450 Final
Healthcare prices are set using the same economic equilibrium found in all major industries. True or False
False Prices in health care are not set by the same economic equilibrium found in all major industries. For the most part, healthcare pricing is highly influenced by the government and the reimbursement plans. For example, both Medicare and Medicaid impose pricing on hospitals and there is no room for negotiation.
Case management has become a very important role for all acute care organizations. Nurses must partner with case managers in reaching organizational goals. The ideal partnership includes the following contribution(s) by the nursing staff: A. Knowledge of patient goals, expected outcomes, and anticipated discharge date B. A comprehensive assessment of the patient and family C. Appropriate and timely interventions when the patient is not progressing as expected D. Ongoing patient and family education regarding discharge planning as well as identifying barriers to discharge E. All of the above
E. Case management has become a very important role for all acute care organizations. Nurses must partner with case managers in reaching organizational goals. The ideal partnership includes the following contributions by the nursing staff: Knowledge of patient goals, expected outcomes, and anticipated discharge date; comprehensive assessment of the patient and family; appropriate and timely interventions when the patient is not progressing as expected; appropriate management of pain, activity, skin integrity, bowel and bladder integrity, and cognition; ongoing patient and family education regarding discharge planning and reducing the risk of readmission; and identifying barriers to discharge (Bower, 2013).
Group decision making offers the following advantages and disadvantages: A. More ideas can be generated by groups and they have a synergistic effect. B. Implementing solutions becomes easier when individuals have been actively involved in the decision-making process. C. The time required for making group decisions may not be appropriate, especially in a crisis situation. D. Groups may be more concerned with maintaining group harmony than engaging in an active discussion on a particular issue. E. All of the above statements are true.
E. The advantages of group decision making are numerous. The adage "two heads are better than one" illustrates that when individuals with different knowledge, skills, and resources collaborate to solve a problem or make a decision, the likelihood of a quality outcome is increased. More ideas can be generated by groups and they have a synergistic effect. In addition, when followers are directly involved in the process, they are more apt to accept the decision, because they have an increased sense of ownership and commitment to the decision. Implementing solutions becomes easier when individuals have been actively involved in the decision-making process. Although group decision making and problem solving have distinct advantages, involving groups also carries certain disadvantages and may not be appropriate in all situations. The time required for making group decisions and for achieving consensus may not be appropriate, especially in a crisis situation, which requires making prompt decisions. In addition, some decisions may have been made at the organizational level and discussing the decision as though other options were possible is counterproductive. Groups may be more concerned with maintaining group harmony than engaging in active discussion on the issue and generating creative ideas to address it. Group members who manifest a "groupthink" mentality may be so concerned with avoiding conflict and supporting their leader and other members that important issues or concerns are not raised.
What is the most important component of role transition? A. Clear delineation of role expectations and accountabilities B. A supportive manager C. A detailed position description D. Orientation
A. Clear delineation of role expectations and accountabilities. A is the answer. B: Helpful but not always necessary. C: Assists with delineating role. D: Assists with socialization to organization.
A patient's family asks the nurse why a clinical pathway is being used to determine her care. The best answer is "Clinical pathways: A. help everyone caring for you to provide effective care based on research findings." B. help us to give you care without spending too much money." C. make sure you meet the criteria for improvement." D. keep your doctors and nurses from giving care that is not appropriate."
A. Clinical pathways are designed to integrate research and best practices into the care.
A nurse manager wants to highlight the accomplishments of the nurses who are providing high-quality care on a medical unit in a tertiary care medical center. Which of the following is an example of a nurse-sensitive outcome that could be used for this project? A. Pressure ulcer rate compared to a national benchmark rate B. Patient satisfaction scores compared to other hospitals C. Nurse satisfaction scores compared to other hospitals D. Percentage of patients with heart failure who are prescribed an ACE inhibitor on hospital discharge
A. Nurse-sensitive outcomes are patient outcomes that are primarily dependent on the quality of nursing care rather than a multidisciplinary team effort. Although patient satisfaction is an important measure, it may not necessarily be linked to the quality of care. The prescription of an ACE inhibitor is an outcome measure dependent on medical care.
Which of the following describes comparative effectiveness research? A. A study designed to determine which of three strategies for teaching self-management works best for adolescents diagnosed with type 1 diabetes B. A meta-analysis that evaluates strategies to prevent delirium in hospitalized patients C. A qualitative study that examines family members' experience of being allowed to observe procedures being performed on their children D. Determining whether the implementation of an evidenced-based protocol reduces the rate of catheter-associated bloodstream infection (CLABSI)
A. Comparative effectiveness research is designed to compare the benefits and harms of methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the quality of care. The type of qualitative research described here is phenomenological research and is focused on the experience of the study participants. Examining the impact of an evidence-based protocol for CLABSI would be characterized as quality improvement. A meta-analysis combines the results from different studies in order to test the pooled data for statistical significance.
A cost-based system consists of: A. The cost of providing a service plus a mark-up for profit. B. A method in which the cost associated with the service is attributed in advance by a third party. C. A method of reimbursement based on outcomes.
A. Response option B describes a prospective payment system defined as a method in which the third-party payer decides in advance what will be paid for a service or episode of care. Response option C describes a pay for performance system that reimburses hospitals and eventually providers based on performance and outcomes and not on the cost associated with providing the care.
A clinical unit just received its patient satisfaction scores for the last month and the unit's scores are lower than that of other general medical/surgical units in the hospital and much lower than previous scores. Which of the following would be appropriate strategies for addressing the low patient satisfaction scores at this time? (Select all that apply). A. Ask staff members what they think might be the cause of the decline. B. Examine nurse turnover data from the unit in comparison to other units. C. Ask for volunteers for a committee to make recommendations to investigate and address the problem. D. Institute a training program on how to improve patient satisfaction. E. Institute an hourly rounding program.
A., B., C. An initial approach would be to assess what might be happening on the unit. Involving staff members is key to addressing the problem, and soliciting their involvement would be important to the success of any plan. Turnover data might provide additional information about this clinical unit, since patient satisfaction has a demonstrated link to nurse satisfaction. More information is needed before instituting corrective action either through a training program or a change in procedures.
For years, a small community hospital had a wound/ostomy nurse who took all photographs of pressure ulcers and uploaded a picture to the patient's medical record. The nurse retired and now nursing administration is expecting that registered nurses should assume this responsibility. Which of the following should be included in planning to use evidence for this approach? (Select all that apply.) A. Perform a literature search for the evidence for best practice for taking photographs of pressure ulcers. B. Include staff members in planning for this policy change. C. Determine whether the evidence demonstrates that staff nurses are reliable in taking photographs of pressure ulcers. D. Organize a meeting with nursing administration to recommend that a wound/ostomy nurse be hired. E. Demonstrate that the literature indicates that taking photographs of pressure ulcers is inappropriate unless the photographer is a wound/ostomy nurse.
A., B., C. Performing a literature search makes no assumptions about the potential findings related to taking photographs of pressure ulcers and which staff members may be qualified to perform this task (A) and will involve a careful analysis of the results. Including staff members would be an important strategy for the implementation of a change (B). Evaluating the evidence for application to this setting would be an important step in developing a protocol (C). Organizing a meeting with nursing administration without having evidence in place to support a policy change would be inappropriate as an initial strategy. Searching the literature to support a specific finding might bias the results.
A shared governance council has approved a new protocol for a delirium prevention program that is based on the latest evidence. Which of the following strategies might be included to enhance the effectiveness of this program? (Select all that apply.) A. Assessment of nurses' attitudes about caring for elderly patients B. Selecting individuals to serve as protocol champions C. Disseminating evidence about the protocol in a journal club D. Using academic detailing or educational outreach visits E. Distributing education materials on the clinical units F. Including only the early adopters in planning for the rollout of the program
A., B., C., D. Things to consider in making practice changes include the strength of the evidence, internal and external factors driving the change, contextual factors, and method of changes. The Promoting Action on Research Implementation in Health Services (PARiHS) framework illustrates the complexity of the process. Assessment of nurses' attitudes will provide valuable information about contextual factors. Protocol champions are likely to have an understanding of the problem and the unit context. Academic detailing has been shown to be successful in implementing evidence-based practice changes. Dissemination of evidence with the opportunity for active engagement in a journal club is more likely to stimulate uptake. Distributing educational materials without concomitant involvement of staff is not likely to be successful. Not including all staff members in planning for the program rollout may create resentment and lead to sabotage of the program.
After providing the unit staff with an in-service class on shared governance models, the manager knows the education was effective if staff do which of the following? (Select all that apply.) A. Assemble a subgroup of staff to develop new unit policy. B. Search the literature together for best practice articles regarding a clinical question. C. Develop a peer recognition program. D. Ask the manager to determine policy for the unit. E. Request a team be assembled to implement a clinical ladder. F. Boast openly about the quality of their direct involvement through shared governance to their colleagues from other units.
A., B., C., E., F. Nurses empowered through effective shared governance will take bold and independent actions to improve unit life, patient outcomes, and workplace cohesion. All of these answer options are indicative of teamwork and empowered behaviors except option D. Asking the manager to determine a unit policy is not congruent with shared governance.
Healthcare organizations that wish to develop a comprehensive workplace violence prevention program should do which of the following? (Select all that apply.) A. Commit to a zero tolerance policy for workplace violence and ensure that managers, supervisors, co-workers, clients, patients, and visitors know about this policy. B. Conduct a worksite analysis of risk for workplace violence of both physical and psychological nature. C. Ignore safety concerns identified through reporting of violent incidents. D. Develop a plan for workplace safety, prevention, and control of violence. E. Collect and analyze data and evaluate the effectiveness of the program. F. Provide training for staff on conflict management and de-escalation techniques. G. Address horizontal violence at all levels of the organization. H. Assign responsibility or accountability for a violence prevention program to individuals or teams with inadequate training and skills in workplace violence. I. Withhold adequate resources for this effort from the team responsible for developing workplace violence prevention in health care.
A., B., D., E., F., G. Options A, B, D, E, F, and G are all appropriate steps in developing a comprehensive workplace violence prevention plan. An organization would not ignore safety concerns, would assign responsibility and accountability to adequately trained staff, and would provide resources for those developing a plan.
A hospital in a large metropolitan area hopes to obtain magnet status. The following are characteristics of the nursing service in this hospital. Select the areas that must be addressed in order to become a magnet hospital. (Select all that apply.) A. The hospital has a nurse vacancy rate of 20%. B. The chief nursing officer holds a MSN, with a specialty in nursing administration. C. 50% of the nurse managers hold a BSN. D. Transforming Care at the Bedside has been implemented in all units. E. Cost reduction at the hospital has resulted in a 50% decrease in the number of staff in the Education Department.
A., C., E. Magnet status highlights hospitals that provide a positive work environment for nurses and other staff. A high vacancy rate suggests that nurses are leaving the hospital, in some cases, because the environment does not "hold" them to their job. Similarly, cost reduction in the area of staff development suggests a lack of support for ongoing professional development. Finally, effective January 2014, all nurse managers must hold a BSN.
Which objective best reflects the SMART objectives? A. To obtain the Beacon Award B. To successfully work as a team and gather all evidence to obtain the Beacon Award by December 2015 C. To conduct a gap analysis for the Beacon Award D. To think about applying for the Beacon Award
B. Option B contains all the components of the SMART objective: S-Specific M-Measurable A-Agreed on R-Realistic T-Time bound
The nurses at a community hospital are selecting research articles to use for the development of a new protocol for the removal of indwelling urinary catheters in surgical patients. This would be characterized as which of the following? A. Research B. Review of the literature C. Evidence-based practice D. Implementation science
B. A review of the literature includes seeking and analyzing information by identifying and selecting articles for review. Research involves the generation of new knowledge. Evidence-based practice involves the synthesis of best available evidence along with patient preferences. Implementation science involves identifying scientifically based strategies for implementing a practice change.
Recently, a medical center surveyed its patients who smoked about their desire to quit. A high percentage were "motivated smokers," interested in quitting in the next 30 days, but were not offered resources to help with quitting. The nursing research council at a large medical center wants to introduce an evidence-based protocol for smoking cessation. Which of the following would be an appropriate initial action? A. Start a journal club to review the protocol. B. Survey nurses to determine barriers and facilitators to using smoking cessation interventions. C. Distribute the protocol to all staff nurses. D. Collaborate with physicians to develop a standard set of orders to be implemented for all patients.
B. Advance planning should include a thorough and frank discussion of barriers and facilitators. Surveying the nurses would provide the opportunity to involve key stakeholders—in this instance, nurses—to understand the challenges they face in providing care related to smoking cessation. The other strategies may be employed later in the process.
A clinical unit is instituting hourly patient rounding. Nurses are being taught a standardized script to use when making rounds to improve patient satisfaction. One of the nurses objects to using a standardized script. What is the best response by the nurse manager? A. "The policy requires you to use the script and if you don't, you will receive a warning." B. "What are your concerns about using a standard script while you make your rounds?" C. "You don't have to use the script as long as your patients don't have any complaints about the care that you provide." D. "Why don't you serve as our representative to the nurse council on Quality and Patient Satisfaction?"
B. Asking the nurse about concerns involves the nurse in care processes and acknowledges her contributions. This would be an important first step in involving nurses in making decisions about practice. Allowing one nurse to be exempt from a policy is counterproductive to fostering staff morale, as is threatening the nurse with consequences. Having the nurse serve as a representative to a committee might be a solution, but it would not necessarily be the first choice or the most appropriate at this time.
Which of the following statements is true? A. Decision making and problem solving are synonymous. B. Decision making and problem solving are similar. C. Although decision making and problem solving are similar, only problem solving requires critical thinking. D. Although decision making and problem solving are similar, only problem solving can improve the practice of nursing.
B. Decision making and problem solving are not synonymous terms. However, the processes for engaging in decision making and problem solving are similar. Both skills require critical thinking, which is a high-level cognitive process, and both can be improved with practice.
During bedside rounds, a surgeon turns to you and says, "The poor nursing care has caused this wound to become infected. Can't nurses at this hospital do anything right?" The best response is: A. "The nursing care on this unit has received awards and certainly is not the problem." B. "Let's first decide what to do for Mrs. Johnson and then step into the hall and talk further about your concerns." C. "It is inappropriate to talk to me that way. I will report this to my supervisor." D. "Would you like to change the antibiotic Mrs. Johnson is receiving?"
B. Effective interprofessional communication may necessitate choosing appropriate conflict-handling modes. Collaborating about the health needs of Mrs. Johnson and then talking privately with the surgeon ensures a better setting in which to address the bullying. Although Option D is patient centered, the use of avoidance does not resolve the conflict or address the surgeon's disruptive behavior.
You are caring for a 15-year-old female who has been admitted to the Emergency Department (ED) with severe abdominal pain. The teen's mother is present in the patient's room and does not let the teen really answer any questions. Which of the following is an appropriate strategy in continuing with the history and physical exam? A. Insist that the mother remain outside the room during the patient's ED visit. B. Thank the mother for her concerns, indicating that some time will be spent examining the teen alone. C. Allow the mother to remain in the room for the entire history and physical exam. D. Have the nurse manager explain the policy for treatment of adolescents.
B. Responding to the adolescent as a developing adult would include providing an opportunity for a private examination and confidential discussion of concerns. Being respectful of the mother while addressing the needs of the adolescent is the most appropriate strategy. The nurse should be familiar with local and state laws regarding care for adolescents. Nurses need to be sensitive to the teaching needs of different populations as well as developmental needs.
Which of the following items would be included on a CV but not on a résumé? A. Licensure type and states where licenses are held B. List of professional activities throughout career C. Educational preparation and degrees awarded D. Contact information including address and phone
B. The CV includes extensive listing of all prior professional activities, whereas the résumé is focused on details pertinent to a specific position. Some items, such as contact information, educational preparation, and licensure, would be included on both résumés and CVs.
There are three types of decision-making style: paternalistic, informative, and shared decision making. A shared decision model has been shown to increase productivity and work performance because: A. Just like the paternalistic model, it values the input of others and the staff may express and discuss options and preferences. B. Unlike the paternalistic model, decisions are made through an interactive, deliberate process and the staff may express and discuss options and preferences. C. It is identical to the informative model. D. The managers decide what is best for the team since the managers have more experience and have the competency to make decisions for their respective teams.
B. The decision-making style of a nurse manager can be conceptualized using three distinct models: paternalistic, informative, and shared decision making (Moreau, 2012). In the paternalistic model, the managers decide what is best for their team. The informative model offers the staff the ability to make a decision after the information has been shared and without the active involvement of the manager. In a shared decision model, the decisions are made through an interactive, deliberate process, and the staff may express and discuss options and preferences. The shared decision model has been shown to increase work performance and productivity, decrease employee turnover, and enhance employee satisfaction
A nurse manager wants to decrease the number of medication errors that occur within her department. The manager arranges a meeting with the staff to discuss the issue. The manager conveys a total quality management philosophy by: A. Explaining to the staff that disciplinary action will be taken for further errors. B. Recommending that a multidisciplinary team assess the root cause of the medication errors. C. Suggesting that the pharmacy department explore their role in the problem. D. Changing the unit policy to allow a certain number of medication errors per year without penalty.
B. The goal of quality management is to improve systems and processes, not to assign blame. Assembling an interprofessional team to assess the root cause of medication errors allows an avenue to comprehensively explore a systems problem and collectively identify a course of action firmly grounded in data that can be embraced by all involved disciplines. See Box 20-1.
The main purpose(s) of collective action in nursing is/are which of the following? (Select all that apply.) A. To facilitate formation of a recognized bargaining unit (union) B. To promote the practice of professional nursing C. To establish and maintain standards of care D. To facilitate the orientation and competency of newly licensed registered nurses E. To allocate resources effectively and efficiently F. To create satisfaction and support in the practice environment
B., C., E., F. Minarik and Catramabone (1998) described four main purposes of collective participation for nurses: (1) to promote the practice of professional nursing, (2) to establish and maintain standards of care, (3) to allocate resources effectively and efficiently, and (4) to create satisfaction and support in the practice environment.
Which of the following is a professional role transition? A. Purchasing a car B. Marriage C. Starting a new job D. Retirement
C. A is not a role transition. B and D are personal role transitions. The acquisition of a new job is a professional role transition.
An 80-year-old woman has been admitted for diagnostic procedures and then potential surgery for symptoms related to an abdominal mass. Today, she was scheduled for two tests that required that she be NPO. After the first test, the patient was returned to the floor. The patient's assigned nurse was at lunch. Another nurse checked with the radiology department and was told that the test was completed and that the patient could eat. She then provided the patient with a cold cereal until lunch trays were available. Subsequently, it was learned that the second test had not been completed, the test would then be delayed to the next day, and the patient would need to be NPO again. The patient's daughter displayed considerable anger regarding the delay in testing. Which of the following is the most appropriate response? A. "I will call your physician to discuss this and other testing options in more detail with you." B. "Your nurse should have done a better job of explaining the situation to the nurse who was covering. We won't let it happen again." C. "I am sorry that this caused a delay in your testing. What can we do now to address this?" D. "The delay in testing won't have an impact on your care since we can schedule the second test for early tomorrow morning."
C. Apologizing to the patient and daughter without blame and asking for what can be done to provide better service is an axiom of service recovery. Blaming another staff member is counterproductive. Referral to the physician delays the discussion and could be perceived as avoidance. Statements minimizing the impact dismiss the patient and family's concerns.
James and Susan are new graduates employed in a small community hospital. They see that practices seem to be very physician driven and that patients have little input into their care. Families are seen as a nuisance rather than as partners in potential care provision. What is the best approach James and Susan might use to improve care in this setting? A. Do nothing. They are too new to the organization to make change. B. Share with the physician the recommendations from various IOM reports. C. Share with their team members what they know about the aims of providing health care. D. Report the team members to the chief nursing officer who is unlikely to know the lack of details on this unit.
C. As accountable professionals, doing nothing is not an option. The chief nursing officer (CNO) is likely to know the standard of care on every unit in a small community hospital and bypassing the unit manager violates a "chain of command" approach. Similarly, going to the physician fails to engage the nursing chain of command. Sharing with team members what the aims of providing health care are provides the opportunity to discuss patient-centered care.
A newly hired nurse has observed bullying behaviors on her new unit that include gossip, demeaning, criticizing, and intimidation. She also feels other nurses are avoiding her or giving her the silent treatment. The unit manger does little to address these behaviors. The consequences of this toxic culture include all of the following EXCEPT: A. Loss of productivity and potential for high staff turnover B. Potential for patient safety errors that may increase the cost of care C. An increase in teamwork and communication D. Increase in anxiety, low self-esteem, and sleep disorders among the staff
C. Bullying behaviors negatively impact teamwork and communication and can contribute to all of the other issues listed.
The chief nursing officer (CNO) of a large metropolitan hospital is preparing to defend her request for more staffing in certain units during budget development. Research has illustrated that a number of outcomes are improved when there is sufficient staffing on the unit. To make her case for more nursing staff, the CNO should gather data on which outcomes associated with staffing patterns and highlighted in the research? A. Average length of stay of patients on a unit B. Number of physicians who regularly admit patients to a unit C. Number of errors in patient care identified over time on a unit D. Unit revenue generated
C. Inadequate staffing has been linked to an increase in the number of patient care errors.
Which strategy can be used with nurses who are in the late majority group for the adoption of an evidence-based innovation to increase breast-feeding rates? A. Seeking and analyzing reviews that demonstrate the effectiveness of breast-feeding B. Incorporating an assessment of breast-feeding implementation into annual performance reviews C. Use of informal networks to foster positive attitudes D. Assigning the late majority nurses to patients who have already been successful with breast-feeding
C. Informal communication networks can be used to foster the development of positive attitudes for the implementation of a change. Gathering data about the breast-feeding would have occurred in the early phases of planning the project. Incorporating practices into performance reviews may have negative consequences and backfire. Selective assignment of patients does not address the problem.
You are the nurse manager for a busy intensive care unit (ICU). Two patients are awaiting admission to the ICU; one is a 42-year-old bank president admitted through the emergency center with a diagnosis of an acute myocardial infarction, and the other is an elderly woman who experienced a cardiac arrest on the general medical unit. After reviewing the charts of all the patients already in the ICU, you contact the physician about a patient who can safely be discharged to a general medical unit so that two beds will be available for the two people awaiting admission. The ethical principle that you have most closely applied is that of: A. Respect for others B. Beneficence C. Justice D. Fidelity
C. Justice concerns treating people equally and fairly. Both patients awaiting admission to the ICU are equally in need of the medical and nursing care available in this unit. The next best choice is respect for others, transcending culture differences, gender issues, racial concerns, and, in this instance, age differences. Though one of the patients is much younger and seemingly more affluent in the local society, both are deserving of the highest quality care. Beneficence could also be said to be applied in this instance; doing good by assuring that both patients are admitted to the unit. Fidelity is the least applicable principle in this instance as it pertains to keeping one promises and commitments and, given the facts of the scenario, there is no indication of any promise being made to either of the patients to be admitted.
Mr. Grandion was admitted to a rehabilitation center after discharge from a hospital. He has not walked in 5 days while he was hospitalized and is provided a wheelchair. Dining with other residents is expected, and staffing is limited on a holiday weekend. What is the best strategy to be sure Mr. Grandion has sufficient nutrition and exercise? A. Tell Mr. Grandion to stay in bed and someone will bring a tray to his room because the staff can't get him to the dining room in time for dinner. B. Assist Mr. Grandion into his wheelchair and remind him that in 2 hours he must be in the dining room if he wished to eat. C. Request help from another unit before dinner and indicate the nature of help needed. D. Order a lift device to transfer Mr. Grandion from his bed to the wheelchair.
C. Leaving Mr. Grandion in bed fails to provide any exercise. Assisting him to the wheelchair 2 hours in advance of when he needs to eat may pose physical discomfort and the potential for skin breakdown. Ordering a lift device might be useful, but it might not be timely. Requesting help to prevent personal injury and aiding Mr. Grandion into a wheelchair in a timely manner provides some activity and helps him gain appropriate nutrition.
Which of the following statements by a newly promoted nurse manager indicates the need for follow-up? A. "As a new leader, I should identify and work with a mentor." B. "I intend to promote shared decision making in my unit." C. "I don't need to worry about engaging my workforce because all nurses are naturally engaged." D. "I will purposefully cultivate a broad follower base in my unit."
C. Option A is true: Mentorship relationships are invaluable to professional growth. Option B is true: Shared decision making results in employee engagement, improved satisfaction, and better patient outcomes. Option C is untrue and indicates the need for follow-up. Engaged workers require cultivation and attention from the manager. Option D is true: Successful leaders require many followers.
When entering the postoperative care unit, the nurse manager notices that the temporary agency nurse has incorrectly entered the rate of infusion for the patient's vasopressor medication and that the arterial line is indicating a blood pressure of 76/40. Discontinuing the intravenous infusion, the nurse manager's next most appropriate action is to determine which of the following? A. The nurse in charge of the unit B. If there is an assigned resource nurse to serve as mentor for the temporary nurse C. If there are standing orders for interventions for hypotension D. If the temporary nurse has had an orientation to the unit
C. Patient safety is always the first concern, and attention must first center on ensuring the patient's welfare. To prevent such an occurrence in the future, the nurse manager should next determine who is in charge of the unit. Questions to ask the charge nurse include asking about the temporary nurse's qualifications and experiences caring for critical postoperative patients, if a resource nurse was assigned to the temporary nurse so that the temporary nurse had a mentor and could ask questions if needed. Finally, the nurse manager should ask about the orientation to the unit and whether the temporary nurse was informed about the types of intravenous pumps used in this facility, how to set the appropriate drip rate, and the necessary monitoring of patients who are receiving vasopressor agents.
The nurse educator of the pediatric unit determines that vital signs are frequently not being documented on children returning from surgery. According to total quality improvement (TQI), to correct the problem, the educator, in consultation with the patient care manager, would do which of the following? A. Talk to the staff individually to determine why this is occurring. B. Call a meeting of all staff to discuss this issue. C. Have a group of staff nurses review the established standards of care for postoperative patients. D. Document which staff members are not recording vital signs and write them up.
C. The educator should request the manager provide time for select unit staff to participate in quality improvement measures, including reviewing the established standards of care for postoperative patients. Having the entire unit involved is inefficient and premature.
A new graduate is asked to serve on the hospital's Quality Improvement Committee. The nurse understands that the first step in quality improvement is to: A. Collect data to determine if standards are met. B. Implement a plan to correct the problem. C. Identify the standard. D. Determine if the findings warrant correction.
C. The first step in the quality improvement (QI) process is to identify the needs most important to the consumer of healthcare services, which includes identifying the standard to be measured. See Box 20-3 for the six steps of the QI process.
The most important role of the nurse case manager is to: A. Provide supportive therapy during the grieving process. B. Provide education to patients regarding upcoming surgery. C. Serve as a communication link between all providers of care. D. Perform a psycho-social assessment of the patient and his family.
C. The primary role of the case manager, according to the Case Management Society of America, is to increase the involvement of individual and caregivers in the decision-making process.
Janet has accepted a new position in a different organization and is composing a resignation letter for the manager of her current position. Which of the following items, if included in the letter, is likely to prevent Janet from being rehired in the same organization in the future? A. An offer to negotiate a resignation date around department needs B. A summary of the verbal resignation discussion with the manager C. A list and full description of co-workers' annoying off-duty behaviors D. A positive statement about what has been learned from the position
C. The resignation letter should be honest yet diplomatic. There may be a future time when you would like to return to the organization, so maintain a positive tone about what you have gained by working in that organization.
The new chief nursing officer has asked for volunteers to participate in a strategic thinking activity. You volunteer because: A. You know getting ahead in an organization depends on how well you know the leader. B. You want to represent the voice of your colleagues who don't seem to be well heard. C. You consider this an opportunity to stretch your limits in your position by taking on a safe risk. D. Your nurse manager said you need to do this activity to meet the next clinical promotion step.
C. This is an example of considered risk taking and it is supported by the highest position in the nursing organization.
Which observation by the charge nurse indicates the new nurse needs additional education regarding the safe use of the electronic health record? A. The nurse logs off the computer before walking away. B. The nurse using a computer outside of the patient room minimizes the screen when a family member approaches. C. Before leaving the patient's room, the nurse minimizes her documentation on the computer screen. D. The care assistant needs to document and asks to use the nurse's computer; before the care assistant begins documentation, the nurse logs out of the system.
C. While minimizing the documentation removes it from immediate view, it is not a secure method to lock down patient information. Logging off or password-locking the system is the best process for securing patient information.
An 83-year-old Caucasian man is admitted to a large suburban nursing home. Today, an African-American nurse's aide is assigned to care for the patient and assist him with a shower. The patient refuses to go with the nurse's aide for the shower. Later in the day, the patient's son arrives and insists that no African Americans be allowed to participate in the patient's care. Only a few nurse's aides and professional staff members in this setting are African American. Which of the following is the best strategy for addressing this issue? A. Refer the patient and his son to the administration. B. Since this will be the patient's home, plan the care to accommodate the family's wishes. C. Offer to have someone else bathe the patient today until someone in administration can talk with the patient. D. Indicate that it is not within the institution's practice to restrict who provides care to patients.
D. Acceding to the patient and family's demands about restricting caregivers is discriminatory and makes it difficult to appropriately staff the facility. Hospitals, nursing homes, and other healthcare facilities should disclose their nondiscriminatory practices to patients and train staff on how to deal with such requests. Patients have a right to refuse treatment, but they do not have the right to demand that treatment only be provided by certain people. This is disruptive to the usual workflow and could be a safety issue for all patients in the facility.
You have been asked to create a new approach to providing care to your group of patients. Your unit's patient satisfaction scores are 92. Your dashboards indicate your organization is functioning at a high level in terms of desired outcomes. Your city has two other big competitors for the same type of service as your organization provides. What is the BEST approach you could take? A. Analyze the patient satisfaction scores to determine why the scores aren't 100. B. Review the literature to determine exactly what the best practices are. C. Do a gap analysis to determine where your organization may differ from the standards expected. D. Peruse a bookstore's magazine section to determine what is going on in the world.
D. Almost no organization consistently achieves scores of 100. Although that is an admirable goal, time might better be spent elsewhere. The review of the literature and a gap analysis, while useful, are more likely to produce history rather than a future perspective. Therefore, looking to other fields to see what is developing might be most useful to continue to excel.
The nurse has received her assignment for the day and notices that her peer has a much lighter assignment in both number and acuity of patients. This is not the first time the nurse has noticed this inequity in assignments. She also has seen her peer and the charge nurse go to lunch together and knows that they spend time outside of work socializing. The nurse feels that this constant inequity in assignment is not fair. What is the best course of action for the nurse to address this problem? A. Avoid the issue and say nothing but remain angry about the situation. B. Confront the charge nurse about the inequity in the assignment. C. Approach the peer and ask to switch assignments. D. Share concerns with the charge nurse and find a mutually acceptable compromise for the situation.
D. Avoiding the situation creates feelings of powerlessness and frustration that can lead to the nurse feeling that she may not want to work in this environment, or may cause lack of focus that could result in patient safety concerns. Confrontation creates a power struggle and may escalate bad feelings for both parties. It may also affect the ongoing relationship between the charge nurse and the bedside nurse. Attempting to switch assignments without the charge nurse's involvement is unacceptable. The best solution to the problem is to initiate a dialogue with the charge nurse. This may shed light on the rationale behind the assignment and allows the charge nurse to acknowledge the nurse's concerns and negotiate an acceptable solution. It also allows the charge nurse to work on developing a better team environment.
Two employees disagree about who should work Christmas Day. The bottom line is that one employee will have to work and the schedule must be posted tomorrow. As the nurse manager, how can you best help them resolve the conflict? A. Use your position of power to resolve the conflict. You decide who will work Christmas Day. B. Rely on centralized staffing to resolve the issue. C. Try to arrange a compromise. Have one employee work the first half of the shift and have the other work the second half. D. Meet with both employees at the same time. Engage them in the problem-solving process.
D. Effective leadership involves guiding and coaching followers to resolve conflict versus employing an autocratic conflict-handling approach to unit management. Being present during the discussion facilitates and promotes conflict resolution strategies that are comfortable and effective for the individuals involved. This approach also strengthens the problem-solving skills of followers and allows each nurse to receive guidance as appropriate.
A long-term acute-care hospital adopted an evidence-based protocol to reduce the rate of catheter-associated urinary tract infections. One year after the protocol was adopted with moderate success, a senior staff nurse continues to insist on calling the healthcare provider for an order to insert a urinary catheter. Which of the following characterizes the behavior of this individual in relation to the adoption of innovation? A. Early adopter B. Early majority C. Late majority D. Laggard
D. Laggards, according to Rogers (2003), are most secure in holding on to the past. They are most comfortable when an idea cannot fail.
An Iranian woman is admitted with a tentative diagnosis of pneumocystis carinii. She is being tested for HIV. The patient has limited English proficiency and her 21-year-old daughter has been translating for her. The daughter asked the nurse why blood tests are being done and when the results can be expected. The nurse indicates she wants to speak to the mother alone. However, both mother and daughter indicate that the nurse should proceed with the explanation. Which of the following is the best response? A. Proceed with the explanation. B. Refer the patient to the healthcare provider. C. Provide the patient with a Farsi language pamphlet on HIV and AIDS. D. Insist that a telephone language translation service be used.
D. Sharing sensitive information with the daughter present violates the patient's right to privacy. In addition, in this instance, it may have serious consequences for the patient if others in the family learn about the tentative diagnosis and plans for HIV testing. Using a telephone language translation service is consistent with the National Standards on Culturally and Linguistically Appropriate Services. Providing a pamphlet does not provide the patient with the opportunity to ask questions. Referring to the healthcare provider does not address the problem of providing the patient with appropriate healthcare information.
An incident report of the incident described in Question 1 needs to be completed. The most appropriate wording to be included in the incident report is: A. Patient was noted to have a low arterial blood pressure (76/40) and the vasopressor medication was discontinued. B. Patient's vasopressor medication was infusing at a higher rate than ordered and the medication was discontinued when the patient's blood pressure dropped to 76/40. C. Nurse MJ started the vasopressor medication; the patient subsequently was noted to have a blood pressure reading of 76/40, the medication was discontinued, and the physician notified. D. Patient receiving vasopressor medication intravenously; blood pressure fell to 76/40 and intravenous infusion discontinued; physician notified and the patient given 500 mL of IV fluid over 15 minutes.
D. The most complete incident report note is Option D because it states what was happening, why an intervention was needed, and the follow-up care for the patient. Option A is also correct but is less desirable as there is no mention of what follow-up measures were done to ensure the patient's welfare. Options B and C are incorrect; there should never be a mention or indication, however slight, of liability in the incident report, as it could later be used in a court of law to show liability against the healthcare providers and the institution.
Upon entering a patient's room, the Emergency Department nurse observes a visitor attempting to choke the patient. The visitor appears agitated and is screaming at the patient. The patient is gasping and looks cyanotic. What should the nurse do first? A. Attempt to remove the visitor from the room. B. Attempt to reason with the visitor and calm him or her down. C. Assess the patient for injuries. D. Call security for help.
D. The nurse should not attempt to intervene in this situation with a clearly agitated and aggressive visitor. In this situation, the safety of the nurse is the primary concern. Assistance is needed to first control the situation, remove the aggressor, and then assess the patient and provide appropriate care.
A rural, critical access hospital has used a total patient care model to deliver nursing care to patients because of the hospital's commitment to individualized care to patients in the community. Environmental factors such as a nursing shortage in the area and limited profitability of the hospital have forced the nursing administration to consider another, less expensive model of nursing care delivery. They want to continue their commitment to individualized care to the extent possible. Which model of care would be most appropriate in this situation? A. Team nursing B. Primary care C. Functional nursing D. Patient-centered care
D. The patient-centered care model of care maintains the commitment to individualized care; however, it uses less expensive unlicensed assistive personnel to extend the practice of the registered nurse.
When administering medications to a patient utilizing bar-code technology, what is the most important first step? A. Scan patient's identification band. B. Scan medication. C. Administer medication. D. Check 5 Rights.
D. While all steps are imperative in the medication administration process, it is most important to remember technology does not replace standard nursing practice (5 Rights) and safely caring for the patient.
What is the benefit of strategic planning for a healthcare organization? (Select all that apply.) A. It allows an organization to set its vision and goals. B. It allows an organization to assess its strengths, weaknesses, opportunities, and threats. C. It defines the driving forces in the environment. D. All of the above
D. Options A, B, and C incorporate the components for strategic planning as noted in the literature review.
