Chapter 8 - Understanding Power and Politics

The nurse is working on a committee responsible for making policy decisions for the healthcare organization. During the work, the nurse has developed a strong belief that the focus of the committee is incorrect. Which statement by the nurse would be most appropriate? 1. "We are going about this all wrong." 2. "We are a good team, but we need to look at this problem from a different viewpoint." 3. "I have to intervene in our work. We are just wasting time." 4. "This is going nowhere. I am resigning."

*Answer: 2* *Explanation:* 1. This statement may be correct, but it is not likely to start a calm and focused conversation about the issue. 2. When offering criticism, one should always begin the conversation with a compliment. 3. "Wasting time" is a strong statement and is likely to inflame the situation. 4. The nurse may feel that continuing on the committee is impossible, but this is not the way to convey that information.

Which statement reflects the most important use of power in nursing? 1. The nurse manager uses power when evaluating staff. 2. The nurse can use power to impact and improve client care. 3. The nurse uses power in relationships with unlicensed personnel. 4. The nurse manager can use power to assist newly licensed nurses.

*Answer: 2* *Explanation:* 1. Using power to evaluate staff is not its most important use. 2. The most important use of power is to affect the quality of client care. 3. The nurse can use power in relationships with unlicensed personnel, but this is not the most important use of power. 4. Using power to assist newly licensed nurses is not the most important way it is used.

Leaders and managers often exercise power differently. Select the powers most frequently used by leaders. Select all that apply. 1. Reward power 2. Information power 3. Legitimate power 4. Expert power 5. Referent power

*Answer: 2, 4, 5* *Explanation:* 1. A leader may not have reward power unless the leader is also the manager. Leaders can be formal or informal. 2. A leader may have information power. 3. A leader may not have legitimate power unless the leader is also the manager. Leaders can be formal or informal. 4. A leader may have expert power. 5. A leader may have referent power.

The nurse has established a reputation for advocating for clients through honesty and hard work. The nurse has worked in the organization for 30 years and often volunteers in local and national political campaigns. This nurse is using which attribute to increase political effectiveness? 1. Image 2. Age 3. Beliefs 4. Political party

*Answer: 1* *Explanation:* 1. A person who portrays an image of success and trust will be politically effective. 2. Age is not the reason people will follow this nurse. 3. Beliefs alone are not enough to make people politically effective. Without other attributes, the nurse would not influence others to follow those beliefs. 4. Affiliation with a particular political party is not enough to make someone politically effective.

How can a nurse best influence policies in an organization? 1. Follow the nursing process. 2. React to problems as they occur. 3. Connect with the outside community. 4. Look to administrators to be the policy makers.

*Answer: 1* *Explanation:* 1. Close examination of the political process shows that it closely follows the nursing process. The nurse will assess the situation, create a plan of action, implement that plan, and evaluate and revise the plan. 2. Reacting to problems as they occur shows a lack of planning. 3. Connecting with the outside community may be necessary, but if the nurse is trying to influence the policies of an organization, the bulk of the work will be done within the organization. 4. The nurse cannot remain passive and expect administrators to create all the policies.

One of the nurses often fails to attend educational offerings available to the staff. The nurse manager implies the nurse may receive a negative evaluation, which is a use of which type of power? 1. Coercive power 2. Information power 3. Referent power 4. Reward power

*Answer: 1* *Explanation:* 1. Coercive power is based on penalties a manager might impose on an employee. A negative evaluation is a penalty. 2. Information power is based on information a manager has and employees want. 3. Referent power is based on the respect the followers have for the manager. 4. Reward power is based on the inducements a manager can give to the employees.

Why would the strategic planning committee choose shared visioning as a strategy for change? 1. Shared visioning makes change easier. 2. Shared visioning facilitates the more rapid implementation of changes. 3. Shared visioning means responsibility for error is shared. 4. Shared visioning means the leader has less responsibility for getting things done.

*Answer: 1* *Explanation:* 1. If leaders and followers share in a vision for the future, it is easier for changes to be made. 2. It is not necessarily true that shared visioning allows changes to be implemented more quickly. 3. Diluting the responsibility for error is not a reason to implement shared visioning. 4. The leader does not have reduced responsibility in shared visioning.

A staff nurse says, "I have so much to do. Why should I spend time being politically aware and active?" Which response by the nurse manager would be most appropriate? 1. "Being politically active helps you influence events and the decisions of others." 2. "You might want to run for political office someday." 3. "It might help you increase your salary." 4. "It will give you a better understanding of client rights."

*Answer: 1* *Explanation:* 1. Nurses can be politically aware and active in an organization or in the community. By being aware of issues and the people who can effect change, the nurse can influence those in the decision-making roles. 2. Running for political office is a way to be politically active, but it is not the reason to be politically aware for most nurses. 3. There is no guarantee that being politically aware and active will have any effect on wages and benefits. 4. A nurse can increase understanding of client rights without being politically aware and active.

Which event would likely improve a nurse's position power within an organization? 1. The nurse is promoted to nurse manager. 2. The nurse is voted "most likable" as part of a Nursing Day celebration. 3. The nurse has just graduated from a master's program in nursing. 4. The nurse's wife has just been elected to the town council.

*Answer: 1* *Explanation:* 1. Position power is determined by job description, assigned responsibilities, recognition, advancement, and authority. Being promoted to nurse manager increases position power. 2. Likability is associated with referent power, which is a personal power. 3. Advancing one's education is more likely to increase knowledge power, which is a personal power. 4. Connection power is based on an individual's links to influential people. Connection power is a personal power.

A nurse cared for Senator Bill Smith while he was hospitalized last year. The nurse now wishes to send him a letter supporting a bill that will be voted on in the current legislative session. Which salutation should the nurse use in the letter? 1. Dear Senator: 2. Dear Bill: 3. Dear Sir: 4. To whom it may concern:

*Answer: 1* *Explanation:* 1. The nurse should use a professional manner in the letter. 2. The nurse should not assume familiarity with the senator in this professional matter. 3. The senator's correct title is Senator. 4. The letter should be addressed specifically to the senator.

Which strategy is best for the newly licensed nurse who wishes to develop power in the organization? 1. Develop a "can do" attitude and reputation. 2. Develop rapport with other staff members by joining in on complaint sessions. 3. Choose uniforms that do not look better than the ones other nurses wear. 4. Refer to the staff as "they" when discussing the unit.

*Answer: 1* *Explanation:* 1. To become powerful in the organization, the newly licensed nurse should develop an image of power. This includes building a "can do" reputation. 2. The nurse who wants to be powerful should not develop a reputation as a complainer. 3. Dressing for success is important. 4. Commitment to the organization is demonstrated by referring to the staff as "we."

The nurse manager reviews the policy and procedure for central line (flushes) maintenance. To determine potential changes, the manager considers which of the following areas? Select all that apply. 1. Current policy and procedures 2. Current research 3. Length of stay 4. Infection rates 5. Practice guidelines

*Answer: 1, 2* *Explanation:* 1. Current policy and procedures allow the manager to know what is already in place and if they need to be updated. 2. Current research determines that the policy and procedures should be guided by evidence-based research. 3. Length of stay is determined by specialized health problems and quality of practice. 4. Infection rates are determined by quality of practice. 5. Practice guidelines determine the care needed by a client with specialized health problems.

Which strategy could be used by nurses to promote nursing's power image? Select all that apply. 1. Maintaining expertise by attending continuing education events 2. Encouraging clients to write letters of praise for a job well done 3. Encouraging all disciplines to work toward organizational goals 4. Attending local events with influential people 5. Asking questions about reasons behind processes and policies

*Answer: 1, 3, 4, 5* *Explanation:* 1. Nursing is a knowledge profession, and the nurse must maintain expertise in order to retain power. 2. Nurses must affect this image personally, not through their clients or other disciplines. 3. Today's healthcare environment requires collaboration across disciplines. The nurse who can effectively work with others toward organizational goals is powerful. 4. Working with and knowing people of influence helps to increase the nurse's power. 5. Asking questions serves a twofold purpose: the nurse is increasing his or her personal knowledge base, and the nurse is seen as being an interested and active participant in the work of the organization.

The female nurse identifies that many of the power positions in her organization are held by male nurses. Which strategies should the nurse use to improve her image and increase her power? Select all that apply. 1. Identify what she really wants. 2. Keep her focus on her unit, not the entire organization. 3. Prioritize her needs in order of importance. 4. Identify her current resources. 5. Determine who stands in the way of what she wants.

*Answer: 1, 3, 4, 5* *Explanation:* 1. To increase power, the nurse must first identify what she really wants. 2. Focus should be on the entire organization, not just the specific unit where the nurse currently works. 3. The nurse should prioritize her needs and goals in the order of their importance to her and to the organization. 4. The nurse must be aware of what resources exist and how she can obtain the resources she needs. 5. The nurse should identify who or what stands in the way of her achieving what she wants.

Which would be the most effective way for nursing to improve the power of its image? 1. All nurses becoming politically active 2. Dressing, speaking, and acting in a professional manner 3. Motivating others to become nurses 4. Encouraging clients to speak positively about their encounters with nurses

*Answer: 2* *Explanation:* 1. Although becoming politically active is important, it is not the most effective way to promote a powerful image. 2. A powerful image would best be created by nurses acting and speaking in a professional manner. 3. Motivating others to become nurses is a result of power, but it is not the most effective way to promote a powerful image. 4. Having clients speak positively about nursing encounters is certainly a good thing, but nurses must improve their own image.

A home health agency has a policy requiring nurses to make routine visits at night. How might politics be used to change this policy? 1. Make visits during the day and tell the supervisor that the clients are not home at night. 2. Obtain research material to provide reasons why routine nursing visits at night are not as effective as during the day. 3. Encourage others to refuse to make routine visits at night so you will not be alone. 4. Take the supervisor to lunch and invite all the staff to join to talk the supervisor into changing the policy.

*Answer: 2* *Explanation:* 1. Lying to the supervisor is dishonest. 2. Research material provides rationales behind why a policy might need to be changed. This is the assessment phase and provides hard facts. 3. Encouraging others to violate policy is not ethical. 4. This strategy is unfair and coercive.

A nurse is overheard saying, "I just don't want to be involved in this power struggle. I don't want power; I just want to do my job." What is a common reason nurses may feel power is not desirable? 1. Nurses are knowledge workers, not power workers. 2. Many nurses view power as oppressive. 3. Having power with others is a part of providing nursing care. 4. Remaining powerful reduces self-esteem.

*Answer: 2* *Explanation:* 1. Nurses are knowledge workers, but this is not the reason that many view power as unattractive. 2. The idea of having power "over" someone or "power-grabbing" is oppressive. Many nurses hold this view of power. 3. Having power with others is not perceived as unattractive by nurses, but having power over others is. 4. Power increases self-esteem.

The local hospital has recently been acquired by a larger hospital corporation. The nurse manager hangs a poster announcing that the new wage scale and benefits package will be discussed in the next unit meeting to encourage staff to attend. This is an example of which type of power? 1. Referent power 2. Information power 3. Legitimate power 4. Connection power

*Answer: 2* *Explanation:* 1. Referent power is based on admiration and respect for an individual. 2. The nurse manager possesses information that employees desire. The only means of getting the information is through the manager, so the manager has information power. 3. Legitimate power stems from the manager's right to make a request based on the authority associated with the job. 4. Connection power is based on an individual's formal and informal links to influential or prestigious persons.

The nurse educator has recruited nursing preceptors to work with senior nursing students. The educator is teaching the preceptors about power and the education process. Which statement by a preceptor indicates learning has been effective? 1. "I am only showing the student how to take care of patients, so I have no need for power." 2. "I can use power to teach the student how to motivate, communicate, and achieve outcomes." 3. "I do not want to give the student the idea that nurses are all about who has the most power." 4. "I can use power to ensure that other disciplines know that I am the one who really does the work."

*Answer: 2* *Explanation:* 1. The nurse preceptor needs power to be effective in the teaching role. 2. Nurses must use power to influence others. 3. Nurses must use power to influence others. Power in this situation does not have a negative connotation. 4. This statement about who really does the work is not an appropriate use of power.

Which statements reveal that the nurse being described has real power? Select all that apply. 1. "She is so powerful. I have to admit that I'm a little afraid of her." 2. "I have such respect for her and the work she does." 3. "It is an honor to work with her." 4. "She had an opportunity to go to another hospital, but she chose to stay here and help us through accreditation." 5. "She knows how to use her power to get what she wants."

*Answer: 2, 3, 4* *Explanation:* 1. Real power does not come from fear. 2. Respect is one of the principles of principle-centered or real power. 3. Honor is one of the principles of principle-centered or real power. 4. Loyalty is one of the principles of principle-centered or real power. 5. Using power for one's own purposes is not part of principle-centered or real power.

Which actions diminish the image of power for nurses? Select all that apply. 1. Wearing a crisp, clean uniform 2. Addressing colleagues in endearing terms 3. Using power plays to achieve goals 4. Aggressively advocating for clients 5. Accepting orders without question

*Answer: 2, 3, 4, 5* *Explanation:* 1. Appearance can add to or detract from power. 2. The nurse should be professional in all encounters. Using endearing terms is not professional. 3. Power plays are attempts to diminish or demolish the opponent. The use of power plays is inappropriate. 4. The nurse should be assertive, not aggressive. 5. The nurse should not accept orders at face value. The nurse should never implement an intervention without knowing why the intervention is being done, that it is appropriate for the particular client, and what the outcome of the intervention should be.

Which statement indicates that a nurse has the skills to be politically involved? Select all that apply. 1. The nurse does not take credit for his or her own ideas but attributes them to others. 2. The nurse knows a lot about what is going on in the organization. 3. People often say that the nurse has a way of dealing with difficult people and situations. 4. Staff members seek out this nurse's ideas on how unit problems should be solved. 5. The nurse has a "sixth sense" about when to present new ideas.

*Answer: 2, 3, 4, 5* *Explanation:* 1. Getting credit for one's own ideas indicates political savvy. 2. Being "in the loop" is a sign of political savvy. 3. Knowing how to deal with a difficult colleague is a sign of political savvy. 4. A politically savvy nurse's ideas get a fair hearing. 5. Knowing when and how to present ideas is being politically savvy.

As part of a career advancement strategy, the nurse has identified a need to increase personal power in the organization. Which abilities should the nurse focus on improving? Select all that apply. 1. Ability to reward others 2. Technical competence and knowledge 3. Ability to access data 4. Relationships with people who are influential in the organization 5. Remain friendly, helpful, and likable

*Answer: 2, 3, 4, 5* *Explanation:* 1. Reward power is not a source of personal power. 2. Technical competence and knowledge are part of expert power. Expert power is a personal power. 3. Ability to access data is information power. Information power is a personal power. 4. Formal and informal links with people of influence are the basis of connection power. Connection power is a personal power. 5. Admiration and respect for an individual is based partly on the person's friendliness, helpfulness, and likability. Admiration and respect result in referent power. Referent power is a personal power.

A nursing leader wishes to maintain an image of power on a multidisciplinary committee. In a meeting, a committee member makes a statement that the nurse believes is in error. How should the nurse respond? 1. "I don't think what you are saying is correct." 2. "Would you clarify what you just said?" 3. "What evidence supports that statement as accurate?" 4. Say nothing and research the topic before the next meeting.

*Answer: 3* *Explanation:* 1. The nurse should do further assessment before confronting the person. 2. Asking for clarification is not the strongest response to this statement. 3. The nurse should not take the statement at face value but should ask for evidence that it is correct. 4. By not saying anything, the nurse allows the rest of the committee to hear and perhaps believe the statement is true. The time to speak up is now.

The nurse leader wishes to develop a culture of shared visioning for the healthcare organization. How should the nurse proceed with this plan? Select all that apply. 1. The leader should be a passive observer in meetings. 2. The leader should encourage a change to a more efficient top-down management system. 3. The leader should survey employees regarding what is important to them for the organization's future. 4. The leader should encourage innovative ideas. 5. The leader should use coercive primary power.

*Answer: 3, 4* *Explanation:* 1. The leader is not a passive participant in visioning. 2. Top-down management is outdated and is not a part of shared visioning. 3. Shared visioning requires that all those involved in the organization have a say in its future. 4. Shared visioning is a strategy that encourages innovation. 5. The leader encouraging shared visioning would not use coercive power.

Which action would help the nurse work with public officials to influence policies? Select all that apply. 1. Contact officials only when necessary to avoid becoming a bother. 2. Avoid social media contact with officials. 3. Address only one issue in each correspondence. 4. Depend on form letters for correspondence. 5. Always make an appointment before visiting an elected official.

*Answer: 3, 5* *Explanation:* 1. The nurse should build relationships with officials by keeping in touch. It is not savvy to make contact only when a need exists. 2. Email and Twitter are considered viable contact methods. 3. The nurse should focus the official's attention on one issue. 4. Handwritten letters get more attention than form letters. 5. Making an appointment is the best way to ensure that the official will be in the office, will have time to talk, and will be prepared to address the issue.

As part of a shared visioning initiative, a new medication administration system has been adopted. A staff nurse has been chosen to relay the unit's dislike of the system to the evaluation committee. Which would be the most effective method to communicate the unit's disapproval? 1. "More than 75% of the nurses on unit 3M want to return to the previous process for passing meds." 2. "The physicians have complained about the new system, and the nurses on 3M have voted to return to the old medication passing routine." 3. "The nurses on 3M do not like the new system. Do other units agree?" 4. "Medication errors have increased 40% on 3M since the new system began. We believe there is a problem."

*Answer: 4* *Explanation:* 1. During a transition, there is a time when it is easier to go back to the way things were done prior to the change. This is not a strong argument for abandoning the change. 2. Physician and nurse preference is not a strong argument for abandoning the change. 3. Nurse preference is not a strong reason to abandon the change. 4. When taking action within an organization, it is more powerful to be prepared with data. This statement focuses on why there is a need for action to address a problem.

There is a shortage of nurses on weekends. The unit manager asks nurses to work every other weekend in return for an additional 8 hours of paid vacation per month. Which type of power is this manager using? 1. Legitimate power 2. Expert power 3. Referent power 4. Reward power

*Answer: 4* *Explanation:* 1. Legitimate power is the authority to make a request of staff. 2. Expert power is based on a manager having unique skills or knowledge. 3. Referent power is based on the employees' respect for a manager. They comply with requests out of respect for the manager. 4. Reward power is based on the inducements a manager can offer a staff. In this case, the manager can offer increased benefits.

The nurse manager realizes that power must be used to influence a change that is needed on the unit. What should this nurse remember when exerting this power? 1. The best strategy is to overwhelm opposition by exerting a great deal of power. 2. The best strategy is to focus the use of power on the individuals who are slow to make the desired change. 3. The best type of power for these situations is coercion. 4. The best strategy is to undertake all power interactions in a polite manner.

*Answer: 4* *Explanation:* 1. One of the rules of using power is to use as little as possible to get the results desired. 2. One of the rules of using power is to focus the power on the problem instead of individual people. 3. Coercion is rarely the best type of power to use. 4. Being polite is an essential part of using power effectively.

Which action is most likely to undermine the political power of a nursing department? 1. The nurse executive reports on the accomplishments of the nursing staff at each board meeting. 2. The nurses in the hospital often ask for and do favors for one another. 3. The nurse manager wears a business suit to meetings. 4. The nurse executive does more talking than listening in meetings.

*Answer: 4* *Explanation:* 1. Reporting the accomplishments of the nursing staff is a way to support their importance and power. 2. Asking for and doing favors for one another is a form of collaboration. 3. The nurse manager should dress in the same manner as others in the meeting. 4. Talking more than listening can undermine credibility in the politics of the organization. The nurse should develop a reputation for listening and responding thoughtfully in discussions.

The nurse manager has decided that the only way to deal with an issue is to use coercive power. What strategy is important for this nurse manager to employ? 1. Administer behavioral warnings in public to alert other staff to the seriousness of the issue. 2. Reduce punishments for noncompliance after the majority of staff members have complied. 3. Wait at least 72 hours prior to responding to infractions so that emotions are better controlled during the meeting. 4. Investigate to get the facts of potential infractions before responding to them.

*Answer: 4* *Explanation:* 1. Behavioral warnings and punishments should always be done in private. 2. Punishment for noncompliance should be fairly and consistently applied. 3. Infractions should be addressed promptly once the manager is certain of the facts. 4. The manager should always investigate to get facts and avoid jumping to conclusions.

A manager wants the unit to be known as the primary wound care unit for the organization. The manager achieves staff buy-in, and they work together to establish goals and share accomplishments. The nurse acknowledges that this power tool is called ________.

*Answer: shared visioning* *Explanation:* Shared visioning is an interactive process in which both leaders and followers commit to the organization's (unit's) goals.