Exam 1, Leadership & MGMT, N560, Evolve Questions

People are often unaware of exactly how they are spending their time. The best strategy is to: a. take control of your calendar using a time journal to see precisely where all one's time is spent in 30-minute increments. b. use every minute possible in the day to accomplish work-related activities. c. simply analyze the workday and prioritize the workload around routine habits to reduce stress. d. use checklists, delegate, plan ahead, and divide large projects or tasks into smaller, more manageable undertakings.

a. The best strategy is to take control of your calendar using a journal to record how time is used in increments, which makes the abstract idea of time a concrete reality and allows for finding opportunities to eliminate time wasters. Using a checklist, part of the fourth answer, is another good strategy, but it is additional to the strategy of keeping track of all completed tasks and starting a daily planner to log all tasks that need to be completed, which focuses on individual personal time management. The fourth answer only partially suggests some of these items, as well as other methods used. The second answer is incorrect because the goal of time management is not to use every minute possible in the day to accomplish work-related activities but rather to accomplish specific activities during the time available. The third answer is incorrect because analyzing the workday and prioritizing the workload is difficult when comfortable habits that consume time need to change. DIF: Cognitive Level: Apply (Application) REF: Pages 84-85, 87-88 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

A situational leader can best be described by which of the following statements? a. This leader tailors his or her leadership style based on the employee, experience, and circumstances. b. This leader requires minimal participation and directing, resulting in high productivity. c. This leader is one who motivates employees to their full potential. d. This leader advances innovative changes and sustains good care delivery processes.

a. The situational leader tailors his or her leadership style based on the employee, experience, and circumstances. The laissez-faire leader requires minimal participation and directing, but this does not result in high productivity. The transactional leader is one who maintains and sustains good care processes with a focus on daily operations. The transformational leader motivates employees to their full potential or empowers employees to advance innovative changes to create new services and improve existing processes. Thus the latter three statements are incorrect. DIF: Cognitive Level: Understand (Comprehension) REF: Pages 14-18 TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Environment

Management is often described in three core roles. Select the statement that is true. a. Allocating resources, negotiating contracts, handling disturbances, and proposing new services are decision-making roles. b. Monitoring processes, disseminating guidelines, and motivating nurses in organizations, states, and nationally or internationally are interpersonal roles. c. Representing nurses, leading nurses, and associating information technologies are informational roles. d. Providing care, coordinating time for patients, and interacting with physicians, pharmacists, and clients are caregiving roles.

a. Allocating resources, negotiating contracts, handling disturbances, and proposing new services are decision-making roles. Monitoring processes, disseminating guidelines, and speaking for nurses in organizations are informational roles. Representing nurses, leading and motivating nurses, and connecting nurses to others are interpersonal roles. Mintzberg identified 10 roles that are described as decision-making, informational, and interpersonal roles. Providing care; arranging access to services; coordinating care for a client or group; and interacting with physicians, pharmacists, and clients are caregiving roles. DIF: Cognitive Level: Evaluate (Synthesis) REF: Pages 4-6 TOP: Nursing Process: Management MSC: Client Needs: Safe and Effective Environment

Which is the statement that best defines management? a. A process of coordination and integration of resources through group activities of planning, organizing, coordinating, directing, and controlling to accomplish specific institutional goals and objectives b. A process of planning and directing human effort to attain established objectives c. A process by which organizational goals are met through the use of the right resources d. A process of working with executives to allocate capital, technology, and equipment resources to accomplish organizational goals

a. Management is a process of coordination and integration of resources through a group's activities of planning, organizing, coordinating, directing, and controlling to accomplish specific institutional goals and objectives. Management is a process of planning and directing human effort to attain established objectives, but it also involves efficient use of scarce resources. Management is a process that requires not only resources but also skills. Management is working not just with executives but also with individuals, groups, and other resources such as equipment, capital, and technology to accomplish the organization's goals. DIF: Cognitive Level: Remember (Knowledge) REF: Pages 19-23 TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Environment

Porter O'Grady and Malloch emphasized four practices for current workplaces that foster learning organizations. Examples of organizational structure changes to environmental and financial pressures would include: a. population-based care, case management, patient-centered care, and patient safety initiatives. b. medical home payment for physicians, relative value units, pay-for-performance, and pay based on outcomes. c. electronic health records (EHRs), health information exchange (HIE) networks, and clinical decision support. d. empowerment, shared governance, shared decision making, and self-directed teams.

a. Population-based care, case management, patient-centered care, and patient safety initiatives are organizational changes. Medical home payment for physicians, relative value units, pay-for-performance, and pay based on outcomes are reimbursement pressures. EHRs, HIE networks, and clinical decision support are information system changes to societal pressures. Empowerment, shared governance, shared decision making, and self-directed teams are examples of nursing labor force pressures. DIF: Cognitive Level: Understand (Comprehension) REF: Pages 50-51 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

In one research-based model, which of the following behaviors were core to leadership success? a. Visioning, interactive planning, workload complexity analysis, interdisciplinary team building, work process analysis, stakeholder analysis, and trust b. Interdisciplinary team building, strategic planning, data mining, motivating workers, developing culture, and trust c. Analysis of process and outcomes, trust and honesty, performance management, continuous improvement, and communicating the vision d. Interdisciplinary team building, trust and honesty, motivating workers, performance management, analysis of processes and outcomes, stakeholder analysis, and strategic planning

a. The core behaviors critical to success are visioning, interactive planning, complexity analysis, interdisciplinary team building, work process analysis, and stakeholder analysis. Trust and honesty are behaviors expected within leaders. While interdisciplinary team building is core, the other activities (strategic planning, data mining, motivating workers, developing culture, performance management, continuous improvement, communicating the vision) were not identified in the research as critical to success. DIF: Cognitive Level: Analyze (Analysis) REF: Pages 8-9 TOP: Nursing Process: Implementing MSC: Client Needs: Safe and Effective Environment

Many trends will impact health care in the United States and foster leaders to innovate and change. Which trends require innovation towards preventive and wellness health care services? a. Rising rates of obesity, patient-centered care, and accountable care organizations b. Aging population, increased numbers of veterans with posttraumatic stress disorder (PTSD) and traumatic brain injury, pay-for-performance, focus on safety and quality, and medical homes c. Advances in genomics, integrative medicine, and increased emphasis on evidence-based interventions d. Advances in technology with HIE networks, personal health records, EHRs, and telehealth

a. The trends of rising rates of obesity, patient-centered care, and accountable care organizations could lead to innovation from illness care towards prevention and wellness care. The trends of aging population, increased number of veterans with PTSD and traumatic brain injury, safety, quality performances for pay, and medical homes could lead to changes in best practices for illness care. The trends in advances in genomics, integrative medicine, and increased emphasis on evidence-based interventions could lead to changes in what care is needed and where and how care is delivered. The trends in advances in technology with HIE networks, EHRs, personal health records, and telehealth could lead to interventions in workflow processes. DIF: Cognitive Level: Apply (Application) REF: Pages 51-52 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

What habits are characteristic of critical thinking by nurses? (select all that apply) a. Questioning, reflection, contextual perspective b. Confidence, creativity, flexibility c. Open-mindedness, perseverance d. Purposeful, systematic, within a frame of reference, grounded in information

a. b. c. Scheffer and Rubenfeld (2000) have stated that habits of the mind that are characteristic of critical thinking by nurses include confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, open-mindedness, perseverance, and reflection. The Critical Thinking Community (2008) characterized for a broader population that critical thinking has a purpose, is systematic, considers alternative viewpoints, occurs within a frame of reference, and is grounded in information. DIF: Cognitive Level: Apply (Application) REF: Pages 67-68 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

Hersey and colleagues identified three skills needed for leading or influencing workers. Identify three skills leaders must possess to influence people (select all that apply). a. Diagnosing Correct b. Directing c. Adapting Correct d. Communicating Correct

a. b. d. The correct competencies include diagnosing, which is a cognitive activity that involves being able to understand the situation and the problem to be solved or resolved; adapting, which is a behavioral skill that involves being able to adapt behaviors and other resources to match the situation; and communicating, which is a process to advance the process in a way that individuals can understand and accept. Directing is incorrect, because the process of directing may not influence workers, though the skill is part of leadership. DIF: Cognitive Level: Evaluate (Synthesis) REF: Page 4 TOP: Nursing Process: Management MSC: Client Needs: Safe and Effective Environment

Rogers described five factors to determine successful planned change: relative advantage, compatibility, complexity, trialability, and observability. The statements below relate to four of the success factors. Leaders will present information on two of these to explain the necessity for the change and the expectations. Which of the following are those two (select all that apply)? a. The degree to which a change can be tested out on a limited basis b. The degree to which a change can be tested out on a limited basis c. The degree to which the results of a change are visible to others d. The degree to which a change is perceived as difficult to use and understand

a. c. The leader promotes diffusion of innovation when explaining to others the relative advantage or degree to which the change is thought to be better than the status quo and the observable stories or degree to which the results of a change are visible to others. The leaders explain this to the early majority to expand the diffusion of such an innovation. The degree to which a change can be tested out on a limited basis is called testability and is of interest to those innovating. The degree to which a change is perceived as difficult to use and understand is called complexity and is of interest to the team designing the innovation and diffusion of it. The leaders are working with innovators to design and early adopters to test. DIF: Cognitive Level: Analyze (Analysis) REF: Pages 43-44 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

Critical thinking is central to decision making. Which of the following is a true statement? a. Critical thinking and creative problem solving are the same. b. Two cognitive processes, intuition and analysis, are used in critical thinking for nursing judgments. c. A critical thinker sustains the norm or status quo. d. Clinical decision making is the same thing as diagnostic reasoning.

b. The correct answer is that the two cognitive processes used in critical thinking for nursing judgments are analysis and intuition. The first statement is incorrect because critical thinking is a set of cognitive skills that include interpretation, analysis, evaluation, inference, explanation, and self-regulation. The third statement is incorrect because a critical thinker challenges and questions the norm and considers potential unintended consequences in the context of decision making. The fourth statement, "Clinical decision making is the same thing as diagnostic reasoning," is incorrect because reasoning is based on aspects of thinking skills, such as inductive or deductive reasoning for diagnosing. DIF: Cognitive Level: Analyze (Analysis) REF: Pages 65-68 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

Complexity and chaos theory has application to leadership and management decision making. Which of the following statements apply to this theory (select all that apply)? a. A web of interdependence and mutual interconnection among nurses, physicians, and support staff results in an adaptive system with open boundaries, multiple levels of organization, and rule sets that serve as the organization's operating procedures. b. Organizational behaviors emerge from personal changes creating ever-changing feedback loops and new ways for health care delivery. c Changes in external and internal environments from manager changes result in system changes over time. d. The behavior of nurses is governed by the rules (formal and informal), information flow, diversity, and interconnectedness of the organization.

a. d. "A web of interdependence and mutual interconnection among nurses, physicians, and support staff results in an adaptive system with open boundaries, multiple levels of organization, and rule sets that serve as the organization's operating procedures" is correct. "The behavior of nurses is governed, to some extent, by the rules (formal and informal), information flow, diversity, and interconnectedness of the organization" is the other correct statement. It is incorrect to state that organizational behaviors emerge from personal changes creating ever-changing feedback loops and new ways for health care delivery, because multiple feedback loops exist and new ways of organizational behavior will emerge. "Changes in external and internal environments from manager changes result in system changes over time" is incorrect because the system changes over time as it adapts to changes in the environments. DIF: Cognitive Level: Analyze (Analysis) REF: Pages 78-79 TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment

The areas where leadership and management overlap are explained by which of the following statements (select all that apply)? a. Bring teams together. b. Spark innovation. c. Inspire a vision. d. Direct activities.

a. d. An integrative analysis of literature by Jennings and colleagues found 96% of the 894 competencies that applied to both leadership and management. Bringing teams together and directing activities are responsibilities that are common to both leadership and management, while the goals for the teams may be different. Where managers use teams to make improvements, often leaders use teams to accomplish change for different reasons. Inspiring vision and sparking innovation are incorrect answers, because both strategies and processes are unique to leadership competencies. DIF: Cognitive Level: Apply (Application) REF: Pages 1-2 TOP: Nursing Process: Implementing MSC: Client Needs: Safe and Effective Environment

Change behaviors displayed in a variety of ways. Identify the two correct statements (select all that apply). a. Resistance can be useful and should be listened to and analyzed. b. Resistance most commonly arises because individuals are trying to gain more power. c. Changing individual behavior requires less time and energy. d. Too much change is disruptive and can result in disorganization.

a. d. The correct statements are that resistance can be useful and should be listened to and analyzed, and too much change is disruptive and can result in disorganization. This disruptive change is often seen with moving to a newly designed location, such as a new home or city, and this results in disorganized, less efficient workflows for a period of time. Resistance most commonly arises because individuals do not understand why change is necessary, rather than as a desire to gain power. Changing individual behavior requires more time and energy, not less. DIF: Cognitive Level: Understand (Comprehension) REF: Pages 46-47 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

Which time management strategies are the best strategies to re-energize people to handle the activities of the workplace and decrease the stress response? a. Dividing up a project into manageable parts and setting deadlines for each part b. Having time to think c. Becoming skillful with technology to manage deadlines and tracking project progress online d. Utilizing the management team (assistants, charge nurses, clinical nurse specialists, educators) to strategize timing for all team members to schedule people time

b. A key survival technique in health care services where timeliness is of the essence for many is having time to think. There is a need to create time, plan for it, and commit to it. An appointment for thinking time is self-energizing. It has been recommended to have at least 2 hours. The first answer, though a good strategy, does not re-energize the manager or other people involved. It reduces stress by not kicking the deadlines into the future, which results in sustaining the issue or problem. The third answer is also a good strategy, but one does not need technology to manage time. Some workers are in roles where human interaction is more essential than technology, and stress is lower. The fourth strategy is also good for managers working with their team. This is a form of role modeling or setting the expectations with team members to support the staff of caregivers who ultimately impact the outcome of care to clients. DIF: Cognitive Level: Apply (Application) REF: Pages 91-92 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

Nurse leaders must possess competency in five domains: (1) leadership, (2) communication and relationship management, (3) professionalism, (4) knowledge of the health care environment, and (5) business skills and principles. Which of the following statements best describes the domain of professionalism? a. Guiding, directing, teaching, and motivating to set and achieve goals b. An approach to an occupation that distinguishes it from being merely a job, focuses on service as the highest ideal, follows a code of ethics, and is seen as a lifetime commitment c. Coordination and integration of resources to accomplish specific goals d. Ethical fitness and moral courage form the backbone of making necessary and hard—but right and unpopular—decisions.

b. The professionalism competency can be described best by the occupation's approach to distinguish itself from being merely a job in that focuses on ideal services, a code of ethics, and lifelong commitment. Leadership competencies are described as skills of guiding, directing, teaching, and motivating to set and achieve goals. The coordination and integration of resources to accomplish specific goals exemplifies the business skills and management principles domain competencies to coordinate and integrate resources to accomplish specific goals. DIF: Cognitive Level: Remember (Knowledge) REF: Pages 5, 7-8, 17 TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Environment

The research of which team states that the leader needs to be flexible in behavior, able to diagnose the leadership style appropriate to the situation, and able to apply the appropriate style? a. Fiedler's contingency model b. Hersey and Blanchard's model c. Blake and Mouton's attitudinal model d. Ohio State model

b. Hersey and Blanchard's Leadership findings synthesize the interplay among task behavior, relationship behavior, and the readiness of the followers to determine the best style for a situation. Hersey's team described the Tri-Dimensional Leader Effectiveness Model, which was advanced from Hersey and Blanchard's work on the two-dimensional model. Fiedler's contingency model describes measures for leaders to become aware of their natural style tendency: relationship-oriented or task-oriented. Blake and Mouton's was an early attitudinal model in the 1960s that measured the values and feelings of managers. Ohio State model included both attitudes and behaviors. The early models focused on the leaders whereas the Tri-Dimensional Effectiveness Model measured the followers' ability to determine effective leadership. DIF: Cognitive Level: Apply (Application) REF: Pages 11-14 TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Environment

Effective leadership is exemplified by values, confidence in employees, and a sense of security in the face of uncertainty. This aspect of leadership is known as: a. relationship management. b. self-awareness. c. social awareness. d. self-management.

b. Self-awareness is the ability to know one's own emotional state and be aware of how mood and actions affect relationships, while having confidence in others and comfort in dealing with uncertainty. This aspect of self-awareness is crucial to effective leadership. Relationship management is the use of effective communication with others to disarm conflict and the ability to develop the emotional maturity of the team members. Social awareness is the intuitive skill of empathy and expressiveness in being sensitive and aware of emotions and moods of others. Self-management is the ability to take corrective action and not to transfer negative moods to staff relationships. DIF: Cognitive Level: Apply (Application) REF: Pages 4-5 TOP: Nursing Process: Implementing MSC: Client Needs: Safe and Effective Environment

Managers who proceed with a change can best engage staff and prevent resistance by doing which of the following? a. Assisting the executives with controlling change communication and limiting the staff involvement b. Communicating accurate information to engage staff and overcome misunderstanding regarding the need for change c. Expecting that frustration, aggression, or indifference is a phenomenon of the change experience for staff d. Determining what the resistant person is trying to protect, such as employment or control of processes

b. The correct and best answer is communicating accurate information to engage staff and overcome misunderstanding regarding the need for change. Executives and managers should not limit staff involvement by controlling communication about changes; they should involve staff in implementing the project, which is important for smooth transition and change. Managers can expect resistant behaviors of frustration, aggression, and indifference, but they should be ready to handle these disengaging behaviors with greater communication and involvement. The last statement, determining what the resistant person is trying to protect, is important but does little to engage staff within the change process. DIF: Cognitive Level: Apply (Application) REF: Pages 47-48 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

Five competencies were identified by nurse leaders in recent research. What are those competencies? a. Building effective teams, empowering workers, decision making, communicating, and managing conflict b. Communicating vision and strategy internally, translating vision into strategy, building effective teams, managing patient-centered customer focus, and managing conflict c. Managing conflict, analyzing performance, guiding and empowering workers, sharing a vision with workers, and directing operations d. Focusing on patient and customer, directing and guiding workers, building effective teams, managing conflict, and analyzing performance

b. The correct answer is communicating vision and strategy internally, translating vision into strategy, building effective teams, managing patient-centered customer focus, and managing conflict. While building effective teams, communication, and managing conflict are necessary skills, the steps to empowering workers are part of building teams and decision making is not unique to leadership roles. While managing conflict and sharing a vision with workers are important competencies, analyzing performance, guiding and empowering workers, and directing operations are often completed by nurses managing patient care. While focusing on the patient and customer, building effective teams, and managing conflict are skills, analyzing performance can be accomplished by many nurses as they are directing and guiding workers. DIF: Cognitive Level: Apply (Application) REF: Page 19 TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Environment

A transformative leadership style influences the effectiveness of group decision making. The rational group decision-making model is based on which of the following? a. Power, influence, negotiation, bargaining, and interest group influence b. Economic perspective of decision making and maximum utility c. Difficulty identifying and resolving problems due to ambiguity, complexity, and illogical step taking d. Use of standard operating procedures and guidelines

b. The correct answer is that a rational model is based on the economic perspective of decision making and maximum utility. The first answer is incorrect because it is the political model that is based on power, influence, negotiation, bargaining, and interest group influence. The third answer is incorrect because it is the garbage model that involves difficult problem identification and problem resolution under circumstances of ambiguity, complexity, and illogical step taking. The fourth answer is incorrect because it is the process model that is based on using standard operating procedures and guidelines. DIF: Cognitive Level: Understand (Comprehension) REF: Pages 74-75 TOP: Nursing Process: Analysis MSC: Client Needs: Safe and Effective Care Environment

Levels of job stress that are either too low or too high have which consequence? a. They manifest in emotional and physical exhaustion. b. They decrease individual productivity. c. They increase tension related to the person-in-environment demands. d. They intensify acute and chronic health problems.

b. The correct answer is that levels of job stress that are too low or too high decrease individual productivity. The first answer is not seen with low job stress but is a consequence of when job stress is high. It is also known as burnout, and this will lower job productivity. The third answer is an aspect related to job stress from tension between a person's environments within the job; home, family, and professional responsibilities; and health and social status. The fourth answer is a consequence that may occur with prolonged chronic stress over time. DIF: Cognitive Level: Apply (Application) REF: Pages 83-84 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

Any decision in a chaotic health care delivery environment may cause an unanticipated future problem. Identify the true statement about decision making. a. Decision-making strategies are interchangeable and can be used effectively in any situation. b. Decision making is used to solve problems. c. Decision making must be even more deliberative when problems require urgent action. d. Decision making is not a behavior but rather a method in selecting and implementing a course of action from alternative courses of action for dealing with a situation or problem.

b. The correct statement is that decision making is used to solve problems. The statement "Decision-making strategies are interchangeable and can be used effectively in any situation" is incorrect because, for example, ethical decision making uses ethical principles and moral reasoning in its steps for specific situations and is not useful when clinical expert decision-making activities are necessary, which require creative and innovative ideas, adaptation to uncertainty, understanding of the context of the current problem, and learning obtained from prior experience. The statement "Decision making must be even more deliberative when problems require urgent action" is incorrect, because urgent action requires a rapid decision-making process. The last statement is incorrect, because decision making is a behavior exhibited in selecting and implementing a course of action from alternative courses of action for dealing with a situation or problem. It may or may not be the result of an immediate problem. DIF: Cognitive Level: Remember (Knowledge) REF: Pages 66-69 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

The Institute of Medicine (IOM) identified five areas of management practice for leaders to attend to during turbulent times. Which of the following are included in those areas (select all that apply)? a. Maintaining and sustaining quality and safety in service delivery b. Balancing reliability and efficiency in service delivery c. Creating and sustaining a trustworthy, learning, and evidence-based organization d. Managing change through manager involvement and bi-directional communication

b. c. The IOM identified, implementing evidence-based management, balancing reliability and efficiency tensions, creating and sustaining trust, developing a learning environment, and managing change with open communication with others as areas to focus on. Maintaining and sustaining quality and safety in delivery of services is incorrect because of the ever-changing societal impacts. Managing change through manager involvement and bi-directional communication is incorrect because of worker involvement and active communication, feedback, and sustaining of training and attention to those doing the service work. DIF: Cognitive Level: Analyze (Analysis) REF: Pages 2-3 TOP: Nursing Process: Management MSC: Client Needs: Safe and Effective Environment

Important decisions are made by nurses. Which of the following are examples of collaborated decisions (select all that apply)? a. Devise an array of plans to optimize client recovery, mobility, and self-care; maintain airway patency and hemodynamic stability; and prevent the development of decubitus ulcers b. Plan steps to achieve organizational goals, implement multisystem change processes, and improve service delivery and client outcomes c. Address complicated and difficult client care risks and problems regarding infection, injury, and contamination d. Diagnose and document client needs for health promotion, risks, and problems

b. c. The second and third statements are correct. Nurses collaborate on complex client care issues that require the talents and perspectives of various health care professionals to maximize client outcomes. Nurses collaborate with colleagues from various disciplines, including medicine, social work, pharmacy, and pastoral services, to address complicated and difficult client care problems. Nurse managers and directors collaborate with those in other disciplines to achieve organizational goals, implement multisystem change processes, and improve service delivery and client outcomes. The first statement is specific to nursing practice in the provision of nursing care and care management to devise an array of strategies to optimize client recovery, mobility, and self-care; maintain airway patency and hemodynamic stability; and prevent the development of decubitus ulcers. The fourth statement is specific to nurses' role in assessing the client's functional health patterns to diagnose and document client needs for health promotion, risks, and problems. DIF: Cognitive Level: Apply (Application) REF: Pages 71-72 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

The distinction between change and innovation is best described in which of the following statements (select all that apply)? a. Leaders are necessary to help create the environments that encourage creativity to innovate, whereas the opportunities for change can be accomplished in most environments. b. Innovation refers to the process of bringing any new or problem-solving idea into use, whereas change is a process for reducing variation within an existing process with a problem. c. Innovation is often linked with creativity and viewed as the use of a new idea to solve a problem, whereas change means improving incrementally. d. Change is a disruption; innovation is systematic, takes hard work, and has little to do with genius and inspiration.

b. c. d. Innovation is a systematic process for bringing any new or problem-solving idea into use and is often linked with creativity and viewed as the use of a new idea to solve a problem or change a service. Change process is used to reduce variation within an existing process. Change is a disruption, and change does result in incremental improvements. Three of the answers provide this distinction. The first choice is incorrect because leaders are necessary to make change to occur, not just for spawning the creativity to innovate. DIF: Cognitive Level: Analyze (Analysis) REF: Pages 42-43 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environments.

The difference between the focus of managers and leaders is best described by which one of the following statements? a. The processes and strategies look similar and are employed for different goals. b. The manager focuses on people, and the leader focuses on systems and structure. c. The manager focuses on systems and structure, and the leader focuses on people. d. Management and leadership are not equally important processes to accomplish outcomes.

c. While leaders and managers both focus on people and processes, the correct answer is that the manager focuses on systems and structure to a larger degree, and the leader focuses on people and motivating people. The processes and strategies do indeed look similar, but it is incorrect to say the goals are different but rather are employed for a similar outcome. Leadership and management are equally important processes to accomplish the outcomes together, so it is incorrect to say that they are not equally important. DIF: Cognitive Level: Apply (Application) REF: Page 2 TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Environment

Healthy work environments increase patient satisfaction, support patient outcomes, and avoid errors. Healthy work environment standards to adopt would include: a. setting expectations and controlling behaviors within the workplace. b. establishing transparency of information and setting strict communication patterns. c. acknowledgement, awareness, and assessment of workplace stress. d. knowing what the executive boss wants as a priority.

c. Health care organizations that want to assure quality care for patients can begin with the acknowledgement, awareness, and assessment of workplace stress. The first answer should state setting positive behaviors for all in the workplace and recognizing the simple acts of kindness every day to decrease stress for everyone. An example of this strategy is shared and used by the Studer's Group. The second answer is incorrect, because even though establishing transparency of information is helpful, the expectation is for communication patterns to exist through regular conversation, notes, or words of praise (workplace spirituality) that bring enjoyment, recognition and commitment to helping self, each other, and the organizational environment in simple ways (greetings, smiles, tone of voice, keeping environment tidy). The fourth answer is incorrect because nurses get caught up in priorities set by others. Knowing what is and what is not a priority is a first step. Asking the boss brings relief when true priorities are revealed. As managers, staff are the priority, when caring for staff means caring for patient. DIF: Cognitive Level: Apply (Application) REF: Pages 89-90 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

Which process best describes leadership? a. Giving people the authority, responsibility, and freedom to act on their expert knowledge and skills b. Planning, organizing, coordinating, directing, and controlling resources to accomplish specific institutional goals c. Influencing behavior of either an individual or a group in an effort to achieve goals in a given situation d. Working with and through individuals and groups and other capital and technology resources to accomplish organizational goals

c. Leadership is best described as a process of influencing behavior of either an individual or a group in an effort to achieve goals in a given situation. Empowerment means giving people the authority, responsibility, and freedom to act on their expert knowledge and skills. Planning, organizing, coordinating, directing, and controlling resources to accomplish specific institutional goals are management processes. Working with and through individuals and groups and other capital and technology resources to accomplish organizational goals are management processes. DIF: Cognitive Level: Apply (Application) REF: Pages 4-5 TOP: Nursing Process: Implementing MSC: Client Needs: Safe and Effective Environment

Role strain means: a. expectations are incompatible with the professional values of the nurse. b. one cannot possibly complete all assigned activities in the scheduled time frame. c. expectations of the multiple responsibilities of the manager can produce stress. d. expectations are unclear to the nurse.

c. Role strain is when the expectations of the multiple responsibilities of the manager can produce stress. Role incongruity means the role expectations are incompatible with the professional values. Role overload is when one cannot possibly complete all assigned activities in the scheduled time frame. Role ambiguity is when role expectations are unclear to the nurse. DIF: Cognitive Level: Apply (Application) REF: Page 88 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

Leaders are change agents and have a role in change that includes which of the following? a. Motivating staff through posting notes on the change for others to read in the usual communication place b Avoiding having the groups participate with details until they have to implement the change c. Providing reliable information and details to those who are to implement the change and avoiding setting expectations or promising anything beyond what can be delivered d. Posting the change steps for others to read in the usual communication place

c. The best approach for change agents is to provide reliable information and details to those who are to implement the change and to avoid setting expectations or promising anything beyond what can be delivered. When expectations are high, and the project or program does not meet the expectations, the effort is seen as unsuccessful. Change agents do not motivate by posting notes; they motivate through rewards and benefits to help the change along. They frequently communicate the purpose for change through direct communication. When a manager avoids having the groups participate in the details until it is time to implement the change, the staff lacks engagement to support the change process, because they are unaware of why and how to implement the change. Change agents will need to do much more to communicate and motivate change than just posting the change steps for others to read in the usual communication place, where they will likely miss many staff members. DIF: Cognitive Level: Apply (Application) REF: Pages 49-50 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance, Safe and Effective Care Environment, Psychosocial Integrity, Physiological Integrity

Wheatley identified four core principles of change. One principle states that we do not see reality; we create our own interpretation of what is real. Select the statement that aligns with this principle. a. This principle is based on a strong respect for systems, and it supports the leader's task of strengthening communication and connections within the system. b. This principle suggests offering invitations for others to work with the team, rather than issuing directives, orders, or visionary messages. c. This principle stresses the importance of not arguing who is right or who is wrong, but rather understanding that each one of us filters what is real through our own lenses. d. This principle stresses engaging people in the change from the beginning to prevent unintended consequences.

c. The third principle stresses the importance of not arguing who is right or who is wrong, but rather understanding that each one of us filters what is real through our own lenses. The first principle listed stresses living systems, so a leader has a strong respect for systems, and it supports the task of strengthening communication and connections within the system. The second principle stresses reaction, so a leader suggests offering invitations for others to work with the team, rather than issuing directives, orders, or visionary messages. The fourth principle stresses participation, not reality, so a leader engages people in the change from the beginning to prevent unintended consequences. DIF: Cognitive Level: Analyze (Analysis) REF: Page 52 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

Great leaders possess four essential skills. Identify two statements that describe those skills (select all that apply). a. Great leaders possess popularity to establish followers to engage. b. Great leaders are visible, set examples, and share responsibility. c. Great leaders possess a sense of integrity with a distinctive and compelling vocal tone to engage others in shared meaning. d. Great leaders possess a combination of hardiness and the ability to grasp context, called "adaptive capacity."

c. d. Great leaders have (1) a sense of integrity, (2) a distinctive and compelling vocal tone, (3) the ability to engage others in shared meaning, and (4) a combination of hardiness and the ability to grasp context, called "adaptive capacity." The other two statements are incorrect about effective leaders, because leaders do not need to possess popularity to engage followers, and leaders need to be visible, set examples, and take responsibility, not share responsibility. DIF: Cognitive Level: Analyze (Analysis) REF: Pages 7-8 TOP: Nursing Process: Implementing MSC: Client Needs: Safe and Effective Environment

Change is inevitable in health care, just as it is in life. Which two statements are true about change (select all that apply)? a. Change is a linear process requiring a series of discrete steps. b. Change occurs in a logical, planned manner. c. Change is inevitable and is necessary for organizational viability. d. Individuals become aware of the need for change when needs are unmet.

c. d. The correct statements are that change is inevitable and is necessary for organizational viability and that individuals become aware of the need for change when needs are unmet. Change is not a linear process requiring series of discrete steps, but rather change is challenging, complex, and irrational. Change does not occur in a logical, planned manner; planned change is dynamic and complex. DIF: Cognitive Level: Apply (Application) REF: Pages 37-42 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

Select the statement that describes how clinical decision making differs from managerial decision making. a. Professional nurses in clinical practice are making clinical decisions about client diagnoses and care plan orders, but the technical nurses are making managerial decisions about containment of costs and maximizing health care delivery. b. Clinical decision making involves the collection of information, selection, and evaluation of an action, whereas managerial decision making involves the processing of existing information to select an action. c. Clinical decision making by nurses is far less sophisticated than managerial decision making by nursing executives, nurse managers, and directors. d. Clinical decision making focuses on diagnosing client health issues, risks, or problems and planning or coordinating nursing interventions, but managerial decision making focuses on resolution of organizational problems and the plans to achieve organizational goals.

d. "Clinical decision making focuses on diagnosing client health issues, risks, or problems and planning or coordinating nursing interventions, but managerial decision making focuses on resolution of organizational problems and the plans to achieve organizational goals" is the correct statement. The first statement is incorrect: Professional nurses in clinical practice are making clinical decisions about client diagnoses and care plan orders, and the nurse executives and nurse managers are making managerial decisions about containment of costs and maximizing health care delivery. Technical nurses more often lack the formal management and/or leadership education for managerial decisions. The second statement is incorrect because both forms of clinical and managerial decision making involve the collection and processing of information and the selection and evaluation of an action; the focus of the decisions differs. The third statement is incorrect, because the sophistication of clinical decision making differentiates the professional nurse from the technical nurse and can be more challenging than managerial decisions, though the scope of coverage will vary between the two decisions. DIF: Cognitive Level: Analyze (Analysis) REF: Page: 77 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

When nurse leaders are pressured to implement organizational change from powerful economic and political interests, the purpose for change is driven externally and not internally. Nurse leaders can implement changes to alleviate immediate problems and: a. evaluate and quantify the external imposed changes for long-term effects. b. speak up, articulate, and support the value of a nurse's role. c. use positional influence to outline nursing's own destiny and prevent destructive practices. d. all of the above

d. All are correct statements and are highlighted within the 2011 Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health, which calls for more nurses to be involved in leadership roles in the health care system and to use their own positional influence to chart nursing's own destiny and prevent destructive practices like those that emerged in the 1990s. Evaluating and quantifying the impact of externally imposed changes provides nurses with information and knowledge to speak up and voice the impact and consequences to a nurse's role. DIF: Cognitive Level: Apply (Application) REF: Pages 50-51 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

A number of decision-making strategies have been identified for clinical and managerial decision making. An effective strategy for nurse managers to select in examining possible causes related to production would be: a. pilot projects. b. cost-benefit analysis. c. scenario planning. d. fish bone charts.

d. The correct answer is fish bone or cause-and-effect charts. Pilot projects are limited experimental trials used to develop an optimal and alternative solution to a problem. Cost-benefit analysis is an appropriate strategy to use when deciding budgetary issues and may include listing the positive and negative aspects of a given outcome to assist with decision making. Scenario planning is used in a group setting to brainstorm about the future and is a beneficial strategy to use in a constantly changing environment. DIF: Cognitive Level: Apply (Application) REF: Pages 66, 73-75, 80 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

Which of the following statements is true about problem solving? a. Problem solving is a high-level skill used only by health care professionals. b. Critical thinking and problem solving are the foundation of effective decision making. c. The team problem-solving method is a slow process and is a poor method for making decisions. d. Problem solving is a rational and logical thought process.

d. The correct answer is that problem solving is a rational and logical thought process. The statement that problem solving is a high-level skill used only by health care professionals is incorrect, because the high-level skill nurses and others use is critical thinking, a cognitive skill. The second statement is incorrect and should state that critical thinking and effective decision making are the foundation of effective problem solving. Health professionals improve the effectiveness by using the skill of critical thinking. The third statement is incorrect because team problem solving is a faster process for making decisions, because the use of interdisciplinary members of the team enhances the timeliness of a decision that is made in a silo. DIF: Cognitive Level: Apply (Application) REF: Pages 65-66, 70 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

Decision-making tools and strategies support the process for decisions. Select the one statement that is true. a. Group decision making tends to be more ineffective for system problems. b. All decision tree questions have a yes or no answer. c. Managers who use trial and error as the usual strategy for decision making often are effective. d. Critical pathways are a type of decision tree.

d. The correct statement is that critical pathways are a type of decision tree; they are used for clinical care and other industry decisions. The first statement is incorrect because group decision making tends to be more reflective and include more information and experts to effectively solve system problems with fewer consequences. The second statement is incorrect because only simple decision trees use questions that must be answered yes or no to direct the flow of thinking for making a decision. Algorithms for emergent care scenarios are an example of yes/no trees. The third statement is incorrect because managers using evidence-based strategies for decision making will be effective, and those using trial and error are ineffective more often. DIF: Cognitive Level: Apply (Application) REF: Pages 73-75 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

Research on leadership attitudes identified that which approach emphasized attention to the people's needs to affect the satisfaction of relationships? a. Authority-obedience b. Team c. Organization man d. Country club

d. The country club approach is correct, because it describes the attention to the needs of people to affect their satisfaction in relationships. The authority-obedience approach strives for efficiency in operations. The team approach promotes work accomplishment from committed people and interdependence through a common cause, leading to trust and respect. The organizational man approach works on balancing the necessity to accomplish the task with maintaining morale. DIF: Cognitive Level: Apply (Application) REF: Pages 11-12 TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Environment

Nurses who challenge assumptions, consolidate a purpose, build the culture, and move a vision forward are more likely within which role? a. Nurses b. Nurse managers c. Clinical nurse leaders d. Nurse executives

d. The nurse executives are positioned to challenge assumptions, consolidate a purpose, build the culture of safety and quality, and move a vision forward. Nurses coordinate and deliver health services. Nurse managers coordinate and integrate human, fiscal, and other nursing resources to accomplish nursing practice with 24-hour accountability for client care units or areas. Clinical nurse leaders guide other nurses through process, measurement, and document changes. DIF: Cognitive Level: Apply (Application) REF: Pages 2, 17 TOP: Nursing Process: Management MSC: Client Needs: Safe and Effective Environment

Which management theory's principle is to consider the situation and all elements when making a management decision? a. Complexity theory b. Chaos theory c. Systems theory d. Contingency theory

d. The principle of contingency theory is that managers need to consider the situation and all its elements when making a decision. The principle of complexity theory is the behavior over time of certain complex and dynamically changing systems with a concern for the predictability of the behavior of systems and how under certain conditions the system performs in regular and predictable ways, and in other conditions of change it becomes irregular and unpredictable. Management is a process of handling the stability of the system. The principle of chaos theory is the behavior that is unpredictable in spite of certain regularities. Nurses often are handling the unpredictable, yet organizing and planning and controlling for these unpredictable situations. The principle of systems theory is to recognize that a manager's work is embedded within a system and to understand what a system is. Nurses are a part of a larger agenda for health care services, and managing the role within the system produces the efficiencies and effectiveness. DIF: Cognitive Level: Remember (Knowledge) REF: Pages 30-32 TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Environment

Principles of leadership and management are best described by which of the following statements? a. Followership is a process whereby leaders participate in group decisions. b. Empowerment is the ability to lead a group successfully. c. Important skills for leading include diagnosing, adapting, and directing. d. Critical skills in leadership are interpersonal, decision making, and problem finding and solving.

d. The statement that critical leadership skills include interpersonal, decision making, and problem finding and solving is correct. Followership is best described as an interpersonal process of participation and implies an engagement of the group of followers with the leader who provides guidance and direction to accomplish group goals. The leader is not participating necessarily with the decision. Empowerment means giving people the authority, responsibility, and freedom to act on their expert knowledge and skills. Important skills for leading include diagnosing, adapting, and communicating, but not directing. DIF: Cognitive Level: Analyze (Analysis) REF: Pages 5, 18-19 TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Environment

7 mistakes leaders:

o Cult of personality o Lack of acct o Lack of self awareness o Comms is 2 way street o Not firing poor performers o Succumbing to small bs instead of big pic o Micromanaging

5 choices regret:

o Decision fatigue: brain tires like a muscle. o 1 others opinion based decisions o 2 don't work too much o 3 don't express your feelings o 4 don't stay close to friends o 5 don't let yourself b happy

Authentic leadership:

o Don't have to be born a leader. o Know yourself/ know your past o Be authentic/integrity

• Attitude more important than IQ:

o Inspires growth, not resistance to change.

Institute 4 healthcare improvement open school:

o New age courses for leaders o Improvement in healthcare

Building whole new mind:

o Students like "open school", IHI finds.

12 things u should never reveal at your job:

o U hate your job o U think someone is incompetent o How much money you make o Political/ religious o FB stuff o Your sex o Others sex o After somebody else's job o Used 2 b wild in college o How drunk u get o Offensive joke o U r job hunting