Leadership Chapter 1

The A O N E identifies important principles for nurse managers and executives. Which statements represent these principles? Select all that apply. 1. Relationships are important. 2. The core of nursing is caring. 3. Knowledge is synthesized. 4. Care is patient- and family-centered. 5. Nurse managers are the same as nurse leaders.

ANS: 1, 3, 4

The Future of Nursing progress report indicates which of the following has occurred? Select all that apply. 1. Number of Magnet hospitals is increasing. 2. Enrollment in P h D programs continues to decline. 3. Majority of states have granted nurse practitioners full practice and prescriptive authority. 4. The recommendation to increase B S N graduates to 80% has been met.

ANS: 1, 2 Explanation: 1. Magnet hospitals are increasing, adding 30 more in 2017. 2. There are now more nurses enrolling in D N P programs than P h D programs. 3. Authority for nurse practitioners is increasing but not for the majority of states. 4. As of 2018, the recommendation to increase B S N graduates to 80% by 2020 has not been met and the percentage of B S N graduates has to increase to meet the 2020 deadline.

1) The staff nurse is considered to be a leader by nursing peers on the unit. What characteristics does this nurse likely possess? Select all that apply. 1. Awareness of happenings throughout the hospital 2. Ability to encourage newly hired nurses 3. Skepticism about using technology for standard nursing tasks 4. Adaptability 5. Collaboration skills

ANS: 1, 2, 4, 5 Explanation: 1. The staff nurse can also be a leader. The same aspects of leadership and characteristics of a person holding a leadership position are important for leaders at the staff nurse level. 2. The staff nurse can also be a leader. The same aspects of leadership and characteristics of a person holding a leadership position are important for leaders at the staff nurse level. 3. An important aspect of being a leader is being able to see the benefits of technology. 4. The staff nurse can also be a leader. The same aspects of leadership and characteristics of a person holding a leadership position are important for leaders at the staff nurse level. 5. The staff nurse can also be a leader. The same aspects of leadership and characteristics of a person holding a leadership position are important for leaders at the staff nurse level.

1) A key skill in today's healthcare environment is the ability to collaborate with others. A nurse identifies need to improve in this area. Which skills or traits would be essential for an effective nurse manager to develop to improve collaboration with others? Select all that apply. 1. Flexibility 2. The ability to share information and ideas 3. A service orientation 4. A desire to work hard 5. The ability to listen to others

ANS: 1, 2, 5 Explanation: 1. In order to collaborate effectively, the nurse must be flexible, must be willing to listen to others and include them in his or her work, and must work together toward the best solution to any problems that might arise. 2. In order to collaborate effectively, the nurse must be flexible, must be willing to listen to others and include them in his or her work, and must work together toward the best solution to any problems that might arise. 3. While a service orientation is common among nurses, it is not an essential trait for collaboration. 4. This is not an essential skill for ability to collaborate. 5. In order to collaborate effectively, the nurse must be flexible, must be willing to listen to others and include them in his or her work, and must work together toward the best solution to any problems that might arise.

Which strategy supports a professional practice environment? Select all that apply. 1. Provide an effective staff education program. 2. Promote leadership advancement. 3. Attract nurses to leadership positions by increasing salaries. 4. Engage nurses in decision making. 5. Nursing philosophy focus is on collaboration.

ANS: 1, 3, 4 Explanation: 1. Education is necessary to support a professional practice environment. 2. Leadership is recognized in a professional practice environment. 3. Leadership opportunity is greater than salaries. 4. This is part of the perspective of professional practice environment. 5. Collaboration should be part of the philosophy, but should also include quality and safety, and collaboration should be interprofessional.

Which scenarios are examples of issues facing nursing in an age of healthcare change? Select all that apply. 1. Six of the 18 nurses working on a unit speak English as their second language. 2. The hospital has decreased medication errors dramatically in each of the last two quarters. 3. The unit manager has been asked to use a creative strategy for scheduling with fewer staff. 4. There was a report on the nightly news about recruitment and retention of nurses. 5. An Emergency Room nurse was injured by a patient seeking drugs.

ANS: 1, 3, 4, 5 Explanation: 1. An issue is the need for nurses to work as a team, despite differences in age, language, and culture. 2. There is a need to develop a culture of safety, which this hospital is doing already. 3. An issue is the need to be creative in doing more with less. 4. An issue is the increasing press coverage of recruitment and retention of nurses. 5. An issue is the increase in workplace violence.

1) The nurse wishes to improve personal emotional intelligence (E I) in hopes of a promotion to nurse manager. Which skills are important for this nurse to improve? Select all that apply. 1. Self-confidence 2. Knowledge base of nursing 3. Proficiency in technical skills 4. Empathy 5. Ability to initiate change

ANS: 1, 4, 5 Explanation: 1. E I competencies are self-confidence, empathy, change catalyst, and visionary leadership. 2. While this is an important aspect of professional nursing, it is not a competency of EI. 3. While this is an important aspect of professional nursing, it is not a competency of EI. 4. E I competencies are self-confidence, empathy, change catalyst, and visionary leadership. 5. E I competencies are self-confidence, empathy, change catalyst, and visionary leadership.

The new chief operating officer (C O O) of the healthcare facility states, "I believe that Fiedler had it right in his Contingency Theory." The nurse executive understands that this C O O will work to create which type of environment in the facility? Select all that apply. 1. Positive relationships between leaders and employees 2. A low amount of structure in task assignments 3. A decentralization of power from the leadership to the employees 4. A static approach to leadership matters 5. Leadership must change as the situation changes

ANS: 1, 5 Explanation: 1. Fiedler believed that the best type of situation occurs when there are positive leader-member relations. 2. Fiedler believed that high task structure resulted in the best situations. 3. Fielder believed that high position power resulted in the best situations. 4. This is not a static approach to leadership, but rather a situational approach. 5. In this theory, as the groups and situations change, leadership also changes.

The nurse executive wishes to be a transformational leader. What should this nurse focus on to become effective in this role? Select all that apply. 1. Improving interpersonal skills 2. Advancing personal formal education 3. Identifying mentors 4. Becoming an expert clinician 5. Creating a vision for the future of nursing in the facility

ANS: 1, 5 Explanation: 1. Transformational leadership requires interpersonal skills and having a vision for the future. 2. While formal education might increase the nurse's knowledge base for decision making, it is not a requirement for transformational leadership. 3. Having a mentor is not a requirement of transformational leadership. 4. This does not guarantee that the nurse will be a transformational leader. 5. Transformational leadership requires interpersonal skills and having a vision for the future.

The nurse has just been promoted to unit manager. Which advice, offered by a senior unit manager, will help this nurse become inspirational and motivational in this new role? 1. "If you make a mistake with your staff, admit it, apologize, and correct the error if possible." 2. "Don't be too soft on the staff. If they make a mistake, be certain to reprimand them immediately." 3. "Give your best nurses extra attention and rewards for their help." 4. "Never get into a disagreement with a staff member."

ANS: 1. "If you make a mistake with your staff, admit it, apologize, and correct the error if possible." Explanation: 1. Managers need to be honest and forthcoming with staff, which includes taking responsibility for one's own actions and errors. This also provides a positive role model for the staff. 2. When errors occur, the manager should use the opportunity for improvement, not punishment. 3. When staff feel some staff are given extra credit, they will feel uncomfortable with the manager and resentment will build. 4. Staff need to feel that they can share their feedback, positive or negative, and not feel threatened when they disagree with the manager.

Which modern leadership theory focuses on changes within the organization and external to the organization? 1. Contingency 2. Connective 3. Leadership 2.0 4. Deming's theory

ANS: 1. Contingency Explanation: 1. This describes contingency theory. 2. This theory focuses on caring and collaboration. 3. This theory focuses on the integration of multiple theories. 4. This theory focuses on teams/groups.

Describe the primary focus of a manager in a knowledge-work environment. 1. Developing the most effective teams 2. Taking risks 3. Routine work 4. Understanding the history of the organization

ANS: 1. Developing the most effective teams Explanation: 1. The most important focus of this manager is on developing and supporting effective teams, utilizing the knowledge of many. 2. Risk taking is a part of knowledge work, but is not the most important of this manager's tasks. 3. Knowledge work is a combination of routine and nonroutine work, so the manager will have focus on the routine. This is not the manager's most important focus. 4. Understanding the history of the organization is important as it will help the manager work within the organization, but it is not the most important focus.

Compare and contrast transformational leaders and bureaucratic leaders by choosing the options that are examples of transformational leadership. Select all that apply. 1. The leader focuses on organizational functions and the structure to get work done. 2. The most common type of leader in today's healthcare arena. 3. This leader follows the leadership style that is recommended by the Institute of Medicine. 4. The leader allows the staff to take risks to improve care within the organization. 5. The leader seeks to guide staff in their understanding of their importance to the work of the facility.

ANS: 2, 3, 4, 5 Explanation: 1. This is a characteristic of a bureaucratic organization and leadership-stick to the structure and identified functions. 2. This is the transformational leader. 3. The I O M recommended transformational leadership in its report Leadership by Example (2003). 4. This is a quality of transformational leadership. 5. This is a quality of transformational leadership.

Typically, the nurse manager of a unit uses a participatory style of leadership. Today, a patient suffered a cardiac arrest. The manager took over the patient's care, issuing orders, and expecting staff to obey them immediately. Which type of leadership did this manager exhibit today? Select all that apply. 1. Bureaucratic 2. Autocratic 3. Permissive 4. Directive 5. Authoritarian

ANS: 2, 4, 5 Explanation: 1. This style is focused on organizational rules and policies. 2. Autocratic, directive, and authoritarian are all terms used to describe leadership in which the leader makes the decisions for the group, issues direct orders, and expects staff to immediately obey. This is an appropriate leadership style in emergencies such as a cardiac arrest. 3. This is a "hands-off" approach. 4. Autocratic, directive, and authoritarian are all terms used to describe leadership in which the leader makes the decisions for the group, issues direct orders, and expects staff to immediately obey. This is an appropriate leadership style in emergencies such as a cardiac arrest. 5. Autocratic, directive, and authoritarian are all terms used to describe leadership in which the leader makes the decisions for the group, issues direct orders, and expects staff to immediately obey. This is an appropriate leadership style in emergencies such as a cardiac arrest.

A very young nurse has been promoted to nurse manager of an inpatient surgical unit. The nurse is concerned that older nurses may not respect the manager's authority because of the age difference. How can this nurse manager best exercise authority? 1. Use critical thinking to solve problems on the unit. 2. Give assignments clearly, taking staff expertise into consideration. 3. Understand complex healthcare environments. 4. Maintain an autocratic approach to influence results.

ANS: 2. Give assignments clearly, taking staff expertise into consideration. Explanation: 1. Critical thinking is important for every R N, not just a manager, and will not diminish the manager's authority. 2. Giving clear assignments is a characteristic of authority. The young nurse who takes staff expertise into consideration when making assignments is likely to be more successful in leading the group. 3. Nurse managers work in complex healthcare environments, but must create an appropriate organizational environment as a way of exercising authority. 4. In autocratic leadership, one person has all of the power. This is not a good approach for a younger leader to adopt when working with a group of older, more experienced nurses.

Keeping Patients Safe and The Future of Nursing reports both address important nursing issues related to leadership and management. What aspect of healthcare delivery do they both emphasize in relationship to nurses? 1. Nursing image is an important aspect of the profession and its success. 2. Nurses should be leaders in quality improvement, but are not fully prepared for this leadership. 3. Nursing leadership is focused on formal management positions in healthcare organizations. 4. Nursing scope of practice is important and needs to be broadened.

ANS: 2. Nurses should be leaders in quality improvement, but are not fully prepared for this leadership. Explanation: 1. Nursing image is not a strong focus in both reports. 2. Both reports recognize need for nurses to be leaders in quality improvement, but there is need for more preparation in quality improvement and leadership. 3. Nurses are leaders in many positions, not only in management, and this is not addressed in both reports. 4. The Future of Nursing report comments on scope of practice, but not Keeping Patients Safe.

The nurse executive of a healthcare organization wishes to prepare and develop nurse managers for several new units that the organization will open next year. What should be the primary goal for this work? 1. Focus on rewarding current staff for doing a good job with their assigned tasks by selecting them for promotion. 2. Prepare these managers so that they will focus on maintaining standards of care. 3. Prepare these managers to oversee the entire healthcare organization. 4. Prepare these managers to interact with hospital administration.

ANS: 2. Prepare these managers so that they will focus on maintaining standards of care. Explanation: 1. This is an illustration of the "Peter Principle," which is promoting people to management positions just because they are doing a good job in their current position. Management level employees should be selected based upon the potential ability to manage and their desire to do so. 2. Nurse managers are directly responsible for maintaining standards of care, and managing fiscal resources and development of staff. 3. This is not the responsibility of most nurse managers. In this question, it is clear that managers of nursing units are being prepared and developed. 4. Interacting with hospital administration is a rare requirement for a unit nurse manager and, if it is required, it is not as important as maintaining standards of care.

The nurse manager asked all staff nurses to develop effective leadership competencies. How should the staff nurses interpret this request? 1. This is an unrealistic expectation, because only managers are leaders. 2. This is possible if the nurses learn about and use relevant leadership and management theories and styles. 3. In order to become leaders, the staff nurses will have to emphasize control, competition, and getting the job done. 4. Unless the staff nurses possess the traits of a natural born leader, this is an unrealistic expectation.

ANS: 2. This is possible if the nurses learn about and use relevant leadership and management theories and styles. Explanation: 1. A nurse does not need to have a formal management position with a management title to be a leader; if nurses demonstrate leadership competencies, they are considered nurse leaders. 2. In today's healthcare environment, nurses must have knowledge of relevant leadership and management theories and styles. This knowledge helps nurses emerge as leaders. Nurses are also leaders of their own nursing practices. 3. Control, competition, and getting the job done are past theories and styles that are not as useful in today's environment. 4. Leadership is a skill that can be learned.

Compare and contrast manager roles and leadership roles by choosing the options that are more aligned with the manager role. Select all that apply. 1. Focus is change 2. Have the ability to influence others 3. Control the environment 4. Focus is on people 5. Focus on efficiency

ANS: 3, 5 Explanation: 1. The manager accepts the status quo, while the leader challenges it. 2. The manager controls people, while the leader influences others. 3. The manager controls the environment, patient care, and the staff that deliver that care. 4. The leader focuses on people, while the manager focuses on systems and structure. 5. Managers focus on efficiency, while leaders focus on effectiveness.

What statement, made in the morning shift report, would help an effective manager develop trust on the nursing unit? 1. "I know I told you that you could have the weekend off, but I really need you to work." 2. "The others work many extra shifts, why can't you?" 3. "I'm sorry, but I do not have a nurse to spare today to help on your unit. I cannot make a change now, but we should talk further about schedules and needs." 4. "I can't believe you need help with such a simple task. Didn't you learn that in school?"

ANS: 3. "I'm sorry, but I do not have a nurse to spare today to help on your unit. I cannot make a change now, but we should talk further about schedules and needs." Explanation: 1. To develop trust, managers who make promises to staff must keep the promise. 2. This statement implies that the staff nurse is not a team player. It also sets up one nurse against the remainder of the staff. Effective managers must be fair and supportive with all staff. 3. This manager is standing up for staff by not allowing another unit to take a nurse today. 4. This statement is belittling to the staff nurse. This attitude does not demonstrate trust that staff performances will be effective.

The rural hospital has experienced a very small patient census over the last two months. Salary costs for this period have been over budget, and the nurse manager announces that all nurses will be required to rotate taking unpaid furlough days until the census improves. Which type of leadership does this manager exemplify? 1. Impoverished leadership 2. Country club leadership 3. Authority-obedience leadership 4. Team leadership

ANS: 3. Authority-obedience leadership Explanation: 1. This style of leadership has limited interest in production or people. 2. This type of leader has an interest in people, but productivity is not a major focus. 3. This type of leadership focuses on efficiency and getting the job done and is not as concerned with staff members as people, but in this case this most likely is the only approach that the nurse manager can take. 4. This type of leader is very concerned about productivity and about staff morale and satisfaction.

There have been several patient complaints that the staff members of the unit are disorganized and that "no one seems to know what to do or when to do it." The staff members concur that they don't have a real sense of direction and guidance from their leader. Which type of leadership is this unit experiencing? 1. Autocratic 2. Bureaucratic 3. Laissez-faire 4. Authoritarian

ANS: 3. Laissez-faire Explanation: 1. Autocratic and authoritarian leaders make decisions for the group and assume people are incapable of making independent decisions. While this is not always a good leadership style, it is unlikely the complaints in this scenario would occur. 2. Bureaucratic leaders depend upon policy and rules. This is not always a good style of leadership, but it is unlikely the complaints in this scenario would occur. 3. This style of leadership can be so detached that there is no direction or real leadership. This will often be reflected in the work of the staff and the perceptions of the patients. 4. Autocratic and authoritarian leaders make decisions for the group and assume people are incapable of making independent decisions. While this is not always a good leadership style, it is unlikely the complaints in this scenario would occur.

Porter-O'Grady, a nursing leader, comments on a critical concern for nursing, as noted in this chapter. What is this concern? 1. Need to increase the number of advanced practice registered nurses 2. Need for more nursing publications 3. Need to engage and embrace change 4. Need for more nursing research

ANS: 3. Need to engage and embrace change Explanation: 1. This is important, but not what Porter-O'Grady comments on. 2. This is important, but not what Porter-O'Grady comments on. 3. This is what Porter-O'Grady thinks the nursing profession must do to succeed in the changing healthcare environment. 4. This is important, but not what Porter-O'Grady comments on.

Choose the option that best describes knowledge management theory. 1. Leaders are intelligent. 2. Focus is on routine work. 3. The knowledge worker is critical as an organization asset. 4. Evidence-based practice is the core.

ANS: 3. The knowledge worker is critical as an organization asset. Explanation: 1. Knowledge is more important than intelligence. 2. Focus is on routine and nonroutine work. 3. Knowledge management sees the knowledge worker such as nurses as critical assets to success. 4. Evidence-based practice is important, but so are other concerns such as quality.

Which behavior demonstrates the nurse's competency as an emotionally intelligent leader? 1. The nurse is proficient in technical skills. 2. The nurse relies on policies, not options. 3. The nurse supports team members. 4. Productivity is not a major concern.

ANS: 3. The nurse supports team members. Explanation: 1. While technical skill is important for all nurses, it is not a hallmark of a competent leader. 2. Chaos theory states that solutions are not always clear and policies might not always be applied easily; other options might need to be considered. 3. In Emotional Intelligence theory, team members support each other and feel supported by the team leader. 4. This statement reflects the country club leadership style.

A nurse manager is preparing performance appraisal evaluations. Which management function is the manager demonstrating? 1. Planning 2. Organizing 3. Leading 4. Controlling

ANS: 4. Controlling Explanation: 1. This is not planning. If the manager took the information from performance appraisals and made a staff education plan, it would be planning. 2. This is not organizing, but if the manager was deciding how she would do her performance appraisals and in what order, this would be organizing. 3. The focus is not on the function of leading-though some aspects of leading are found in all of the other three management functions. 4. This function is controlling, as the manager is ensuring quality and meeting standards.

Select the reason that transformational leadership sometimes fails in an organization. 1. The need to change is addressed urgently. 2. The coalition guiding the facility is too diverse. 3. Influence, power, and empowerment are all used. 4. Poor recognition of organizational culture and does not value staff.

ANS: 4. Poor recognition of organizational culture and does not value staff. Explanation: 1. Failure often results from a lack of urgency. 2. Failure often results from a lack of a guiding diverse coalition. 3. Failure often results from not applying influence, power, or empowerment. 4. This is a reason for failure of transformational leadership.

Peter Drucker's view of management stimulated the shift toward the realization of the importance of participatory organizations. Which option provides a scenario that is an example of a participatory organization? 1. The control of the organization is centralized, and decisions are made by upper-level management. 2. Staff nurses are expected to provide support and nurturing for management's decisions. 3. The organization's approach to leadership is autocratic and bureaucratic. 4. Staff nurses provide input into planning and changes for their own unit.

ANS: 4. Staff nurses provide input into planning and changes for their own unit. Explanation: 1. In participatory organizations, the control of the organization is decentralized and many decisions are made by those "on the front lines" of the organization. 2. The theory is that the staff should be nurtured to promote greater leadership competency. 3. According to Drucker, when staff participate in the core functions of management, the organization is more effective. 4. According to Drucker, when staff participate in the core functions of management such as planning and changes for their own units, the organization is more effective.

The nursing staff communicates that the new manager has a focus on the "bottom line," and little concern for the quality of care. What is likely true of this nurse manager? 1. The manager is looking at the total care picture. 2. The manager is communicating the importance of a caring environment. 3. The manager understands the organization's values and how they mesh with the manager's values. 4. The manager is unwilling to listen to staff concerns unless they have an impact on costs.

ANS: 4. The manager is unwilling to listen to staff concerns unless they have an impact on costs. Explanation: 1. This action would enable the manager to make a decision and not just evaluate the financial status of the environment. 2. If the manager is indeed focusing only on the "bottom line," the manager is not promoting a caring environment on the unit. 3. The organization may set great value on the "bottom line," but also must be concerned about quality of care. Problems with quality of care can impact the "bottom line." If the manager believes the financial status of the organization is the only organization value, a misunderstanding has probably occurred. 4. This manager has primary focus on the financial issues associated with provision of care. This will make the manager ineffective in the role.

Which of The Future of Nursing report recommendations will have an impact on nursing leadership? 1. Associate degree nursing programs should increase by 20%. 2. Nurses who provide direct care are critical and provide leadership. 3. The rate of completion of the doctoral degree is at a high level. 4. There should be an increase of 80% in BSN graduates.

ANS: 4. There should be an increase of 80% in BSN graduates. Explanation: 1. This is not a report recommendation. 2. This is not a report recommendation. 3. This is not a report recommendation. 4. This is a report recommendation and is designed to increase nursing leadership by recognizing the need for the BSN as the entry-level degree for nursing.