NSG 310 - Foundations - Lecture 9 (Leading and Managing)

management

2 major schools of thought in _____: 1- scientific 2 - human relations-based

resistance to change

4 approaches to decreasing ____ __ _____: - Commanding change - Sharing information - Refuting currently held beliefs - providing psychological safety

SWOT analysis

(strengths, weaknesses, opportunities, threats) plan, borrowed from the corporate world, can guide you through an analysis of your own internal strengths and weaknesses and reveal external opportunities and threats that may help or hinder your leadership and management skills

informal negotiation

** discussion among involved parties to find a solution 1. clarify situation in your own mind 2. set the stage 3. conduct the negotiation 4. continue with offers and counteroffers 5. agree on the resolution of the conflict

democratic leadership

- AKA participative leadership - shares planning, decision making, responsibility - provides guidance rather than control

laissez faire leadership

- AKA permissive or nondirective leadership - inactive style - intervenes only when goals have not been met or a problem arises - poor quality and inefficient work output

scientific management

..., a management theory using efficiency experts to examine each work operations and find ways to minimize the time needed to complete it

mentor

A ____ is someone more experienced who provides career development assistance, such as coaching, sponsoring advancement, providing challenging assignments, protecting proteges from adversity and promoting positive visibility.

leader

A _____ in health care has 3 primary tasks: - set direction - build commitment (teamwork) - confront challenges that arise from innovation, change, and turbulence

manager

A _____ is an employee of an organization who has the power, authority and responsibility for enforcing decisions and for planning, organizing, coordinating and directing the work of others.

behavioral theory

A leadership theory that is focused on what the leader DOES - 3 styles of leadership: 1 - democratic - tries to move the group toward its goals 2 - autocratic - tries to move the group toward the leader's goals 3 - Laissez-faire - makes little or no attempt to move the group

d (Integrating change occurs after the change has been made and involves evaluating acceptance, comfort levels, and residual resistance of those affected.)

A nursing unit is now doing a walking change-of-shift report. The unit manager puts out a survey asking for employee feedback about the new process. This would be termed a Overcoming resistance b Unfreezing c Implementing change d Integrating change

delegate

Ability to delegate: The American Nurses Association (ANA) (2010) has specified that RNs may NOT ______ the following tasks: - Initial nursing assessment; follow-up assessments if nursing judgment is indicated - Nursing diagnosis - Decisions and judgments about outcomes - Formulation and approval of a patient plan of care - Interventions that require professional nursing knowledge, decisions, or skills - Decisions and judgments necessary for the evaluation of patient care

effective manager

Activities of an _____ _____: - interpersonal activities - decisional activities - informational responsibilities

nurse manager

An effective ____ ____ must have the following qualities: - Leadership - Clinical expertise - Business Sense

1, 3, 5, 6 (Feedback 1: You should ask, "Is the change necessary?" If the change is not necessary, there is no point in making it. Feedback 2: You should not ask, "How will the change benefit me?" You should consider whether the change will benefit the unit as a whole and patients. Feedback 3: You should ask, "Is the change technically correct?" Feedback 4: You should not ask, "Will the change make all of the staff happy?" A needed change may not make everyone happy, but it should still be implemented. Feedback 5: You should ask, "Will the change work?" Feedback 6: You should ask, "Is there a better way to do this?")

As a nurse manager, you are considering making a change in the process for scheduling nurses on your unit. Which of the following questions should you ask yourself before attempting to implement this change? SELECT ALL THAT APPLY. 1) Is the change necessary? 2) How will the change benefit me? 3) Is the change technically correct? 4) Will the change make all of the staff happy? 5) Will the change work? 6) Is there a better way to do this?

1 (A nurse who says he's looking forward to making the change but keeps missing meetings during which you demonstrate the change is exhibiting passive resistance to the change. He is avoiding the change. A nurse who e-mails your superior complaining about the change is exhibiting active resistance, which is characterized by aggressive actions or outright refusals to comply. A nurse who has embraced the change and is helping you promote it to others is not resisting but supporting the change. A nurse who cites several research studies that refute the approach you are proposing is exhibiting active resistance, which is characterized by aggressive actions or outright refusals to comply.)

As a nurse manager, you are implementing a new handwashing protocol to improve infection control on your unit. You are excited about the change, but your staff have mixed responses. Which of the following is an example of passive resistance? 1) A nurse who says he's looking forward to making the change but keeps missing meetings where you demonstrate the change 2) A nurse who e-mails your superior complaining about the change 3) A nurse who has embraced the change and is helping you promote it to others 4) A nurse who cites several research studies that refute the approach you are proposing

delegation

Important aspects of _____ include: - assess and diagnose - assess each client's needs - plan goals and interventions - mentally identify which staff member is best suited for the task(s) - implement- which personnel have the knowledge and skills to perform the task - evaluate - were client care needs met by selected person

human relations based

In ____ _____-____ management - - the focus is on guidance rather than control - development rather than close supervision - reward rather than punishment - focused on keeping morale high

2 (The ability to communicate clearly with all types of people is a strength. A shortage of nurses on the unit, leading to a heavy workload, is a threat to leadership development. Having a supervisor willing to provide one-on-one training is an opportunity. A lack of self-confidence in leading others is a weakness.)

In considering your development as a leader in nursing, you decide to perform a SWOT (strengths, weaknesses, opportunities, threats) analysis on yourself. Which of the following results of your analysis is an example of a threat to your leadership development? 1) Ability to communicate clearly with all types of people 2) Shortage of nurses on the unit, leading to a heavy workload 3) Having a supervisor willing to provide one-on-one training 4) Lack of self-confidence in leading others

power

Individuals who have ____ in healthcare - even at first it seems like they don't: - managers (reward, coercion, authority) - patients (reward) - RNs (authority, expertise, coercion) - assistants and technicians (expertise and coercive power)

servant leadership

Leader puts the needs of others first. Is committed to the growth of his/her people.

transformational theories

Leadership theory that people need a sense of mission that goes beyond good interpersonal relationships or the reward for a job well done. - Meaning, Inspiration, Vision - Ability to inspire and motivate followers - Coach and mentor

emotional intelligence theory

The capability to identify, assess, and manage the personal emotions of oneself and other people, as well as the collective emotions of groups of people.

3 (Rationale Option 1: Nurse aides are trained and supervised by the nurse, not other nurse aides. Option 2: Although this is important, it is not the priority. Option 3: Safety of the patient is the priority. The nurse aide must perform only the skills that are within the legal role of the nurse aide, understood, and practiced and have been performed correctly on a return demonstration. Option 4: Although this may be desirable, it is not the priority.)

Question 19. The most important reason why a nurse aide must fully understand how to implement a delegated procedure is because the nurse aide must be able to: 1. Teach the procedure to another nurse aide 2. Explain the procedure to the patient 3. Complete the procedure safely 4. Perform the procedure quickly

3 (Rationale Option 1: Delegation is unrelated to creating change. Delegation is the transfer of responsibility for the performance of a task to another while remaining accountable for the actions of the person to whom the task was delegated. Creating change is associated with responding to a stressor that is either planned or unplanned, which results in change that is positive or negative. Option 2: Delegation is unrelated to networking. Networking occurs when a person makes connections with others for sharing ideas, knowledge, information, and professional support. Option 3: Delegation allows the Registered Nurse to assign tasks to various individuals on the nursing team who are best qualified to complete the task. In today's health-care environment, nursing team members have different levels of educational preparation. The Registered Nurse must take into account the qualifications and scope of practice of each professional and nonprofessional nursing team member and assign tasks accordingly. When this is done, each person's skills and abilities are used most appropriately and productivity increases. Option 4: The person who is assigned a task is responsible for the outcome of the assigned task. However, the Registered Nurse delegating the task is not relieved of accountability but is responsible for the actions of the person to whom the task was delegated as well as the outcome of the intervention.)

Question 1. A Registered Nurse delegates a procedure to a Licensed Practical Nurse. What is the primary purpose of delegation? 1. Create change 2. Establish a network 3. Improve productivity 4. Transfer accountability

3 (Rationale Option 1: The organizational chart schematically plots the reporting relationship of every position within the organization. It does not help a staff nurse identify a solution to a complex problem. Option 2: The nursing procedure manual is not designed to help a staff nurse identify a solution to a complex problem. The nursing procedure manual contains details of policies relative to nursing practice and nursing procedures along with the purpose and all the steps that one must follow to implement the procedure safely. Option 3: Generally, in the chain of command of an organization the staff nurse works under the direction of and reports to the unit's nurse manager. The nurse manager generally is an experienced nurse and is the primary resource person for the staff nurse. The staff nurse should seek guidance from the nurse manager when assistance is needed to solve a complex problem. Option 4: The nursing supervisor is higher up the chain of command in a Table of Organization than another employee who is the best person for the staff nurse to seek assistance from when needing help to solve a complex problem.)

Question 1. A staff nurse must solve a complex problem. Which is the nurse's most effective resource? 1. Organizational chart of the institution 2. Nursing procedure manual 3. Unit's nurse manager 4. Nursing supervisor

1 (Rationale Option 1: Although planning, problem solving, and empowering others are tasks of a manager, the bottom line is for the manager to accomplish the work of the organization. Option 2: Although empowering others is one of the tasks of a manager, the major focus is identified in another option. Option 3: Although problem solving is one of the tasks of a manager, the major focus is identified in another option. Option 4: Although planning is one of the tasks of a manager, the major focus is identified in another option.)

Question 1. What is the major focus of nursing management? 1. Accomplishing an objective 2. Empowering others 3. Problem solving 4. Planning

3 (Rationale Option 1: Assigning the procedure to another staff member is premature. Another option has priority. Option 2: The employee may be fully aware of the requirements of the job description and not need to have them described. Even though a task is within one's job description, a person can refuse to perform a procedure because of a reason that is considered acceptable. Option 3: This is the issue that the nurse manager needs to explore. The employee may have an acceptable reason for refusing to comply. When the reason is identified, then the nurse manager can take an informed action. Option 4: The reason for refusal may have nothing to do with the lack of understanding of the procedure.)

Question 1. When delegating a specific procedure to a patient care aide, the aide refuses to perform the procedure. What should the nurse do first? 1. Assign the procedure to another patient care aide 2. Explain that it is part of the patient care aide's job description 3. Explore why the patient care aide refused to perform the procedure 4. Send the patient care aide to the procedure manual to review the procedure

2 (Rationale Option 1: Collaborative is not a classic leadership style. Collaborative refers to the democratic leadership style. Democratic leaders encourage discussion and decision making within the group, which requires collaboration, coordination, and communication among group members. Option 2: This is the most appropriate leadership style in a crisis when urgent decisions are necessary. In a crisis, one person needs to assume the responsibility for decisions. Autocratic leaders give orders and directions and make decisions for the group. Option 3: This leadership style is not appropriate in a crisis when urgent decisions are necessary. Laissez-faire leaders are nondirective and permissive, which allows for self-regulation, creativity, and autonomy but limits fast-acting efficiency. Option 4: This leadership style is not appropriate in a crisis when urgent decisions are necessary. Democratic leaders encourage discussion and decision making within the group, which takes time.)

Question 10. A nurse manager is informed that a large number of patients will be admitted in response to a terrorist attack. Which type of leadership style is most appropriate in this situation? Course Topic: Leadership and Management Concept(s): ManagementCognitive Level: Comprehension [Understanding] 1. Collaborative 2. Authoritarian 3. Laissez-faire 4. Democratic

4 (Rationale Option 1: This assessment should be made before, during, and after care is delivered to determine the patient's response to activity. Option 2: This requires a health-care provider's order. In addition, too high a concentration of oxygen diminishes the respiratory drive in some people (individuals with COPD). Although the nurse can administer oxygen without a health-care provider's order in an emergency situation, this is not an emergency situation. Option 3: Not all patients receiving oxygen are required to stay in bed. Option 4: When the patient uses accessory muscles to increase lung volume during inspiration, the work of breathing increases. This places greater demands on the body and increases the metabolic rate, which in turn increases the need for oxygen. Pacing care allows for periods of rest, which reduces the physical demand for oxygen.)

Question 10. A patient receiving oxygen via nasal cannula exhibits an elevation of the clavicles on inspiration. What nursing intervention takes priority when the nurse assists the patient with activities of daily living (ADLs)? Course Topic: Leadership and Management Concept(s): OxygenationCognitive Level: Analysis [Analyzing] 1. Monitoring the respiratory rate hourly 2. Increasing the oxygen flow rate 3. Promoting bedrest 4. Pacing care

3 (Rationale Option 1: Students are assigned to care for patients for a specific time period and generally are included as members, not leaders, of the nursing team. Option 2: Although students are expected to complete all planned care, the patient's condition can change or some unforeseen event may interfere with the plan. The student must keep the instructor or preceptor informed about the patient's condition and use the instructor or preceptor as a resource person when the unexpected occurs or guidance is needed. Option 3: Students are accountable for the tasks assigned by the instructor or preceptor. As part of accountability, students are obligated to keep the instructor or preceptor informed about the status of the patient, how the assignment is progressing, and whether all interventions are implemented as planned. Option 4: Students should not help other students unless specifically assigned to do so by the instructor or preceptor. An exception occurs when assistance is needed to ensure patient safety in an emergency.)

Question 10. A student nurse in the clinical area is given an appropriate patient assignment by the instructor. What should the student nurse do? 1. Accept the role of leader of the patient's health-care team 2. Complete the care indicated on the patient's plan of care 3. Assume accountability for the tasks that are assigned by the instructor 4. Help other students to complete their assigned tasks whenever necessary

4 (Rationale Option 1: Making disapproving verbal comments about the change is overt aggressive behavior; passive-aggressive behaviors are covert behaviors. Option 2: Writing negative memos and contacting the union are overt behaviors; passive-aggressive behaviors are covert behaviors. Option 3: Organizing resistance to change is an overt resistance to change; passive-aggressive behaviors are covert behaviors. Option 4: Passive-aggressive resistance to change is reflected by covert negative behavior. The nurse missing the meetings can provide "rational excuses" for not attending the meetings, rather than overtly stating opposition to the change.)

Question 10. An agency is changing from paper medical records to electronic medical records. Multiple meetings were conducted to involve all members of the health team that will be influenced by the change. A nurse manager identifies that a nurse may be exhibiting passive-aggressive resistance to change. What behavior by the nurse led the nurse manager to this conclusion? 1. Making disapproving comments about the new method of charting 2. Writing negative memos to the nurse's labor union in the agency 3. Organizing a group of nurses to resist the new policies 4. Avoiding meetings to learn how to use a computer

1, 2, 3 (Rationale Option 1: Delegating a nursing assistant to sit with a suicidal patient is appropriate, provided the nursing assistant was oriented to the role. Option 2: Changing bed linens is an appropriate task for a nursing assistant. It is a repetitive skill that usually does not entail negative consequences. Option 3: Delegating patient feeding to a nursing assistant is appropriate; it is a skill that nursing assistants are taught and, with supervision, can implement safely. Option 4: Having a nursing assistant obtain the first set of vital signs of a postoperative patient is inappropriate. The nurse should always perform the first set of postoperative vital signs because it involves in-depth knowledge about the postoperative complications patients may exhibit. Option 5: It is inappropriate to have a nursing assistant perform any dressing change. A nursing assistant does not have the educational background or license to perform this skill safely. The primary health-care provider performs the first dressing change, and the nurse assumes responsibility thereafter.)

Question 11. A nurse caring for a group of patients is planning the day's activities. What tasks are appropriate for the nurse to delegate to a nursing assistant? Select all that apply. 1. Sitting with a suicidal patient 2. Changing the patients' bed linens 3. Feeding a patient with dysphagia 4. Obtaining the first set of vital signs of a postoperative patient 5. Performing a second dressing change for a postoperative patient

2 (Rationale Option 1: The nurse who is delegating the task is ultimately responsible. Option 2: A nurse can delegate only those tasks permitted by the state Nurse Practice Act and the policies and procedures within the agency. Legal parameters of practice are indicated in state nurse practice acts. Option 3: Although experience does broaden one's experiential background, each person within a job description must be minimally competent to perform required skills. Option 4: Although a patient's acuity level is an important factor to consider, legal parameters of practice must be considered first.)

Question 11. A nurse in charge of a patient care unit is considering staff member assignments. What criterion is most significant that the nurse must consider when delegating a task to another member of the nursing team? 1. Who will ultimately be responsible for the patient's care? 2. Is the activity within the person's job description? 3. How much experience does the person have? 4. What is the acuity level of the patient?

4 (Rationale Option 1: The word directive refers to the autocratic, not democratic, leadership style. Option 2: The word permissive refers to the laissez-faire, not democratic, leadership style. Option 3: Oppressive is the way some people refer to the autocratic, not democratic, leadership style. There is little freedom and a large degree of control by the autocratic leader, which frustrates motivated and professionally mature staff members. Option 4: The word consultative is most closely related to the democratic leadership style. Democratic leaders encourage discussion and decision making within the group. The leader facilitates the work of the group by making suggestions, offering constructive criticism, and providing information.)

Question 11. When considering leadership styles, an "autocratic" leader is to "authoritarian" as a "democratic" leader is to: 1. Directive 2. Permissive 3. Oppressive 4. Consultative

1 (Rationale Option 1: Risks and benefits must be carefully analyzed before initiating change. Some change is not worth the risk, because the consequences of failure are greater than the benefits. Option 2: The stages of change are not always predictable. Although effective change moves through three zones (comfort, discomfort, and new comfort), what happens in each stage is not always predictable and change is not always successfully achieved. Change is dynamic and the stages are not rigid. Option 3: Outcomes of change can be positive or negative. Sometimes well-planned change meets with resistance and the effort to change can result in a loss of credibility, lack of achieving the goal, and confusion. Option 4: Smaller goals are much easier to achieve than large goals. Smaller goals generally are designed to ensure achievement, which is motivating.)

Question 11. Which statement is most significant in relation to the concept of change theory in the health-care environment? Course Topic: Leadership and Management Concept(s): Evidence-based PracticeCognitive Level: Analysis [Analyzing] 1. Weigh the risks and benefits 2. The stages of change are predictable 3. Change in activity results in positive outcomes 4. A large change is easier to adapt to than multiple smaller changes

1, 2 (Rationale Option 1: A task of this complexity requires the knowledge and judgment of a Registered Nurse. If the caregiver is unable to assess the patient's condition adequately, this task has great potential for harm. In addition, it requires problem solving that may call for innovation in the form of an individually designed plan of care to address the presence of a dysrhythmia. Option 2: Patient teaching is a complex task. It requires knowledge of principles, such as identifying readiness to learn, progressing from simple to complex information, using motivational theory, and evaluating outcomes. Also, it requires knowledge of principles related to colostomy care such as: the bag opening must be at least 1/8 of an inch larger than the stoma, a pale stoma may indicate ischemia, and what to include in an assessment of the characteristics of intestinal output. Option 3: Applying a condom catheter is not a complex task. It requires simple problem-solving skills, involves a predictable outcome, and employs a simple level of interaction with the patient. Although this task has the potential to cause harm if the critical elements of the skill are not implemented, it is within the scope of practice of an unlicensed Nursing Assistant. It does not require the more advanced competencies of a Registered Nurse. Option 4: Making an occupied bed is not a complex task. It requires simple problem-solving skills, involves a predictable outcome, and employs a simple level of interaction with the patient. Although this task has the potential to cause harm if the critical elements of the skill are not implemented, it is within the scope of practice of an unlicensed Nursing Assistant. It does not require the more advanced competencies of a Registered Nurse. Option 5: Transferring a patient is not a complex task. It requires simple problem-solving skills, involves a predictable outcome, and employs a simple level of interaction with the patient. Although this task has the potential to cause harm if the critical elements of the skill are not implemented, it is within the scope of practice of an unlicensed Nursing Assistant. It does not require the more advanced competencies of a Registered Nurse.)

Question 12. A charge nurse is delegating assignments to other members of the nursing team. Which actions should be implemented only by a Registered Nurse? Select all that apply. 1. Taking the pulse of a patient with a dysrhythmia 2. Teaching a patient how to change a colostomy bag 3. Applying a condom catheter on a patient who is incontinent 4. Changing the linen on an occupied bed for a comatose patient 5. Transferring a patient from a bed to a chair with a mechanical lift

4 (Rationale Option 1: Unit-level managers are often responsible for the 24-hour operation of a nursing unit, including scheduling staffing, budget management, the supervision of staff, and ongoing quality improvement. Titles may be Assistant Nurse Manager or Nurse Manager. Option 2: First-level managers are responsible for managing the work of daily activities of a specific group of people on a unit level. Titles may include Primary Nurse, Team Leader, or Charge Nurse. Option 3: Upper-level (top-level) managers often are nurse executives who are responsible for determining organizational goals and developing strategic plans to achieve the goals. They are responsible for the management and practice of nursing within the organization. Titles may include Vice President of Nursing, Associate Administrator, or Assistant Administrator. Option 4: Middle-level managers are responsible for supervising a number of unit-level managers and for the overall functioning of their assigned areas, units, or departments for which they are responsible. They spend less time on day-to-day management issues and more time on departmental planning and interdisciplinary problem-solving. Titles may include Nurse Coordinator, Supervisor, or Assistant or Associate Director of Nursing.)

Question 12. A nurse is seeking a position in nursing management. The nurse reads a classified ad that indicates that the hospital is seeking a person who will spend less time on day-to-day management issues and more time on departmental planning and interdisciplinary problem- solving. Which level manager is this agency seeking? 1. Unit-level manager 2. First-level manager 3. Upper-level manager 4. Middle-level manager

1, 4 (Rationale Option 1: Maintaining a patent airway is essential for life; in addition, this patient should be monitored for the response to the administration of the bronchodilator. A patient with asthma who was medicated with a bronchodilator 30 minutes ago should be assessed before other less-critical patients. Option 2: Although a patient with a pacemaker recently inserted should be assessed directly, other patients can be assessed first; the patient's heart rate and rhythm is being monitored continuously, and an alarm will sound if the patient encounters a problem. Option 3: Care for a patient who is receiving an IV infusion can wait until more urgent nursing care is administered to other patients. With 200 mL left in the bag, the nurse has time before a new bag needs to be hung. Option 4: Administering care to this patient is a priority because before a cardiac catheterization there are certain interventions that must be accomplished as per protocols, including obtaining the patient's signature on the informed consent, applying an identification bracelet, and assessing for allergies. Option 5: Assessment of the patient with a total knee replacement can be delayed until the patients with priority needs are cared for first.)

Question 12. A nurse receives a change-of-shift report from the previous primary nurse at 7:00 a.m. The nurse determines that two patients should be assessed before the other patients. Select the two patients. 1. A patient who had an asthma attack and was medicated with a bronchodilator 30 minutes ago 2. A patient who had a pacemaker inserted the day before and is being monitored via telemetry 3. A patient who is receiving an IV infusion at 75 mL/hour and has 200 mL left in the bag 4. A patient who has just arrived for a cardiac catheterization at 8:00 a.m. 5. A patient who had a total knee replacement 2 days ago and is receiving continuous passive range of motion to the affected leg

2 (Rationale Option 1: Providing fluids based on a practitioner's order is a dependent, not independent, function of the nurse. Option 2: Delegating tasks within the scope of nursing practice is an independent function of the nurse and does not require a practitioner's order. Option 3: Wound care is a dependent function of the nurse and requires a practitioner's order. Option 4: Applying heat requires a practitioner's order and is a dependent function of the nurse.)

Question 12. Which action is an example of a nurse working independently? Course Topic: Leadership and Management Concept(s): Critical Thinking; ManagementCognitive Level: Analysis [Analyzing] 1. Limiting fluids when a patient has an order for 1000 mL fluid restriction 2. Assigning another nurse to administer medications 3. Irrigating a patient's wound with normal saline 4. Applying a warm soak on an infiltrated IV site

1, 3 (Rationale Option 1: Delegating obtaining vital signs of this patient to an LPN, rather than an NA, is appropriate because the LPN has the knowledge to identify postoperative complications as they relate to the vital signs. Option 2: Delegating a bed bath for a patient on contact precautions to an LPN is inappropriate in this situation because an NA is capable of caring for patients on contact precautions. Option 3: Delegating blood glucose monitoring to an LPN, rather than an RN, is appropriate; the LPN has the knowledge and skill to perform this skill safely. Option 4: All patient education must be performed by an RN. Option 5: All interventions concerning the administration of blood should be performed only by an RN.)

Question 13. A nurse is in charge of a team consisting of a registered nurse (RN), a licensed practical nurse (LPN), and a nursing assistant (NA). Which tasks should the nurse delegate to the LPN for the most effective use of the expertise of staff members? Select all that apply. 1. Take vital signs on a postoperative patient one day after surgery. 2. Perform a bed bath for a patient on contact precautions. 3. Obtain a blood glucose level on a patient with diabetes. 4. Provide patient education regarding a dressing change. 5. Discontinue tubing that was used to administer blood.

1 (Rationale Option 1: Determining the results of vital signs monitoring is not within the legal role of a nursing assistant. Although a nursing assistant may collect vital signs, determining the significance of vital signs is dependent on the educational preparation of a registered nurse. Option 2: All teaching interventions require the expertise of a registered nurse. Option 3: A licensed practical nurse is educationally prepared to change sterile dressings. Option 4: A nursing assistant is educationally prepared to bathe a patient with dementia.)

Question 13. A nurse manager identifies that the nurse in charge on evenings needs additional in-service education about the legal roles of nursing staff members when the charge nurse assigns the: 1. nursing assistant to monitor vital signs and determine those that are significant. 2. registered nurse to teach a patient with a colostomy how to care for the stoma. 3. licensed practical nurse to change several sterile dressings. 4. nursing assistant to give a bath to a patient with dementia.

4 (Rationale Option 1: This is not an example of influence power. Influence power is the use of persuasion and communication skills to exercise power informally without using the power associated with formal authority. Option 2: This is not an example of coercive power. The leader bases coercive power on the fear of the punitive withholding of rewards or retribution. Option 3: This is not an example of referent power. Referent power is associated with respect for the leader because of the leader's charisma and prior successes. Option 4: This is an example of expert power. Expert power is the respect one receives based on one's ability, skills, knowledge, and experience.)

Question 13. A unit manager mentors a new unit manager as part of orientation to the position. Which type of power is being used by the unit manager mentor? 1. Influence 2. Coercive 3. Referent 4. Expert

4 (Rationale Option 1: Effective leaders and managers both should have vision. Option 2: Effective leaders and managers both should have charisma Option 3: Effective leaders and managers both should have confidence. Option 4: Managers, not leaders, have responsibility. Leaders can be formal or informal. Informal leaders are not assigned to direct others. They are viewed as leaders by the members of the group because of their experience, vision, charisma, confidence, expertise, or age.)

Question 13. The primary difference between effective leaders and managers is that managers have: 1. Vision 2. Charisma 3. Confidence 4. Responsibility

2 (Rationale Option 1: A nursing assistant is capable of measuring a patient's hourly urine output. When the output is reported, the registered nurse determines the significance of the output. Option 2: Teaching requires the education and experience of a licensed registered nurse. Teaching is outside the scope of practice of unlicensed assistive personnel. Option 3: A nursing assistant is capable of caring for a patient with a restraint. Option 4: A nursing assistant is capable of positioning a patient who had an above-the-knee amputation several days ago. For the first 24 hours, the nurse should position the patient in the supine or semi-Fowler position, with the affected extremity elevated on a pillow. After the first 24 hours, initially, the nurse should position the patient in the prone position several times a day to extend the hip joint. This avoids a hip flexion contracture. Once the patient is familiar with moving to the prone position, the nursing assistant can facilitate moving the patient to this position.)

Question 14. A charge nurse is making patient assignments for a nursing assistant and registered nurse. Which patient should the charge nurse assign to the registered nurse? 1. A patient who needs to have hourly urine output measured 2. A patient who is learning how to irrigate a recently created colostomy 3. A patient who has a mitt restraint in response to pulling out a urinary retention catheter 4. A patient who had an above-the-knee amputation several days ago and must assume the prone position twice a day

1, 5 (Rationale Option 1: The Nursing Assistant is trained to identify major abnormal or unexpected signs and symptoms and to notify the nurse when they are changed from the patient's baseline; the nurse then completes a professional assessment of the patient's condition. Option 2: It is illegal for the Nursing Assistant to administer drugs, even if under the supervision of the nurse. Option 3: A Nursing Assistant should not be responsible for the supervision of other employees. Option 4: The Nursing Assistant is not prepared for this responsibility. Teaching requires a strong scientific knowledge base and an ability to use scientific teaching/learning principles when planning and implementing an educational plan. Option 5: Nursing Assistants are permitted to distribute meal trays to patients. They just have to verify the patient's name to the name on the menu on the tray.)

Question 14. A nurse is formulating a Nursing Assistant assignment. Which activities should the nurse delegate to the Nursing Assistant? Select all that apply. Course Topic: Leadership and Management Concept(s): Collaboration; Nursing RolesCognitive Level: Application [Applying] 1. Reporting unusual gross symptoms to the nurse 2. Ensuring that patients swallow their medication 3. Orienting a new employee to the unit 4. Teaching patients personal hygiene 5. Distributing meal trays to patients

1 (Rationale Option 1: Effective management depends on careful planning. Planning activities include deciding what is to be done, when to do it, where and how to do it, and who will do it and with what level of assistance. Planning is multifaceted and involves assessment, problem identification, establishment of goals, identifying interventions based on priorities, and how outcomes will be evaluated. Option 2: Getting the work accomplished (directing) is associated with only one step in the management process. Option 3: Sharing expectations, identifying the chain of command, and determining responsibilities (organizing) are associated with only one step in the management process. Option 4: Ensuring that plans are carried out and the outcomes evaluated (controlling) is associated with only one step in the management process.)

Question 14. An accurate assessment drives the rest of the steps of the nursing process. The nurse in charge understands that the management function that drives effective management is: 1. Planning 2. Directing 3. Organizing 4. Controlling

economic climate

The ____ ____ of healthcare is one challenge to being an effective leader and manager: - resources are scarce - resources have alternate uses - individuals want different things or have different preferences Another challenge is the Nursing Labor Market

4 (Rationale Option 1: There is no end to a system. Individual parts of a system are interrelated and the whole system responds in an integrated way to changes within a part. Option 2: Systems do not function in a linear (straight-line) format. Systems are complex. Option 3: Trial and error is unrelated to systems theory. Trial and error is a problem-solving method in which a number of solutions are tried until one is found that solves the problem. Option 4: Systems theory is a cyclical process in which a whole is broken down into parts and the parts are studied individually as well as how they work together within the system. Every system consists of matter, energy, and communication. Because each part of a system is interconnected, the whole system reacts to changes in one of its parts. The concept of treating a patient holistically is based on an understanding of systems theory.)

Question 14. Which is most related to systems theory? 1. End result 2. Linear format 3. Trial and error 4. Cyclical process

4 (Rationale Option 1: Directive is not a classical leadership style. Option 2: This is not an example of the autocratic leadership style. Autocratic leaders give orders and directions and make decisions for the group. There is little freedom and a large degree of control by the leader. Option 3: This is not an example of the democratic leadership style. Democratic leaders encourage discussion and decision making within the group. Option 4: This is an appropriate example of the laissez-faire leadership style. Laissez-faire leaders are nondirective and permissive, which allow for self-regulation, creativity, and autonomy.)

Question 15. A nurse manager is charged with implementing a change in the procedure for discharging patients from the unit. The nurse manager empowers group members to be creative and independent. Which leadership style is being used by the nurse manager? 1. Directive 2. Autocratic 3. Democratic 4. Laissez-faire

1 (Rationale Option 1: The autocratic leadership style is most appropriate in an emergency. Control and responsibility are retained by the leader and decisions are made by the leader. This style is highly efficient and appropriate in an emergency situation in which quick decisions are required. Option 2: The democratic leadership style is not the most appropriate style in an emergency. The leader and subordinates share control and responsibility, and the democratic leadership style is only moderately efficient in emergency situations. Option 3: The laissez-faire leadership style is the least appropriate leadership style in an emergency situation because there is little or no control by anyone. Option 4: Transformational is a leadership theory, not a leadership style. Transformational leaders motivate followers by communicating the importance of their vision, inspiring commitment, and exciting others to participate in achievement of the goal.)

Question 15. A nurse manager of an emergency department of a trauma center receives notification of a domestic terrorist attack in the community and that multiple casualties are en route to the hospital. What leadership style is most appropriate when the nurse manager responds to this event? 1. Autocratic 2. Democratic 3. Laissez-faire 4. Transformational

2, 1, 3 (The first phase is called "unfreezing" and is concerned with identifying the need for change, exploring alternative solutions, and stimulating enthusiasm. The second phase is called "moving/changing" and is concerned with creating actual visible change. The third phase is called "refreezing" and is concerned with providing feedback, encouragement, and constructive criticism to reinforce new behavior.)

Question 15. Lewin's planned change theory progresses through phases. Order these statements by the nurse manager as change moves through the process. 1 "Let's implement a pilot project next week." 2 "This is a new venture that should be exciting." 3 "I know it may be difficult but you are doing a great job."

4 (Rationale Option 1: Patient classification systems are not a nursing-care delivery model based on case management. Patient classification systems are designed to assign an acuity level to patients based on their needs for the purpose of determining the number of nursing care hours required to provide care. Option 2: Diagnostic Related Groups (DRGs) is not a nursing-care delivery model based on case management. Diagnostic Related Groups is a prospective reimbursement plan in which patients are grouped based on medical diagnoses for the purposes of reimbursing the cost of hospitalization. Option 3: Critical pathways are not just a nursing-care delivery model based on case management but are tools used in managed care that are sets of concurrent and sequential actions by nurses as well as other health-care professionals to achieve a specific outcome. They represent specific practice patterns in relation to specific medical populations. Option 4: Primary nursing is a case management approach in which one nurse is responsible for a number of patients 24 hours a day, 7 days a week. It is a way of providing comprehensive, individualized, and consistent nursing care.)

Question 15. What nursing-care delivery model is based on case management? 1. Patient classification system 2. Diagnostic Related Groups 3. Critical pathways 4. Primary nursing

4 (Rationale Option 1: The right place is not one of the Five Rights of Delegation. Option 2: The right route refers to the Five Rights of Medication Administration, not the Five Rights of Delegation. Option 3: Feedback is part of communication, which is one of the Five Rights of Delegation already cited in the stem of the question. Option 4: The one who delegates a task is responsible for ensuring that the task is performed safely and according to standards of practice.)

Question 16. A nurse manager considers that there are "Five Rights of Delegation"—right task, right person, right communication, right time, and right: 1. Place 2. Route 3. Feedback 4. Supervision

4 (Rationale Option 1: Evaluating the performance of a subordinate does not fall under the planning function of management. Planning activities include assessment, problem identification, establishment of goals, planning interventions based on the priority identified, and how outcomes will be evaluated. Option 2: Evaluating the performance of a subordinate does not fall under the directing function of management. Directing activities involve getting the work accomplished and includes activities, such as assigning and communicating tasks and expectations, guiding and teaching, and decision making. Option 3: Evaluating the performance of a subordinate does not fall under the organizing function of management. Organizing activities include sharing expectations, identifying the chain of command, and determining responsibilities. In addition, because the manager is responsible for delegating tasks to subordinates, the manager is responsible for ensuring that policies and procedures clearly describe standards of care and expected outcomes. Option 4: The controlling function of management includes the evaluation of staff members. This is in addition to ensuring that plans are carried out and the outcomes evaluated.)

Question 16. The nurse manager evaluates the performance of a subordinate. Which management function is being implemented by the nurse manager? 1. Planning 2. Directing 3. Organizing 4. Controlling

4 (Rationale Option 1: Assessment of patient needs requires the knowledge and judgment of a registered nurse. This task has great potential for harm if the caregiver incorrectly assesses the patient's condition. In addition, it requires an assessment of numerous systems and risk factors, a complex level of interaction with the patient, problem solving, and innovation in the form of an individually designed plan of care that provides for the patient's safety. Option 2: The skill of evaluation requires the knowledge and judgment of a registered nurse. This task has great potential for harm if the caregiver incorrectly assesses the patient's response. Option 3: The choice of the type of restraint is based on the health-care provider's order. Option 4: Performing range-of-motion exercises is not complex, requires simple problem-solving skills, and employs a simple level of interaction with the patient. It is within the scope of practice of an unlicensed nursing assistant and does not require the more advanced competencies of a registered nurse.)

Question 16. What action associated with restraint use can the nurse delegate to an unlicensed nursing team member? 1. Assessment of a patient's safety needs 2. Evaluation of a patient's response to restraint use 3. Selection of the appropriate type restraint to meet a patient's needs 4. Performance of range-of-motion exercises to a patient's joints after release of a restraint

1 (Rationale Option 1: This is an activity that an unlicensed nursing assistant is capable of performing safely. Collecting urine for a 24-hour creatinine clearance test does not require sterile technique. The collection container is set up by the nurse, and all staff members are instructed to add all of the urine voided by the patient during the 24-hour period to the collection container. Option 2: All activities related to patient teaching are the responsibility of a registered nurse. The registered nurse has the educational background regarding teaching principles and knowledge about the topic being taught and is therefore the qualified person to engage patients in teaching activities, not an unlicensed nursing assistant. Option 3: Only a registered nurse or licensed practical nurse is permitted to place a feeding tube on hold. Option 4: Only a registered nurse or licensed practical nurse is permitted to assist a primary health-care provider with an invasive procedure. An unlicensed nursing assistant does not have the educational foundation to assist other health-care providers with an invasive procedure.)

Question 16. Which activity is appropriate for an unlicensed nursing assistant to implement? 1. Collecting urine for a 24-hour creatinine clearance test 2. Giving an obese patient a brochure on an 1,800-calorie diet 3. Placing a tube feeding pump on hold while bathing a patient 4. Helping with the insertion of a nasogastric tube by a primary health-care provider

4 (Rationale Option 1: Directive is not one of the four classic leadership styles. Option 2: The autocratic leadership style is probably the least effective style to use with a professionally mature and motivated staff. Autocratic leaders give orders and directions and make decisions for the group. There is little freedom and a large degree of control by the leader, which frustrates motivated and professionally mature staff members. Option 3: The democratic leadership style is the second best style to use when the staff is motivated and professionally mature. The democratic style offers fewer opportunities for autonomy for staff members who are mature and motivated than a leadership style in another option. Option 4: The laissez-faire leadership style is appropriate for a group of individuals who have an internal locus of control and desire autonomy and independence. Individuals who are professionally mature and motivated more often have an internal locus of control.)

Question 17. A group of nurses on a unit are personally and professionally mature and motivated. Which leadership style should the nurse manager employ when working with this group? 1. Directive 2. Autocratic 3. Democratic 4. Laissez-faire

2, 4 (Rationale Option 1: Evaluating vital signs requires professional nursing judgment. The nurse is educationally prepared to determine the significance of vital sign measurements, not the Nursing Assistant. Option 2: Making occupied and unoccupied beds is within the role of Nursing Assistants. Nursing Assistants are taught to perform this activity safely. Option 3: It is not legal for a Nursing Assistant to monitor tube feedings; this action is within the legal practice of a licensed nurse. Option 4: Nursing Assistants are trained to provide basic hygiene measures under the direction of a nurse. Option 5: Nurses should ambulate postoperative patients for the first time after surgery; nurses have the knowledge to analyze a patient's response to ambulating)

Question 17. A nurse is planning to delegate patient care to a Nursing Assistant. Which are appropriate activities for a Nursing Assistant? Select all that apply. 1. Evaluating vital signs 2. Making occupied beds 3. Monitoring tube feedings 4. Providing patients with physical hygiene 5. Assisting postoperative patients with their first ambulation

2 (Rationale Option 1: Offering an incentive, such as an increase in pay or a promotion, reflects the power of a reward. Option 2: The power of coercion is used when a negative consequence is used as a threat or an incentive to influence behavior. Option 3: The power of expertise results from knowledge and proficiency exhibited by a qualified, proficient individual. Option 4: The power of competence is related to ability, capability, and proficiency; it does not involve identifying consequences or making threats.)

Question 17. A staff nurse is counseled by the nurse manager regarding excessive time taken for lunch and breaks. The nurse manager indicates that if this behavior continues then the nurse will receive an undesirable performance evaluation. What type of power did the nurse manager exhibit? 1. Reward 2. Coercion 3. Expertise 4. Competence

1 (Rationale Option 1: This statement is associated with the concept of authority. Managers have the authority to direct the work of others based on the power associated with a title. Option 2: This statement is associated with the concept of accountability. Option 3: This statement is associated with the concept of responsibility. Option 4: This statement is associated with the concept of accountability.)

Question 17. Which of the following is most related to the statement, "Managers have authority in the workplace"? 1. Managers have the power to direct the work of others. 2. Managers are expected to maintain personal ethical integrity. 3. Managers assume the obligation to accomplish tasks associated with the job description. 4. Managers assume liability for the consequences of ones' actions as well as those of subordinates.

leadership

The essence of _____ is the ability to influence other people.

1, 2, 3 (Rationale Option 1: Managers who support Theory X management principles believe that continuous supervision and evaluation produce productive workers. Option 2: Managers who support Theory X management principles believe that firm rules and regulations ensure that people will conform to the culture of the organization. Option 3: Managers who support Theory X management principles believe that the fear of negative consequences produces effective workers. Option 4: Managers who support Theory Y management principles believe that guidance and support provide an atmosphere that produces effective workers. Option 5: Managers who support Theory Y management principles believe that assistance and mutual respect produce productive workers.)

Question 18. A nurse manager believes in Theory X human relations-oriented management. What behavior can a newly hired nurse expect the nurse manager to exhibit? Select all that apply. 1. Describing the continuous evaluation of nursing performance 2. Explaining the agency's policies regarding the use of sick days 3. Informing the nurse of the consequences for being late to work 4. Ensuring the nurse that an orientation program will provide guidance 5. Directing the nurse to seek assistance from another nurse when necessary

4 (Rationale Option 1: A nursing assistant is capable of assisting a patient with a urinary retention catheter with activities of daily living; however, the registered nurse is responsible for those interventions, which exceed the role of a nursing assistant (e.g., assessing color, volume, clarity of urine output). Option 2: A nursing assistant is capable of assisting a patient with a failure to thrive with activities of daily living. Option 3: A nursing assistant is capable of assisting a confused and disoriented patient with activities of daily living. Option 4: The registered nurse should always assist postoperative patients to ambulate for the first time after surgery. The nurse draws on knowledge and experience to evaluate the patient's response to the activity and to react appropriately. Patient evaluation is within the scope of practice of the registered nurse.)

Question 18. A nurse manager is making patient assignments for a nursing team that consists of one registered nurse and two nursing assistants. Which patient should the charge nurse assign to the registered nurse? 1. A patient with a urinary retention catheter 2. A patient who is on bedrest because of failure to thrive 3. A patient who is confused and disoriented to time and place 4. A patient with abdominal surgery who is reluctant to walk for the first time

1 (Rationale Option 1: A nurse manager must engage in evaluation activities when determining if organizational goals are being met. Current outcomes must be compared to desired outcomes. When a problem occurs, it should be explored to determine if it is an isolated event or if it has occurred before. Problems that reoccur must be addressed to prevent continuation of the problem. Option 2: Planning occurs earlier in the management process. Effective planning should result in the attainment of organizational goals. Option 3: The development of strategies to achieve objectives occurs earlier in the management process. Effective strategies should result in the attainment of organizational goals. Option 4: Although sharing this information with colleagues promotes collaboration, it does not evaluate whether organizational goals are being met.)

Question 18. A nurse manager of a patient care unit is determining if the nursing team members of the unit are meeting organizational goals. What should the nurse manager do first? 1. Identify trends that indicate a problem. 2. Plan approaches to meet patient needs. 3. Develop strategies to achieve objectives. 4. Share the purpose of the unit with colleagues.

1 (Rationale Option 1: A task of this complexity requires the knowledge and judgment of a registered nurse. This task has great potential for harm if the caregiver misassesses the patient's condition. It requires an assessment of numerous systems and risk factors, a complex level of interaction with the patient, and problem-solving abilities. In addition, it requires innovation in the form of an individually designed plan of care that addresses protecting the patient's skin. Option 2: Providing a bed bath for a patient with hemiparesis is not a complex task, requires simple problem-solving skills, involves a predictable outcome, and employs a simple level of interaction with the patient. Although this task has the potential to cause harm if the critical elements of the skill are not implemented, it is within the scope of practice of an unlicensed nursing assistant. It does not require the more advanced competencies of a registered nurse. Option 3: Offering apple juice to a patient on a clear liquid diet is not a complex task, has little potential for harm, requires only simple problem-solving skills, involves a predictable outcome, employs a simple level of interaction with the patient, and is within the scope of practice of an unlicensed nursing assistant. It does not require the more advanced competencies of a registered nurse. Option 4: Measuring the urinary output of a patient after surgery is not a complex task, has little potential for harm, requires simple problem-solving skills, employs a simple level of interaction with the patient, and is within the scope of practice of an unlicensed nursing assistant. It does not require the more advanced competencies of a registered nurse.)

Question 18. Which intervention should the registered nurse perform rather than delegate to an unlicensed nursing assistant? 1. Assessing the skin of a newly admitted patient 2. Providing a bed bath for a patient with hemiparesis 3. Offering apple juice to a patient on a clear liquid diet 4. Measuring the urinary output of a patient after surgery

3 (Rationale Option 1: An older adult postoperative client who has uncontrolled pain requires frequent assessment by the RN, and care of this client cannot be delegated to a licensed practical nurse. Option 2: A child who has a temperature of 103.5°F (39.7°C) requires frequent assessment by the RN, and care of this client cannot be delegated to a licensed practical nurse. Option 3: It is most appropriate for the RN to delegate care of a client with dehydration to a licensed practical nurse because this client is the most stable and does not require frequent monitoring, evaluation, and planning of care. Option 4: A client who is receiving an IV insulin drip for diabetic ketoacidosis requires frequent assessment by the RN, and care of this client cannot be delegated to a licensed practical nurse. IV insulin is a high-alert drug that can be administered only by licensed health-care providers (health-care providers, nurse practitioners, and health-care provider assistants) and RNs.)

Question 19. A registered nurse (RN) is planning care for several clients. Which client would be most appropriate for the RN to delegate to a licensed practical nurse? 1. An older adult postoperative client who has uncontrolled pain 2. A child who has a temperature of 103.5°F (39.7°C) 3. A client who is receiving IV fluids for dehydration 4. A client who is receiving an IV insulin drip for diabetic ketoacidosis

2 (Rationale Option 1: Both leaders and managers must be able to think critically to function effectively in their respective positions. Option 2: Nurse managers usually are required to participate in the preparation of a budget or manage the finances of a unit within an agency. Option 3: Both leaders and managers must communicate and collaborate with other members of the health team. Option 4: Both leaders and managers must demonstrate competence to earn the respect of others; this is known as the power of expertise.)

Question 19. An upper-level manager is assessing the qualities of several nurses who demonstrate leadership abilities for a promotion to a first-level management position. Which ability is required of a nurse manager that is not a necessity for a leader? 1. Thinks critically 2. Understands budgets 3. Collaborates effectively 4. Demonstrates competence

coercion

The threat of pain or harm, which may be physical, economic or psychological.

2 (Rationale Option 1: Taking the vital signs of all the patients on the unit at the same time is called functional nursing and is unrelated to the adage in the question. Option 2: This action is an appropriate example of the adage, "A stitch in time saves nine." It means that if you sew a tear when it is small, you need fewer stitches and time to repair it than when it is large. The same adage can be applied to the collection of equipment before a procedure. If the nurse has all the equipment that is needed before beginning a procedure, less time is used than when forgotten equipment is obtained later. Every time the nurse leaves the room for forgotten equipment, the patient is inconvenienced and time is wasted. Option 3: Delegation is related to the efficient use of staff and is unrelated to the adage in the question. Option 4: This example is unrelated to the adage in the question.)

Question 19. Which situation is most reflective of the saying, "A stitch in time saves nine?" 1. Obtaining the vital signs for the patients on the unit at the same time 2. Collecting equipment for a procedure before entering the room 3. Delegating some interventions to the Licensed Practical Nurse 4. Documenting the nursing care given every few hours

1, 2, 3 (Rationale Option 1: A nurse manager is responsible for the quality of care delivered by the members of the nursing team working in the areas assigned to the nurse coordinator. Option 2: A nurse manger is responsible for making decisions regarding allocation of resources within the assigned budget. Option 3: Case managers are responsible for ensuing continuity of care for patients transitioning back to the community setting with assistance from community resources Option 4: Nurse managers and case managers both are responsible for ensuring that patient needs are met in a timely manner within their own area of responsibility. Option 5: Although a nurse manager ensures that the patient's needs are met within the acute care facility, it is the case manager's responsibility to ensure that a patient's needs are met through the entire health-care system.)

Question 2. A nurse is promoted to the role of nurse manager. Which activities can the nurse expect to be included in this new job description that are not included in the role of case manager? Select all that apply. 1. Evaluating the quality of nursing care delivered 2. Making decisions regarding allocation of resources 3. Ensuring continuity of care with community resources 4. Ensuring that patient needs are met in a timely manner 5. Overseeing a patient's progress through the health-care system

3 (Rationale Option 1: The nurse manager can provide negative feedback in a manner that is firm without being assertive. Not yielding under pressure (firm) is less confrontational than being confident in a persistent way (assertive). Option 2: When providing negative feedback, the exploration of alternative solutions is performed later in the counseling session. Option 3: Problem recognition is the first step in the problem-solving process. Once the unacceptable behavior is identified and acknowledged, then the reasons for the problem can be explored, solutions suggested, and expectations reinforced. Option 4: Although this should be done, it is not feedback. Feedback is necessary for the nurse to recognize one's offending behavior. In addition, documentation is the last, not the first, step in the counseling process.)

Question 2. A nurse manager plans to provide feedback to a subordinate who needs a change in behavior. What is the best intervention by the nurse manager? Course Topic: Leadership and Management Concept(s): Collaboration; ManagementCognitive Level: Application [Applying] 1. Be assertive 2. Explore alternatives 3. Identify the unacceptable behavior 4. Document the content of the counseling session

2 (Rationale Option 1: It is the patient care aide who is late and takes extensive lunch breaks who needs to review the responsibilities related to time, not the patient care aides who follow the rules. Option 2: Recognition of a problem is the first step in the problem-solving process. Once the unacceptable behavior is identified and acknowledged, then the reasons for the problem can be explored, solutions suggested, and expectations reinforced. Option 3: It is not the responsibility of others to confront the employee who is late for work and takes extensive lunch breaks. The employee reports to the nurse manager who is superior in the chain of command of the organization. The nurse manager should meet with the employee. In addition, counseling sessions with employees should be confidential and conducted in private. Option 4: This is premature. The nurse manager first needs to implement an action identified in another option.)

Question 2. Several nurses complain to the nurse manager that one of the patient care aides constantly takes extensive lunch breaks. What should the nurse manager do? 1. Convene a group meeting of all the patient care aides to review their responsibilities related to time management 2. Talk with the patient care aide to explore the reasons for the behavior and review expectations 3. Arrange a meeting with the nurses so that they can confront the patient care aide as a group 4. Document the patient care aide's behavior and place it in the aide's personnel file

1 (Rationale Option 1: Change that is consistent with current values and beliefs is easier to implement than change that is inconsistent with current values and beliefs. Values and beliefs are difficult to change. Option 2: This is not the priority intervention. Although incentives might motivate some individuals, it does not motivate all because some people have an internal rather than an external locus of control. Option 3: Although small steps are more effective than large steps because they are easier to achieve and once achieved are motivating, this approach is not the first thing the nurse should do to overcome resistance to change. Option 4: Although one person sharing explanations with another (informational power) is helpful when trying to change behavior, it is not the most effective type of power to use when trying to effect change. Another option identifies an action that the nurse should do first.)

Question 2. What should the manager do first to overcome resistance to change? 1. Ensure that the planned change is within the current beliefs and values of the group 2. Provide incentives to encourage commitment to the change 3. Implement change in small steps rather than large steps 4. Use informational power to ensure that goals are met

4 (Rationale Option 1: Counseling subordinates who fail to meet expectations is not the best example of role modeling from among the options offered. Option 2: Holding team meetings to review rules of the agency is not the best example of role modeling from among the options offered. Option 3: Reviewing job descriptions with employees is not the best example of role modeling from among the options offered. Option 4: When the nurse manager follows policies and procedures, the manager is demonstrating the behavior that is expected. Role modeling is more effective than telling as a teaching strategy.)

Question 3. What activities does a nurse manager engage in who values the importance of positive role modeling? 1. Counseling subordinates who fail to meet expectations 2. Holding team meetings to review rules of the agency 3. Reviewing job descriptions with employees 4. Following the policies of the agency

1 (Rationale Option 1: This is essential to overcome resistance to change. There are many different reasons people resist change. Each person will respond to different strategies. There are four different types of interventions to overcome resistance: providing information, disproving currently held beliefs, maintaining psychological safety, and administrating an order or command. Option 2: Although it is important to state the purpose of the change clearly and concisely, another option is a more important action that can be implemented by the nurse manager to overcome resistance to change. Option 3: Modifying a goal compromises the integrity of the planned change. All ramifications associated with the change should be explored before beginning and all contingencies planned for so that modifying a goal will be unnecessary. Option 4: Although emphasizing the positive consequences of the change might be done, another option is a more important action that can be implemented by the nurse manager to overcome resistance to change.)

Question 20. A nurse manager is experiencing staff resistance when implementing change. What is the most important action by the nurse manager to overcome resistance to change? Course Topic: Leadership and Management Concept(s): Collaboration; ManagementCognitive Level: Application [Applying] 1. Identify the reason for the resistance 2. Restate the purpose of the change concisely 3. Modify the objectives to appeal to more key people 4. Emphasize the positive consequences of the change

4 (Rationale Option 1: Although this may be planned, it is not the priority. Incentives may motivate people with an external locus of control but not staff members with an internal locus of control. Option 2: Although this may be planned because the achievement of small steps is motivating, it is not the priority. Option 3: This is the use of the power of authority and even a veiled threat via the use of the power of coercion. It may be perceived that an undesirable performance evaluation would ensue if the staff member resisted the change. Option 4: Change that is harmonious with beliefs and ethics is easier to implement than when not harmonious with beliefs and ethics. Change is difficult to implement when it is not consistent with the beliefs and ethics of staff members.)

Question 20. A nurse manager is planning to implement a change in how administered medications are documented. What is most important for the nurse manager to do to avoid resistance to change? 1. Incorporate incentives to promote a commitment. 2. Establish multiple short-term goals to promote motivation. 3. Convey to the staff that administration is committed to the new policy and procedure. 4. Ensure that the new policy and procedure is consistent with the beliefs and ethics of staff members.

2 (Rationale Option 1: This response suggests an intervention before collecting enough information to make an informed decision. Option 2: Conflict resolution is best approached by having all the involved people together and discussing the issues. This approach allows each person to explain a personal point of view as well as gain insight into another's point of view. Suggestions from both perspectives will help achieve a win-win resolution. Option 3: This response denies the night nurse's concerns. Option 4: The night nurse's response to this statement may be an action that is inappropriate or impossible to implement. The nurse manager should take the initiative and intervene appropriately from an objective perspective.)

Question 20. A nurse on the night shift is frustrated with the nurse on the day shift because the day nurse often does not complete patient care, leaving extra work for the night staff. The night nurse tells the nurse manager that intravenous bags are left with less than 100 mL of fluid, urinary collection devices are not emptied, patient teaching has not been performed, and medication drawers do not always contain required medications. What is the nurse manager's best response? 1. "Are there tasks you can delegate to the nursing assistant assigned to work with you?" 2. "I will arrange a meeting for the three of us so that we can discuss these issues." 3. "We are team members and we should all extend ourselves to help each other." 4. "What would you like me to do to help resolve these problems?"

2 (Rationale Option 1: The word sharing is associated with the democratic, not autocratic, leadership style. The democratic leadership style fosters two-way communication and input from others and creates a spirit of teamwork that results in staff satisfaction. Option 2: The word dictatorial means domineering and is associated with the autocratic leadership style. Autocratic leaders use directive and controlling behavior and make decisions alone, without input from others. Option 3: The word participative is associated with the democratic, not autocratic, leadership style. The democratic leadership style fosters two-way communication and input from others and creates a spirit of teamwork that results in staff satisfaction. Option 4: The word collaborative is associated with the democratic, not autocratic, leadership style. The democratic leadership style fosters two-way communication and input from others and creates a spirit of teamwork that results in staff satisfaction.)

Question 20. When considering leadership styles, "democratic" leadership is to "consultative" as an "autocratic" leadership is to: 1. sharing. 2. dictatorial. 3. participative. 4. collaborative.

3 (Rationale Option 1: The nurse coordinator is not using the power of reward. The power of reward is based on incentives to influence others, such as a pay increase. Option 2: The nurse coordinator is not using coercive power. Coercive power is based on retribution or the fear of the punitive withholding of a reward. Option 3: The nurse coordinator is using the power of expertise, which is based on the respect one receives because of advanced education, ability, skills, knowledge, and experience. A nurse coordinator is a middle-level manager who has ascended the ranks from a staff nurse to first-level manager (e.g., team leader, charge nurse), to a unit-level manager (e.g., nurse manager), to a middle-level manager (e.g., supervisor, nurse coordinator). Option 4: Although the nurse coordinator has authority over the new nurse manager, the power of authority is not being used by the nurse coordinator when functioning as a mentor.)

Question 3. A nurse coordinator is orienting a new manager to the responsibilities associated with scheduling staffing and managing a budget. Which type of power is most associated when a nurse coordinator functions as a mentor in this situation? 1. Reward 2. Coercive 3. Expertise 4. Authority

1 (Rationale Option 1: This is one of the most important actions by the nurse seeking a new position. The job description provides an overview of the requirements and responsibilities of the role. Job descriptions include factors such as educational and experiential requirements, job responsibilities, subordinates to be supervised, and to whom one reports in the chain of command. Option 2: Requesting references protects the hiring agency, not the nurse. This is not the most important thing the nurse should do when applying for a new position within an agency. Option 3: Although understanding the power of the position may help a person meet the responsibilities associated with the job description, it is not the priority when applying for a new position. Option 4: Although it is important to recognize where the new position fits into the organization's Table of Organization, it is not the priority when applying for a new position. A Table of Organization schematically plots the reporting relationship of every position within the organization.)

Question 3. What is the first thing the nurse should do when planning to apply for a new position within an agency? 1. Review the job description 2. Provide at least several positive references 3. Identify if power is associated with the position 4. Locate the position on the agency's Table of Organization

1 (Rationale Option 1: Strong communication skills are an essential competency of a nurse manager. Research demonstrates that 80% to 90% of a manager's day is spent communicating verbally and in writing. Managers need to express their thoughts clearly, concisely, and accurately. Option 2: Although confrontation may be used occasionally, it can be learned as one socializes into the role of nurse manager and is not as important as a competency identified in another option. Option 3: Although knowledge of the role of change agent is important, it can be learned as one socializes into the role of nurse manager and is not as important as a competency identified in another option. Option 4: Recognition by peers as a leader is not as important as a competency identified in another option. A person generally is promoted to a management position because upper management recognizes leadership qualities. As a nurse manager grows into the role, peers will recognize the leadership ability of the nurse manager.)

Question 3. Which is most basic for a nurse new to a management position? 1. Strong interpersonal communication skills 2. Awareness of when to be confrontational 3. Knowledge of the role of a change agent 4. Recognition by peers as a leader

4 (Rationale Option 1: An incident report is not the appropriate format to document this event. Incident reports are used to document unusual events associated with the performance of health-care activities and includes events such as falls, medication or treatment errors or omissions, and any situation that causes an injury to a patient, visitor, or staff member. Option 2: The nurse's lateness should not be ignored because it is the second time it has happened. Option 3: This is too long a time to wait to address the nurse's lateness. Option 4: The nurse's behavior needs to be addressed by the nurse manager and the expected behavior reinforced. Counseling sessions with employees should be confidential and conducted in private as soon as possible after the offending event.)

Question 4. A nurse arrives on the unit during the last 5 minutes of a 20-minute change-of-shift report for the second time within a week. How should the nurse in charge handle this situation? Course Topic: Leadership and Management Concept(s): Collaboration; Communication; ManagementCognitive Level: Application [Applying] 1. Document the lateness in an incident report. 2. Ignore the lateness but intervene if it should happen again. 3. Include the lateness in the nurse's yearly performance evaluation. 4. Discuss the lateness with the nurse in private immediately after the report.

3 (Rationale Option 1: Focusing on negative consequences as a form of motivation to adhere to policies and procedures is a component of the Theory X human relations-oriented management style. Option 2: Constant supervision of staff members is a component of the Theory X human relations-oriented management style. Option 3: This intervention is associated with the Theory Y human relations-oriented management style. This management style is concerned with support, guidance, and assistance as being integral to promoting effective, productive staff members. Option 4: This intervention is associated with the Theory X human relations-oriented management style. Test Taking Tip: Identify the unique option. Option 3 is unique; it is the only option that is not autocratic.)

Question 4. A nurse manager endorses the Theory Y human relations-oriented management style. What intervention by the nurse manager reflects this style of leadership? 1. Reviewing periodically the consequences for not adhering to the steps listed in an activity in the procedure manual 2. Explaining that an interim performance evaluation may be necessary if standards of care are not maintained 3. Offering help when a nurse is overwhelmed with work at the end of a shift 4. Ensuring that staff members adhere to policies established by the agency

2 (Rationale Option 1: This is not an example of the planning function of management. Planning involves assessment, problem identification, establishment of goals, designing interventions based on the priority identified, and how outcomes will be evaluated. Option 2: This is an example of the directing function of management. Directing involves getting the work accomplished and includes activities such as assigning and communicating tasks and expectations, guiding and teaching, and decision making. Option 3: This is not an example of the organizing function of management. Organizing activities include sharing expectations, identifying the chain of command, and determining responsibilities. In addition, because the manager is responsible for delegating tasks to subordinates, the manager is responsible for ensuring that policies and procedures clearly describe standards of care and expected outcomes. Option 4: This is not an example of the controlling function of management. Controlling activities ensure that plans are carried out and the outcomes and staff are evaluated.)

Question 4. A supervisor communicates expectations about a task to be completed and then delegates the task. Which management function is being implemented by the supervisor? 1. Planning 2. Directing 3. Organizing 4. Controlling

3 (Rationale Option 1: This may not be possible depending on the needs of patients. Option 2: Patient needs are the priority, not the convenience, of the nurse. Option 3: Legally required activities must be accomplished because they are dependent functions that support the medical regimen of care. Although legally required activities should be accomplished first, many independent actions by the nurse also must be implemented to maintain a basic standard of care and patient safety. Some nursing interventions, which are not essential, can be implemented after the required activities. Option 4: This may not be possible depending on the needs of patients.)

Question 9. What should the nurse do to ensure efficiency when managing a daily assignment? 1. Give care to a patient in isolation first 2. Plan activities to promote nursing convenience 3. Organize care around legally required activities 4. Perform routine bed baths between breakfast and lunch

2 (Rationale Option 1: Providing just a verbal description is unsafe. This does not ensure that cognitive information can be converted to a psychomotor skill. Option 2: Demonstration is the safest way to assess whether a person has the knowledge and skill to safely perform a procedure. A superior delegating care is responsible for ensuring that the person implementing the care is legally qualified and competent. Option 3: A peer should not be held responsible for the care assigned to another team member. The Registered Nurse who delegates a procedure to a subordinate is directly responsible for ensuring that the care is safely delivered to patients. Option 4: This intervention does not address the original Licensed Practical Nurse's need to know how to perform the procedure safely. This procedure is within the legal scope of practice of a Licensed Practical Nurse.)

Question 4. The nursing team leader delegates a wound irrigation to a Licensed Practical Nurse (LPN). It has been a long time since the LPN performed this procedure. To ensure patient safety the nursing team leader should: 1. Verbally describe to the LPN how to perform the procedure 2. Have the LPN demonstrate how to perform the procedure 3. Assign another LPN to assist with the procedure 4. Delegate the procedure to another LPN

1 (Rationale Option 1: This is an appropriate example of the autocratic leadership style. Autocratic leaders make the decisions for the group. Option 2: This is not an example of the democratic leadership style. Democratic leaders encourage group discussion and decision making. Option 3: This is not an example of the bureaucratic style of leadership. The bureaucratic leader relies on policies, procedures, and rules to direct the decision-making process. Option 4: This is not an example of the laissez-faire leadership style. The laissez-faire leader assumes a hands-off permissive approach, which allows for self-regulation.)

Question 5. A nurse identifies that a postoperative patient is hemorrhaging. The nurse directs another nurse to immediately call the surgical resident and sends a nurse aide to gather specific equipment from the clean utility room and then proceeds to implement measures to stem the bleeding. Which style of leadership did the nurse use in this situation? 1. Autocratic 2. Democratic 3. Bureaucratic 4. Laissez-faire

3, 4 (Rationale Option 1: Although nursing assistants can be self-directed within their role, nursing assistants must work under the direct supervision of a nurse. Option 2: Nursing assistance can refuse to perform tasks that are outside the parameters of their role and job responsibilities. Option 3: Nursing assistants are members of the health team, specifically the nursing team. Health team members provide or assist other team members to provide care to patients. Option 4: Nursing assistants should perform only those tasks that are within the nursing assistant role, that have been learned, and that have been assigned. The responsibilities and job description of the nursing assistant must be clear to all members of the health team. Option 5: Health team members must have a professional relationship with mutual respect; they do not have to be friends.)

Question 5. A nurse makes a work assignment for a nursing assistant at the beginning of a shift. What are acceptable expectations regarding the functioning of a nursing assistant? Select all that apply. 1. Works without supervision 2. Completes everything assigned 3. Acts as a member of the health team 4. Performs within the role of the nursing assistant 5. Becomes friends with other health team members

4 (Rationale Option 1: The nurse manager is responsible for taking the initiative. The nurse manager should collect information, identify the problem, and implement an appropriate response. The night nurse's response to this statement may be an action that is inappropriate or impossible to implement. Option 2: This response suggests an intervention before collecting enough information to make an informed decision. Option 3: This response denies the night nurse's feelings and concerns. Option 4: Conflict resolution is best approached by having the individuals involved discuss the concerns. This approach allows each person to explain a personal point of view as well as gain insight into the other person's point of view. Suggestions from both perspectives will help achieve a win-win resolution.)

Question 5. A nurse on the day shift is annoyed with the nurse on the night shift and reports concerns to the nurse manager. The day nurse states that the night nurse often does not complete patient assignments or provide for needed supplies, such as medication draws that are missing the next dose of medication, supplies that are not stocked for isolation rooms, and specimens that are not collected. What is the nurse manager's best response? Course Topic: Leadership and Management Concept(s): Collaboration; Communication; ManagementCognitive Level: Application [Applying] 1. "What do you think I should do to correct these problems?" 2. "Which of these jobs can you assign to the nursing assistant on your team?" 3. "Working nights is difficult, so do you think you can help the night shift staff when you can?" 4. "When are you available so that I can arrange a meeting for the three of us to discuss these concerns?"

2, 3 (Rationale Option 1: Taking routine vital signs is not complex, has little potential for harm, requires only simple problem-solving skills, involves a simple level of interaction with the patient, and is within the scope of practice of an unlicensed nursing assistant. It requires the more advanced competencies of a Registered Nurse only when previous vital signs have been outside the expected range. Option 2: Discharge teaching requires the knowledge and judgment of a Registered Nurse. It requires synthesizing and summarizing information as well as coordinating a variety of community health-care services to meet patient needs. Option 3: Evaluation requires the knowledge and judgment of a Registered Nurse. The skill of evaluation requires reassessing, synthesizing and analyzing data, determining significance of data, and diagnosing and responding to the data. In addition, it involves an unpredictable outcome and requires problem solving that may call for innovation in the form of an individually designed plan of care to address the patient's need for pain relief if pain is still being experienced. Option 4: Administering an enema is not a complex task. It requires simple problem-solving skills, involves a predictable outcome, and employs a simple level of interaction with the patient. Although this task has the potential to cause harm if the critical elements of the skill are not implemented, it is within the scope of practice of an unlicensed nursing assistant. It does not require the more advanced competencies of a Registered Nurse. Option 5: Transporting a patient is not a complex task. It requires simple problem-solving skills and involves a predictable outcome and a simple level of interaction with the patient. Although this task has the potential to cause harm if the critical elements of the skill are not implemented, it is within the scope of practice of an unlicensed nursing assistant. It does not require the more advanced competencies of a Registered Nurse.)

Question 5. Which tasks should be delegated to a Registered Nurse? Select all that apply. 1. Obtaining vital signs 2. Providing discharge teaching 3. Evaluating a patient's response to morphine 4. Administering a cleansing enema to a patient 5. Transporting a patient to the operating room for surgery

2 (Rationale Option 1: Although repeating the nurse's message is an invitation to respond, the nurse could respond with a yes or no answer that would close communication. Option 2: This response encourages the nurse to elaborate on the statement, "This new schedule is ridiculous." It sends the message that the nurse manager is interested in the nurse's thoughts and feelings. Option 3: This response is confrontational and accuses the nurse of being judgmental. This response will cut off communication. Option 4: Although the first part of the statement is an attempt to validate feelings, the second part of the statement is confrontational because it implies that the nurse is being negative; this may shut off communication.)

Question 6. A new float rotation schedule is to be implemented in the hospital. A staff nurse, in an exasperated tone, says to the nurse manager, "This new schedule is ridiculous." What is the nurse manager's best response? 1. "Do you really think that the schedule is unreasonable?" 2. "Share with me your concerns about this new schedule." 3. "You need to work with the new schedule a little before being judgmental." 4. "I know that you are upset with the new schedule, but try to be more positive."

2, 3, 4, 5 (Rationale Option 1: This can be viewed by staff members as a threat. Option 2: Communication, information, and participation are essential precursors to change. An increase in knowledge and time to process the information may promote a willingness to participate in the change with a positive attitude. Option 3: Verbalization of concerns and feelings allows issues to be discussed with mutual respect. New information can be provided and misinformation corrected. In addition, feelings can be validated. Option 4: Organizational goals should be shared and clarified with the staff involved with the change. An organization committed to a change should provide the physical, emotional, and financial support necessary to successfully achieve the change. Option 5: This fact provides a sense of security and may lower resistance to change)

Question 6. A nurse manager of an emergency department identifies that a more efficient triage process is necessary. What should the nurse manager do to limit resistance to this change? Select all that apply. 1. Offer to transfer staff members to another unit if they do not support the new policies. 2. Allow adequate time for understanding the change before implementing the change. 3. Provide a nonjudgmental climate for people to voice their concerns. 4. Explain that the organization is committed to this change. 5. Assure participants that they will not lose their jobs.

3 (Rationale Option 1: Exploring possible alternative solutions occurs before achieving a consensus. A consensus is achieved when all, or most, agree or have the same opinion. Option 2: Consensus, not flexibility, is the goal. However, some members of the group may be flexible and change their opinion to ensure the achievement of a consensus. Option 3: Cooperation and teamwork are essential for the achievement of any goal. If a consensus is achieved about the value of the expected outcome, people are more likely to work together constructively. Option 4: Autocratic decision making does not seek a consensus when making a decision within a group. Autocratic leaders give orders and directions and make decisions for the group. There is little freedom within the group.)

Question 6. What is the main reason the nurse manager achieves a consensus when making a decision within a group? 1. Explore possible alternative solutions 2. Demonstrate that staff members are flexible 3. Facilitate cooperative effort toward goal achievement 4. Ensure the use of effective autocratic decision making

1, 3 (Rationale Option 1: Ambulation of a patient requires a health-care provider's order. Patient activity (e.g., bed rest, out of bed to chair, out of bed) is a dependent function of a nurse. Option 2: Documenting nursing care is an independent function of the nurse and does not require a health-care provider's order. Option 3: Dependent activities of the nurse are those activities that require a health-care provider's order; changing a sterile dressing requires a health-care provider's order. Option 4: In an emergency, the nurse may administer oxygen to a patient experiencing acute shortness of breath until a health-care provider's order is obtained. Option 5: Selecting among choices of foods offered within a diet is an interdependent function; however, the type of diet is a dependent function.)

Question 6. Which activities are dependent functions of the nurse? Select all that apply. 1. Ambulating a patient down the hall 2. Documenting perioperative nursing care 3. Changing a sterile dressing that is soiled 4. Providing oxygen for acute shortness of breath 5. Assisting with selection of choices on the menu

2 (Rationale Option 1: An elevated temperature after an ectopic pregnancy may indicate peritonitis, which can be life-threatening. This patient should be cared for by a nurse more experienced than a new graduate. Option 2: This patient is less likely to experience a life-threatening complication than the possible complications associated with the other patient situations. The other patients require more critical assessments that a more experienced nurse with a broader knowledge base and experiential background can draw upon when diagnosing, planning, and implementing nursing care. Option 3: A patient who sustained multiple traumatic injuries may experience any number of serious life-threatening complicationsas a result of the fractured femur, including hemorrhage, fat emboli, or neurovascular deficits. This patient should be cared for by a nurse more experienced than a new graduate. Option 4: A patient who may be hemorrhaging should be cared for by a nurse more experienced than a new graduate. Also, the patient's continuous bladder irrigation flow rate should be managed so that clotting and tube obstruction are avoided.)

Question 7. A charge nurse is delegating assignments to staff members working on a surgical unit. Which patient should be assigned to a recently registered nurse rather than an experienced registered nurse? 1. A woman with an elevated temperature after surgery for an ectopic pregnancy 2. A middle-age patient who had elective surgery for repair of an abdominal hernia 3. A young adult who had a fractured femur as well as multiple soft-tissue injuries from an automobile collision 4. An older adult male who had a transurethral resection of the prostate who has cherry red drainage from the continuous bladder irrigation

4 (Rationale Option 1: This is not an example of a management activity related to planning. Planning is associated with the development of goals, objectives, and/or outcomes and determining strategies that are most likely to achieve organizational goals. Option 2: This is not an example of a management activity related to directing. Directing is associated with motivating, guiding, and leading staff members in meeting organizational goals. Option 3: This is not an example of a management activity related to organizing. Organizing is associated with obtaining and managing human and economic resources to meet desired clinical and financial goals. Option 4: This is an example of a management activity related to controlling. Controlling is associated with using outcome criteria to measure the effectiveness in goal achievement, ensuring ongoing evaluation, and implementing corrective actions when necessary.)

Question 7. A nurse manager implements a corrective action plan when a unit goal is not achieved. Which management function is being implemented by the nurse manager? 1. Planning 2. Directing 3. Organizing 4. Controlling

2 (Rationale Option 1: Teaching requires the knowledge and judgment of a Registered Nurse. Teaching requires a complex level of interaction with the patient, problem solving, and innovation in the form of an individually designed teaching plan of care that addresses the specific learning needs of the patient. In addition, the outcome is unpredictable and it has the potential to cause harm if the skill is taught incorrectly. Option 2: Obtaining vital signs can be delegated to a nursing assistant because it is not a complex task. It requires simple problem-solving skills and a simple level of interaction with the patient. Although this task has the potential to cause harm if the critical elements of the skill are not implemented appropriately, it is within the scope of practice of an unlicensed nursing assistant. It does not require the more advanced competencies of a Registered Nurse. Option 3: Assessing a patient's level of understanding is a complex task that requires knowledge and judgment and is within the scope of practice of a Registered Nurse. This task requires a complex level of interaction with the patient, problem solving, and innovation in the form of an individually designed teaching plan of care that addresses the specific learning needs of the patient. Option 4: Teaching requires the knowledge and judgment of a Registered Nurse. Teaching requires a complex level of interaction with the patient, problem solving, and innovation in the form of an individually designed teaching plan of care that addresses the specific learning needs of the patient. In addition, the outcome is unpredictable and it has the potential to cause harm if the skill is taught incorrectly.)

Question 7. A patient is to be discharged from the hospital. Which discharge task can be delegate to a nursing assistant? 1. Teaching the patient how to measure weight using a standing scale 2. Obtaining the patient's temperature, pulse, and respiratory rate 3. Determining if the patient knows how to measure fluid intake 4. Demonstrating to the patient how to use a walker

3 (Rationale Option 1: Although this is a true statement, its tone is autocratic. It is not a visionary, charismatic approach. Option 2: This statement begins with a negative tone; in addition, it may be false reassurance for some staff members. The nurse manager should accentuate the positive. Option 3: This statement is inspiring and motivating; it creates excitement and relates a new initiative to the role of the nurse. Option 4: An edict is a proclamation, directive, or an order to do something. This approach is autocratic.)

Question 7. At a nursing organization meeting, the vice president for nursing informs the nurse managers that each patient care unit must engage in one nursing research project a year as part of attaining Magnet status. A nurse manager holds a unit meeting to inform the nursing staff of this new initiative. What nurse manager statement provides the best introduction? 1. "To improve the status of the hospital in the community, we must become involved in nursing research." 2. "I know that it will require more effort, but you will find it very rewarding to engage in nursing research." 3. "We have a great opportunity to expand our involvement within our profession by performing nursing research." 4. "I have just received a new edict from nursing administration that we have to get involved in nursing research."

3 (Rationale Option 1: The educational preparation of people is considered in both functional and team nursing. However, functional nursing is a task-oriented approach in which tasks are assigned to one person. It focuses on efficiency and productivity, but it can lead to fragmentation of care and failure to meet the emotional needs of patients. For example, an unlicensed team member may be assigned to collect all of the vital signs of all of the patients on the unit. Team nursing assigns responsibilities to a team and the members work together and share the work to meet the needs for a specific group of patients. Option 2: This statement is related to both functional nursing and team nursing, not primary nursing. In primary nursing the nurse communicates laterally with nurses on the other shifts who are assigned to care for the patient. Option 3: This statement is related to primary nursing. A registered nurse is responsible for assigned patients throughout a patient's hospitalization, 7 days a week, 24 hours a day (primary nurse). The primary nurse does not deliver all care personally, but is responsible for ensuring that comprehensive and individualized care is delivered. Communication is lateral. The primary nurse communicates directly with the nurses on the other shifts who are assigned to care for the patient. Primary nursing requires more registered nurses; however, it may not be more costly because it improves collaboration, avoids delays, and supports comprehensive care. Option 4: This statement is related to team nursing. A registered nurse team leader makes assignments based on the abilities of each member of the team, such as registered nurses, licensed practical nurses, and unlicensed nursing assistants. Team members work together and share responsibility for the care of a group of patients. The team leader is responsible for coordinating the team, planning care, and collaborating with professionals in other disciplines and, therefore, often does not provide direct patient care.)

Question 8. A nurse is interviewing for a position as head nurse for a medical-surgical unit. During the interview, the nurse manager mentions that primary nursing is the nursing care delivery model used in the agency. Which statement is associated with this nursing care delivery model? 1. Tasks are assigned based on a person's educational preparation. 2. Communication occurs in a hierarchy from head nurse to subordinate. 3. The nurse is responsible for ensuring that comprehensive care is delivered. 4. Responsibility for care is shared by nursing staff, but is directed by a team leader.

1 (Rationale Option 1: This is an example of the authoritarian leadership style. Authoritarian leaders give orders and directions and make decisions for the group. There is little freedom and a large degree of control by the leader. Option 2: This is not an example of the laissez-faire leadership style. Laissez-faire leaders are nondirective and permissive, which allows for self-regulation and autonomy. Option 3: This is not an example of the bureaucratic leadership style. Bureaucratic leaders rely on the policies, procedures, and rules of the agency to direct the work efforts of the group. Option 4: This is not an example of the democratic leadership style. Democratic leaders encourage discussion and decision making within the group.)

Question 8. A nurse manager makes out the daily assignment, including the specific activities of subordinates, and continually monitors their activities. What leadership style is reflected by these actions? 1. Authoritarian 2. Laissez-faire 3. Bureaucratic 4. Democratic

active resistance

This type of resistance to change attacks the idea, refuses to change, argues, organizes resistance of other people

3 (Rationale Option 1: Monitoring a blood glucose level is a procedure that requires the skill of a licensed nurse. Option 2: Patient teaching is within the legal scope of a licensed nurse, not unlicensed assistive personnel. Option 3: Emptying and recording the volume of output collected from a urine collection bag is within the legal role of unlicensed assistive personnel. The nurse will then calculate the volume of urine by deducting the volume of irrigating solution instilled from the total output. Calculating the actual urine output is an assessment that requires the skill of a licensed nurse. Option 4: The postanesthesia care unit (PACU) nurse should be assisted by the primary nurse responsible for the care of the patient. In addition, the PACU nurse needs to provide a thorough report of the patient's status and important information that the primary nurse needs to know to safely and adequately care for the patient.)

Question 8. The nurse and a nursing assistant (unlicensed assistive personnel) are working together on a surgical unit. Which nursing activity should the nurse assign to the nursing assistant? 1. Assessing the results of blood glucose monitoring 2. Explaining to a patient how to use an incentive spirometer 3. Emptying a urine collection bag that is attached to continuous bladder irrigation 4. Assisting the postanesthesia care unit nurse to help a patient to make the transition to the surgical unit

2, 5 (Rationale Option 1: Counseling a parent experiencing "empty nest" syndrome is an intervention that supports a person experiencing a maturational, not a situational, stress. Maturational stresses are situations that occur during a period of growth. Maturational growth requires the mastery of tasks in a relatively predictable order and includes the assumption of new roles, according to Erikson. Option 2: A situational stress is an external event that is not associated with growth and development. Although the abuse of a child occurs during a developmental level, the reporting of the person to the authorities constitutes a situational crisis. Child abuse is not an expectation of growth and development. Option 3: Counseling an older adult to visit the senior center is an intervention supporting a person experiencing a maturational stress, not situational stress. Option 4: Providing sex education to an adolescent is an intervention that supports a person experiencing a maturational, not situational stress. Option 5: A situational stress is an external event that is not associated with growth and development. Physical illness is always a situational stress because it is a physical and emotional assault on the "self," requires the sudden assumption of new roles, triggers behaviors that reflect an attempt to cope, and requires the learning of new coping skills to deal with the stress.)

Question 8. What nursing actions provide support during a situational stress? Select all that apply. 1. Counseling a parent experiencing "the empty nest" syndrome 2. Reporting a person to the authorities for child abuse 3. Encouraging an older adult to visit the senior center 4. Providing sex education classes to adolescents 5. Providing pain relief for a woman with cancer

2 (Rationale Option 1: Another Nursing Assistant should not be held accountable for the care assigned another staff member. The nurse is directly responsible for ensuring that delegated care is safely delivered to patients. Option 2: Demonstration is the safest way to assess whether the Nursing Assistant has the knowledge and skill to safely transfer a patient using a mechanical lift. Option 3: This teaching method does not take into consideration the need for the Nursing Assistant to practice the psychomotor skills associated with this task. Explaining is not sufficient. Option 4: This does not address the Nursing Assistant's need to know how to move a patient safely with a mechanical lift.)

Question 9. A nurse assigns a Nursing Assistant to a patient who transfers to a chair with a mechanical lift. It has been a long time since the Nursing Assistant has used the lift. What should the nurse do to ensure the safety of the patient? 1. Request that another Nursing Assistant assist with the patient's care. 2. Ask the Nursing Assistant to demonstrate how to use the lift. 3. Explain to the Nursing Assistant how to use the lift. 4. Assign the patient to another Nursing Assistant.

1 (Rationale Option 1: Leaders can inspire others with their vision and gain cooperation through their persuasion and communication skills (influence power), the respect others have for their knowledge and abilities (expert power), and their charisma and prior success (referent power). Option 2: Creating change is the major function of a change agent, not a leader. Change agents are often managers rather than leaders because managers have responsibility for ensuring that the work of the organization is done. Option 3: Controlling others is a function of a manager, not a leader. Option 4: Producing a product is a function of a manager, not a leader. The manager is responsible for ensuring that the work of the organization is done, and this often requires the development of such things as a policy or procedure, management reports, and work schedules.)

Question 9. What is the major focus of leadership? 1. Inspiring people 2. Creating change 3. Controlling others 4. Producing a product

4 (Rationale Option 1: Although health-care needs generally increase as people become older, this is not the key factor that influences the role of the nurse in the occupational setting. Option 2: Although the general health of employees may influence their health-care needs, this is not the key factor that influences the role of the nurse in the occupational setting. Option 3: The stresses are not the key factors that influence the role of the nurse in an occupational setting. The stresses of the work environment must be maintained within the standards for a safe environment identified by the Occupational Safety and Health Administration (OSHA) within the Department of Labor. Option 4: In the occupational setting, health-care services provided beyond those required by OSHA depend on the philosophy and vision of the company's administration. In the occupational setting, nurses work within the legal definition of the practice of nursing and provide services that the company is willing to support.)

Question 9. What is the most important factor that influences the role of the nurse employed in the occupational setting? 1. Average age of the workforce 2. General health of the employees 3. Stresses of the work environment 4. Policies established by management

task versus relationship theories

Some nurses emphasize the tasks (e.g., administering medication, completing patient records) and fail to recognize that interpersonal relationships (e.g., attitude of physicians toward nursing staff, treatment of housekeeping staff by nurses) affect the morale and productivity of employees. Others focus on the interpersonal aspects and ignore the quality of the job being done as long as people get along with each other. The most effective leader is able to balance the two, attending to both the task and the relationship aspects of working together.

conflict resolution

Steps of _____ _____: 1. identify the problem or issue 2. generate possible solutions 3. evaluate suggested solutions 4. choose the best solution 5. implement solution chosen 6. evaluate - is the problem resolved?

B (The preceptor role often includes orienting a new employee to the routine of the work area as well as to the policies and procedures. The preceptor must have ample time, adequate experience, and a positive attitude to complete the new employee's training.)

The new graduate RN needs to have a preceptor assigned to him as he begins working in the Pediatric Clinic. The BEST person for this assignment would be a The charge RN who is a natural leader and knows all of the policies. b The staff RN who has 3 years of experience who enjoys orienting new employees. c The LPN with 15 years of experience who knows all of the doctors' preferences. d The staff RN with 10 years of experience who refuses to work with students.

expert

The power derived from knowledge and skills an individual is believed to possess

authority

The power granted to an individual or a group by virtue of position (within the organizational heirarchy for example)

reward

The promise of money, goods, services, recognition, or other benefits to an individual or group to influence them to change.

situational theories

This theory propose that the effectiveness of a particular style of leader behavior depends on the situation. As situations change, different styles become appropriate. This directly challenges the idea of one best style of leadership. This leadership theory grew out of an attempt to explain the inconsistent findings about traits and styles.

2, 3, 5 (Feedback 1: The scarcity of resources means that three decisions must be made: How much do we spend on healthcare services, and what do those services consist of? How will those healthcare services be produced? How should, or can, we distribute healthcare? In other words, how are services apportioned within the population? Feedback 2: Because resources are limited, a choice to spend resources in one area eliminates the allocation of those same resources for another use. Feedback 3: Preferences for products and services can be influenced—hence, the extensive marketing of healthcare services. Feedback 4: The number of registered nurses employed in the nurse workforce in the United States is at 2.6 million, and continues to grow. The need for nurses is expected to increase even more dramatically as the baby boomers reach their 60s, 70s, and beyond. Feedback 5: The questions are (1) whether there will be enough nurses available to fill those jobs, and (2) even if nurses are available, whether it will be economically feasible for organizations to hire as many as they need. Feedback 6: For many years, decisions about care were based primarily on providing the best quality care, whatever the cost. More recently, healthcare providers are pressured to seek methods of care delivery that achieve quality outcomes at lower costs. You must juggle the needs of your patients with the needs of the organization.)

Which of the following accurately describe how the economic climate has affected the practice of healthcare? SELECT ALL THAT APPLY. 1) An abundance of resources means that a decision must be made about how to distribute healthcare. 2) A choice to spend resources in one area eliminates the allocation of those same resources for another use. 3) Preferences for products and services can be influenced. 4) The need for nurses is expected to decline dramatically in the future. 5) It may not be economically feasible for organizations to hire as many nurses as they need. 6) Nurses must focus on providing the best quality care, whatever the cost.

1, 3, 5 (Feedback 1: Assisting with activities of daily living (e.g., feeding, drinking, ambulating, grooming, toileting, and dressing) is an appropriate task to delegate to NAP. Feedback 2: The American Nurses Association (ANA) has specified that nurses may not delegate the nursing diagnosis to NAP. Feedback 3: Taking vital signs is an appropriate task to delegate to NAP. Feedback 4: The ANA has specified that nurses may not delegate the formulation and approval of a patient plan of care to NAP. Feedback 5: Providing transport for noncritical clients is an appropriate task to delegate to NAP. Feedback 6: The ANA has specified that nurses may not delegate the initial nursing assessment to NAP.)

You are preparing to delegate some tasks to nursing assistive personnel (NAP). Which of the following would be appropriate to delegate? SELECT ALL THAT APPLY. 1) Assisting a client with going to the toilet 2) Developing a nursing diagnosis for a client 3) Taking a client's blood pressure 4) Formulating a client's plan of care 5) Taking a client in a wheelchair to get an x-ray 6) Conducting an initial nursing assessment

1, 4, 6 (Feedback 1: Being a good follower includes suggesting ways to improve client care. Feedback 2: You should give honest feedback and constructive criticism, even if it means politely challenging the leader's ideas. Suggest alternative courses of action. Feedback 3: You should function independently and be a self-starter; take on extra tasks without being asked. You don't necessarily have to ask permission before starting a task. Feedback 4: You should be supportive of new ideas and directions suggested by others. Feedback 5: Although you should be supportive, you should also think critically about ideas that are proposed. Seek information so that you can see the larger picture. Feedback 6: You should avoid gossip.)

You are working on developing your followership skills. Which of the following behaviors should you adopt? SELECT ALL THAT APPLY. 1) Suggest ways to improve client care. 2) Avoid disagreeing with your leader. 3) Obtain permission before starting a task. 4) Be supportive of new ideas and directions suggested by others. 5) Avoid thinking critically about ideas that are proposed. 6) Don't gossip.

4 (Authority is the power granted to an individual or a group by virtue of position (within the organizational hierarchy, for example). Reward is the promise of money, goods, services, recognition, or other benefits to an individual or group to influence them to change. Expertise is the power derived from knowledge and skills an individual is believed to possess. Coercion is the threat of pain or harm, which may be physical, economic, or psychological, as may occur when workers go on strike.)

You arrive at the hospital where you work to find crowds of nurses on strike outside, holding signs and shouting demands for increased pay. Which source of power are the nurses drawing on in this situation? 1) Authority 2) Reward 3) Expert 4) Coercion

2, 3, 5, 6 (Feedback 1: You should demonstrate an ability to move toward independence, not dependence. Feedback 2: You should demonstrate an eagerness to learn. Feedback 3: You should seek feedback and use it to modify your behaviors. Feedback 4: You should demonstrate flexibility and an ability to change, not a determination not to change. Feedback 5: You should evaluate your choices and their outcomes. Feedback 6: You should be open in your relationship with the mentor.)

You have just begun meeting with a mentor who has agreed to help guide you as you begin your career as a nurse. Which of the following are your responsibilities in this relationship, as the mentee? SELECT ALL THAT APPLY. 1) Demonstrate an ability to move toward dependence. 2) Demonstrate an eagerness to learn. 3) Ask for feedback on your behavior and use it to make changes. 4) Demonstrate a determination not to change. 5) Evaluate your choices and outcomes. 6) Be open in your relationship with the mentor.

2, 4, 6 (Feedback 1: You should work on the most difficult tasks when you have the most energy. This decreases frustration later in the day, when you may be more tired and less efficient. Start when levels are high and not at, say, 4 p.m., if that is when you find yourself winding down. Feedback 2: Make a "to do" list and prioritize the tasks in order of importance. Determine how much time each task will require, and when each must be completed. Feedback 3: Take control to avoid time wasters. It is important to prevent endless activities and other people controlling you. Learn when to say no. Learn to say, "I would really like to help you; can it wait until I finish this?" Or, "I am sorry, I won't be able to help you with that." Feedback 4: Delegate tasks to others when possible. Feedback 5: Do not multitask. Studies show that people who do many things at once do none of them well, even though they believe they do. Do not check your voicemail while documenting in the patient record, for example. Finish one task, and then move on to the next one. Feedback 6: Streamline your work. Many tasks cannot be eliminated or delegated, but they can be done more efficiently.)

You struggle to manage your time well at work. Which of the following actions should you take to develop your time management skills? SELECT ALL THAT APPLY. 1) Start big projects toward the end of your shift. 2) Make prioritized "to do" lists. 3) Be open to taking on additional tasks that others ask you to do. 4) Delegate tasks to others when possible. 5) Multitask to increase your efficiency. 6) Streamline your work.

1, 2, 4, 5 (Feedback 1: Actively participate in interdisciplinary team conferences and patient-centered conferences on your unit. Feedback 2: Attend continuing education activities to enhance your expertise. This might include local, regional, national, and international conferences sponsored by nursing organizations. Feedback 3: Use evidence-based practice guidelines, current nursing journals, and books to make decisions regarding your nursing practice, not your own clinical expertise. Feedback 4: Participate in nursing research projects related to your clinical area. Feedback 5: Discuss with colleagues in nursing and other disciplines how to handle a difficult clinical situation. Feedback 6: Observe the practice of experienced nurses, not less experienced.)

You would like to enhance your power as a nurse by increasing your professional knowledge and competence. Which of the following are ways you can effectively do this? SELECT ALL THAT APPLY. 1) Actively participate in interdisciplinary team conferences and patient-centered conferences on your unit. 2) Attend continuing education activities sponsored by nursing organizations. 3) Use your own clinical experience in making decisions regarding nursing practice. 4) Participate in nursing research projects related to your clinical area. 5) Discuss with colleagues in nursing and other disciplines how to handle a difficult clinical situation. 6) Observe the practice of less experienced nurses.

1, 5, 6 (Feedback 1: You need to use active listening to pick up all levels of meaning in a communication. Feedback 2: Surface listening, or inattention, often causes a misinterpretation of the message. Feedback 3: Congruence (agreement) between your words and your deeds promotes trust. Feedback 4: A leader is responsible for providing frequent evaluative feedback. Done poorly, evaluation can be stressful, even injurious. Done well, it promotes growth and employee satisfaction. Feedback 5: Praise is an excellent motivator. Feedback 6: To manage client care effectively, it is important to keep the lines of communication open on all levels.)

You would like to improve your communication skills so that you can be a better leader in nursing. Which of the following actions should you take? SELECT ALL THAT APPLY. 1) Use active listening to pick up all levels of meaning in a communication. 2) Use surface listening while performing other tasks so that you can improve efficiency. 3) Use words that communicate a message that is different from that conveyed by your actions. 4) Avoid providing evaluative feedback, as it can be stressful and even injurious. 5) Provide praise when appropriate, as it is an excellent motivator. 6) Keep the lines of communication open on all levels.

2 (Democratic leadership is also called participative leadership. In contrast to the authoritarian leader, a democratic leader shares the planning, decision making, and responsibility for outcomes with members of the group. This type of leader tends to provide guidance rather than control. Also called permissive or nondirective, the laissez-faire ("let it alone") leader has a relatively inactive style and intervenes only when goals have not been met or a problem arises. Laissez-faire leadership gives followers the majority of control in the decision-making process. The authoritarian leader gives orders, makes decisions for the group as a whole, and bears most of the responsibility for the outcomes. Transformational leadership involves the ability to inspire and motivate followers. The transformational leader creates a supportive climate, listens to followers, and acts as a coach and mentor. Transformational leaders communicate their vision in a way that is so meaningful and exciting that it reduces negativity and inspires commitment in the people with whom they work.)

Your nurse manager tends to give great freedom and autonomy to the nurses who work under her. She encourages you and the other nurses to make decisions independently, and she becomes involved only if a problem emerges. Which of the following leadership styles does she exhibit? 1) Democratic 2) Laissez-faire 3) Authoritarian 4) Transformational

3 (Conflict negotiation and resolution involves helping employees resolve disagreements, for example, over work schedules on a unit, especially on holidays. Employee development includes providing for continuing learning and upgrading employees' skills. Networking involves managers clearly articulating nurses' roles and value to the institution. The goal of coaching is to help the employee do a better job through learning. Some managers use a directive approach ("Let me show you how to do this"). Others use a nondirective approach ("How do you think we can improve our outcomes?").)

Your nurse manager works hard to develop relationships with the administration of the hospital where you work, the physicians on your floor, patients, and even leaders in the community. She promotes the contributions that nurses make to the hospital and to the community every chance she gets. Which interpersonal skill is she demonstrating? 1) Conflict negotiation and resolution 2) Employee development 3) Networking 4) Coaching

4 (Emotional intelligence theory focuses on the relationship aspects of leadership. In part, what sets leadership "stars" apart from ordinary leaders is that they consciously address the effect of people's feelings on the team. Adaptability is the key to the situational approach. Instead of assuming that one particular approach works in all situations, situational theories recognize the complexity of work situations and encourage the leader to consider a number of factors when deciding what action to take. Every situation is different. Transformational leadership involves the ability to inspire and motivate followers. The transformational leader creates a supportive climate, listens to followers, and acts as a coach and mentor. Transformational leaders communicate their vision in a way that is so meaningful and exciting that it reduces negativity and inspires commitment in the people with whom they work. Transactional theory assumes that people are motivated by reward and punishment and that they work best within a clear chain of command. The leader creates structures to make clear what is required of subordinates and what the rewards are. The structure usually includes formal systems of discipline. These leaders monitor behaviors closely to point out errors and make corrective criticisms. They enforce rules to avoid mistakes.)

Your supervisor works hard to make sure that all the nurses on the floor clearly understand the chain of command and the rewards and punishments associated with certain behaviors. He believes strongly in performance evaluations and taking corrective measures to fix problems. Which type of leadership theory does this leader embrace? 1) Emotional intelligence 2) Situational 3) Transformational 4) Transactional

power

____ is the ability to influence other people despite resistance from them

evaluative feedback

_____ ____ is important because it: - reinforces constructive behavior - discourages unproductive behavior - provides recognition

decisional

_____ activities of an effective manager include: - employee evaluation - resource allocation - personnel action (hiring/firing) - planning for future changes - job analysis and redesign - unit based decisions

interpersonal

_____ activities of an effective manager include: - networking - conflict negotiation and resolution - employee development - rewards and punishments - coaching

empowerment

______ is a psychological state, a feeling of competence, control, and entitlement that a person experiences. This includes: - self-determination: feeling free to decide how to do your work - meaning: caring about your work, enjoying it, and taking it seriously - competence: confidence in your ability to do your work well - impact: feeling that people listen to your ideas, that you can make a difference

informational

______ responsibilities of an effective manager include: - spokesperson - monitoring - public relations

transactional theories

_______ ______ are applicable to a managerial approach to leadership. They offer a simplistic style that is based upon 'transactions' or instructions between a manager and employee that can be linked to reward for successful completion of work, or, possibly, punishment for perceived failure.

trait theory

a leadership theory that holds that effective leaders possess a similar set of traits or characteristics - intelligence - initiative - interpersonal skills - high self esteem - creativity - willingness to take risks - ability to tolerate consequences of taking risks

Authoritarian leadership

characterized by a leader who takes charge, makes all the decisions, and dictates strategies and work tasks - Autocratic, Directive, Controlling - efficient - Can inhibit creativity and motivation in the long term

preceptor

experienced members of a clinical staff who work one on one with students or new graduates to provide guidance for a predetermined amount of time. They help build confidence to the new graduate but less encompassing than the mentor role.

passive resistance

type of resistance that involves avoidance - canceling appointments to discuss implementing the change, being too busy to implement the change, ignoring the process as much as possible

followership

willingness to work with others toward accomplishing the group mission