Chapter 29: Developing the Role of Manager Yoder-Wise: Leading and Managing in Nursing, 7th Edition, Chapter 30: The Strategic Planning Process, Chapter 28: Developing the Role of Leader Yoder-Wise: Leading and Managing in Nursing, 7th Edition, Chapt...

5. After being interviewed for the unit manager position, the staff nurse reflects on the interview process. The staff nurse is aware that leadership begins: a. within. b. through a relationship with a mentor. c. with the job description. d. with the chief nursing officer of the organization.

ANS: A People notice differences in workplaces and tend to choose those that evidence a high degree of trust between leaders and followers. Stephen M.R. Covey suggests that trust begins with self and that leaders must focus first on developing character and confidence, which is their credibility. Credibility enables leaders to trust themselves and gives others someone or something that they can trust.

To meet the social and human needs of a target market, it is critical to: a. assess the needs and priorities of the target market. b. revise the organization's mission statement to reflect external needs. c. assess the internal culture and needs. d. develop highly sophisticated media.

ANS: A Marketing emphasizes the identification and meeting of human and social needs, which can only be known through assessment of the needs of the consumer (as opposed to the needs of the organization).

12. 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.

Assessment of the needs of the consumer or client (in developing a strategic marketing plan) focuses on: a. present needs only. b. present and future needs. c. the development of surveys. d. secondary analysis of existing data.

ANS: B Assessment of needs takes into account needs of the consumer now and for the future, using a variety of data-gathering techniques. Future orientation aids in anticipating how marketing and programs will need to shift to meet those needs.

To enhance team leadership skills for your team leaders, you arrange opportunities for: a. certification. b. continuing education. c. graduate courses. d. volunteerism.

ANS: B Continuing education provides systematic learning opportunities that augment existing skills and knowledge for delivery of quality care and advancement of career goals. Graduate and certification courses provide advanced knowledge and skills.

8. 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.

Pacific Hospital's team develops a process to include staff in development of the mission statement. Which of the following statements would indicate that the staff has been able to develop an effective mission statement? a. Pacific Hospital will increase its sustainability by increasing revenue streams within the next 3 years. Revenue streams are important to our hospital and are a driving force in our sustainability in the face of insurer and government funding changes. b. Pacific Hospital has a desire to relate to its community to enable appropriate identification of programming needs by July. c. Pacific Hospital will provide family-centered care to the community of Pacific Rim. It is committed to delivering a full spectrum of services that foster collaborative partnerships among clients, families, and the hospital, and it utilizes evidence-based practice to guide planning and interventions. d. To provide health promotion programs for school-aged children

ANS: C An effective mission statement reflects the values and direction of the organization. Included in the statement are beliefs about individuals, health, practitioners, and the relationship of the organization to practice, research, professionalism, and/or education.

A private ambulance clinic established a few streets away from Pacific Hospital markets its services as quality-based within caring relationships. The clinic is part of the __________ environment. a. public b. macro c. competitive d. social

ANS: C The competitive environment includes factors and elements that compete for resources with another organization. These elements may include those in public and macro environments.

At the beginning of the strategic planning processes, Pacific Hospital learns that nursing staff members are uncomfortable with utilizing evidence-based practice, and that staff perceives that only limited resources are available to support translation of evidence into their usual practice. Because this issue has been identified, the management team determines that a plan of action is required to address the issue. Who should be involved at this point? a. Nursing unit managers b. Staff nurses c. All staff d. Administration

ANS: C The first phase in planning is conducting an assessment of the external and internal environments. Assessment of the internal environment should include all levels of staff and facilitates feedback on effectiveness of strengths and weaknesses of systems and processes within the institution.

During an interview for a manager's position, you find the supervisor and staff unfriendly. Responses to questions are met with vague responses. After the interview, you decide not to pursue the position. What follow-up, if any, is most appropriate? a. There is no need for you to do anything further. You likely will not be offered the position anyway. b. You should file a complaint with human resources about the supervisor's lack of interviewing skills. c. You should send a thank-you note to the interviewer, indicating appreciation for her time. d. You should call and leave a voicemail, indicating your disinterest in the position.

ANS: C Even if you are disinterested in the position or think that the interview has gone badly, an appropriate follow-up is a thank-you note to the interviewer. This recommended follow-up creates a positive impression and may leave open the possibility of future interactions.

On your curriculum vitae, which of the following is the recommended approach for listing employment and educational history information? a. 1979 RN Diploma 1985 BScN 2002 MN b. 2002 Mount Rush Health Center Staff Nurse 1997 Cedar Falls Clinic Staff Nurse 2007 Kilkarney Rehab Center Case Manager c. 2007 MN 2005 BScN d. 1997 Sturgeon County Hospital Head Nurse 2002 Sturgeon County Supervisor 2007 Sturgeon County Director

ANS: C Information that is included in the body of the curriculum vitae should always be in reverse chronological order so that the most recent and, presumably, most relevant job information appears first.

Professional associations: a. set regulatory requirements and establish entry requirements for nursing. b. offer graduate programs for clinical and career advancement. c. provide opportunities for career networking and support. d. are open to all individuals who meet the criteria for membership.

ANS: C Professional associations are frequently, although not always, voluntary groups whose members provide leadership in issues and policies of interest to nurses. Professional associations also offer networks of nurses with similar interests.

4. The director of nursing has been observing staff interactions in a 20-bed coronary care unit. Based on her observations, which of the following staff members is an obvious leader? a. The unit secretary who knows everyone's business b. The chief nursing officer who is in charge and is responsible for nursing services c. The chief cardiologist who admits the largest number of patients and brings in more revenue than any other physician d. The staff nurse who persuades other staff members to practice by making evidence-based decisions

ANS: D Leaders are those who do the best job of sharing their vision of where the followers want to be and how to get there. It is the ability to inspire others to bring a vision (such as evidence-based decision making) to reality and is not necessarily tied to status or information flow.

Benchmarks in the strategic marketing planning process are useful in: a. establishing programs. b. setting targets. c. rewarding employees. d. measuring progress.

ANS: D Establishing benchmarks enables measurement of the interim and final achievements of programs.

A cover letter and a résumé together should be no longer than ________ page(s). a. two b. one c. four d. three

ANS: D Two pages are recommended for a résumé and one for a cover letter.

Steady state styles would be most likely in which of the following situations? a. Small hospital, in an isolated rural setting, with limited hierarchy b. Large urban teaching hospital c. Health network with several organizations d. Travel nurse agency

ANS: A Steady state career styles (career-long commitment to a particular position) are more likely in rural settings, where commitment to the community is high and alternative career opportunities are limited.

18. Kari, a head nurse on the dialysis unit, has been informed during budget planning meetings that budget cuts are likely. She discusses this at the next unit meeting and tells staff members that unless they do their jobs well, their positions may be terminated, and there will be no replacement. Kari is enacting which management style? a. Transformational b. Transactional c. Trusting d. Truthful

ANS: B Transactional leaders tend to rely on position and power, and they tend to reward and punish according to performance and conformity with expectations.

Shifts such as changes in the percentage of seniors in the population, governmental initiatives in health care, and the influence of income on health status are factors in the __________ environment. a. public b. macro c. competitive d. social

ANS: B The external environment in strategic marketing planning includes the public, competitive, and macro environments. Demographic, social, and political factors are included in the macro environments.

As a nursing leadership student, you have had the opportunity to develop a palliative care manual that will be utilized by the palliative care network (PCN) in your region for teaching healthcare professionals. The PCN has requested that you provide a prioritized plan of action for marketing the manual on a regional and state basis. What is the first priority? a. Motivate the target market. b. Research the target market. c. Communicate benefits to the target group. d. Package the product.

ANS: B To put a strategic plan into place for marketing, it is necessary to conduct an external assessment.

A young male nurse began in nursing as a staff nurse at a hospital. After 3 years, he moved to a home healthcare agency for increase in pay and taking a position as a manager in the agency. What type of motivation does this exemplify in career success? a. Internal b. External c. Spiral d. Entrepreneurial

ANS: B This type of career success is exemplified by external focus or motivation. The motivation in external focus is from tangible measures such as salary and promotions.

A nurse manager has been employed in the same facility for 20 years and has held the same position. This career style is known as: a. linear. b. spiral. c. steady state. d. entrepreneurial/transient.

ANS: C Career styles that are marked by selecting and staying in a role throughout a career are characterized as steady state.

22. The senior executive praises John for the positive patient evaluations that his unit has received. As an effective leader, John: a. thanks the senior executive for having confidence in him and celebrates by going out to a special restaurant. b. points out the impact that the changes he has initiated have had on the unit. c. advises the senior executive that the mission statement and goals are important to him. d. points out the contributions of his staff to the outcomes and shares the praise with his staff.

ANS: D An effective leader is eager to share the glory with those who have worked with him or her to achieve outcomes and success. The act of acknowledging the achievement to the senior executive and of sharing the positive feedback with his staff empowers the staff and builds a support base for the leader.

In preparing for a fair interview process as a hiring manager, you should: a. put water out for the candidates. b. ensure that you know the names of all candidates. c. dress comfortably and professionally. d. prepare a schedule of questions to be asked of all candidates.

ANS: D Although providing water, knowing names, and dressing appropriately sets a professional and respectful tone for the interview, developing a schedule of questions to be asked of all candidates is important for gathering comparative data and ensuring equitable treatment.

2. 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.

Nurses are valuable partners in marketing strategies because they: a. are more likely than other members of the organization to use marketing tools. b. have a strong background in using evidence to support decisions. c. have close involvement with patients, who are the target group for marketing. d. constitute the largest staff group in most healthcare organizations.

ANS: C As nurses are directly involved with patients who use services and who are the target group for marketing efforts, nurses have excellent insights into patient needs.

19. 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 new graduate is seeking a new position in nursing and wants to "sell" herself effectively. The best strategy is to: a. create a résumé. b. practice interviewing. c. call the personnel offices. d. create a curriculum vitae.

ANS: A A résumé provides a customized overview of details of your professional background that relates specifically to a position for which you are applying. Résumés advertise your skills to a prospective employer.

A clinic nurse developed objectives for a diabetic education program. The characteristics of well-written objectives include that they should be what? (Select all that apply.) a. Achievable b. Understandable and specific c. People-oriented d. Manager-oriented e. Means-oriented f. Measurable

ANS: A, B, F The S.M.A.R.T. acronym describes the attributes of objectives: specific, measurable, agreed-upon, reasonable (achievable), and time-bound.

The reasons cited by nursing administrators for not planning in a systematic manner include: a. lack of understanding of the planning process. b. lack of knowledge regarding the internal and external operations of the organization. c. not enough hours in the day for both day-to-day operations and planning. d. delegation of the task to subordinates.

ANS: A The nurse manager should participate in strategic planning and quality initiatives with the governing body. Lack of knowledge is a common reason for nonparticipation in planning initiatives.

3. 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.

To conduct assessment of the internal environment, the strategic planning team for Pacific Hospital: a. invites community members and staff of the hospital to an evening focus group session. b. discusses what it sees as the primary threats and opportunities in demographic shifts affecting the hospital. c. invites all levels of staff to focus groups on the effectiveness of the hospital environment, including information systems and staffing. d. asks the board to provide a summary of major opportunities for the future.

ANS: C Assessment of the internal environment should include all levels of staff and facilitates feedback on effectiveness of strengths and weaknesses of systems and processes within the institution.

A unit manager recently graduated as a clinical nurse specialist with a focus in gerontology. She applied to take a certification exam. Certification is designed to recognize: a. basic knowledge in a specified area. b. advanced practice in functional roles. c. special knowledge beyond basic licensure. d. continued competence as a registered nurse.

ANS: C Certification is an expectation in some settings for career advancement in advanced practice or in specialized areas and goes beyond basic preparation.

You are offered an opportunity to take a temporary leave from your position as a nurse manager to lead a technology implementation project. Which of the following reasons for accepting the opportunity is most consistent with developing a solid career path? a. You are pressured to do so by your supervisor. b. The organization has no other suitable candidate for the position. c. You have limited knowledge of information technology and no real interest, but this will increase your knowledge. d. Accepting a position outside of your established skill set may establish you organizationally as an innovative, adaptable leader.

ANS: D Although giving into organizational or supervisory pressure may bring an enhanced learning and organizational profile, what is to be gained needs to be assessed against your career goals, interest, and aspirations. Increasing and expanding your skill set within defined career interests is a valid reason to consider a chance opportunity.

The chief nursing officer has to write a strategic plan. The most difficult stage in the strategic planning process is: a. assessment of the external and internal environment. b. review of mission statement, goals, and objectives. c. identification of strategies. d. implementation of strategies

ANS: A Determination of strengths, weaknesses, opportunities, and threats requires openness to what is being said and observed and is critical to setting the stage for relevant responses in the latter phases of strategic planning.

21. 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.

20. 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.

6. The nurse manager in the Emergency Department needs to implement new staffing patterns. As a transformational leader, the nurse manager would: a. explain in detail how well the new idea will work. b. reinforce how this change will respond to the ideas and solutions generated by staff members. c. reason with staff members that the new idea will save money and allow more free time. d. imply that raises will be smaller than anticipated if the new idea is not accepted.

ANS: B Transformational leadership inspires and motivates others through influence and persuasion rather than through rewards (e.g., free time) and punishment (e.g., smaller raises). This type of leader listens to the views of others (such as those of the staff members), empowers others to lead (such as in generating solutions for staffing problems), finds ways to remove barriers, and serves as an advocate for those who care for patients.

7. To retain supervisory staff members, the director of nursing develops a mentoring program. The best person to be a mentor for a new supervisor in a leadership position is someone who has: a. been in the same position and can relate to the new supervisor's problems. b. had vast leadership opportunities and likes to talk about his or her past experiences. c. leadership experience and time to spend communicating with the new supervisor about his or her experiences. d. people who can help the new supervisor get what he or she needs to make the organization grow quickly and prosper in the process.

ANS: C Mentors need to have experience and some success in the leadership area of interest, as well as interest in the future development of the novice. The mentor can be geographically distant or close and able to provide advice and feedback.

An example of a career is: (Select all that apply.) a. employment in short-term contract jobs in business, nursing, and whatever is available. b. involvement in an area of practice that is regulated. c. continuous employment in the same position and the same arrangement for 20 years. d. moving into and out of nursing positions in various cities while pursuing travel and education that develop understanding of global health.

ANS: C, D Career refers to progression of skills, consistency, knowledge, and/or status. This movement through nursing life is predicated on having a vision of a career as opposed to a series of jobs. Career styles can be defined as linear, steady state, entrepreneurial, or spiral. Deepening skills in one area is an example of a steady state career style, whereas moving into and out of positions in various cities can characterize an entrepreneurial style. Involvement in a regulated field defines a professional interest but not necessarily a career.

A community-based pain management program is being planned for your region. As a coordinator of a home care agency, you have been requested to develop a conceptual framework, mission statement, philosophy, and objectives for the program. In what order will you pursue this endeavor? a. Objectives, philosophy, and mission statement b. Philosophy, objectives, and mission statement c. Philosophy, mission statement, and objectives d. Mission statement, philosophy, and objectives

ANS: D The development of the mission statement is the first step in defining the purpose and direction of the organization after an assessment has been completed.

15. Which of the following nurses is MOST likely to inspire others to do their best? a. Nancy, RN, is an individual who enjoys details and organization. She regularly leaves notes for the next shift about what has been done incorrectly or omitted. b. Jim, RN, has been involved in nursing for several years and is well liked by patients and families. He continually searches for new knowledge and skills, and his sense of humor and optimism are infectious. c. Clara has been the head nurse on Unit 3Y for years. She is quiet but enjoys patients and their families. She has not been to a conference in years because the unit is her entire life. d. Karen is a team leader. She is extraordinarily vigilant about ensuring that everyone is treated fairly in assignments. She is also very conscientious about care and regularly checks up on what everyone is doing to ensure that it is done correctly.

ANS: B To be inspired, people must have a positive leader who radiates energy, a zest for learning, and an interest in the common good, and is engaged in self-renewal. This leader is hopeful and optimistic. Leaders, not managers, inspire others to work to their highest level.

To develop a curriculum vitae, or résumé, a nurse must develop a personal data file. The goal of a personal data file is to: a. create an opportunity to be interviewed. b. have a listing of facts about your professional life. c. have a tool in place for marketing yourself. d. create a document that lists your skills.

ANS: B A personal data file enables storage and recall of career-specific details that can be retrieved and shaped for a specific purpose using cut-and-paste approaches rather than creating whole new documents.

The executive team at Hospital XYZ develops a polished strategic plan that includes a mission statement, goals, and objectives. The executive team involves the marketing team, so that the plan can be communicated internally and externally. After 2 years, no significant progress has been made toward any of the goals. What has been omitted in the plan? a. Planning b. Marketing c. Integrated financial planning d. Customer focus

ANS: C Without the inclusion of a business plan with the strategic plan and integration of financial planning and allocation of resources execution of the strategic plan can become paralyzed, even with the most effective communication of the strategic plan itself.

22. 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.

In implementing the strategic plan for effective utilization of evidence to guide nursing practice at Pacific Hospital, the nursing unit managers take the next step, which is the implementation. Implementation most likely would involve: a. revisiting the mission statement and objectives. b. reevaluating external and internal factors affecting evidence-based practice. c. preparing a budget to support implementation. d. developing unit-based objectives related to the plan.

ANS: D The previous planning (assessment of internal and external environments, development of a mission and plan, and allocation of resources) has already been completed. The next step involves adapting the strategic plan to the nursing units.

12. Becky graduated 5 years ago and is keenly interested in pursuing leadership opportunities. She has been active in learning about leadership through workshops and Internet research and recently began a graduate degree program with a focus on nursing administration. She has excellent clinical skills and eagerly accepts responsibility for various projects on the unit. Her sarcastic and sometimes aggressive behavior tends to alienate other staff members on the unit. In coaching Becky, you: a. suggest that she reflect on situations in which she has had a positive influence and consider how her interactions contributed to the situation. b. suggest that she not consider leadership roles because her interaction skills are more suited to roles in which she has limited opportunities to work with others. c. ask staff members on the unit with whom she works to provide her feedback about ways in which her behavior irritates or turns them away. d. encourage her to continue her graduate courses, as information about strategies and technical aspects of the role will compensate for negative interactions.

ANS: A Leadership involves radiating positive energy and the ability to inspire and motivate others. Management can be taught through formal instruction, but leadership is attained through reflection on rich personal experience.

17. The adage "leaders are born and not made" reflects which of the following ideas around leadership? a. Management can be taught; leadership depends on abilities. b. Mentorship is important in developing innate skills of leaders. c. Leadership is a natural skill that cannot be refined or developed. d. Succession planning and formal education related to leadership are ineffective.

ANS: A Leadership is an abilities role that is reflective of rich personal experience. It can be developed and refined through such strategies as coaching, mentorship, and reflection. Management can be taught and learned.

6. 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.

17. 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.

11. 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.

23. During a discussion of concern about approaches used with aggressive patients in the Emergency Department, several staff members express concern for their safety. As a leader, the nurse manager should: a. look directly at speakers and acknowledge their comments. b. promise to implement each suggestion that is made. c. implement the idea that receives the most discussion. d. listen but implement the plan that she had in mind before the discussion began.

ANS: A One of the five rules for leaders is to listen to the constituents—in this instance, the staff members who have safety concerns. Active listening in the United States means establishing direct eye contact and asking probing questions. Listening does not obligate the leader to any one course of action. Action will be based on what is best for the group.

3. A nurse executive is hired to restore a unit's productivity, which has decreased as the result of low staff morale. The nurse executive utilizes which of the following leadership principles? a. The leader declares the intent and goals to enhance productivity and assumes that the unit also wishes to increase productivity, which allows nurses to feel in control of the environment. b. If staff members increase productivity, then they are given opportunity to engage in learning events such as workshops and conferences. If the staff members are not satisfied, they will insist on a different leader, who will get them what they want. c. Leaders at the national level who are seeking relief for nurses in the workplace are seen as the solution to the nursing shortage. d. Workplace satisfaction depends on staffing ratios, adequate pay, and tuition reimbursement, and these are things the leader can control.

ANS: A Stephen M.R. Covey suggests that Smart Trust is a method for restoring trust in organizations. Smart Trust Actions include declaration of the leader's intent and assumption by the leader that others also have positive intentions. Building trust involves signaling goals and intended actions in advance. Actions such as promising external rewards such as additional learning opportunities, workload relief, and compensation are consistent with transactional leadership, which leads to low to stable commitment and limited satisfaction.

18. 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.

Planning is a process designed to achieve goals in dynamic, competitive environments. As a new manager, what is the first step you will undertake to develop a strategic plan of action for a congestive heart failure program? a. Search the environment to determine changes that may affect the organization. b. Appraise the organization's strengths and weaknesses. c. Identify the major opportunities for and threats to the organization. d. Identify and evaluate the various strategies available to the organization.

ANS: A Assessment of the external environment is the first step in the strategic planning process.

The clinic nurse understands that the advantages of planning include: a. assisting staff in critical thinking and improving decisions. b. orienting people to react instead of act. c. forcing managers to be cost-efficient and cost-effective. d. focusing on activities, not results.

ANS: A Effective planning means that everyone in the organization manages his own work and sees how it relates to organizational goals. Being proactive means "aggressive planning" that ensures that decisions are improved and are oriented toward organizational goals.

Which of the following represents an effective goal statement? a. Involve patients and families in planning health care. b. To revise clinical guidelines for incontinence care from evidence within 6 months. c. Patients and families are partners first in care planning. d. To acquire $4 million in additional funding within 12 months to support clinical education programs for dementia.

ANS: A Goal statements formalize targets for an organization. Objectives include the word to and an action word, and specify dates for attainment. Mission statements convey values and beliefs of the organization.

Northwestern Hospital has decided to implement peer review. As a clinical leader in the Emergency Department, you have overall responsibility for ensuring that this is in place by next month. The most important step in this process is to: a. provide an educational session for staff on peer review. b. revise the mission statement, objectives, and performance standards. c. develop objectives and performance standards with employees. d. implement objectives and performance standards.

ANS: A Once a strategic plan has been developed, the next step is open communication and execution of the specific plan, which, in this instance, is peer review.

The primary difference between a résumé and a CV is that a résumé: a. reflects your skills, knowledge, and background in relation to a specific position. b. offers a detailed listing of positions held and where positions were held. c. includes a long and detailed explanation of academic and work experience. d. provides contact information and focuses on your background, in general.

ANS: A A résumé is a short, customized overview of your professional life that relates to the qualifications of specific positions and how you are able to match your background to the qualifications that are desired. Provision of contact information is common to both the résumé and the CV. Résumés are more effective if details of particular positions that have been held are highlighted as compared with a detailed listing of positions held.

Knowing your professional strengths is important to: a. find your fit in positions and a career path. b. maintain a professional status. c. act in a manner that is legal and ethical. d. understand the role expectations of a position.

ANS: A Being aware of your strengths is critical in determining what you will bring to a position and can be used to find your fit and possible career path. Knowledge and experience are important in maintaining the privilege of belonging to a profession and of behaving ethically and legally

A functional résumé focuses on: a. experience and skills gained in positions. b. positions held and specific roles in the positions. c. academic qualifications and achievements. d. relating skills and experience to qualifications in a specific position.

ANS: A Functional résumés highlight skills and experience gained rather the details of specific positions. As with résumés in general, skills and experiences are customized to create an image of an individual in a particular position.

1. 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.

21. A group of managers is meeting to discuss ideas related to the successful implementation of evidence-based practice on their units. Susan has been asked by the director of care to assume leadership of these discussion groups. After two such sessions, Susan expresses disappointment to her mentor that the group seems disinterested in her ideas and that they are listening to Ken, who has much less experience with leadership. In discussing this with Susan, the mentor understands that leadership: a. is a designated role. b. must be earned. c. is more likely to be taken by someone who is more talkative. d. rarely is taken over by someone with less experience.

ANS: B A person can have an impressive title, but title or designation does not make the person a leader. A leader must have the ability to inspire others to follow.

8. Recruiting among the emerging work force (18 to 35 year olds) is a challenge for healthcare agencies. Marketing brochures should address the leadership and vision of the healthcare agency. Which of the following workplace environments will attract applicants in the emerging work force? a. A highly professional environment b. A nurturing and receptive environment c. An environment highlighted by lots of meetings, so staff members can have lots of input d. A totally online environment, so staff members will not have to interface with uncaring colleagues

ANS: B A study of student nurses who represent this age-group indicates that they want a leader who is receptive, approachable, a team player, and motivating.

9. A nurse executive who considers herself a Baby Boomer will have the challenge of convincing the emerging work force of the necessity of committee meetings. One of the primary reasons that the Baby Boom generation appears to have so many meetings in the work environment is that: a. they feel more comfortable in a group. b. they find that the journey to the solution is as important as the solution itself. c. they were deprived of collective action opportunities in the past and now feel that solutions are better when many people have input. d. Baby Boomers are aging and need the respite from work that meetings offer, so they can recuperate from the physical demands of the work environment.

ANS: B Baby Boomers mistrust authority and trust in collective action, based on successes with social movements in their formative years.

16. The new head nurse on G Unit has been the subject of a great deal of discussion and complaining during breaks. She is a competent nurse of tremendous integrity with approximately 30 years' experience. Her predominant method of problem solving and communication is through meetings, which can go over the allotted time. The staff may: a. be represented by a high number of Baby Boomers. b. be presenting different generational values and attitudes than the head nurse. c. be unresponsive to her transactional leadership style. d. want a leader rather than a manager.

ANS: B Leaders who come out of the Baby Boomer generation may be more comfortable with collective action than followers who come out of the Emerging Work force generation, who are more comfortable with interactions if they are seen as having value for them and with activities if they are seen as having benefit. A group that is highly weighted toward the Emerging Work force generation may find the approach of a leader who is part of the Baby Boomer generation frustrating and may not understand the meaning or value of the meetings.

7. 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.

13. The Sunny long-term care facility has experienced numerous difficulties with staff relationships, despite its success in maintaining financial viability and judicious use of resources. Staff members complain that the primary concerns of the facility include applying policy, saving money, and ensuring that lawsuits are avoided. There is little trust in, and involvement of, staff members. This facility may be: a. well managed and well led. b. overly managed and not well led. c. poorly managed and well led. d. overly led and overly managed.

ANS: B This organization is concerned primarily with coordination of resources, application of current policy, and economic issues connected to the present. These behaviors are consistent with the management role. There is little evidence that the organization displays leadership, which involves trust, belief, hope, and vision.

20. The style of leadership that Kari is exhibiting is likely to: a. ensure that the organization is financially stable. b. stifle innovative thinking about ways to move out of financial jeopardy. c. lead to apathy and disinterest in the organizational goals. d. lead to decreased attrition of staff on her unit.

ANS: B Whether or not the organization achieves financial stability is a function of financial envisioning and planning, but the style of leadership (transactional) that Kari is demonstrating is likely maintaining the status quo within the organization, without generating creative and innovative ideas to address the financial issues. Staff commitment is low to stable, and conformity to organizational goals is motivated by external rewards.

In assessing the internal environment, the strategic planning team at Pacific Hospital discovers that 90% of staff members have no idea what the current mission statement means. This is most likely related to: a. the level of abstraction inherent in mission statements. b. development of the statement by the administration team with no other staff involvement. c. outdated goals and objectives contained in the mission statement. d. failure to provide action statements within the mission statement.

ANS: B A mission statement reflects the beliefs of the organization in relation to those it serves and services it provides, and it communicates the direction of an organization. Covey (1990) believes that the process of developing the mission statement is vital to an organization's success and should involve everyone.

A nurse is applying for a new position. This position is one in which she will serve as a liaison between a hospital and a school of nursing. The nurse must update her résumé to include her teaching experience. The goal of creating a curriculum vitae is to: a. have a listing of facts about your professional life. b. provide potential employers with information about where you are in your career. c. respond quickly whenever a position becomes available. d. be certain you can recall facts for a prospective position.

ANS: B A curriculum vitae provides an all-inclusive but not detailed listing of your professional life. This approach allows a prospective employer to find the most recent information quickly and gain a sense of where you are in your career.

1. As a senior executive, you are keen to develop your hospital as a learning organization. Part of your purpose in translating this vision into practice is to: (Select all that apply.) a. retain funding from third-party payers. b. develop leaders. c. maintain and/or improve quality of care. d. stay abreast of new knowledge and evidence.

ANS: B, C, D Learning organizations are concerned with providing opportunities and incentives for individuals and groups to engage in lifelong learning, in recognition of the positive impact that learning has on patient outcomes and staying abreast of new knowledge. Lifelong learning and reflection are also characteristics of leaders.

10. The hospital administration is discussing the possibility of closing hospital beds in your unit because of a nursing shortage and the increased amount of overtime required to care for patients. As the leader on the unit, which of the following examples best demonstrates your transformational leadership style? a. Your entire staff walks out on strike. b. Your staff sends an ultimatum to the clinic director demanding higher pay. c. A group of your staff members goes to the administration to propose closing of a different unit. d. A group of your staff members goes to the administration to request that they be allowed to work the overtime hours.

ANS: C Commitment to the vision that has been created is seen in the ability of the leader to influence, motivate, and persuade others. The transformational leader can motivate employees by encouragement of novel, innovative thinking. True transformational leadership as occurring when the leader is able to motivate followers to create new ways to problem solve and manage the changes together.

24. In working with Cheryl, her mentor suggests that it is really important for Cheryl to engage in self-appraisal and to know her strengths. This observation is based on an understanding that: a. self-confidence comes automatically out of leading. b. self-confidence requires constant self-affirmation of strengths. c. there is little external motivation and affirmation in leadership. d. supervisors of leaders rarely provide feedback.

ANS: C Followers usually hold opinions about decisions that are made; these opinions can be favorable or not, which means that external motivation and affirmation are rare. Leaders have to be confident in their own abilities and enthused about the vision that they have created.

1. As the clinical director of 24 employees, you have been asked to explain to staff members why they are not getting a raise this year, even though they have been working short-handed for many months and patient satisfaction scores have never been higher. Because you believe yourself to be a transformational leader, you will approach this problem by: a. telling the assistant clinical director and asking her to share the bad news with the other staff members. b. posting a note on the bulletin board that includes the phone number of the chief nursing officer, so anyone who has complaints may express them. c. showing staff members the budget and asking for input about how to cut costs so that raises will be possible in the future. d. meeting with a small group of seasoned staff members and asking them how to break the news.

ANS: C Transformational leadership involves engaging those being led and inspiring shared vision in moving toward a goal that all will accept as desirable. This involves enabling and empowering others to believe that their input and effort will make a difference in solving problems.

4. 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.

An experienced staff nurse applies for a distinct position of patient advocate at a new clinic. Based on the various tools available to her, which of the following should she bring to her interview to best present her skills? a. Résumé b. Annual evaluations c. Portfolio d. Patient advocacy project

ANS: C A portfolio enables prospective employers to view evidence of significant achievements and responsibilities that would be pertinent to the position.

A well-written letter of resignation is critical to: a. first announce your intent to resign. b. formally signal discontent in your current position. c. maintain a positive relationship with your former organization and colleagues. d. fulfill your legal obligations as a departing employee.

ANS: C A well-written resignation letter outlines your intent to leave the organization and your appreciation of the organization but should follow an initial meeting with your manager to first discuss your intention. A well-written letter maintains a positive relationship with the organization.

During performance appraisal interviews, Joanne's nurse manager notices Joanne's excitement when she talks about how she has helped patients on a rehab unit understand the complexities of their regimens. When Joanne's nurse manager asks her about her career path plans, Joanne says that she wants to become a nurse administrator. The best response to Joanne would be: a. "Nursing administration is rewarding. What experiences would help you along this path?" b. "You do not appear excited about nursing administration. Unless you are excited by that career path, I wouldn't advise going in that direction." c. "You seem to find teaching others very rewarding. Have you considered that as a possible career path?" d. "You are too inexperienced to consider administration. Work for a few years, and then consider administration."

ANS: C Joanne evidences excitement about teaching patients, and although administration could be a rewarding path for her, education might be a better option for her to consider. Looking at job aspects that are rewarding is helpful in determining which career direction to pursue.

Which of the following situations is most likely to result in a productive, whole work situation? a. Amy, RN, 5 years of experience in the Emergency Department. Amy accepts a position working with older clients in a home health agency because she has relocated, and this is the only full-time position available. b. Adam, RN, 8 years of experience in various nursing positions, including that of a nurse manager. Adam accepts a new nurse manager position because he has a family and wants more regular hours. He is most comfortable working in direct client care. c. Louise, RN, 10 years of experience in an Emergency Department. She accepts a position as a case manager in home health care, working with older clients. She especially enjoys working with older adults and wants to take on leadership and management challenges. d. Courtney, RN, a new graduate. Courtney is getting comfortable with delivering nursing care as an RN. She is offered a position on surgery as a permanent team leader. The unit has had a great deal of turnover recently, and only limited mentorship is available.

ANS: C The whole of any work situation is composed of two elements: person and position. A productive, whole work situation results when a person's talents and strengths are successfully blended with expectations of the position. Of the situations described previously, the one most likely to result in a productive, whole work situation is that of Louise, who, although her experience has not been in home health, is interested in both the roles and the responsibilities of the position, as well as the target group being served. She also considers the group being served as an area in which she demonstrates strength.

11. John is interested in leadership positions within his nursing organization. Although he has been on the same unit for 10 years, he has attended two workshops during that time and has steadfastly refused opportunities to engage in leadership development opportunities or other learning offered as part of the hospital's succession planning strategy. He says that he is interested in a leadership role primarily because it will give him a more stable work schedule and will enable him to spend more time with his family. In coaching John, it would be important to: a. affirm that his years of service and stability on the unit are the most important attributes for assumption of a leadership role. b. reinforce that his concern with maintaining balance outside work would be a key factor in selecting him for a leadership position. c. encourage him to consider the financial rewards of the position, as well as the positive effect on his work schedule. d. encourage him to seek out new experiences and learning that will complement his existing strengths derived from experience and his interest in work-life balance.

ANS: D According to Covey, effective leaders continually engage in learning and self-renewal, as well as in maintaining a balanced life, radiating positive energy, believing in other people, being concerned with the common good, and being synergistic.

9. 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.

23. 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.

2. After a newly hired director of nursing has reviewed the hospital's strategic plans, she develops a time line for achieving those plans. The new leader is: a. not expecting that novice leaders will have a vision. b. demonstrating mistrust of the abilities of her staff to implement the plans. c. instituting deadlines against which the performance of staff will be evaluated. d. translating a global document into realistic plans for nursing.

ANS: D Followers need three things from leaders: direction, trust, and hope. Developing time lines for the strategic plan involves translating a vision into reality and being able to communicate a vision meaningfully, which is an example of a leader's influencing behavior.

19. Susan, a new graduate on the dialysis unit, appears to take Kari's remarks very seriously and works even harder, often volunteering for extra assignments. She also is often in Kari's office, advising of successes with her patients and of the extra effort that she is committing. This behavior suggests that Susan: a. is fearful of losing her job. b. lacks understanding of Kari's leadership style. c. is not intimidated by Kari's leadership style. d. knows how to "play the game."

ANS: D Followers under transactional leadership feel secure about what will happen next or what is needed to be rewarded; therefore, they learn to "play the game."

5. 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.

15. 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 orstaff. 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.

1. Role theory has its underpinnings in management theory. Management theories influence managers' leadership styles. Which of the following styles would a nurse manager be mostlikely 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.

16. 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.

14. 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.

14. While explaining the importance of developing leadership skills among nurses to a group of first-year nursing students, Natalie, a nursing unit manager, emphasizes that: a. most nurses are not expected to assume leadership roles. b. the role of nurse leadership is only at the bedside, ensuring that patient care is performed according to established standards. c. only individuals in formal leadership roles are expected to be leaders. d. the public depends on nurses to assume leadership in moving consumer advocacy concerns forward.

ANS: D The complexity of nursing and the healthcare environment demands that all nurses assume roles of manager, leader, and follower, depending on the situation. Nurses are involved in providing leadership in direct patient care, in leading others at a unit or organizational level, in moving the profession forward, and in participating in legislative and policy arenas. Consumers depend on nursing leadership to carry the healthcare agenda forward.

After an extensive campaign to ensure that the community surrounding Pacific Hospital has been exposed to the emphasis of excellence in clinical care that occurs through the use of evidence, the marketing team finds that the public perception has changed little. This determination is made possible through: a. marketing surveys. b. focus groups. c. informal feedback. d. comparison of data against benchmarks.

ANS: D Developing benchmark data at the beginning of a project enables comparison of later data against the benchmark to determine if a marketing plan has met its objectives.

After a year, the staff at Pacific Hospital is frustrated, and implementation of evidence-based practice has gone poorly. In responding to this situation, the strategic planning team at Pacific Hospital: a. recommends that the mission, objectives, and goals of the hospital be reassessed. b. revises the goal statements in the strategic plan. c. consults an external team on preparation of materials on evidence-based practice. d. holds focus groups with staff to determine what kinds of issues, challenges, and obstacles have occurred in implementation.

ANS: D On a consistent basis, the strategic plan is reviewed at all levels to determine whether the execution of goals, objectives, and activities is on target. As stated, a sense of flexibility regarding the objectives is important to consider, and objectives may change as a result of legislation, budget changes, and change in structure or other environmental factors. Involving staff enables development of creative methods to ensure that necessary changes occur.

Before beginning her own nursing agency, a nurse worked with other temporary nursing agencies in nine states and multiple agencies. She had set a personal goal to start her own agency. What type of motivation does this exemplify in career success? a. Linear b. Spiral c. External d. Internal

ANS: D This is an example of internally motivated career success for the nurse. She set a goal and achieved the goal, meeting her own internal focus and resulting in her career success.

Thomas has been a nurse in your ICU for 10 years. In facilitating Thomas' professional development, the nurse manager would focus on: a. certification for the ICU environment. b. discussions about how Thomas can fit with role expectations and relationships. c. possible changes to other ICU environments. d. encouraging him to lead changes that leave long-term impacts after his retirement.

ANS: D Thomas is a mid-career professional. As such, you would expect him to be interested in honing areas of expertise (such as leadership or developing a deeper expertise in a particular area of ICU nursing) as opposed to gaining skills necessary for his work environment such as certification or becoming comfortable with his role and relationships in ICU, which would be critical to an early career nurse. Legacy building is characteristic of mid-career professionals.

Which of the following needs revision on a résumé or CV? a. John Jones 87 Highway Drive City, MI 79110 [email protected] b. M. Howes Anyway Highway City, MO 77700 (H) 777-777-0000 e-mail: [email protected] c. Dr. L. Jones 99 Carway Drive City, NY 84003 (H) 999-999-0000 (Cell) 999-000-9999 d. Tanya Jones 67 Honeywell Drive City, MO 66907 [email protected]

ANS: D When including Web or e-mail addresses, it is important to use addresses that are not overly casual or that communicate personal information.

From your observation of planning activities in the organization, you have noticed that planning and decision making occur at various levels of the organization. The nurse manager has overall responsibility for which of the following? a. Sending out postcards b. Organizing a telephone follow-up c. Monitoring ongoing activities and projects d. Listing the patient population

ANS: C The nurse manager should articulate organizational decision making for the criteria model adopted by the organization and monitor ongoing implementation of the plan.

13. 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.

Which of the following represents a well-written objective? a. Hospital-acquired infections are reduced, and procedures to reduce infections are implemented. b. To increase staff satisfaction and to decrease burnout. c. To increase the health of the community. d. To implement evidence-based practice on nursing units, as evidenced by adoption of evidence-based processes, by June 1.

ANS: D Objectives are specific (begin with word to followed by an action word; specify single result to be achieved; and specify a target date for attainment) and measurable (provide level of accomplishment at the end).

10. 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.