Chapter 29: Developing the Role of Manager

The nurse manager is anticipating changes on the unit because of managed care. It is up to the manager to "sell" the staff on this care concept. A goal of managed care that the staff must understand is that managed care is: a. grounded in business theory. b. useful for long-term patients only. c. designed to reduce unit resources and staff. d. not concerned with the best interests of clients.

ANS: A Managed care combines delivery of needed care with business principles of efficiency and cost. Nurse managers who know business principles become conduits for ensuring safe, effective, affordable care.

Nurses on Unit 17 complain that their manager frequently "checks up on them" and encourages little involvement in decision making and yet, during performance reviews, praises them for their outstanding performance. Nurses on Unit 18 indicate that their experience is different from that of nurses on Unit 17. The manager on Unit 18 encourages active involvement in decision making and provides authentic, growth-promoting feedback. The practices on Units 17 and 18 reflect. a. differences in the managers' expectations of their role. b. shaping of the workplace behavior of employees. c. different approaches to cooperation and collaboration. d. recognition of institutional priorities.

ANS: A Management theory addresses how managers address employees' concerns and needs and the interactions of managers with employees. Expectations of the managerial role affect expectations of self as the manager and of others. McGregor's (1960) Theory X and Theory Y made two basic opposing assumptions about employees and how the manager should interact with them. Theory X suggests that people do not like their work and that lower order needs are more important. Theory Y adopts an optimistic view in which people are seen as capable of self-direction and autonomy.

While interviewing for a nurse manager position, Ann is asked to give an example of a situation in which she demonstrated leadership. Which of the following examples exemplifies leadership? a. Through research and investigation of best practice and practice-based evidence, she proposed a change in the management of incontinence in older adult patients. b. She ensures that new policies related to parenteral infusions are implemented consistently within her team. c. When asked by her students about institutional policies, she readily and patiently interprets policies to facilitate quality care. d. She organizes the team and delegates responsibilities effectively in providing nursing care.

ANS: A Nurse managers have the responsibility of day-to-day decisions for their units and interpret established policy, procedures, and mandates. They meet their goals by organizing, staffing, controlling, and solving problems. By contrast, leaders develop a vision and translate that direction into action.

The successful integration of informatics into healthcare settings is key to: a. quality decision making related to management of resources and patient care. b. accessing current information about business practices. c. meeting the modern-day expectations of staff regarding technology use. d. speeding up calculations and decisions in budget development.

ANS: A The use of informatics to research evidence and alternative models of delivery, to compare data and solutions with those of other managers, and to enhance the coordination and delivery of patient care can assist managers in making solid decisions about resource utilization. The use of informatics is embraced by Generation X-ers and Millennials who grew up with technology, but may be more difficult for older staff.

A nurse manager is discussing with unit staff the repeated lack of staff compliance in documenting exercise activity for post-cardiac surgery clients. The unit's licensed practical/vocational nurses are responsible for ensuring that clients carry out the prescribed exercise regimen and that the activity is documented. Using Drucker's five basic functions of a manager, identify appropriate functions for the nurse manager to use when addressing this situation: (Select all that apply.) a. divide the necessary activities into manageable tasks, so clients adhere to the exercise regimen. b. establish objectives and goals for each area and decide who is accountable for them. c. allow clients to organize the activities. d. engage in activities that motivate the team and communicate effectively with the responsible staff members. e. analyze, appraise, and interpret the performance of responsible staff, and communicate these findings to staff management. f. allow clients to establish objectives and goals.

ANS: A, B, D, E Drucker's five basic functions include division of work into tasks, development and communication of goals and outcomes, motivation and communication, and analysis, approval, and interpretation of staff performance.

The nurse manager plays a unique role in institutional management in that the nurse manager: a. encourages shared decision making. b. models professional nursing behavior. c. interprets healthcare trends and their impact on revenues. d. coordinates care and allocates resources.

ANS: B Encouragement of shared decision making, coordination of resources, and interface between internal and external factors and a unit are all associated with effective management but could be performed by a manager from any discipline. The nurse manager's unique role is modeling professional behavior.

The nurse manager, as the leader of the unit's "customer (client) first" initiative, has asked the staff nurses to develop and administer a survey to every client before discharge. In asking the staff nurses to accomplish this task, the nurse manager is demonstrating: a. accountability. b. shared leadership. c. a common purpose. d. independence in the nursing manager's role.

ANS: B Healthy work environments are facilitated by involving staff and others in decision making; gaining access to information is one characteristic of shared decision making. Shared decision making enables staff to feel valued in policy development and in directing and leading.

A manager who is concerned with ensuring that patients on her surgical unit have the necessary information to make informed choices is: a. practicing legal nursing care. b. demonstrating respect for patient rights. c. avoiding risks. d. likely experiencing staff issues with informed consent.

ANS: B In demonstrating respect for and advocacy for informed consent, the nurse manager is reflecting a professional philosophy. Professional nurses are ethically and legally accountable to the standards of practice and the accompanying nursing actions delegated to others. Conveying high standards, holding others accountable, and shaping the future of nursing are inherent behaviors in the role of a manager.

Budgeting and protection of revenues is a function of: a. leadership. b. management. c. team leadership. d. followers.

ANS: B Managers address complex issues such as planning, budgeting, and allocating resources, whereas leaders address change.

Nurses in the CCU are unhappy and frustrated with their nurse manager. They complain that "nothing is ever good enough for him." These statements suggest that the nurse manager's goals may be: a. measurable. b. unrealistic. c. attainable. d. too low.

ANS: B Nurse managers who are successful in motivating staff often provide an inclusive environment that facilitates clearly set, achievable goals that can result in both team and personal satisfaction.

The hospital administrator approves a case management position for a new rehabilitation unit to help reduce costs. In developing the job description, the nurse manager understands that a key element of case management is: a. managing of care by nurse managers. b. coordination of resources for effective outcomes. c. rapid discharge of clients to decrease costs. d. managing of care for outpatient clients only.

ANS: B The key to effective case management is proactive coordination of care from the point of admission to accomplish appropriate and effective outcomes. Case management involves components such as case selection, multidisciplinary assessment, collective planning, coordination of events, negotiation, and evaluation and documentation of the outcomes of patient status in measures of cost. Case management is employed in a variety of settings.

In planning a new wing, the nurse manager complies with the workplace safety requirements of the Occupational Safety & Health Administration (OSHA). Which of the following groups is considered to be at high risk for violence in the workplace? a. Pediatric staff b. Postsurgical unit staff c. Emergency Department staff d. Medical oncology unit staff

ANS: C Nurse managers have responsibility for both patient and staff safety. High-risk areas, such as the Emergency Department, require special attention.

A nurse manager has worked to bring the staff to participate in and then accept changes in the unit's mission, so that downsizing can be avoided. How is the nurse manager using change theory for this situation? a. Focusing on past concerns related to the mission b. Teaching staff members how to self-manage themselves c. Determining accurately the direction of change in the institution d. Requiring all staff members to review and reinforce their technological skills

ANS: C The manager is using change theory to have the staff develop and therefore buy into the changes. Determining the direction of change for the institution allows the manager to work using change theory to guide staff for changes.

A nurse manager is experiencing considerable conflict among staff members because of weekend staffing coverage. During a called staff meeting, the nurse manager asks the disgruntled staff to meet as a group and determine the best staffing practices. In doing this, the nurse manager is using the concept of collaboration to: a. demonstrate interdependence. b. depict flexibility and broadmindedness. c. focus all energies of staff members on a best possible strategy. d. defuse the possibility that staff members will escalate their discontent when staffing the unit on weekends.

ANS: C When collaboration is used to solve a conflict or to create new directions, the energies of all parties are focused on solving the problem versus defeating the opposing party and creating the "best possible" versus an "okay" direction. When groups come together and mutual expectations are discussed and fostered, communication and collaboration are enhanced, which results in a more structurally empowered work force.

In developing an orientation program, the hospital educator breaks essential organizational information down into chunks, which she develops as online modules. This is an application of which of Drucker's functions of management? a. Establishment of goals and objectives b. Motivation and communication c. Analysis and interpretation of performance d. Organization of activities into manageable tasks

ANS: D Organizing the information into online modules is an application of Drucker's organizational analysis and the division of activities, decisions, and relations into manageable tasks.

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

ANS: D Participative style of leadership allows for the input by the participants involved to have input to the decision process. This assists in making change easier and is one way a manager uses this leadership to lead the unit.

Electronic health records (EHRs) are being instituted at Pleasant Valley Hospital. Some of the staff on Unit 4 complain to the manager that acquiring the technologic skills required is too time consuming. They question its value in patient care. The manager responds that: a. the use of technology is inevitable in our technologically oriented society. b. the hospital is no longer able to find the space to accommodate paper record-keeping. c. the initiative is being driven by decision makers higher up in the hierarchy and there is no choice. d. EHRs will increase effectiveness of care by enhancing coordination and improving patient outcomes.

ANS: D As technology improves, informatics must be integrated with budget and personnel as a critical resource element. Basing practice on evidence-based care can assist in making solid decisions about resources and in leading and encouraging staff toward positive changes in patient outcomes. EHRs, for example, are expected to enhance coordination of care, improve health outcomes, and increase accuracy of diagnoses.

Which of the following is not important in a positive work environment, as defined by the AONE? a. Clear, open, trustful communication b. Accountability and clarity of roles and responsibilities c. Participatory decision making d. Challenge and striving for excellence

ANS: D Clear and open communication, accountability and clarity of roles, and participatory decision making are considered by the AONE to be important to a healthy environment. Challenge and excellence are not specifically identified by the AONE as important to healthy work environments.

Nancy is a staff nurse who works on a rehabilitation unit. Nancy tells you that the assistants are experiencing difficulty with the new lift and wonders what your thoughts are on organizing an in-service training. Nancy is exhibiting which trait of a follower? a. Provides a vision for safety that is communicated. b. Thrives on taking risks in identifying the problem with safety. c. Coordinates the development of knowledge and skills necessary to use the lift. d. Assumes responsibility for identifying a safety concern and concedes authority for solution to you.

ANS: D Communication of a vision and risk taking are leader traits, whereas coordination is associated with manager traits. Taking responsibility while conceding authority to the leader is characteristic of followers.

A nurse manager's responsibility for financial management involves making budgetary decisions. Budgets that allow the nurse manager to allocate resources at the unit level allow: a. minimal nurse manager input. b. limited rationale for budgetary requests. c. budgetary allocations at the executive nurse level. d. budgetary decision making at the point-of-service (POS).

ANS: D In organizational structures where decision making occurs at the POS, nurse managers are given some self-control, which includes preparing and implementing a budget that meets the long- and short-term needs of their unit without requiring hierarchical approval.

As a nurse manager, you embrace the usefulness of resources such as Smart Bed. This behavior is important to: a. budget development. b. a manager's role. c. succession planning. d. encouragement of staff utilization of technology.

ANS: D Informatics such as Smart Bed facilitates effectiveness and efficiency in care. By becoming an early adopter of technology, staff members, particularly older staff, who may be less comfortable with technology, are encouraged to value its use in care delivery and management.

A nurse manager in a hospital is deeply concerned that senior administration makes decisions about budgetary directions that affect staffing and other resources without sharing the rationale for changes or demonstrating concern as to how these changes may affect patients or staff. She says she does not feel respected and is emotionally tired as a result. This situation represents: a. bureaucratic organization. b. realities of current health care. c. negative organizational culture. d. lack of engagement by administration.

ANS: D Organizational culture refers to the basic assumptions and values of an organization and whether they contribute to relationships and decision making that is marked by empowerment, information sharing, and truthfulness. Positive work cultures contribute to a perception of being respected in the work environment. Collaborative organizational cultures are essential for nurse managers to proactively work in today's complex healthcare environment in a manner that engages them in their work. Interpersonal relationships can be fostered with organizational designs fostering a culture of collaboration, reward and recognition, communication, and a mentoring environment. This demonstrates a lack of engagement by the administration.

As a nurse manager, you identify that a shift in nursing care models might increase patient and staff satisfaction and avoid downsizing. Administration is reluctant to adopt this approach because downsizing is seen as critical to reduction of costs. To leverage your ideas, you: a. ask staff to send e-mails to administration encouraging consideration of your option. b. invite a senior member of administration to your staff meeting, so you can tell him what you are planning. c. write a letter of complaint to a member of the institutional board about the lack of openness of the administration. d. identify influential members of your nurse manager group with similar ideas and request an opportunity to meet with administration to discuss options.

ANS: D Staff members often look to nurse managers to lead them in addressing workplace issues with higher levels of administration. To do this, nurse managers must possess the ability to address power sources in the work environment and to define power-based strategies, such as in organizing a following of other nurse managers with similar concerns.

As a nurse manager on a urology unit, you note that there has been a marked increase in medication errors on the unit. Which of the following actions would be consistent with the National Database of Nursing Quality Indicators (NDNQI) measures? a. Staff are consulted regarding improvements in interprofessional approaches to patient care. b. Nursing staff are asked for input regarding the purchase of new medication carts. c. A recognition program is developed to acknowledge nurses who have provided safe and exemplary care utilizing skills in the staffing mix to optimize the delivery of patient care. d. Recent changes in staffing mixes are examined to determine if the timing of changes coincides with the increase in errors.

ANS: D The NDNQI measures are specifically concerned with patient safety and aspects of quality of care that may be affected by changes in the delivery of care or staffing resources. The quality indicators address staff mix and nursing hours for acute-care settings, as well as other care components. The NDNQI project is designed to assist healthcare organizations in identifying links between nursing care and patient outcomes.