Leadership - Quiz 1 Review

Managers may or may not be leaders; however, manager do all of the following EXCEPT: A. Avoid addressing complexity so that the staff does not worry and change may occur anyway. B. Collaborate and translate direction into action, warning the team of potential barriers to the vision. C. Build a culture of teamwork. D. Organize, plan, control, and solve problems.

A. Avoid addressing complexity so that the staff does not worry and change may occur anyway. RAT: Managers must address complexity and facility change. They must communicate and encourage the dissemination of information to allow staff to be a part of the change process and be engaged in solutions. They must be fully transparent with their team to obtain the appropriate buy-in to change.

Managers need to address all but which of the following when effectively implementing organizational change that promotes patient safety? A. Learn quickly as you must complete all tasks before the end of the shift. B. Create and sustain trust. C. Actively manage the change process. D. Involve the staff in decision making in the redesign of the workflow.

A. Learn quickly as you must complete all tasks before the end of the shift. RAT: Managers need to view themselves as a change coach, enabling a positive work environment for the staff. While managers must learn and create a positive learning environment, this environment does not occur by the end of the shift or day. The environment is transformed over time.

Which of the following statements is true regarding complexity theory? A. Nurses can understand the dynamic nature of health care processes using complexity theory. B. The need for additional staff can be justified based on complexity theory. C. Complexity theory is used to explain the relationships among leading, managing, and following. D. Complexity theory is used to predict the health and illness trajectory of critically ill patients.

A. Nurses can understand the dynamic nature of health care processes using complexity theory. RAT: The complex nature of health systems and related processes can be best understood using complexity theory. Option A is incorrect because complexity theory does not project medical outcomes. Staffing is not directly tied to complexity theory; therefore, option C is incorrect. Leading, managing, and following are concepts related to management, but their interrelationships are not explained by complexity theory.

Mr. G was admitted to a rehabilitation center after discharge from a hospital. He has not walked in 5 days while he was hospitalized and is provided a wheelchair. Dining with other residents is expected, and staffing is limited on a holiday weekend. What is the best strategy to be sure Mr. G has sufficient nutrition and exercise? A. Request help from another unit before dinner and indicate the nature of help needed. B. Tell Mr. G to stay in bed and someone will bring a tray to his room because the staff can't get him to the dining room in time for dinner. C. Order a lift device to transfer Mr. G from his bed to the wheelchair. D. Assist Mr. G into his wheelchair and remind him that in 2 hours he must be in the dining room if he wished to eat.

A. Request help from another unit before dinner and indicate the nature of help needed. RAT: Leaving Mr. G in bed fails to provide any exercise. Assisting him to the wheelchair 2 hours in advance of when he needs to eat may pose physical discomfort and the potential for skin breakdown. Ordering a lift device might be useful, but it might not be timely. Requesting help to prevent personal injury and aiding Mr. G into a wheelchair in a timely manner providers some activity and helps him gain appropriate nutrition.

Which of the generations is challenged by sharing leadership with other generations? A. Generation Y B. Baby Boomers C. Generation Z D. Generation X

B. Baby Boomers RAT: Baby Boomers are more likely to want to do the work themselves than to rely on someone else who may not have the same work ethic as they have. They tend to see the younger generations as less dedicated to excellence and less willing to work as hard as they do.

Which of the following represents outcomes of transformational leadership? A. Deadlines are met. B. Increased job satisfaction. C. Pay tends to be higher. D. Work is completed according to the rules.

B. Increased job satisfaction. People tend to have higher satisfaction when they are motivated and intellectually stimulated, as are hallmarks of the transformational leader. Regimented, deadline-oriented leadership does not tend to promote higher job satisfaction.

Which of the following statements is true? A. Although decision making and problem solving are similar, only problem solving requires critical thinking. B. Decision making and problem solving are similar. C. Although decision making and problem solving are similar, only problem solving can improve the practice of nursing. D. Decision making and problem solving are synonymous.

B. Decision making and problem solving are similar. RAT: Decision making and problem solving are not synonymous terms. However, the processes for engaging in decision making and problem solving are similar. Both skills required critical thinking, which is a high-level cognitive process, and both can be improved with practice.

When entering the postoperative care unit, the nurse manager notices that the temporary agency nurse has incorrectly entered the rate of infusion for the patient's vasopressor medication and that the arterial line is indicating a blood pressure of 76/40. Discontinuing the intravenous infusion, the nurse manager's next most appropriate action is to determine which of the following? A. The nurse in charge of the unit. B. If there are standing orders fro interventions fro hypotension. C. If the temporary nurse has had orientation tot he unit. D. If there is an assigned resources nurse to serve as mentor for the temporary nurse.

B. If there are standing orders fro interventions fro hypotension. RAT: Pt safety is always the first concern, and attention must first center on ensuring the patient's welfare To prevent such an occurrence in the future, the nurse manager should next determine who is in charge of the unit. Questions to ask the charge nurse include asking about the temporary nurse's qualifications and experiences caring fro critical postop pts, if a resources nurse was assigned to the temporary nurse so that the temp nurse had a mentor and could ask questions if needed. Finally, the nurse manager should ask about the orientation to the unit and whether the temporary nurse was informed about the types of IV pumps used in this facility, how to set the appropriate drip rate, and the necessary monitoring of patients who are receiving vasopressor agents.

Which of the following best demonstrates the concept of followership? A. Assessing a clinical situation and following a set of guidelines in order to delegate tasks to unlicensed personnel. B. Preparing for a committee meeting by reviewing the agenda and supplemental materials, so that you can be an active participant in the meeting. C. Completing the tasks associated with your patient assignment without deviation with the intent of receiving praise from your manager. D. Administering medications to patients in conjunction with other nursing actions in order to make effective use of your time.

B. Preparing for a committee meeting by reviewing the agenda and supplemental materials, so that you can be an active participant in the meeting. RAT: A follower would prepare for the meeting so that he/she can be an active participant, rather than arriving to the meeting unprepared to contribute to the group activities. Options A and C are examples of activities associated with managing. Option D is an example of time management and does not reflect followership.

An incident report of the incident describe in Question 1 (postop care unit, vasopressor, hypotension) needs to be completed. The appropriate wording to be included in the incident report is: A. Nurse MJ started the vasopressor medication; the pt subsequently was noted to have a blood pressure reading of 76/40, the medication was discontinued, and the physician notified. B. Pt receiving vasopressor medication IV; BP fell to 76/40 and IV infusion discontinued; physician notified and the pt given 500 mL of IV fluid over 15 minutes. C. Patient was noted to have a low arterial blood pressure (76/40) and the vasopressor medication was discontinued. D. Patient's vasopressor medication was infusing at a higher rate than ordered and the medication was discontinued when the patient's blood pressure dropped to 76/40.

B. Pt receiving vasopressor medication IV; BP fell to 76/40 and IV infusion discontinued; physician notified and the pt given 500 mL of IV fluid over 15 minutes. RAT: The most complete incident report note because it states what was happening, why an intervention was needed, and the follow-up care for the pt. Other options are less desireable as there is no mention of what follow-up measures were done to ensure the pt's welfare; there should never be a mention or indication, however slight, of liability in the incident report, as it could later be used in a court of law to show liability against the healthcare providers and the institution.

Being able to think systematically involves: A. Refusing to come to staff meetings on your day off. B. Focusing on the number of patients each nurse is assigned, unrelated to patient acuity. C. Being able to consider the "Big Picture," beyond the needs of your unit. D. Considering what nursing tasks need to be completed before the next medication pass.

C. Being able to consider the "Big Picture," beyond the needs of your unit. RAT: A system thinker has the big picture by looking beyond what is going on during a shift or the events of the nursing unit. The other options demonstrate a focus on short-term objectives and lack of flexibility.

James and Susan are new graduates employed in a small community hospital. They see that practices seem to be very physician driven and that patients have little input into their care. Families are seen as a nuisance rather than as partners in potential care provision. What is the best approach James and Susan might use to improve care in this setting? A. Do nothing. They are too new to the organization to make change. B. Share with the physician the recommendations from various IOM reports. C. Share with their team members what they know about the aims of providing health care. D. Report the team members to the chief nursing officer who is unlikely to know the lack of details on this unit.

C. Share with their team members what they know about the aims of providing health care. RAT: As accountable professionals, doing nothing is not an option. The chief nursing officer (CNO) is likely to know the standard of care on every unit in a small community hospital and bypassing the unit manager violates a "chain of command" approach. Similarly, going to the physician fails to engage the nursing chain of command. Sharing with team members what the aims of providing health care are provides the opportunity to discuss patient-centered care.

You are the nurse manager for a busy intensive care unit (ICU). Two patients are awaiting admission to the ICU; one is a 42-year-old bank president admitted through the emergency center with a diagnosis of an acute myocardial infarction, and the other is an elderly woman who experienced a cardiac arrest on the general medical unit. After reviewing the charts of all the patients already in the ICU, you contact the physician about a patient who can safely be discharged to a general medical unit so that two beds will be available for the two people awaiting admission. The ethical principle that you have most closely applied is that of: A. Respect for other B. Beneficence C. Fidelity D. Justice

D. Justice RAT: Justice concerns treating people equally and fairly. Both patients awaiting admission to the ICU are equally in need of the medical and nursing care available in this unit. The next best choice is respect for others, transcending culture differences, gender issues, racial concerns, and, in this instance, age differences. Though one of the patients is much younger and seemingly more affluent in the local society, both are deserving of the highest quality care. Beneficence could also be said to be applied in this instance; doing good by assuring that both patients are admitted to the unit. Fidelity is the least applicable principle in this instance as it pertains to keeping one promises and commitments and, given the facts of the scenario, there is no indication of any promise being made to either of the patients to be admitted.

Which of the following is not a rule of leadership? A. Maintain balance. B. Listen to people. C. Maintain a positive attitude. D. Maintain likeability.

D. Maintain likeability. RAT: Although likeability may derive from effective leadership, it may not always be the case when leaders strive hard to do the right thing.

Managers can effectively reduce workplace stress, improve job satisfaction, and promote a positive work environment by doing all of the following EXCEPT: A. Encouraging autonomy in the workplace. B. Bringing in food for all shifts and encouraging social support among the team. C. Building strong relationships within the leadership team as well as other peers. D. Eliciting support, communicating to the team that deadlines are quickly approaching and that the department is performing poorly.

D. Eliciting support, communicating to the team that deadlines are quickly approaching and that the department is performing poorly. RAT: The manager's role is to encourage and facilitate job satisfaction, while focusing on social supports that are intended to reduce stress. Autonomy and maintaining a positive work environment are paramount to ensuring a healthy workforce. Demoralizing the department by pressuring them and demeaning them is not motivating to a team.

There are three types of decision-making style: paternalistic, informative, and shared decision making. A shared decision model has been shown to increase productivity and work performance because: A. The managers decide what is best for the team since the manager have more experience and have the competency to make decisions for their respective teams. B. Just like the paternalistic model, it values the input of others and the staff may express and discuss options and preferences. C. It is identical tot he informative model. D. Unlike the paternalistic model, decisions are made through and interactive, deliberate process and the staff may express and discuss options and preferences.

D. Unlike the paternalistic model, decisions are made through and interactive, deliberate process and the staff may express and discuss options and preferences. RAT: The decision-making style of a nurse manager can be conceptualized using three distinct models: paternalistic, informative, and shared decision making (Moreau, 2012). In the paternalistic model, the managers decide what is best for their team. The informative model offers the staff the ability to make a decision after the information has been shared and without the active involvement of the manager. In a shared decision model, the decisions are made through an interactive, deliberate process, and the staff may express and discuss options and preferences. The shared decision model has been shown to increase work performance and productivity, decrease employee turnover, and enhance employee satisfaction.

Group decision making offers the following advantages and disadvantages: A. Implementing solutions becomes easier when individuals have been actively involved in the decision-making process. B. Groups may be more concerned with maintaining group harmony than engaging in an active discussion on a particular issue. C. The time required for making group decisions may not be appropriate, especially in a crisis situation. D. More ideas can be generated by groups and they have a synergistic effect. E. All of the above statements are true.

E. All of the above statements are true. RAT: The advantages of group decision making are numerous. The adage "two heads are better than one" illustrates that when individuals with different knowledge, skills, and resources collaborate to solve a problem or make a decision, the likelihood of a quality outcome is increased. More ideas can be generated by groups and they have a synergistic effect. In addition, when followers are directly involved in the process, they are more apt to accept the decision, because they have an increased sense of ownership and commitment to the decision. Implementing solutions becomes easier when individuals have been actively involved in the decision-making process. Although group decision making and problem solving have distinct advantages, involving groups also carries certain disadvantages and may not be appropriate in all situations. The time required for making group decisions and for achieving consensus may not be appropriate, especially in a crisis situation, which requires making prompt decisions. In addition, some decisions may have been made at the organizational level and discussing the decision as though other options were possible is counterproductive. Groups may be more concerned with maintaining group harmony than engaging in active discussion on the issue and generating creative ideas to address it. Group members who manifest a "groupthink" mentality may be so concerned with avoiding conflict and supporting their leader and other members that important issues or concerns are not raised.