NR321 Quiz 2

The charge nurse of a step down unit is implementing a new procedure for charting, which will impact all of the nursing staff. According to Lewin's Model of Change, the Movement stage can be more successful if certain things are considered by the change agent.

Include all stakeholders Set target dates Implement the change

What is the effect on a nurse who experiences a disconnection between personal and organizational values?

Intrapersonal conflict and burnout

True of False: Change should be immediately implemented if the need for change has been identified.

False

Which of the following delineates the set of values and beliefs of an organization's goals and guides the development of the philosophy statement?

Purpose or mission statement

A nurse leader is thinking about approaching their manager with a new idea. To be properly prepared, the nurse leader should recognize this as a natural and unexpected response to change.

Resistance

What is the role of the change agent?

Seeks to lead or create change

A nurse on a busy medical surgical unit must delegate some care assignments to an experienced nursing assistant. What factors does the nurse consider prior to delegating the care to the nursing assistant?

State or national standards

Unit philosophy

adapted from the nursing service philosophy, specifies how nursing care provided on the unit will correspond with nursing service and organizational goals.

Strategic planning typically examines

an organization's purpose, mission, philosophy, and goals in the context of its external environment.

Vision Statements

are used to describe future goals or aims of an organization.

The forces that push the system toward change are

driving forces

A working philosophy

is evident in a department's decisions, in its priorities, and in its accomplishments.

It is critical that managers not

view change as a threat

Planning

All planning involves choice: a necessity to choose from among alternatives. Definition: deciding in advance what to do; who is to do it; and how, when, and where it is to be done. Therefore, all planning involves choosing among alternatives.

The oncology unit has recently experienced a higher than normal patient census, which is requiring that nurses pick up an additional patient. The hospital CFO has indicated that there are no additional funds available to hire additional full-time nurses. As such, the unit manager anticipates some behavioral responses by the stakeholders of change (nursing staff) within the unfreezing phase. What are some possible behavioral responses?

Anger Withdrawal Discontentment

You are the nurse manager of a medical surgical unit that is in need of a change in staffing rotation patterns. which will lead to major changes in how the unit is staffed. According to Lewin's Change Theory, what forces are in play to enact these changes?

Driving Force

The chief nursing officer (CNO) at an acute care facility has weekly mandatory meetings with all managers and staff members to discuss what is going well, what could be better, and communication from the executive team. This CNO is part of what type of organization?

Flat

Leadership characteristics required for planning:

Flexibility and Energy

The mission of the acute care facility is "We are dedicated to creating a healthy community, one person at a time" What nursing leadership activities would correlate with that mission?

Notifying nursing staff of an upcoming CEU seminar on healthy eating for low-income families. Mentoring a nursing student who is interested in introducing smoking cessation to patients and patient families without being preachy. Reviewing health care provider orders to guarantee the nursing staff is appropriately carrying them out.

The nurse leader is a change agent and needs to identify factors that lead to resistance of change. Identify factors of resistance:

Poor timing Fear of loss of control Lack of trust Person energy needed Comfort with the current way of completing goals or tasks

Stages of Change

Precontemplation Contemplation Preparation Action Maintenance

Mission Statement

a brief statement (typically no more than three or four sentences) identifying the reason that an organization exists

Proactive Planning

is dynamic, and adaptation is considered to be a key requirement because the environment changes so frequently.

An organization must truly believe and act on its

mission statement; otherwise, the statement has no value.

the forces that pull the system away from change are called

restraining forces

Normative-Reeducative

strategies use group norms and peer pressure to socialize and influence people so that change will occur

Refreezing

the change agent assists in stabilizing the system change so that it becomes integrated into the status quo

Planning (implications)

a proactive and deliberate process that reduces risk and uncertainty.

Power-Coercive Strategy:

features the application of power by legitimate authority, economic sanctions, or political clout of the change agent

Chaos theory is really about

finding the underlying order in apparently random data

Rational-Empirical

gives current research as evidence to support the change

Although goals may direct and maintain the behavior of an organization, there are several dangers in using

goal evaluation as the primary means of assessing organizational effectiveness.

Change should be implemented only for

good reasons.

When a nurse experiences cognitive dissonance between personal and organizational values, the result may be

intrapersonal conflict and burnout.

Whenever possible, all those who may be affected by a change should be

involved in planning for that change.

Strategic planners using a balanced scorecard develop

metrics (performance measurement indicators), collect data, and analyze that data from four organizational perspectives: financial, customers, internal business processes (or simply processes), and learning and growth

CAS theory suggests that the relationship between elements and agents within any system is

nonlinear and that these elements are constantly in play to change the environment or outcome

Reactive planning

occurs after a problem exists. Because there is dissatisfaction with the current situation, planning efforts are directed at returning the organization to a previous, more comfortable state

Unfreezing

occurs when the change agent convinces members of the group to change or when guilt, anxiety, or concern can be elicited

It is unrealistic for managers to accept a position under the assumption that they can change

organization's philosophy to more closely match their personal philosophy.

Today, most health-care organizations find themselves undergoing continual change directed

organizational restructuring, quality improvement, and employee retention.

Change agents must be

patient and open to new opportunities during refreezing, as complex change takes time and several different attempts may be needed before desired outcomes are achieved.

Unlike the 20-year strategic plans of the 1960s and 1970s, most long-term _____ today find it difficult to look even 5 years in the future.

planners

Managers who are uninformed about the legal, political, economic, and social factors affecting health care make______ errors that may have disastrous implications for their professional development and the financial viability of the organization.

planning

Organizational Philosophy

provides the basis for developing nursing philosophies at the unit level and for nursing service as a whole

Because change disrupts the homeostasis or balance of the group

resistance should always be expected.

The nurse leader should identify the _______ forces prior to attempting to implement change.

restraining

Nursing service philosophy

should address fundamental beliefs about nursing and nursing care; the quality, quantity, and scope of nursing services; and how nursing specifically will meet organizational goals

An organization will never be greater than

the vision that guides it.

Long-range or strategic plans

time span and complexity or comprehensiveness. Generally, complex organizational plans that involve a long period (usually 3 to 7 years) are referred to as

Which of the following is not included in the contemporary change process?

Evaluation

A nursing staff member who is on a unit committee to bring about a planned change is currently in the integrating phase of change. What activities are associated with the integrating phase?

Assessing how well the new process is accepted and becoming the new norm. Assessing how well the change is working against an established measurement for success.

The nurse manager for a medical surgical unit is implementing change in unit procedures as it relates to patient discharge. During the fourth phase of change known as action, the manager should incorporate the major component known as:

Communication

A nurse manager notices that supply carts are unorganized and could use some attention. What strategy can the manager use to help implement change in this area?

Encourage input from subordinates for potential options

As the nursing manager of a unit, which key steps should be performed before implementing a change effort?

Encourage input from team members who would be impacted by the change. Investigate the magnitude and complexity of the intended change. Use a roadmap as a guide to complete the change

Who developed a theory that provides nurse leaders with tools to become effective change agents?

Kurt Lewin

A nurse manager is assigned to a new unit due to issues of administrative mismanagement, which had resulted in staff becoming disillusioned as to the mission of the unit. As the unit manager, you are expected to develop new policies for the staff to follow. What is one of the greatest factors that may contribute to resistance of change on this unit?

Lack of trust

A nurse leader recently transferred to a different hospital that is much older than the hospital at which the nurse was previously employed. After working in the new hospital for a month, the nurse leader believes it would be a great idea to brighten the rooms with a lighter paint job, obtain newer hospital beds and curtains, and hang some fun artwork. However, the nurse leader doesn't want to be perceived as a threat to the team. How could these ideas be presented to minimize resistance?

- Engage other nurses in a discussion about the benefits of exam room aesthetics, then present the idea - Engage other nurses in a discussion about the benefits of exam room aesthetics, then solicit their ideas to improve aesthetics. - Make over one of the exam rooms and use it as a test case to collect data on patient satisfaction, then present the data with the idea to the team if the experiment was successful

A few months ago, a new nurse leader at a hospital discovered via EBP that tablet computers improved accuracy of documentation and decreased patient wait time. The leader noted that these outcomes are beneficial to the facility, staff, and patients as tablets provide portable access to patient electronic medical records. The nurse leader is currently in the planning stage. Which activities are part of the planning stage?

Anticipating resistance to the change by less tech savvy staff. Determining the scope of the change of the project, a schedule for its implementation, and a budget to submit to administration for approval.

A newly employed nurse is reviewing the organizational chart of the facility, observing that there is a shared governance. What type of organizational chart does the nurse recognize the facility follows?

Matrix

A nurse leader has an idea for changing the intake flow in the ER to leverage more of the nursing staff. The leader knows that if they could implement the idea as a pilot program, they could prove its effectiveness and then use it in all the ERs in the region. The nurse leader is frustrated, however, because in order to implement even a pilot of the idea, a proposal must be submitted to the ER Supervisor with a start to finish scenario that details not only the process but also the risks, liabilities, and cost estimates. If the supervisor approves, the proposal would then be sent to the Chief Nursing Officer, who would then send it to the Administrator and Board of Directors for review and approval. Which of these factors are influencing the nurse leader's ability to implement the pilot program?

Organizational Structure

A nurse leader is working in the ER when a patient presents with a deep head laceration requiring immediate suturing. The nurse leader went to the medical supply area for antibacterial ointments, gloves, and bandages. However, the nurse noticed that the medical supply cabinet was extremely disorganized, so it took much longer than it should have to find the necessary supplies. The next morning, the nurse leader began to ask team members if they had any input regarding the organization of medical supplies, and then began to brainstorm a few different ideas, such as rearranging the supplies and relabeling items. What is the next stage of change the nurse leader should address?

Plan

Last month, two nursing units were merged to save on staffing costs. The nursing manager is now inquiring among the staff about how the change is working and if any barriers remain. What stage of change is this?

Plan Design Integrate

Select the classic change strategies that nurse leaders use to apply the change process.

Rational-Empirical Normative-Reeducative Power-Coercive Strategy

A single parent raising two children and relying on public transportation, is determined to become a registered nurse. What are the restraining forces in this situation?

Relying on public transport Being a single mother Stress of being away from children

True of False: All people and organizational units that will be affected by a planned change should be included in the planning.

TRUE

The unit manager of a medical surgical unit is transitioning the unit to electronic charting. According to Lewin's model, which of the following roles describes you as the change agent?

The unfreezer

The nurse leader should not only understand the change process but also understand how to adapt to various methods in order to become an effective change agent int their organizations.

True

True of False: It is important for nurse leaders to establish a trusting relationship with those involved in the change process.

True