Leadership Midterm

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 bidirectional communication e. Involving workers to manage and sustain change

b. c. and e. The IOM identified the need to focus on implementing evidence-based management, balancing reliability and efficiency tensions, creating and sustaining trust, developing a learning environment, and managing and sustaining change with open communication and involvement with others. Maintaining and sustaining quality and safety in delivery of services is incorrect because the ever-changing societal impacts require change. Managing change through manager involvement and bidirectional communication is incorrect because of worker involvement and active communication, feedback, and sustaining of training and attention to those doing the service work.

Nurses and nurse managers are guided by both legal and ethical considerations in making decisions. Which of the following is the correct statement regarding this fact? a. Administrative rules include those regulations promulgated and adopted by federal or state agencies to implement statutory law adopted by Congress or state legislatures. b. Physicians govern the legal practice of nurses. c. As professional autonomy and responsibility increase, the level of accountability and liability decreases. d. When conflict exists between federal and state statutes, the state statute will usually, but not always, take precedence.

a. Administrative rules include those regulations promulgated and adopted by federal or state agencies to implement statutory law adopted by Congress or state legislatures is the correct statement. The Centers for Medicare & Medicaid Services would be an example of a federal agency that uses administrative rules to implement the acts legislated by Congress and signed by the President. The second statement is incorrect because each country or, in the United States, each state legislates the practice act for nursing, and a board of nursing in most states administers the act. The third statement is incorrect because the level of accountability and liability increases when professional autonomy and responsibility increase. The fourth statement is incorrect because when federal and state statutes conflict, the federal statute will usually, but not always, take precedence.

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

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 nurse. Historically 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.

Effective delegation skills are important for leaders and managers whose function is to get work done through the efforts of others. The individual who accepts this work is called the: a. delegate. b. adaptor. c. supervisor. d. delegator.

a. Delegates accept the service, work, activities, or projects that need to get done. In nursing, a team of delegates from an organization may gather together to do service projects locally in communities or in third world countries. An adaptor is an individual who generates new solutions to problems. A supervisor is an individual who guides others to accomplish a specific task or activity. A delegator is an individual who assigns a task to another.

Ethical dilemmas encountered as a result of the clash between clinical and organizational ethics differ from those encountered in clinical practice. Budget cuts, the inability to replace equipment that is failing, and lost time to complete services would be examples. Proactive strategies by managers would include: a. developing an organizational culture of respecting each other's ethical standards and not asking nurses to compromise their ethics. b. communicating what is inappropriate ethical behavior. c. listening to staff and others concerns about unresolved dilemmas arising from the ongoing conflict between clinical and organizational ethics. d. assessing situations in which a client's needs are beyond a nurse's qualifications and competencies.

a. Developing an organizational culture of respecting each other's ethical standards and not asking nurses to compromise their ethics is the best strategy listed. The proactive steps to develop such a culture would be educational opportunities; processes that include communication plans and networking plans; evaluation of risks; and early intervention techniques, such as rapid responses by skilled teams to reduce the impact of a dilemma which can cause distress to some. The second strategy is not adequate with communication only about the inappropriate; a leader will have strategies to model and communicate the positive approach to understanding dilemmas and finding resolution between the conflicting sides. Communication and understanding the sides to a dilemma is a starting point. The third strategy is not adequate, although listening to staff and others may help to determine the core issues and guide in selecting another more useful strategy, this does not improve the culture and avoid unresolved dilemmas in short term. The fourth strategy is not an adequate response because the situations in which a client's needs are beyond a nurse's qualifications and competencies must be handled promptly and not just assessed. Ethical dilemmas should be resolved based on values-centered principles that focus on doing the right thing and taking the right action.

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.

Trends in twenty-first century health care in the United States are described as revolutionary by various individuals. Leaders will innovate and change toward preventive and wellness health care services because of which of these trends? a. New laws and regulations from the Affordable Care Act (ACA) to cut costs and improve indicators of quality and staffing challenges. 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 e. Strain on emergency services, "never events," accountable care organizations, pay-for-performance, the Human Genome Project, and nurse shortages followed by a flood of new nurses have all affected and led to changes in the health care system over the last decade.

a. The ACA is not just a payment or insurance program but aims to guide the United States to shift health care priorities to wellness and prevention. The anticipated changes to the ACA law and regulation increase the focus on both cost cutting and indicators of quality and staffing services to improve outcomes. The trend of aging population does not relate to prevention. Strain on emergency services, never events, accountable care organizations, reimbursement, the Human Genome project, and nursing shortages have led to changes in the last decade. 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 work-flow processes.

Team dynamics will need to be addressed to form an effective team. Select the best strategy to help address the challenges in forming effective teamwork. a. Set group norms on how team members treat each other, how support is demonstrated, how conflict is handled, and the decision-making process to help team members operate with disruptive behaviors. b. Lead group members through "just in time" training to work together to overcome lack of trust and commitment to the team. c. Organize appropriate representation and delegation of authority to the group to help team members avoid confusion about the team's work, accountability, and inattention to results. d. Keep the number of members in groups between 10 and 14, build a structural team, and coach the team to avoid conflict.

a. The best strategy is having the group set group norms on how team members treat each other, how support is demonstrated, how conflict is handled, and the decision-making process to help team members operate with disruptive behaviors. The second statement was not suggested as a strategy, though steps to teach team-building skills would overcome the lack of trust and improve the group's commitment. The third and fourth statements were not suggested strategies to overcome the challenges with team dynamics related to confusion about the team's work, accountability, and team conflicts. Trust and communication are critical elements of building effective work teams that demonstrate commitment, accountability, and attention to results.

People are often unaware of exactly how they are spending their time. Which of the following is the best strategy to manage your time? a. Take control of your calendar using a time journal to see precisely where all your 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.

In one research-based model, which of the following behaviors were core to clinical leadership success? a. Challenge the process, inspire a shared vision, model the way, enable and trust others to act and encourage others work-outcomes. b. Build an interdisciplinary team, engage in strategic planning and data mining, motivate workers, develop culture and trust. c. Analyze processes and outcomes, model trust and honesty, engage in performance management and continuous improvement, and communicate the vision. d. Build interdisciplinary team, model trust and honesty, motivate workers, guide performance management, analyze processes and outcomes, conduct stakeholder analysis, and strategically plan.

a. The core behaviors critical to success are to challenge the process, inspire a shared vision, model the way, enable and trust others to act and encourage others work-outcomes. Leaders go beyond the status quo processes to search for opportunities, research-based evidence, and take risks. Visioning, interactive planning, complexity analysis, interdisciplinary team building, work process analysis, and stakeholder analysis were not core to the current research model. Leaders foster collaboration, strengthen others, and recognize others. Trust and honesty are behaviors expected within leaders. While interdisciplinary team building is the 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 model as critical to success.

All nurses must know how to be effective team players, which includes a variety of skills such as technical and functional expertise, problem-solving and decision-making skills, and interpersonal skills. Which of the following statements best reflects this? a. Leaders and managers must be able to function both independently and interdependently with others. b. The formation of a well-functioning group or team is often the work of the leader. c. Nursing staff members must be able to function interdependently with others. d. Members need skills to give input, participate in decision making, share responsibility, and hold the manager accountable for the outcomes of the group.

a. The correct answer is leaders and managers must be able to function both independently and interdependently with others. This statement applies to all nurses as well. The formation of a well-functioning group or team is never the work of just the leader. Staff members must be able to function independently as well as function interdependently with others. Members need skills to give input, participate in decision making, share responsibility, and hold themselves, not the manager accountable for the outcomes of the group.

In nursing, group process theory relates to how to work as an employee within an organization that is often large and complex. Which statement best reflects the need for teams and groups? a. Interdisciplinary work teams are necessary for complex situations. b. The major reason for individuals to join groups is to gain information. c. In all groups, decision making is a joint process, with all members participating. d. Group decision making is cost-effective in all situations.

a. The first answer is correct. Interdisciplinary work teams are necessary for complex situations. The high-performance teams create an organization's efficiency and effectiveness because the collaborative knowledge of the team achieves high-quality work outcomes and controls costs. The second answer is not a reason for individuals to join groups, rather two reasons were identified: (1) to provide a personal or professional socialization and exchange forum, and (2) to provide a mechanism for interdependent work accomplishment. The third answer is about the joint process of decision making, but not all members may participate in a group decision, which typically results in individuals being more committed to a decision, even if there is disagreement. Group decision making is not cost-effective in all situations. It is if it saves time. As new members join the team, it is important to share team members' expectations. It is also beneficial to revisit the defined expectations on a regular basis.

The advantages of group problem solving over individual problem solving are best described by which of the following? a. Obtaining a wider range of knowledge and information from group members stimulates thinking. Strength in diversity, more individual perspectives, and member's commitment to the decision save time. b. Groups can be positive and constructive, and costs are more because more ideas are generated over an individual effort to solve the problem. c. People with the expertise get together in a group to talk about issues and resolutions, so alternative approaches or options can be planned, and consequences discussed. d. Groups that include ideas from both inside and outside the unit will understand the different aspects of the problem, plan a series of tasks with options to resolve the problem, and together implement the solution faster with role assignment.

a. The first answer is correct: Obtaining a wider range of knowledge and information stimulates the thinking of other group members, showing strength in the diversity of individual perspectives and their commitment to the decision, which saves time. The group has increased acceptance of the solutions when individuals are affected by the decision and committed to implementing it. When more approaches to a problem are considered, the group diversity exceeds the individual effort. The second answer is incorrect because there are not generally more costs associated more with more ideas. The third answer is incorrect because having the experts in the room prevents those with diverse knowledge from contributing to the solution, which means the consequences to others are not considered. The fourth answer is incorrect because groups should include those with process knowledge related to the issue or problem more often. Only those inside will have responsible roles to implement, while ideas from the outside may be unrealistic resource solutions.

The critical care nurses' specialty organization identified five factors that should be considered to make the best decisions. Which of the following identifies all five factors? a. Care is complex and requires attention, adaptation, or innovation in approach, with some risk that the activity may cause potential harm, and the level of patient interaction and the patient's response to the activity are unpredictable. b. The complexity of the intervention or task, the skill of the registered nurse's (RN's) delegation, the competencies of unskilled assistive caregivers, the risk of harm to patients, and the criticality of the outcome. c. The care requires special attention, adaptation, or an innovative approach, the skill of the RN's delegation, and the competencies of unskilled assistive caregivers. d. A patient's risk for potential harm, the skill of the RN's delegation, the competencies of assistive caregivers, the difficulty of the intervention, and the fact that a patient's response to the activity is unknown or unpredictable.

a. The first answer is the best because it covers the five factors of when not to delegate: (1) When the potential for harm or risks for the activity are high for an individual patient; (2) when the complexity of the task makes it less desirable to delegate; (3) when the amount of problem solving and innovation requires special attention, adaptation, or an innovative approach for a particular patient; (4) when the outcome is unpredictable, which depends on how stable the patient is; and (5) when the level of patient interaction with delegated activity increases or decreases the amount of time the RN can spend with the patient and patient's family. Every time a nursing activity is delegated or one or more additional caregivers become involved, a patient's stress level may increase, and the nurse's opportunity to develop a trusting relationship is diminished. The other three answers provide one or more of the above five factors, but not all five are included in them.

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.

The five factors that are used to described and determine successful planned change: relative advantage, compatibility, complexity, trialability, and observability. The statements below relate to these 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 the change is thought to be better than the status quo b. The degree to which the change is compatible with existing values of the individuals or group c. The degree to which a change is perceived as difficult to use and understand d. The degree to which a change can be tested out on a limited basis e. The degree to which the results of a change are visible to others

a. and b. The degree to which the change is thought to be better than the status quo (relative advantage) and the degree to which the change is compatible with existing values of the individuals or group (compatibility) are the only two of the five factors identified as being positively correlated with successful change. Complexity is negatively correlated; trialability and observability were not found to be significant factors in correlating with successful change.

Research has shown which two of these statements are correct? (Select all that apply.) a. Nurses need to be responsible for beliefs, values, meanings, goals, and relationships. b. Experienced leaders feel comfortable with the star pattern communication style. c. In crisis situations, members work in a team that capitalizes on the skills and strengths of each team member. d. Less experienced leaders feel most comfortable with the circle pattern communication style. e. Scripting is not useful for communication with physicians and patients.

a. and c. The correct statements are that nurses need to be responsible for beliefs, values, meanings, goals, and relationships and that in crisis situations, members work in a team to capitalize on the skills and strengths of each team member. The second answer should state that experienced leaders feel comfortable with the circle pattern communication style or interaction among the group equally. The statement about less experienced leaders is incorrect as well, because they feel more comfortable with the star pattern communication style or having nurses direct everything to the manager. The fifth statement is incorrect because nurses work in teams and scripting an SBAR message is an effective way to communicate with physicians while briefs, debriefs, and huddles are efficient ways to communicate common scripted care information to staff team members about what to watch or observe with residents and patients and when to report (TeamSTEPPS).

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 e. Manage resources

a. and 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. Managing resources is incorrect answer, because managers oversee the acquisition and use of resources for services.

The 14 Forces of Magnetism has directed research on Hospital Magnet Standards, which measure certain characteristics. Select the answers that best reflect those measures of Magnet standards. (Select all that apply.) a. Clinically competent peers, education support, adequate staffing, and nurse manager support b. Perceptions of work environment, nursing hours per patient day, and medication errors and near misses c. Customer satisfaction, patient discharge disposition, and patient complaints d. Clinical autonomy, control of nursing practice, and collaborative nurse-physician relationships e. Resident outcomes, use of new knowledge and innovations for practice improvements

a. and d. Research that measures the Hospital Magnet Standards focuses on eight characteristics of an excellent work environment: clinically competent peers, collaborative nurse-physician relationships, clinical autonomy, support for education, perception of adequate staffing, nurse manager support, control of nursing practice, and patient-centered values. Seven of the eight measures are found in the first and last answers. While the second and third answers provide measures, the focus has little to do with the climate and culture of nursing practice. The perception of work environment is a measure of climate. Other process elements of climate include supervision, work design, group behavior, and emphasis on quality that is driven by patient centeredness, safety, innovation, and evidence-based practice. Not only hospitals but long-term care facilities can achieve Magnet Recognition Program® status by meeting five key components for transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovations, and improvements; and empirical outcomes.

What habits are characteristics of critical thinking by nurses? (Select all that apply.) a. Questioning, reflection, contextual perspective b. Confidence, creativity, flexibility c. Open-mindedness, perseverance d. Quick, concise, purposeful, systematic, within a frame of reference, grounded in information e. Experience, uses database resources and searches

a. b. and c. It has been noted that habits of the mind that are characteristics of critical thinking by nurses include confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, open-mindedness, perseverance, and reflection. The Critical Thinking Community 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. It has also been stated that reflection was key to refining one's clinical judgment capabilities. Furthermore, clinical experience helps one to refine clinical judgments. As a nurse gets more experience, the intuitive component of judgment allows the nurse to grasp the cues more quickly. The last two statements include items that are incorrect because the thinking is not quick and concise and does not always involve databases searches.

Identify the statements about organizational culture that impact nursing practice. (Select all that apply.) a. Organizational culture affects the quality of nursing care and patient outcomes. b. Mission statements provide a view of strategic priorities for a nursing organization and work setting. c. Culture is developed over time with the shared values that guide members on how to problem solve and manage relationships. d. Organizational culture means there are hidden assumptions about care that should not be questioned. e. Organizational culture is easier to change than the climate within the organization.

a. b. and c. Three of the statements are correct about organizational culture. The culture of an organization can be positive toward evidence-based care or negative toward using best evidence in practice. Often the assumptions may be unknown, but in assessing the culture of a practice, unit, or organization, the nurse should question the current practices that exist within the culture of nursing practice. This is important because organizational culture affects the quality of nursing care and patient outcomes. The taken-for-granted practice and assumptions of a work unit group can exert a significant effect on performance and outcomes. On the other hand, organization culture is complex and enduring over time which makes it hard to change, whereas the climate is easier to change with policy and practices.

A nurse manager and a nurse are liable for which of the following? (Select all that apply) a. Delegating to unlicensed assistive personal b. Supervising completion of appropriate tasks and functions c. Decisions and actions d. Competency of licensed and unlicensed personal e. Reimbursing for errors in clinical practice

a. b. c. and d. Nurses and nurse managers are accountable for their own acts and decisions, their competencies and other team member's competencies, and delegated actions and the completion of the tasks and functions appropriately. Nurses and nurse managers are subject to malpractice lawsuits. Nurses are not directly reimbursing for errors in clinical practice, though professional liability may only be proven by an expert witness who can testify as the actions or inactions of the professional defendant; that is another nurse.

The culture of patient care must transition from care that is driven by providers to care that is patient-centered and family-centered in which patient and family norms, values, and preferences are respected. This direction in health care services has been sited within: (Select all that apply.) a. the Affordable Care Act. b. The Future of Nursing: Leading Change, Advancing Health. c. International Council of Nursing (ICN) Code of Ethics for Nurses. the Institute of Medicine's Crossing the Quality Chasm. d. National Healthcare Quality Report from the Agency for Healthcare Research and Quality.

a. b. d. and e. Each of the reports and the Affordable Care Act all defined aspects of patient-centered care. The Agency for Healthcare Research and Quality defines this as patient experience and patient partnerships. The patient's experience of care includes communication, care, and understanding of the meaning of his or her illness. This approach changes the focus from a patient with a disease to that of an individual with an experience. Patient partnerships, the second dimension of patient-centered care, are formed when nurses are responsive to patient needs, values, and preferences and then customize the care to the patient. For example, when performing discharge teaching, information that is of high importance and value to the patient is addressed first in a patient-centered model of care. As patient advocates, nurses can be leaders in transitioning an organizational culture from provider-driven care to care that is truly patient centered. Only the ICN Code of Ethics for Nurses does not focus on patient-centered or family-centered care.

Disadvantages of group decision making over individual decision making would include: (Select all that apply.) a. premature decisions. b. delayed decisions. c. individual domination. d. disruptive conflicts. e. timely tracking of outcomes

a. c. and d. The answer includes premature decisions, individual domination, and disruptive conflicts. The premature decisions lead to the minority view being pressured to accept the majority decision and acceptance of a less than evidence-based decision. The individual domination can become costly and time-consuming for a group's productivity, because the interpersonal dynamics slow progress and cause an unpleasant experience. The disruptive conflicts can occur over personality differences, differences of opinion, or clashes of values, and these conflicts can become destructive. Individual decision making is without delay and allows timely tracking of outcomes. As a caregiver, the nurse serves a key role as a patient advocate and frequently serves as the coordinator of care with other members of the team. The nurse tracks whether different interventions have been effective. As a care provider spending significant time with the patient, often a nurse will see fine, distinct changes in a patient's condition before other members of the health care team. Nurses oversee the plan of care in home health, long-term care, hospice, and many other settings.

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 b. Directing c. Adapting d. Communicating e. Disciplining

a. c. and 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. Disciplining is incorrect, because supervisors and managers are engaging in the daily processes such as disciplining behaviors.

Chief nursing officers (CNOs) are accountable for establishing systems to assess, monitor, verify, and communicate ongoing competence requirements related to delegation, for both RNs and delegates. Which statements are correct? (Select all that apply.) a. A key element in delegation is to assess the competency level of the staff. b. When an RN delegates a task, he or she is responsible for supervision but is not accountable for the outcome. c. A state's nurse practice act consists of rules that govern how RNs delegate to competent staff. d. The National Council of State Boards of Nursing is opposed to delegation to unlicensed assistive personnel (UAP). e. Any traveling nurse unaware of the organizational systems in place to establish competency requirements for the unlicensed assistive persons.

a. c. and e. The correct statements for the CNO are that a key element in delegation is to assess the competency level of the staff, and the state's nurse practice act consists of rules that govern how RNs delegate to competent staff. The CNO would also need to ensure any traveling nurse who comes into the organization is made aware of the organizational systems in place to establish competency requirements for the unlicensed assistive persons or what the state practice acts legally allow the UAP to perform. The second statement is incorrect because when an RN delegates a task, he or she is responsible for supervision and is accountable for the outcome. The National Council of State Boards of Nursing is not opposed to delegation to UAP.

The research leading to the gold standard for nursing excellence has produced which of the following findings? (Select all that apply.) a. The effects of nursing interventions are facilitated by organizational characteristics at the unit level. b. A health care administrator can nurture a professional nursing environment and advocate for excellence in nursing practice. c. Mortality rates in Magnet hospitals had a significantly lower mortality rate for Medicare patients than that of control hospitals. d. Magnet hospitals cultures provided lower levels of autonomy and control of practice and fostered stronger professional relationships among nurses and physicians than did those of non-Magnet-designated hospitals. e. The provision of adequate resources in unit practice environment is visible.

a. c. and e. Research by Dr. Aiken has found that mortality rates in Magnet hospitals were significantly lower for Medicare patients than those of control hospitals, and the effects of nursing interventions are facilitated by organizational characteristics at the unit level related to culture and climate. A strong visionary nurse leader is necessary, whereas a health care administrator is less likely to nurture and support a professional nursing environment and advocate for excellence in nursing practice. Magnet hospitals cultures have higher levels of autonomy and foster stronger professional relationships among nurses and physicians than do those of non-Magnet-designated hospitals. A nursing unit culture that supports and values nurse autonomy and the provision of adequate resources and effective communication among providers most likely constitutes an environment where practice excellence is the norm. Magnet hospitals are an example of a positive culture that affects nurse and patient outcomes.

Which time management strategies are the best strategies to reenergize 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 about priorities, expectations, and having some routines 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. Saunders (2013), an expert and coach in time management strategies, described the secrets to effective time investment are time for priorities, expectations, and routines because these three things can unlock the potential to manage even the most chaotic situation, regardless of the context, at work or home. 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 reenergize 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.

Effective communication can best be described by which one of the following statements? a. The major part of any communication is the words that we say to others. b. Conversation that is clear, direct, straightforward, and offers frequent message transmission is most effective. c. To respond effectively to communication, place responsibility on others. d. Feedback should be used carefully and only when absolutely necessary, because it inhibits effective communication.

b. Effective communication is clear, direct, and straightforward with frequent message transmission. The major part of any communication is not just the words we say to others; the tone, voice, and expressions add content to the message. To respond effectively to communication, placing responsibility on both oneself and others is necessary. Feedback should be used because it provides a method of clarification of message for more effective communication.

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.

Culture is a concept that is best portrayed in nursing with which of the following statements? a. Culture provides a common bond so members know how to relate to one another and what is valued. b. A relationship-based nursing care model is used, which represents a belief in patient-centered care. c. Culture is a multifaceted phenomenon, difficult to comprehend. d. Culture is a set of values, beliefs, and assumptions that are shared by members of an organization.

b. The best portrayal is the care delivery model of relationship-based nursing care that guides nursing practice to interpret the culture, because it represents an underlying belief in patient-centered care. The other statements are ways that culture has been described. The visible parts are the mission statement, policies, procedures, organizational charts, and the way people dress and the language they use, and the invisible parts in the organization are the unwritten rules and customs that pervade the work environment. The patient-centered care delivery model is dependent upon good communication and collaboration between providers, patients, and their families.

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. The manager needs to model the change in actions and words as well as listen to staff interpret what the change is all about within informal communication with peers and ensure message is accurate. 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. Determining what the resistant person is trying to protect is important but does little to engage staff within the change process.

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.

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, which 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.

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 and chronic. 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.

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.

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 and with more information could require a long-term solution. 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.

The determinant for the decision to delegate is the legal scope of delegation rules described within: a. an institutional policy. b. a nurse practice act. c. the American Nurses Association (ANA) Code of Ethics. d. The Joint Commission (TJC) Patient Care Standards.

b. The state's nurse practice act contains language that allows registered nurses to delegate. Some state nurse practice acts clearly define scope of practice concerning delegable activities, and others are more unclear. Some nurse practice acts have not been updated to account for the current prevalence of home and community-based health care delivery, which can cause role blurring and confusion of delegable tasks. Certain discrete tasks may be delegated in any health care setting, the nursing process consisting of assessment, clinical judgment, and evaluation of outcomes may not be delegated. This foundational fact should direct the nurse's response concerning delegation no matter whether it is a scope-of-practice or organizational issue. Institutional policies do not set rules but rather provide further interpretation of the procedural steps to guide nurses in the intervention of delegation. The ANA Code of Ethics is incorrect because the code guides the conduct of the profession but is not a set of rules. TJC is a standards-setting organization for institutional settings and defers to the state practice acts and local policies to evaluate the quality and safety of care within the organization.

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. e. Smart alerts and drug alerts within health information systems.

b. and 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 nurse's role in assessing the client s functional health patterns to diagnose and document client needs for health promotion, risks, and problems. The last statement is for a variety of providers who see alerts when using electronic health records to ease the complexity and information overload of care delivery and thus reduce errors.

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. e. Change is a new practice that can be implemented quickly and an innovation is a new device or medication that is added to existing services.

b. c. and d. Innovation is a systematic process for bringing any new idea or new service method such as a problem-solving idea implemented into use and 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. Change is not related only to practice and an innovation is not just a device or medications.

What is a wrongful act committed against another person or organization or their property that causes harm and can be remedied by a civil lawsuit? a. Malpractice b. Legal liability c. Tort d. Negligence

c. A tort is a wrongful act (other than a breach of contract) committed against another person or organization or their property that causes harm and can be remedied by a civil lawsuit. Malpractice is the failure of a professional person to act as other prudent professionals with the same knowledge and education would act under similar circumstances. Legal liability is legal responsibility for harm caused to others. Nurses, nurse managers, and health care facilities are all subject to being found legally responsible for harm caused to others by wrong practice from expected practice or evidence-based practice. Negligence is the failure to exercise the proper degree of care required by the circumstances.

__________ is being loyal and faithful to commitments and accountable for responsibilities. a. Autonomy b. Veracity c. Fidelity d. Values

c. Fidelity is being loyal and faithful to commitments and accountable for responsibilities. Autonomy is a client's right to self-determination and freedom of decision making. Veracity is a norm of telling the truth and not intentionally deceiving. Values are strongly held beliefs that are freely chosen.

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. acknowledgment, 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 acknowledgment, 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. 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.

The roles of sender and receiver must be assumed in interpersonal communication. This is reflected within which description of communication? a. Communicating with diagnosing and adapting is one of the basic competencies of influencing, effectiveness in engaging and motivating people, and in getting work done through others. b. When humanistic or democratic values are upheld in an organization, then trusting, authentic relationships become the norm in a nurturing, productive work environment. With humanistic values, intergroup cooperation, flexibility, and organizational effectiveness tend to improve. c. Interpersonal communication is a two-way level of communication involving face-to-face interactions between people who are consistently aware of each other. d. Skillful, positive questioning by a leader or manager can persuade people to willingly commit themselves to see personal benefits and accept change.

c. Interpersonal communication occurs between two or more individuals involving face-to-face interaction while all parties are aware of the others on an ongoing basis. The roles of sender and receiver evolve in the later work by others and may be seen when talking about leaders, managers, and followers. The first answer is regarding the interpersonal competence required for successful leadership where communicating with diagnosing and adapting are basic competencies of influencing and effectiveness in engaging and motivating people and in getting work done through others. The second answer emphasizes the humanistic values of intergroup cooperation and flexibility and the idea that when humanistic or democratic values exist within an organization, then trusting, authentic relationships become the norm in a nurturing, productive work environment. The fourth answer is from the theory that skillful, positive questioning can persuade people to willingly commit themselves to see personal benefits and accept change. The positive questioning capitalizes on inviting agreement, commitment, and realization.

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.

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 which is an unpleasant feeling of frustration and an intense labile emotional state. 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.

Leaders are change agents and have a role in change that includes which of the following? a. Motivating staff through posting notes and expectations 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 understand their view of expectations and plan adequate, timely education on the change d. Posting the change steps for others to read in the usual communication place and avoid setting expectations or promises.

c. The best approach for change agents is to provide reliable information and details to those who are to implement the change; to understand their view of expectations; to plan adequate, timely education on 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.

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

c. 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, integrate and provide care, restore health and nurture human beings in their experiences of health and illness. Nurse managers concentrate on day-to-day administration and coordinate services provided by a group of nurses by integrating human, fiscal, and other nursing resources to accomplish nursing practice with 24-hour accountability for client care units or areas. Clinical nurse leaders and advanced practice registered nurses (APRNs) provide leadership in the care transitions of individuals and populations while providing expertise in specialty areas to guide other nurses through process, measurement, and evidence-based practice changes.

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 and innovation. 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 motivate them. 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.

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. and 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.

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. e. Change results in intended outcomes and unintended consequences.

c. and 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. The results of change should be measured to understand outcomes and evaluated for unintended consequences.

Quality and Safety Education for Nurses (QSEN) was initiated to accomplish which of the following? (Select all that apply.) a. Implementing patient-centered care, teamwork, and collaboration that support quality improvement, safety, and informatics on nursing units b. Gearing toward nurses who have been practicing 20 years and need new competencies through continuing education c. Creating nursing curriculum that emphasizes evidence-based practices, quality improvement, safety, and informatics d. Preparing future nurses with the knowledge, skills, and attitudes necessary to continuously improve the quality and safety of the health care system e. Guiding nursing education and continuous education requirements for maintaining nursing licensure across states

c. and d. The purpose of QSEN is to address the challenge of preparing future nurses with the knowledge, skills, and attitudes necessary to continuously improve the quality and safety of the health care systems in which they work. QSEN program does support schools of nursing in creating a nursing curriculum that emphasizes implementation of patient-centered care, emphasis on teamwork and collaboration, integration of evidence-based practice, and creation of a culture that supports quality improvement, safety, and informatics. QSEN was not designed to implement patient-centered care, teamwork, and collaboration that support quality improvement, safety, and informatics on nursing units. QSEN is not geared toward nurses who have been practicing 20 years and need new competencies through continuing education. QSEN is not guiding any continuous education requirements for licensure.

Criteria can be used to assess co-workers competency for delegation. Which of the following methods can be used to assess the competency of nursing assistive personnel? (Select all that apply.) a. Micro-managing and being able to step in and take over tasks b. Educating and training for the required role function c. Supervising with periodic review and performance feedback d. Orienting to the job description and evaluating tasks within a designated time frame e. Checking with unlicensed assistant when completing the task to obtain feedback about the patient

c. d. and e. The criteria to assess competency accomplished through three answers to supervise with periodic review and performance feedback, to orient to job description and evaluate tasks within a designated time frame, and to check with unlicensed assistant after task is completed to obtain feedback about a patient. The immediate feedback from UAP ensures supervision and validates the competency by asking questions. Micro-managing and being able to step in and take over tasks are incorrect because these will result in mistrust within the delegator-delegate relationship. Educating and training for the required role function is not an assessment process.

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.

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, whereas 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, whereas 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.

Climate is often confused with culture. Which statement best describes aspects of climate? a. Culture is the perceptions of the work environment, and climate is the personality of the organization. b. Climate is the shared beliefs, values, and assumptions that exist in an organization. c. Climate enhances the stability of a social system, and culture is the voice of the organization. d. Culture and climate can both be measured.

d. Culture has been measured, and climate has several measurable characteristics, such as decision making, leadership, supervisor support, peer cohesion, autonomy, conflict, work pressure, rewards, feelings of warmth, and risk. Climate is evident in staff perceptions of policies, practices, and goal achievement. The first statement is incorrect, because climate is the personality of the organization as well as the perception of the work environment. The second statement is incorrect, because it describes the culture, not the climate. The third statement is incorrect, because culture enhances the stability of the social system, and climate is the perceptions.

Which are the four emphasized practices for current workplaces that are fostered in learning organizations. Examples of practices 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-direction.

d. Empowerment, shared governance, shared decision making, and self-directed teams are examples of practices for current workplaces pressures. Population-based care, case management, patient-centered care, and patient safety initiatives are organizational changes for safety and financial pressures from external agencies. 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 technology changes for safety and cost-avoidance pressures.

Duty of care owed by the nursing professional to the client is the minimum requirements that define an acceptable level of care. The minimum requirements are best located in: a. the Social Policy Statement and Washington Manual. b. published standards by the American Nurses Association, nursing textbooks, and databases. c. federal agency guidelines and regulations and the Care Standards Act 2000. d. state nurse practice acts, standards published by nursing professional organizations and specialty practice groups, and/or a facility's policy and procedure manuals.

d. Standards of care can be found in the state nurse practice acts, standards published by the American Nurses Association or other professional organizations and specialty practice groups, federal agency guidelines and regulations, and the facility's policy and procedure manuals. In malpractice cases, the standard of care owed to the injured client is commonly introduced into evidence by expert witnesses, and the impact of that evidence is ultimately determined by the jury after receiving instructions from the judge on the law applicable to its use. The Nursing's Social Policy Statement does refer to where the standards may be found, and the Washington Manual is for medical therapeutics and is a source for medicine but not nursing. In the second answer, the published standards of practice would be appropriate but not the databases or textbooks. Federal agency guidelines and regulations would be appropriate, but not the Care Standards Act 2000, which applies to the United Kingdom and not the United States.

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 delivery of services 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. This strategy helps identify processes, materials, equipment, role responsibilities, or environment as potential causes for the clinical or management effect. 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.

When the group decision-making procedure is that the entire group decides, whether by a two-thirds vote, simple majority, consensus, or some other process, this is known as: a. delegated decision procedure. b. autocratic decision procedure. c. consultative decision procedure. d. joint decision making.

d. The correct answer is joint decision making, where the entire group decides by simple majority, consensus, or a quorum. The delegated decision procedure is when the leader allows participants to make the final decision. The autocratic decision procedure is when the leader controls the power, and the committee exists mainly for the sake of appearance. A consultative decision procedure is when decisions involve employee participation, but the leader still makes the final decision alone.

When the leader engages in dialogue with the nurse to share ideas and help in making decisions, what style of Situational Leadership® communication is being used? a. Selling b. Delegating c. Telling d. Participating

d. The correct answer is participating. The leader engages in dialogue with the nurse to share ideas and help in making decisions; this includes supervision with coaching and mentoring. All are styles the leader may use with task groups and individuals. Selling is when the leader motivates the nurse by explaining the rationale for the task and answers the nurse's questions for clarification about a procedure that the nurse had not completed before. Delegating is when the leader trusts the nurse and turns over the responsibility for the decisions and performance to complete the task. Telling is when the leader clearly describes what to do, when to do it, where to do it, and how to do it, with clear directions and guidance.

Which of the following statements is true about problem solving? a. Problem solving is a high-level skill used primarily 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.

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.

Select the best statement for why communication processes are important to organizations. a. Horizontally decentralized organizations are more efficient than centralized organizations. b. Positive communication techniques include agreeing uncritically and reassuringly. c. Individual communication is more complex than group communication because it is so intensive. d. Human interaction issues are the general area in which leaders and managers spend most of their time.

d. The fourth answer is correct because human interaction issues are the general area in which leaders and managers spend most of their time. The first statement is not correct because the horizontally decentralized organization takes much more effort in communication and is not necessarily more efficient than a centralized organization at communication processes. The second statement is incorrect because positive communication techniques include encouragement, optimistic words, and expressions, and seeking constructive responses through questioning. The third statement is not correct because group communication is more complex than individual communication because it is so intensive.

Nurses may communicate using humanizing and dehumanizing attitudes which affect the outcome of communication. Select the most humanizing option below. a. In a small group session, there were varying opinions, with two individuals quite vocal about their viewpoints on how to proceed with a project. b. The manager handled the nurses on the unit with tolerance, judgment, and role-playing. c. In a unit-based group session, there was disregard for conversation offered by 10 group members with steps to change the agenda item to another topic. d. The manager engaged nurses to share their concerns and ideas openly along with their fears about the developing project.

d. The fourth situation provides a humanizing attitude as conceptualized within the Humanizing Nursing Communication Theory. The first statement is a dehumanizing example of a group with two individuals taking over the conversation; this could be humanized if the individuals were to have positive regards and acceptance of other viewpoints in the group or equally give voice to all who are present. The second statement is a dehumanizing example of a manager who interacts with nurses on the unit using tolerance, judgment, and role playing responses when empathy, caring, and authenticity would be more welcoming to invite the interaction of all nurses. The third statement is a dehumanizing example where the group disregards those sharing thoughts and views, whereas the humanizing attribute would be dialogue, holistic with power to include those points expressed in the group discussion. Humanizing attributes include dialogue, individual, holistic, choice, equality, positive regard, acceptance, empathy, authenticity, caring, irreplaceability, intimacy, coping, and power. Dehumanizing attributes include monologue, categories, parts, directives degradation, disregard, judgment, tolerance, role playing, carelessness, expendability, isolation, helplessness, and powerlessness.

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.

Effective leadership is an integrated blend of leadership principles and characteristics with management principles and techniques. 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. Leadership effectiveness is based on the ability to adapt in a complex and chaotic environment. The need for leaders/managers to adapt to ongoing problems or risks arises from changes in society, technology, or political environment and often creates local systems problems that affect people, planning, institutional operations, or work processes. 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.

Leaders who give and take exchanges aimed at resolving issues are doing which of the following? a. Bargaining b. Effective communication c. Persuasion d. Negotiation

d. When a leader gives and takes exchanges aimed at resolving issues or uses a dialogical discussion between two or more parties to arrive at an agreement about some issue, that is negotiation. Bargaining is the exchange of a series of offers and counteroffers about what each party will do, give, and/or receive, until an agreement is reached to the satisfaction of all. Effective communication is a skilled process necessary in negotiation, persuasion, and bargaining and is the trust, respect, and empathy created with the interaction. Persuasion is influencing another to modify thoughts and behaviors of others.

Change behaviors displayed in a variety of ways. Identify the two correct statements on how leaders identify, support, and promote innovators. (Select all that apply.) a. Resistance to questioning common practices b. Resistance most commonly arises because individuals are trying to gain more power. c. Changing individual behavior requires less time and energy. d. Seeks out knowledgeable experts e. Comfortable with uncertainty

d. and e. The correct statements are seeks out knowledgeable experts and comfortable with uncertainty. The resistance to questioning common practices is incorrect rather leaders listen for staff questioning common beliefs and practices. 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 work flows 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.