emphasizing the individual's needs or the rewards that satisfy those needs-in this case, wages and health benefits. 4. Equity theory suggests that effort and job satisfaction depend on the degree of equity, or perceived fairness, in the work situation.
The nurse manager tells a newly licensed nurse that having a mentor is a benefit to career development. What should the new nurse expect from a mentor-protégé relationship? 1. The protégé will select the mentor. 2. Once established, this relationship lasts forever. 3. The relationship will develop through stages. 4. Mentors are generally of the opposite gender as the protégé.
Answer: 3 Explanation: 1. The mentor typically selects the protégé. 2. These relationships change and often end as the protégé develops. 3. These relationships move through a definable series of stages, just like most relationships. 4. The mentor and protégé are typically the same gender.
After the second week of orientation the new nurse witnesses the death of a child in the ED. Which role should this nurse's preceptor focus on at this time? 1. Orientation of the nurse to protocols associated with this death 2. Socialization of the nurse to the staff 3. Counseling the new nurse 4. Serving as a role model
Answer: 3 Explanation: 1. The new nurse should be oriented to protocols, but this is not the most important role at this time. 2. The new nurse should be socialized to the staff, but this is not the most important role at this time. 3. In this situation, the most important role is counseling. 4. The preceptor should always act as a role model for the new nurse, but this is not the most important role at this time.
An experienced nurse often answers less experienced nurses' questions about client care and teaches hemodynamics during orientation to the unit. The nurse has also participated in research into hemodynamic monitoring of ICU clients. Which clinical ladder designation does this nurse best exemplify? 1. Clinical colleague 2. Clinical mentor 3. Clinical leader 4. Clinical expert
Answer: 4 Explanation: 1. Clinical colleagues are full partners in care, but do not teach or do research. 2. A clinical mentor demonstrates preceptor abilities. 3. A clinical leader demonstrates leadership in practice. 4. The clinical expert combines teaching and research with practice
A nurse manager has planned orientation activities for a new registered nurse. The new nurse is required to observe shift report and UAP delegation for a week. Then the new nurse is required to take shift report and delegate UAP assignments for a week. What is the rationale for making this orientation assignment? 1. Delegation is not taught at all nursing schools. 2. Shift report differs in all hospitals. 3. Shift report and UAP delegation are minimal tasks and good for novice nurses. 4. The manager should focus on those skills specific to the new nurse's role.
Answer: 4 Explanation: 1. Delegation is taught in nursing schools, but must be practiced. 2. The fact that shift report may differ in all hospitals is not relevant to this situation. 3. Shift report and UAP delegation are not minimal assignments. 4. Successful orientation requires that the nurse understand job responsibilities. The manager should focus on those items unique to the employee's specific job. Learning how to delegate staff will take time, and orientation is a good opportunity to allow the employee to learn this role. Cognitive Level: Analyzing
The newly licensed nurse is delighted to have been hired at a Magnet hospital and says, "They even assigned me a mentor." What is erroneous about this statement? 1. Magnet hospitals do not hire new graduates. 2. Magnet hospitals do not use mentor programs. 3. Mentors are only assigned to experienced nurses. 4. Preceptors are assigned; mentors choose protégés.
Answer: 4 Explanation: 1. Magnet hospitals do hire new graduates. 2. Magnet hospitals do use mentor programs. 3. The mentor-protégé relationship is typically between an experienced nurse and a younger, inexperienced nurse. They are not assigned. 4. The nurse is mistakenly describing a preceptor as a mentor. Preceptors are assigned, whereas mentors choose protégés.
The nurse manager has identified physical assessment skills lacking in a new RN. Using goal-setting theory, which statement by the manager would be the most effective in enhancing the RN's assessment skills? 1. "You need to work on your health assessment skills before your next employee evaluation." 2. "Get someone to help you with your health assessment skills by the end of the month." 3. "Read a health assessment book and practice your skills." 4. "Plan to study one body system a week and demonstrate your assessment skills to me every week."
Answer: 4 Explanation: 1. Telling the nurse to develop skills without offering a plan will not motivate the nurse. 2. Saying "Get someone to help you" is not managing the process of development. 3. Reading and practicing skills is a good plan, but there is no component of review by the manager to motivate the nurse. 4. A measurable, realistic, and obtainable goal with a component of follow-up will be more motivating to the nurse.
________ is a technique used to eliminate negative behavior. By ________ a positive reinforcer, undesired behavior is extinguished.
Answer: Extinction, removing Explanation: Extinction is a technique used to eliminate negative behavior. By removing positive reinforcement, undesired behavior is extinguished.
