Leadership exam 2 part 3 (ch. 18,19,20)

A nurse-manager is communicating with a subordinate. What component of this communication would be considered as part of the external climate? a. The clarity of the message b. The subordinate's personality c. The culture of the organization d. The manager's stress level

C Feedback: The organizational climate and culture would be considered part of the external climate of this communication. The sender's and receiver's personality and stress levels are components of the internal climate. The clarity of a message is not a component of the external climate.

What strategy best increases the likelihood that a nurse-manager's communication will be accurately interpreted? a. Using more than one mode of communication b. Using face-to-face communication c. Producing clear, simple, written communication d. Repeating the message as often as possible

: A Feedback: Using various communication methods in combination increases the likelihood that everyone in the organization who needs to hear the message actually will hear it. The other options are single methods. Repeating a message is often not as effective as communicating it in a different way using a different mode.

A large health-care organization has struggled to meet mandated electronic health record (EHR) standards. What actions address the likely challenge that this organization is facing? Select all that apply. a. Improving communication between managers at the organization's various sites b. Increasing the organization's budget for technology c. Investing more in employee training d. Engaging clients and families with the process e. Increasing the use of evidence-based practice

: B, C Feedback: Many of the challenges faced during the adoption of EHRs involve inadequate technology and training. Communication between managers has not been identified as a major hurdle. Evidence-based practice enhances client care but does not directly address challenges around EHRs. Similarly, engaging clients and families greatly benefits the care that nurses provide but not the adoption of EHRs.

What principle should guide the nurse-manager's understanding of gender differences in communication? a. Research has disproven any gender-based differences in communication that were thought to exist. b. Gender is the variable that has the greatest effect on an individual's communication style. c. Men and women communicate and use language differently. d. In contrast with stereotypes, women have been shown to be more competitive communicators.

: C Feedback: Gender is a significant factor in organizational communication, as men and women communicate and use language differently. Women are generally perceived as being more relationship-oriented than men, but this is not always the case. Gender is significant but is not seen as the most significant variable in communication

What is one of the most powerful yet frequently overlooked or underused motivators that the manager can use to create a motivating climate? a. Continuing education b. Fair and objective punishments c. Positive reinforcement d. Adequate self-care

: C Feedback: Positive reinforcement is one of the most powerful motivators the manager can use and is frequently overlooked or underused. Continuing education is necessary but is not identified as a motivator. Punishments are necessary in certain circumstances but are not considered a standard motivation technique. Adequate self-care preserves health and productivity but does not independently provide motivation

The Omnibus Budget Reconciliation Act of 1987 established regulations for the education and training of which category of health-care worker? a. Certified nurse aide (CNA) b. Registered nurse (RN) c. Licensed practical nurse (LPN) d. Ward clerk

A Feedback: Although the Omnibus Budget Reconciliation Act of 1987 established regulations for the education and certification of "nurse's aides" (minimum of 75 hours of theory and practice and successful completion of an examination in both areas), no federal or community standards have been established for training the more broadly defined NAP. LPNs and ward clerks are not addressed by this act

How can the Internet be best used as a means of improving one's personal nursing practice? a. Accessing the latest research and best practice information b. Communicating with other health-care team members c. Minimizing the need for paper documentation d. Securing client information for confidentially

A Feedback: As an information source, the Internet allows nurses to access the latest research and best practice information so that their care can be evidence-based. It is not a secure form of communication in many cases. Electronic health records (not the Internet) replace paper records. It is not secure, so the Internet is not used as a confidential repository of client information.

A nurse-manager is orienting a new graduate nurse to the unit and has found this individual's charting regarding assessment to be inadequate. What is the most appropriate statement to initiate a discussion with the new RN? a. "I'm concerned that your assessment charting seems to be unclear. Can I help you with this?" b. "Unfortunately, your charting is inadequate in every way." c. "Do you think a refresher course in charting would help you?" d. "Are you having difficulty assessing your client?"

A Feedback: Assertive communication is not rude or insensitive, nor is it passive-aggressive. Backing up the communication to focus on the RN's intention is respectful and solution-oriented. The manager should not presume that the nurse is having difficulty with assessment unless there is evidence of this. The manager should avoid accusatory descriptors such as "inadequate in every way." Suggesting remediation would likely be premature before trying to work collaboratively with the nurse

A nurse-manager is in a new position and has observed that many of the employees appear to be unmotivated. The manager can promote employees' motivation by: a. establishing trusting and respectful relationships with the employees. b. making expectations for motivation clearly known. c. assigning preceptors to each of the unmotivated employees. d. increasing recruitment efforts to add new employees to the unit.

A Feedback: Collaborative and supportive relationships between managers and employees are essential to creating an environment that promotes motivation. Motivation cannot be demanded, and preceptors are not normally assigned to existing employees. Adding new staff members will not necessarily increase motivation

A nurse-manager has recently established a "best practice committee" at the clinic. Which behavior by the committee members suggests that it is in the "storming" stage? a. Members attempt to impress each other with their credentials. b. The short- and long-term goals for the group are agreed upon. c. Group members achieve their stated goals. d. The members receive their instructions and mandate from the manager

A Feedback: Competition and posturing characterize the storming stage. Agreeing on goals occurs during norming, and these are accomplished during the performing stage. Initial instructions are given during the forming stage

A new nurse-manager has been warned by colleagues about the prevalence of "the grapevine in the organization's communication." What is the manager's best initial response to this phenomenon? a. Seek to understand the patterns and contributors of this pattern of communication. b. Inform subordinates about the harmful effects of grapevine communication and that it will not be tolerated. c. Instruct subordinates to use formal patterns of communication rather than informal patterns. d. Use grapevine communication to disseminate messages that are accurate and respectful.

A Feedback: Given the frequency of grapevine communication in all organizations, all managers must attempt to better understand how the grapevine works in their own organization as well as who is contributing to it. It cannot normally be dictated into nonexistence, and the manager should avoid using this form of informal communication because messages can be easily distorted.

Which factor is most likely to provide intrinsic motivation to an employee? a. The employee's ambitious career aspirations b. The employee's need to elicit approval from the immediate supervisor c. The employee's need to avoid punishment for unsafe practice d. The employee's fear of being passed up for a promotion

A Feedback: Intrinsic motivation comes from within the individual. An example is an employee's career aspirations. An employee's desire for rewards or desire to avoid punishment is an example of extrinsic rewards

Feedback from a nurse-manager's peers suggests that the manager's face-to-face communication is often ineffective. The manager should consider what potential cause of this problem? a. Incongruence between the manager's verbal and nonverbal messages b. Ineffective listening skills on the part of subordinates and colleagues c. Inadequate formal training on communication skills d. Career stagnation by the nurse-manager

A Feedback: The incongruence between verbal and nonverbal messages is the most significant barrier to effective interpersonal communication. Ineffective listening skills on the part of the receivers may contribute to a perception of poor communication by the manager, but this would be unlikely to be the case among many different individuals. Many people never receive formal training on communication, but this does not necessarily inhibit them from becoming reasonably skilled communicators. Career stagnation would be a problem, but it would be less likely to affect overall communication skills

Which action on the part of a unit's nurse-manager demonstrates the mark of a great leader? a. Acknowledging the accomplishments of staff members at the unit meeting b. Providing onsite in-services on new equipment for the staff c. Including funds in the unit's budget of staff development d. Stressing the importance of patient safety to all new employees

A Feedback: The mark of a great leader is when he or she can recognize the excellent performance of someone else and allow others to shine for their accomplishments. Although the other options are appropriate, they are not identified as being the mark of a great leader but rather an efficient manager.

Which assessment should the RN prioritize when assigning tasks to nursing assistive personnel (NAP)? a. Determining the NAP's skills and knowledge level b. Assessing which tasks the NAP is motivated to perform c. Evaluating the NAP's ability to follow instructions d. Asking colleagues to appraise the NAP's strengths and weaknesses

A Feedback: The nurse or manager must be knowledgeable about the skills and knowledge of all members of the health-care team. These variables are more important than the NAP's motivation, ability to following instructions, or personal attributes because they are more closely associated with client safety and the avoidance of liability.

Which activity demonstrates employee engagement? a. Employee participates in hospital fundraiser. b. Employee accepts position as charge nurse. c. Employee completes annual performance review. d. Employee arrives to work on time.

A Feedback: The term used to describe an employee's emotional commitment to the organization and its goals is employee engagement. Engagement occurs when workers are involved in, enthusiastic about, and committed to their work and workplace. Similarly, Mizne (2018) defines employee engagement as proactively and passionately adding value while aligning with the company mission and operational goals.

What did Victor Vroom emphasize the importance of? a. Managers knowing each employee's expectation of reward b. Managers being honest with their employees c. Making sure that the employees' lower level needs are met d. Understanding that individuals react in a stimulus-response mode

A Feedback: Victor Vroom emphasized the importance of managers knowing each employee's expectation of reward. The other options are not related to Vroom's theory.

An RN is leading a care team on a busy hospital unit. What tasks is the RN justified in delegating to NAP? Select all that apply. a. Feeding a client who has unilateral weakness b. Repositioning an immobile client every 2 hours c. Assessing a client's surgical wound d. Weighing a client who has chronic heart failure e. Transporting a client to a diagnostic test

A, B, D, E Feedback: Assessment is beyond the scope of NAP. However, NAP can appropriately feed, reposition, transport, and weigh clients.

The nurse-manager is overseeing a culturally diverse group of staff. The manager should consider what variables when planning delegation? Select all that apply. a. Communication style b. Concepts of time c. Intelligence d. Biological variations e. Social organization

A, B, D, E Feedback: There are six cultural phenomena that must be considered when working with staff from a culturally diverse background: communication, space, social organization, time, environmental control, and biological variations. Intelligence is not a cultural phenomenon

Which characteristics define the Theory Y employee? Select all that apply. a. Needs only general supervision b. Avoids responsibility c. Has little ambition d. Must be directed e. Seeks responsibility

A, E Feedback: These assumptions, which McGregor labeled Theory X and Theory Y, led to the realization in management science that how the manager views, and thus treats, the worker will have an impact on how well the organization functions. Theory X and Theory Y focus on the employee's attitudes about people and are described as two opposite attitudes that a manager can possess.

A nurse delegated some tasks to a nurse several hours ago. The manager has now learned that the nurse did not complete any of the delegated tasks. What is the manager's best initial action? a. Determine exactly why the nurse did not complete the delegated tasks. b. Assertively state the expectation that delegated tasks will be completed on time. c. Document the nurse's insubordination and arrange a private meeting. d. Take action to reestablish the authority power gap

A. Feedback: If an employee does not complete delegated tasks, the manager should assess the reasons for this before taking action. Addressing the problem before knowing the circumstances or the cause would be premature.

A nurse-manager is new to the unit and is worried about being perceived as incompetent or underqualified by subordinates. The manager should recognize that this creates a risk for what problem? a. Underdelegating b. Overdelegating c. Improper delegating d. Inappropriate delegating

A. Feedback: Underdelegating occurs when a manager has a false assumption that delegation may be interpreted as a lack of ability on his or her part to do the job correctly or completely. This insecurity may make the manager highly reluctant to delegate

A manager's subordinate is having difficulty carrying out a delegated task. What is the manager's best initial action? a. Release the subordinate from the task so he or she will not become demoralized. b. Be available to the employee as a role model and resource for the task. c. Assign another more experienced employee to help with the task. d. Reassign the employee a different, less complex task

B Feedback: A manager should be available to the employee to help identify solutions to problems encountered with a delegated task and should encourage the employee to persevere. Taking back a task that was originally delegated is an absolute last resort. Reassigning and coassigning the task are options that are not initially considered, but which may be necessary later.

Which principle should guide the nurse-manager's use of nonverbal communication? a. It is generally consistent across cultures, unlike verbal communication. b. It supersedes verbal communication when the two are incongruent. c. Nonverbal communication should be minimized because it confuses the receiver regarding the true intent of the message. d. Nonverbal communication is a significant part of the communication exchange only when it is not congruent with the verbal exchange.

B Feedback: Because nonverbal communication indicates the emotional component of the message, it is generally considered more reliable than verbal communication. It varies widely between cultures, and the manager does not normally have to make a conscious effort to minimize it. It is always significant regardless of how it aligns with the verbal message.

A registered nurse has been leading teams of NAP for several years and will soon be leading licensed practical nurses for the first time. In preparation for delegating to these nurses, the RN should: a. delegate the same tasks to the LPNs that the RN normally delegated to NAPs. b. review the practical nurse scope of practice in the jurisdiction where they are working. c. ask each LPN what tasks he or she is comfortable performing. d. consult a decision tree for delegation to unlicensed assistive personnel

B Feedback: Delegation to a LPN is different from delegation to a NAP. The parameters vary from state to state, and the RN should review the scope of practice. The LPN's comfort level is secondary to his or her knowledge, skills, and scope practice. A decision tree for delegation to unlicensed assistive personnel would guide delegation to NAPs, not LPNs.

A subordinate is reluctant to accept a task that the nurse-manager wants to delegate. The manager suspects that the subordinate's reluctance is due to a lack of self-confidence. What is the manager's best initial action? a. Teach the subordinate about the value of self-confidence. b. Try to empower the subordinate. c. Offer a reward to the subordinate in order to motivate. d. Restate the importance of the task to the subordinate

B Feedback: Empowering the subordinate who lacks self-confidence is an appropriate initial action. If this is not possible, then reassigning the task may be necessary. Teaching about the need for self-confidence rarely instills self-confidence in those who lack it. Restating the importance of the task does not address the nurse's confidence level.

The nurse-manager has consulted the hospital information system to address a clinical issue. What characteristic is the hospital information system most likely to have? a. It is likely based on a social media platform. b. It is probably not freely available from the Internet. c. There is a high likelihood that it is out of date. d. It is probably accessible only from desktop computers, not wireless devices.

B Feedback: For security and confidentiality purposes, hospital information systems are typically not available to all on the Internet. However, they have the advantage of being easy to update and are more likely to be up to date than paper-based equivalents. These systems would not be hosted on a social media platform due to security risks. They can often be accessed wirelessly, provided the user has access to the secure network.

Which course of action would be most apt to help a demotivated nurse-manager with personal and professional renewal? a. Begin job hunting in a new field. b. Start practicing self-care. c. Take a management class. d. Reduce work hours whenever possible.

B Feedback: For self-care, the manager should seek time off on a regular basis to meet personal needs, have recreation, form relationships outside the work setting, and have fun. Friends and colleagues are essential for emotional support, guidance, and renewal. A proper diet and exercise are important to maintain physical as well as emotional health. The remaining options are not practical and lack the focus on self

According to Maslow, what statement best describes motivation? a. All needs have equal power in motivation. b. Unsatisfied needs trigger behavior. c. Lower level needs are less valued. d. Some individuals have hereditary needs

B Feedback: Hierarchy of need implies that people are motivated to satisfy certain needs, ranging from basic survival to complex psychological needs, and people seek a higher need only when the lower needs have been predominantly met. Needs exist within a hierarchy, and lower level needs are prioritized over higher level needs

A health-care organization has laid off several RNs and hired numerous NAPs in their place. What effect is this change most likely to have on the remaining RNs? a. There will be a risk of the RNs underdelegating. b. The RNs' level of liability will increase. c. Cultural variables will become a larger consideration. d. The RNs' scope of practice will become expanded

B Feedback: In general, increasing delegation to NAPs increases the scope of liability for the RN. There is no reason why this change in staffing would create a risk for underdelegating or make culture a more salient concern. The RNs' scope of practice is enacted in the jurisdiction's nurse practice act and is not affected by this change.

A nurse-manager has been distributing rewards to employees but has not identified a resulting increase in motivation. What characteristic of the manager's rewards may have limited their effect on motivation? a. The manager did not clearly communicate the intent of the rewards. b. The manager has not been distributing the rewards consistently. c. There is no precedent of giving rewards in the organization. d. The manager's supervisor does not acknowledge the benefits of rewards

B Feedback: Inconsistent distribution of rewards can frustrate and confuse workers, resulting in decreased motivation. The manager does not have to be explicit about the intent of rewards in order for them to motivate. Inexperience and unfamiliarity with rewards would not necessarily limit their benefits, if applied correctly.

A manager needs to delegate some tasks. What consideration should the manager prioritize when identifying the appropriate person to whom to delegate a specific task? a. Whose turn it is to delegate a task b. The qualifications of the person regarding the task c. The fiscal cost of delegating the task d. Whether the person has experience with similar tasks

B Feedback: Managers should ask the individuals to whom they are delegating if they are capable of completing the delegated task. If the person lacks the appropriate qualifications, the fact that he or she has experience is irrelevant. The manager should not base delegation decisions primarily on whose turn it is or on cost.

A hospital is downsizing, but the RNs have been assured that everyone on the unit will keep their jobs and that downsizing will occur through normal attrition. Today, the evening charge nurse reported to the manager that the staff was discussing rumors about mass layoffs. What is the best approach to take? a. Tell an informal leader the truth and let the leader spread the news informally. b. Hold a meeting for all staff members and tell them that the rumor is not true. c. Ignore the rumor because it will soon pass. d. Find out who started the rumor and correct the information

B Feedback: Nurse-leaders should intervene appropriately when communication problems (in this case, rumors) arise. It is not particularly important who started the rumor if all staff members are now privy to it. Direct action is preferred to indirect action, such as introducing a competing message. Inaction would likely fuel the rumors

The nurse-manager can apply Skinner's theory of motivation by performing what action? a. Assigning employees outcomes and having them decide how to achieve them b. Distributing rewards and punishments to influence behavior c. Forming individualized, collaborative relationships with employees d. Prioritize the role of financial rewards and incentives

B Feedback: Skinner emphasized the role of rewards and punishment as conditioning individuals' behavior. Skinner did not emphasize a specific role for financial rewards or the importance of relationships. He did not state that employees should decide independently how to achieve outcomes

The nurse is caring for a postoperative client whose pain is not being relieved by the current analgesia regimen. When using the SBAR model for communicating with the client's health-care provider, how should the nurse best address the "A" component of the model? a. "The client is postoperative day 2 following total hip arthroplasty." b. "The client's pain control might be inadequate because she's been rating it at 9 out of 10 for the past hour." c. "The client also has type 2 diabetes and atrial fibrillation." d. "An increase in her hydromorphone dose is probably a good idea

B Feedback: The "A" in the SBAR or ISBAR model denotes "assessment," in which the nurse summarizes the client's condition and states what the problem likely is.

The nurse is caring for a client with a diagnosis of chronic obstructive pulmonary disease and who is experiencing a new onset of dyspnea. When contacting the client's care provider, the nurse should state the client's admitting diagnosis in what stage of the SBAR tool? a. S b. B c. A d. R

B Feedback: The "B" in the SBAR tool denotes "background." This is the stage of the tool where the nurse communicates the clinical context, including the client's diagnosis.

Which nursing action demonstrates compliance with the American Nurses Association (ANA) principles for social networking by nurses? a. Strictly avoiding the use of social networking in a professional setting b. Participating in the development of institutional policies governing online conduct c. Ignoring any information that appears to have the potential to harm a patient's welfare d. Realizing that social networking is not related to a nurse's professional boundaries

B Feedback: The ANA has developed principles for social networking that include participation in policy development, nurse-patient boundaries, separating personal and professional online information, and reporting to authorities when patient welfare has been potentially harmed. There is not an absolute prohibition against the use of social media in a professional setting, but it must adhere to strict guidelines

A member of a work group that the nurse-manager leads is aloof and dismissive of the group's role. The member has occasionally made jokes during serious discussions and seems skeptical that the group will meet its goals. What role is this member playing? a. Blocker b. Playboy c. Dominator d. Recognition seeker

B Feedback: The playboy remains uninvolved and demonstrates cynicism, nonchalance, or horseplay. The blocker persists in expressing negative points of view and resurrecting dead issues. The dominator attempts to control and manipulate the group, whereas the recognition seeker works to focus positive attention on himself or herself.

The nurse-manager has been approached by an angry employee whose vacation request was denied. What should the manager do when communicating with this employee? Select all that apply. a. Tell the employee that anger will not be tolerated and then leave the situation. b. State, "I understand that you are angry that your vacation request wasn't approved." c. Allow the employee sufficient opportunity to express what she wants from the manager. d. Tell the employee how her mode of communication is hindering the message. e. Ask the employee, "Are you accusing me of bullying you by turning down your request?"

B, C Feedback: When dealing with an emotional employee, the manager should allow the employee time to express what he or she wants and to make statements that reflect back the employee's message. The manager should not terminate the interaction unless there is a plausible safety risk. Telling the employee how her tone is hindering communication and asking whether the employee is accusing the manager are likely to escalate the situation, further harming communication.

A nurse-manager has begun a new role in a community health center and will need to delegate tasks often to subordinates. What actions should the manager perform when delegating tasks? Select all that apply. a. Choose the most time-consuming tasks to delegate to subordinates. b. Evaluate the skills and education of subordinates before delegating. c. Ensure that subordinates know the goal of any delegated task. d. Avoid monitoring the subordinate unless there is evidence of a problem. e. Evaluate subordinates' performance after they have completed a task.

B, C, E Feedback: Safe and effective delegation involves evaluating the skills and education of staff, identifying goals clearly, and evaluating performance after completion. Tasks should not be selected for delegation on the sole basis of being time-consuming for the manager. Monitoring is appropriate and necessary and is not reserved just for problems or emergencies.

A nurse-manager has delegated some administrative tasks to an experienced RN. How does this act of delegation differ from the usual practice of assigning work to subordinates? Select all that apply. a. The nurse's task will be beyond his or her scope of practice. b. The manager transfers the authority for the task to the nurse. c. The nurse is practicing on the manager's license. d. The manager is released of the need to oversee the nurse. e. The manager remains accountable for the task.

B, E Feedback: In delegation, the individual transfers the authority to perform a specific activity from their own practice, to an individual qualified to perform that task, but retains accountability for the delegated task. Delegation does not involve going beyond the nurse's scope of practice, and there is still a need for oversight. The nurse does not perform on someone else's license when completing delegated tasks.

A performance appraisal states that the manager often underdelegates. What is potential cause of this delegation error? a. A high degree of trust in subordinates b. A democratic leadership style c. A need for perfectionism d. Sufficient time to accomplish unit goals alone

C Feedback: A manager with a need for perfectionism and control may believe that another person will not complete a task. Trust in subordinates and a democratic leadership style would support effective delegation. Delegating should not be based on the issue of time exclusively.

A nurse-manager has a reputation as being an assertive communicator. How does this manager most likely communicate? a. Through confrontation and intimidation b. In an unfeminine way that is clear and direct c. Directly and honestly, while respecting the rights of others d. In a clear, but occasionally offensive, manner

C Feedback: Assertive communication allows people to express themselves in direct, honest, and appropriate ways that do not infringe on another's rights. It is a myth that assertiveness is "unfeminine," offensive, or confrontational

The RN overhears the nurses' aide speaking in a harsh tone to a client with early Alzheimer's memory loss. Which statement should the RN make to begin addressing this issue? a. "You must remember to watch your tone of voice with clients. Someone might overhear." b. "Do you think it would be a good idea to have an in-service on dealing with Alzheimer's patients?" c. "I am concerned about your conversation with the client. It sounded short and impatient." d. "I have decided to reassign that client to another aide."

C Feedback: Assertive communication effectively identifies and addresses an issue without being rude, insensitive, or passive-aggressive. None of the remaining options actually identifies the specific communication problem.

Electronic health records (EHRs) have recently been introduced in a health-care organization, and the steering committee is ensuring that the system meets the criteria for meaningful use. This characteristic of the EHR ensures that the system: a. is readily accessible in any care setting, nationwide. b. uses language that is accessible to and understandable by clients. c. contains data that has the potential to improve client outcomes. d. means the same thing to every user.

C Feedback: EHRs must meet meaningful use requirements, which involve capturing the right data that can improve client outcomes. This characteristic of EHRs does not specify their accessibility or require that they mean the same thing to all users

A nurse-manager oversees approximately 12 employees. What strategy should the manager prioritize when trying to motivate the employees? a. Offer praise for exceptional performance. b. Advocate for an increase in pay. c. Apply motivational strategies that are personally meaningful to each employee. d. Apply punishments objectively and fairly

C Feedback: Each person is a unique individual who is motivated by different things. The comparatively small size of the staff allows the manager to determine and apply motivation strategies that meet each employee's needs. There is no guarantee that salary, praise, and punishment will motivate every employee.

Which action is considered a leadership role associated with delegation? a. Creating job descriptions for all personnel b. Providing formal recognition or reward for completion of delegated tasks c. Demonstrating sensitivity to how cultural phenomena affect transcultural delegation d. Reprimanding employees who demonstrate overt resistance to the tasks they are delegated

C Feedback: Factors such as communication, space, social organization, timing, environmental control, and biological variations affect delegation to a culturally diverse staff and should be modeled as a leadership role. The other choices are all management functions

A nurse-manager delegates many tasks in the course of a day. Which practice should the manager reconsider or discontinue? a. The manager grants temporary authority to support completion of a delegated task. b. The manager confirms that the person to whom a task is delegated is adequately qualified. c. The manager provides employees with exact instructions for each step of completing the task. d. The manager asks for regular updates from the employee when tasks take a long time.

C Feedback: If an employee has the skills necessary to complete a task, that employee should be able to carry out the task with autonomy and be provided with the authority and resources necessary. There should be no need for the manager to give excessively detailed instructions. Depending on the complexity of the project, the manager should meet with the employee for updates. The manager must always confirm employees' qualifications.

The nurse-manager has asked an NAP for an update on delegated tasks, and the NAP has said, "I'm swamped right now." What is the manager's best response? a. "Don't be afraid to let me know if you feel the project is overwhelming you." b. "Time management is key to keeping on schedule with your tasks." c. "I can give you a few solutions to help manage this heavy workload." d. "Do you want more time to complete your work?"

C Feedback: If the worker is having difficulty carrying out the delegated task, the leader-manager should be available as a role model and resource in identifying alternative solutions. Leaders should encourage employees, however, to attempt to solve problems themselves first, although they should always be willing to answer questions about the task or to clarify desired outcomes as necessary. Suggesting solutions or removing the person from the task prematurely does not demonstrate an understanding of effective guidance. The NAP has already expressed feeling overwhelmed, so there is no need to give permission to do so.

Which of the following statements best describes an aspect of intrinsic motivation? a. It is within a person and is unalterable. b. It involves a quest for external rewards. c. It can be influenced by others. d. It is sufficient to motivate most workers

C Feedback: Intrinsic motivation comes from within the person, driving him or her to be productive such as personal goals and aspirations. Despite the fact that it comes from within, it can be influenced by others and is changeable. It is rarely sufficient to fully motivate a worker.

A nurse has successfully completed a difficult and complex task that the manager delegated. What is the manager's best action? a. Document the fact that the nurse completed the task. b. Assign a slightly more difficult task the next time. c. Acknowledge the nurse's significant accomplishment. d. Ask the nurse to act as a role model for other staff members

C Feedback: It is important to reward employees for accomplishment. This must precede "stretching" the nurse with even more difficult assignments or asking the nurse to act as a role model.

Which statement is typically true of job satisfaction levels? a. They are generally higher for subordinates than for management staff. b. They decline as the level of participation in unit decision making increases. c. They are related to the degree of work life control subordinates perceive they have. d. They are fairly static given that unit cultures are traditionally very difficult to change

C Feedback: Job satisfaction levels can be correlated with the degree of control subordinates perceive they have over their work life. It is untrue that subordinates enjoy greater job satisfaction. Participation in decision making increases job satisfaction. Job satisfaction is highly dynamic, depending on several factors

Which task would the director of a home health agency not delegate another staff RN? a. Assigning home health aides to specific client care b. Serving on a diabetic study committee of community resources c. Meeting with the agency's administration regarding budget cuts d. Reviewing the care assignment for the following shift

C Feedback: Management responsibilities associated with budgeting would not normally be delegated to another RN on the staff because this is a role that is not the responsibility of an RN. The other options could be appropriately delegated to another RN in most circumstances.

What must managers delegate to another RN in order to assure completion of a task? a. Time and space b. Leadership and creativity c. Authority and responsibility d. Personnel and knowledge

C Feedback: Managers must delegate the authority and the responsibility necessary to complete the task. Qualities like leadership, knowledge, and creativity are not transferable. The remaining option choices are resources that are provided rather than delegated

A nurse-manager who is operating from the position of McGregor's Theory X will most likely hold what assumption about employees? a. Putting forth effort comes naturally for employees. b. Workers are inherently diligent, responsible, and helpful. c. Workers are fundamentally uncreative and indifferent toward their work. d. It is impossible to accurately identify what motivates an employee

C Feedback: McGregor's Theory X posits that workers are lazy, uncreative, and indifferent. Theory Y emphasizes the natural altruism and motivation of workers. McGregor did not explicitly state that it was impossible to know an employee's motivations

What principle should guide the nurse's delegation of tasks to unlicensed nursing assistive personnel (NAP)? a. It is safe to assume that the NAP has at least a high school diploma as a minimum hiring criterion. b. Like all members of the care team, NAP stands to lose their licensure in case of negligent practice. c. No federal or community standards have been established for training the broad classification of NAP. d. The nurse is protected from liability when allowing the NAP to perform only those tasks the employer includes in their job description.

C Feedback: No federal or community standards have been established for the training of the NAP. The hiring policies of institutions vary regarding the employment qualifications of the NAP, and many institutions do not have distinct job descriptions for NAP that define their scope of practice. NAPs do not have a license that they can lose

A nurse-manager is having a difficult conversation with a subordinate whose performance has long been inadequate. The emotional component of the manager's message will be most clearly conveyed by: a. the formality or informality of the words the manager chooses. b. the pace and pitch of the manager's speech. c. facial expressions, body movements, and gestures. d. the amount of time that the manager lets the employee speaks before interrupting.

C Feedback: Nonverbal communication is considered more reliable because it conveys the emotional part of the message. The other variables are not as significant communicators of emotion.

When attempting to create a work environment that includes appropriate and effective monetary incentives, the nurse-manager will initially address which issue? a. Whether incentives are traditionally used in the institution b. Whether the budget will allow for monetary rewards large enough to create incentive c. Whether the staff views monetary incentives as having the greatest value d. Whether other nurse-managers feel that monetary incentives are appropriate

C Feedback: Organizations must be cognizant of the need to offer incentives at a level where employees value them. This requires that the organization and its managers understand employees' collective values and devise a reward system that is consistent with that value system. Although the other options represent reasonable areas to explore, they are not the initial issue to be addressed because they would all be moot if employees did not value monetary incentives

Which attribute plays a factor in intrinsic motivation? a. Gender b. Benefit c. Culture d. Salary

C Feedback: Parents and peers often play major roles in shaping a person's values about what he or she wants to do and be, and cultural background also has an impact on intrinsic motivation because some cultures value career mobility, job success, and recognition more than others. Benefits and salary are considered extrinsic motivation when individuals are motivated to perform a behavior or engage in an activity to earn a reward or avoid punishment.

A nurse-manager wants to express appreciation to an employee. What statement is most effective? a. "You're doing an excellent job of provided care for you clients." b. "I really admire everything that you do on the unit." c. "You did an exemplary job of handling a very heavy workload this shift." d. "Your performance demonstrates a

C Feedback: Praise that is specific and evidence-based is generally more effective than broad, general statements about an employee's performance.

Which statement is true regarding the general delegation liability of the registered nurse (RN)? a. It is minimal because subordinates alone are held accountable for practicing within the accepted scope of practice for their job classification. b. It is high because the RN is automatically held liable for the tasks delegated to all recognized subordinates. c. It is reduced when the RN delegates appropriately and supervises the completion of the tasks. d. It is avoided entirely as long as the nurse delegates only other licensed personnel

C Feedback: Proper delegation practices that include assessment and evaluation help protect the RN from liability. In general, accountability is shared and does not lie solely with the subordinate. Delegation to licensed personnel does not completely release a nurse from liability.

What is an inappropriate reason for delegation? a. To empower subordinates by "stretching" them in their work assignment b. To free the manager to address more complex unit needs c. The manager does not find the task intellectually challenging. d. Someone else is better qualified to do the task.

C Feedback: That the manager is not challenged by a task is not a valid reason for delegating that task to another. The other options are all appropriate reasons to delegate tasks to qualified staff.

The nurse-manager is using the GRRRR model of listening when interacting with a colleague who exhibits challenging behaviors. What is the final action that the manager should implement when using this model? a. Confirm an action plan. b. Request any necessary information from the colleague. c. Thank the colleague for the collaborative conversation. d. Reflect privately on the quality of the interaction

C Feedback: The final phase of the GRRRR model of listening involves reward, when both parties reward each other by recognizing and thanking each other for a collaborative exchange. The model does not explicitly prescribe a time of reflection. Confirming an action plan and requesting information take place in earlier phases of the model

The nurse-manager is sitting on a practice committee and has adopted the role of gatekeeper. What action should the manager perform in this role? a. Acknowledge and praise each member's contributions. b. Mediate, harmonize, and resolve conflict when it arises. c. Facilitate and promote participation by all group members. d. Record the group's process and provide feedback to the group

C Feedback: The gatekeeper makes sure all voices in the group are heard in order to facilitate and promote open communication. Acknowledging and praising each member's contributions is the role of the encourager. The recorder records the group's process and provides feedback to the group. The harmonizer mediates, harmonizes, and resolves conflict.

An RN is a team leader for a small module of clients. While listening to a recorded report on a client, one of the team members remarks, "My mother lives near him, and she says his home life is in chaos." How should the RN best respond? a. Politely ask the team member to be quiet. b. Include the information in report for the next shift. c. Ask the team member how this information relates to the client's care. d. Ignore the team member's comment.

C Feedback: The role of the leader is to encourage communication that is appropriate and discourage communication that is inappropriate among staff. The RN's question about the purpose of this communication helps to determine whether it was appropriate or not. This should be clarified before deciding how to proceed.

A nurse sits at the foot of a patient's bed during an admission interview. This positioning supports the proxemics concept of which psychological comfort zone? a. Intimate relationships b. Personal interactions c. Social exchange d. Public distance

C Feedback: The study of how space and territory affect communication is called proxemics. In the United States, between 6 and 18 inches of space is typically considered appropriate only for intimate relationships, between 18 inches and 4 feet is appropriate for personal interactions, between 4 and 12 feet is common for social exchanges, and more than 12 feet is a public distance. Most Americans claim a territorial personal space of about 4 feet

For several months, a nurse-manager has been rewarding employees' performance in an effort to motivate them. The nurse-manager should be aware of what unintended consequence of this practice? a. Employees may set unrealistically high goals for themselves. b. Unhealthy competition may develop between coworkers. c. Employees' intrinsic motivation may become blunted. d. Employees may expect a corresponding increase in salary

C Feedback: The tendency of extrinsic motivation to interfere with intrinsic motivation is known as the overjustification effect. This involves a decrease in intrinsically motivated behaviors after the behavior is extrinsically rewarded and the reinforcement is subsequently discontinued. Distribution of rewards is not noted to cause unrealistically high goals, unhealthy competition, or an expectation for higher salaries.

The nurse manager believes that her employees are self-motivated, creative, and willing to take responsibility for their jobs. This belief represents: a. Maslow's hierarchy of needs. b. McGregor's Theory X. c. McGregor's Theory Y. d. Herzberg's two-factor theory

C Feedback: These assumptions, which McGregor labeled Theory X and Theory Y, led to the realization in management science that how the manager views, and thus treats, the worker will have an impact on how well the organization functions. Theory X and Theory Y focus on the employee's attitudes about people and are described as two opposite attitudes that a manager can possess.

Periodically during the day, the RN checks with the team members to determine whether they are having difficulty completing their assigned tasks. This describes which manager role? a. Skills evaluation b. Client safety c. Effective delegation d. Micromanagement

C Feedback: This manager provided the team with the autonomy to complete the work and was available should any need arise. This describes effective delegation. This action does not constitute micromanagement, provided it is not excessive. This promotes client safety but is not synonymous with it. This practice is not a form of skills evaluation.

Which vocal delivery suggests to a listener that a person is asking a question rather than making a statement? a. Loudness b. Frequent pauses c. Tentativeness d. Rapid delivery

C Feedback: Vocal clues such as tone, volume, and inflection add to the message being transmitted. Tentative statements sound more like questions than statements, leading listeners to think that you are unsure of yourself, and speaking quickly may be interpreted as being nervous. Loud and frequent pauses can be barriers to communication but do not suggest questioning.

An experienced RN has seen a significant increase in the need for delegation skills over the past several years. This change is most likely attributable to: a. increased numbers of uninsured clients. b. increased lengths of stay. c. increases in the use of NAP. d. decreases in nurse-client ratios

C Feedback: With the increased use of NAP in patient care, the need for nurses to have highly developed delegation skills has never been greater. The impact of insurance, nurse-client ratios, and hospitalization stays does not have as great an impact on delegation as does the correct option. Hospital stays are shorter, not longer, than in the past.

A manager is careful to address nonverbal aspects of communication when communicating with employees. What practices should the manager adopt? Select all that apply. a. Have communications in public places as much as possible to reduce intimidation. b. Stand between 12 and 18 inches from an employee when having an important conversation. c. Be thoughtful about aspects of appearance that can be controlled by the manager. d. Avoid crossing arms across the chest. e. Limit eye contact with employees to avoid being perceived as aggressive

C, D Feedback: The manager should take care on aspects of appearance and should avoid crossed arms, which communicate defensiveness or aggression. There are many communications that are inappropriate to have in a public place and space of 12 to 18 inches is considered unusually close. Even though some individuals and cultures perceive eye contract as provocative or aggressive, it is still valued in most circumstances.

McClelland's studies state that all people are motivated by specific, basic needs. What are these needs? Select all that apply. a. Self-esteem b. Self-actualization c. Achievement d. Power e. Affiliation

C, D, E Feedback: McClelland's studies state that all people are motivated by three basic needs: achievement, affiliation, and power. McClelland does n

What action should the nurse-manager perform when supporting the delegation of a task to a subordinate? a. Holding the subordinate's professional development as the highest priority b. Frequently reassuring the employee that if they are incapable of completing a delegated task, it will be reassigned c. Drafting a preliminary plan of how the task will be redone if the outcome does not meet stated expectations d. Occasionally providing learning or "stretching" opportunities for employees

D Feedback: "Stretching" provides growth opportunities for employees, builds employee self-esteem, and helps prevent boredom and demotivation. Client safety is prioritized over professional development. The manager should avoid excessive reassurance and threats of reassignment. The nurse should not presume that the task will need to be redone before the subordinate has attempted it.

What statement about the maintenance of confidentiality is true? a. It is the right of every client and must never be breached. b. It is made easier with electronic technology. c. It is primarily the duty of the medical records staff. d. It can be violated when there is a legitimate professional need

D Feedback: Confidentiality is a right that must be upheld, unless there is a legitimate professional need to know, such as when a provider must share information about a client with another provider so that the other provider can assume care. New technologies pose new threats to confidentiality, and every health-care provider shares responsibility for it.

A nurse-manager can best implement Gellerman's theory of motivation by performing what action? a. Distributing praise and rewards equitably to all employees b. Establishing authentic relationships with employees c. Being transparent and accountable when administering punishments d. Empowering employees by giving them authority to make decisions

D Feedback: Gellerman states that most managers in organizations overmanage, making the responsibilities too narrow and failing to give employees any decision-making power or to stretch them often enough. Gellerman did not emphasize the importance of distributing praise and rewards equitably, being open when punishing employees, and cultivating relationships with employees.

A nurse-manager is applying the theory of Saul Gellerman to motivating employees. What action by the manager would best exemplify Gellerman's theory? a. Determining whether employees are achievement-oriented, affiliation-oriented, or power-oriented b. Allowing employees to be self-directed in their choice of tasks and schedules c. Providing constructive and positive feedback on a regular basis d. Occasionally assigning employees tasks that are more difficult than usual

D Feedback: Gellerman suggested stretching, which involves assigning tasks that are more difficult than what the person is used to doing. Determining whether employees are achievement-oriented, affiliation-oriented, or power-oriented is associated with McClelland. Gellerman did not explicitly advocate feedback or self-direction

A nurse-manager is applying Herzberg's motivation-hygiene theory. What strategy would the manager most likely use to motivate employees? a. Advocating for an increase in salary b. Approving vacation requests c. Protecting employee's job security d. Praising an employee's exceptional achievement

D Feedback: Herzberg maintained that factors such as pay, working conditions, and job security were maintenance factors that prevent dissatisfaction but which do not actually motivate. He claimed that recognition and achievement, however, were motivators.

What is the best example of downward communication by a nurse-manager? a. The manager reports a nurse's serious error to the chief nursing officer. b. The manager seeks advice from a colleague about how to deal with an employee who is chronically late. c. The manager contacts a client's physician to confirm the client's scheduled transfer. d. The manager reviews the results of a nurse's performance appraisal with the nurse

D Feedback: In downward communication, the manager relays information to subordinates. Reporting to the chief nursing officer would be upward communication; communication with a fellow manager would be horizontal. Communication with a physician would be diagonal

What characteristic of a workplace is most likely to result in creativity and risk taking? a. There are frequent changes in management and supervision. b. There is a high proportion of recent nursing graduates. c. Employees have frequent performance appraisals with the manager. d. The employees feel empowered to advocate for change

D Feedback: In order to be creative and take risks, employees need to feel sufficiently empowered to challenge the status quo. Instability in leadership and management does not promote creativity and risk taking, and new graduates are less likely to be creative risk takers than nurses who have more experience. Frequent performance appraisals are an important part of good management, but these do not lead directly to creativity and risk taking.

Which reward is an example of intrinsic motivation? a. The prized locker is awarded to the staff member voted "most helpful" by their peers. b. An extra vacation day is awarded for every 6 months a staff member has perfect attendance. c. The entire staff is treated to a pizza party each time the unit earns a client satisfaction award. d. A staff member is eager to obtain an advanced practice credential and is working toward this end.

D Feedback: Intrinsic motivation comes from within the individual. It is driven by a need to improve and be more productive. Extrinsic motivation is motivation enhanced by the job environment or external rewards. Rewards and reinforcements are given to encourage certain behaviors and/or levels of achievement. The remaining options are examples of extrinsic motivations

The nurse-manager recognizes the need to avoid burnout and maintain a high motivation level. The manager can best achieve this by: a. working on as large a variety of projects as possible. b. asking supervisors to keep him or her closely accountable for work performance. c. asking subordinates and superiors to provide positive reinforcement whenever possible. d. reflecting on his or her own needs and seeking help when necessary.

D Feedback: It is imperative that discouraged managers acknowledge their own feelings and seek assistance accordingly. A manager can easily become burnt out when working on a large variety of projects. It is inappropriate to overtly ask for positive reinforcement, whether from superiors or from subordinates. Accountability can enhance performance but does not prevent burnout

According to McClelland, what motivates an achievement-oriented employee? a. The extrinsic rewards to be acquired b. A need to nurture others c. A need to have legitimate power over others d. The intrinsic need to be successful

D Feedback: McClelland stated that achievement-oriented people will focus on improving (succeeding) through action rather than seeking extrinsic rewards. Affiliation-oriented people focus on relationships and nurturing others. Power-oriented people are motivated by influence over others

A nurse-manager recognizes the need to foster creativity among employees. What action will best promote creativity? a. Encourage regular turnover of employees. b. Hire young employees whenever possible. c. Demote employees who show a lack of creativity. d. Avoid micromanaging employees' behaviors.

D Feedback: Micromanaging is known to stifle creativity. In order to be creative, employees must have a degree of freedom over their actions. Young employees are not necessarily more creative than older employees, and frequent staffing turnover does not guarantee creativity. Punitive actions are unlikely to promote the sense of exploration and freedom that results in creativity.

A nurse-manager is drafting a memo that will be distributed within the organization. When using this form of communication, the manager should: a. send it to everyone in the organization to ensure equal access to information. b. begin with at least one page of background information to ensure clarity. c. avoid using headings so the reader is not confused. d. include only essential information.

D Feedback: Only essential information is included in a memo because extraneous information will detract from the message. Headers should be used to make the memo easier to read, and it should only be sent to a small to moderate number of people. Brevity is valued, so one page of background information would be excessive.

An RN needs to confirm the specific delegation parameters for RNs. The RN should refer to guidelines from what organization? a. The Joint Commission b. U.S. Department of Health and Human Services c. National League for Nursing (NLN) d. The state board of nursing

D Feedback: State boards of nursing are responsible for clarifying the delegation parameters for RNs. None of the other options are involved in this process

Which is the basic factor involving staff engagement and motivation, and its relationship with the achievement of unit-oriented goals? a. The autonomy the staff has to achieve the stated goals b. The input the staff has in establishing the unit goals c. The value the staff places on the stated unit goals d. The relationship staff has with their management

D Feedback: The interpersonal relationship between an employee and his or her supervisor is critical to the employee's motivation level. We often forget that the only way to achieve our goals is through the people who work with us. Although the other options reflect factors that may impact goal achievement, they are not considered the basic factor.

A member of the team has been delegated some tasks and reports, "I've been given too much to do and I'm not going to be able to complete the work on time." What is the RN's best initial action? a. Assign the work to another team member. b. Take on the responsibility of the tasks. c. Have the team member perform only the most necessary tasks. d. Examine the workload and assist the individual in reprioritizing.

D Feedback: The manager should help the overwhelmed employee reprioritize the workload with the goal of making it manageable for that employee. This strategy should be tried before assigning work to another team member or having the employee abandon some of the tasks. In most cases, it is ineffective if the RN takes on the tasks that the employee was supposed to complete.

A registered nurse (RN) was working with a nursing assistive personnel (NAP) and delegated some tasks to the NAP. The NAP exceeded his scope of practice and caused injury to a client. Ultimate responsibility for this adverse event lies with whom? a. The NAP b. The facility's director of nursing c. The unit's nursing manager d. The RN

D Feedback: The team's RN always bears the ultimate responsibility for ensuring that the nursing care provided by his or her team members meets or exceeds minimum safety standards. This is not the ultimate role of any of the other positions mentioned

What did motivational theorist Victor Vroom state? a. Personal motivators could be separated from job satisfiers. b. People are motivated by three basic needs: achievement, affiliation, and power. c. A manager's assumptions about workers directly affect the intrinsic motivation of the workers. d. Employees' expectations about their work environment or an event will affect their behavior

D Feedback: Vroom's expectancy model says that a person's expectations about his or her environment or a certain event will influence behavior. The other listed statements about motivation are attributable to other theorists.