Health Law and Policy (Chapter 9), Ch. 10: Power and Conflict, Ch. 11 Workplace diversity, Ch.12: Organizational Structure, Ch. 7: Communication Leadership, NUR 3821 Exam 2, Leadership Chapter 14 and 13

10. According to the National Healthcare Quality and Disparities Report, which group has worse access to health care in America, compared with Whites? a. Hispanics b. Asians c. Blacks d. American Indians

ANS: A According to the 2014 National Healthcare Quality and Disparities Report (Agency for Healthcare Research and Quality [AHRQ], 2015), "Historically, Americans have experienced variable access to care based on race, ethnicity, socioeconomic status, age, sex, disability status, sexual orientation, and residence location." This study found that Blacks had worse access to health care than Whites for about half of measures of access, Hispanics had worse access to care than Whites for two-thirds of access measures, and Asians and American Indians and Alaska Natives had worse access to care than Whites for about one-third of access measures.

6. Equity is the absence of avoidable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically. Which group formulated this definition? a. World Health Organization b. Affordable Care Act c. Centers for Disease Control d. Agency for Healthcare Research and Quality

ANS: A According to the World Health Organization (2016), "Equity is the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically."

11. According to the _____ organizational approach, organizations are logical and predictable with identifiable and scientifically measurable characteristics that can be predicted, observed, or manipulated. a. objective b. subjective c. postmodern d. realistic

ANS: A According to the objective perspective, an organization exists as an external reality, independent of its social actors. Organizations are viewed as logical and predictable objects with identifiable and scientifically measurable characteristics (e.g., size) that can be predicted, observed, or manipulated.

7. The phrase "the buck stops here" best describes which of the following terms? a. Accountability b. Authority c. Responsibility d. Trustworthiness

ANS: A Accountability refers to the liability for task performance. Accountability means being answerable and liable. The assignment of responsibility and the granting of authority create accountability.

An action plan: a. breaks a strategic plan into manageable parts. b. details a futuristic view of the institution. c. outlines the steps in performing a procedure. d. provides a strategic plan for actualizing the mission.

ANS: A An action plan breaks a strategic plan into manageable parts

3. Cultural diversity refers to the: a. variety of cultural or ethnic groups within a society. b. belief that one's own culture is similar to another's culture. c. realization that all people in a particular culture have the same beliefs. d. view that individuals living in a country should speak the native language.

ANS: A Cultural diversity is defined by the Oxford Dictionary ("Cultural diversity," 2016) as "The existence of a variety of cultural or ethnic groups within a society."

Operational choices for action that are made to implement a strategy are called: a. tactics. b. objectives. c. core values. d. strategic plans.

ANS: A Tactics are operational choices for action that are made to implement a strategy

15. This generational cohort currently dominates the U.S. workforce. They have grown up with little economic competition. Efficiency, teamwork, quality, and service have thrived under their leadership. This generational cohort is known as: a. baby boomers. b. Generation X. c. Internet Generation. d. Mature Generation.

ANS: A The baby boomers, born between 1946 and 1964, currently dominate the U.S. workforce. They have grown up with little economic competition outside the United States. Efficiency, teamwork, quality, and service have thrived under their leadership.

13. The division of work by occupation or function is a form of: a. specialization. b. interdependence. c. uncertainty. d. technology.

ANS: A The division (or differentiation) of work by occupation or by function is a form of specialization. Specialization is the extent to which work is divided and assigned to positions and divisions

Part of the evaluation design process when developing a strategic plan includes: a. delineation of measures of success. b. designing a form to critique the guidelines. c. formulating an implementation outline. d. writing the vision and mission statement.

ANS: A The final step in the strategic planning process is developing the evaluation design. Planning for evaluation is imperative to ensure that systems and measurements are in place to determine whether the strategic plan has been achieved. During the strategic planning process, measures of success are delineated, responsible individuals are identified, and frequency of evaluation and reporting of these measures is determined.

The statement, "We will provide high-quality care and services to our patients. We are committed to maintaining excellence, respect, and integrity in all aspects of our operations and our professional and business conduct," is an example of: a. a mission statement. b. the core values of an organization. c. a strategic plan. d. the core purpose of an organization.

ANS: A The mission defines what the organization does; the core purpose delineates why.

8. Patient surveys convey that they are uncertain about who is the registered nurse (RN). The CEO makes a decision that mandates that white nursing caps will be worn by all RNs and blue nursing caps by all licensed practical nurses to differentiate professional nurses and occupational nurses from nurses' aides and other ancillary staff. Which type of structure does this represent? a. Centralized b. Decentralized c. Nonparticipative d. Participative

ANS: A This is an example of centralized structure. The CEO makes a top-down decision, and lower-level managers and staff have little decision-making discretion.

15. A rapid response team within an acute care hospital is comprised of critical care physicians, nurses, and respiratory therapists. The team assists staff throughout the hospital with detecting and managing imminent patient deterioration. This is an example of a _____ organizational form. a. parallel b. functional c. modified program d. matrix

ANS: A To address the challenges of purely functional forms, mechanisms in the parallel form assist in coordinating across functional departments (Charnes & Tewksbury, 1993). These mechanisms can include teams, specialists, task forces, liaison roles, and standing committees.

14. A White nurse from the United States is assigned to care for a Vietnamese woman who speaks little English, had a baby 2 months ago, and is 1 day postoperative after fibroid removal. The nurse knows that traditional Vietnamese women will avoid drinking or eating "sour" foods such as lime Jell-O or other citrus types of liquids after surgery. She confirms her patient's values and beliefs. The nurse is exhibiting characteristics of: a. cultural competence. b. ethnic sensitivity. c. stereotyping. d. nonjudgmental behavior.

ANS: A To reduce cross-cultural miscommunications and improve patient satisfaction, the multicultural competence of health care practitioners needs to be improved. The first step toward multicultural competence is to recognize one's own prejudices and learn about other people's differences

An example of an external variable that may affect communication is: a. circumstance. b. personality. c. thoughts. d. feelings

ANS: A Communication may be affected by the interaction of external variables (others, a situation) and internal variables (you). Internal factors are the only thing under our own control. We have little control over others or the situation, because those are external to us.

The nursing supervisor informs the staff that if they refuse to stay on the nursing unit and work an additional 8-hour shift, they will be reported to the state for patient abandonment. This type of power is known as: a. coercive. b. expert. c. legitimate. d. reward.

ANS: A French and Raven's five sources of power (1959) include reward, coercive, expert, referent, and legitimate. When coercive power is used, an individual reacts to the fear of the negative consequences that might occur for failure to comply.

A nursing preceptor is giving feedback to a new nurse who currently is being oriented. Her preceptor suggests a better method of interacting with a family member by saying, "You might want to be cognizant of your non-verbal behaviors when talking with clients. Rather than continuing to chart when you are talking with an American family, stop charting, move closer to the family and client, look at them during the conversation, and take time to let them share their concerns." This preceptor is giving advice about: a. interpersonal communication. b. clarity. c. image. d. intention.

ANS: A If the verbal message is clear, but the non-verbal communication is not congruent, then listeners may misinterpret, distrust, or not even hear the intended message. In this situation, the nurse's non-verbal behavior may suggest that she is not interested in interacting with the family.

_____ is a personal quality that is admired in the person with referent power. a. Problem solving b. Authority c. Knowledge d. Coercive power

ANS: A Referent power comes from the affinity other people have for someone. They admire the personal qualities, the problem-solving ability, the style, or the dedication the person brings to the work

A communication model that focuses on compassion, expression of emotion, and providing validation via support is the: a. validation, emotion, reassurance, activity (VERA) framework. b. situation, background, assessment, and recommendation (SBAR) Communication Theory. c. nonviolent communication (NVC) model. d. Human Relationship Model

ANS: A The VERA (validation, emotion, reassurance, activity) framework for communication was developed to meet a need for nursing students who were at a loss to communicate with persons with communication difficulties (Hawkes et al., 2015).

Organizational tones are based mostly on: a. unspoken cultural norms. b. commitment to success. c. communication behavior. d. leadership styles.

ANS: A The entire tone of the organization is based mostly on unspoken cultural norms. Because nurses make up the bulk of the health care workforce, having nurse leaders at the helm of the organization can influence the culture and climate of the organization as a whole.

5. Which of these are true regarding millennials in the work environment? (Select all that apply.) a. They need clear definitions of outcomes. b. They thrive on deadlines. c. Most enjoy working on their own. d. They struggle with multitasking. e. They lack problem-solving skills.

ANS: A, B, C Millennials have astonishing multitasking skills. They are problem solvers who grew up in a flourishing economy. Most enjoy the liberty of working on their own in a style that favors their work ethic. Millennials have learned that their presence is in demand. To thrive, they need clear definitions of outcomes, resources to do what needs to be done, and a deadline (Hendricks & Cope, 2013).

3. There are three major issues in cross-cultural communication. They are: (Select all that apply.) a. ambiguity. b. ethnocentrism. c. inflexible attitude. d. collectivism. e. negotiation.

ANS: A, B, C Research shows that there are three major issues in cross-cultural communication: ambiguity, inflexible attitude, and ethnocentrism.

4. Which of the following statements describe the benefits of specialization in the health care setting? (Select all that apply.) a. Improved work performance b. Increase in expertise c. Improved efficiency and outcomes d. Increased workload e. Increased error reporting

ANS: A, B, C The advantages of specialization include improved work performance and a critical mass of experts (Charnes & Tewksbury, 1993). In health care, specialist roles have emerged to address the increasing complexities of care and technology.

2. According to organization theories, there are three perspectives regarding the nature of reality and knowledge within an organization. Which of the following are those perspectives? (Select all that apply.) a. Objectivism b. Subjectivism c. Postmodernism d. Realism e. Idealism

ANS: A, B, C The field of organization theory contains a variety of approaches to and assumptions about the phenomenon of organization. Objectivism, subjectivism, and postmodernism reflect three broad perspectives regarding the nature of reality and the nature of knowledge with respect to the concept of organization.

Strategic management, long used in business to ensure a competitive advantage over similar enterprises, involves: (Select all that apply.) a. setting targets. b. establishing goals. c. evaluating success. d. developing an action plan. e. defining the core purpose. f. conducting an environmental scan.

ANS: A, B, C, D, F Strategic management involves conducting an environmental scan, knowing the competition, establishing goals, setting targets, developing an action plan, implementing the plan, and evaluating success. This approach has long been used in business to ensure a competitive advantage over similar enterprises. The core purpose is the reason the organization is in business.

The purpose of strategic management is to: (Select all that apply.) a. ensure customer satisfaction. b. establish a competitive position. c. reach strategic objectives or goals. d. develop the organizational mission. e. provide a blueprint for operating a business.

ANS: A, B, C, E Strategic management involves strategic planning and implementation. It provides a blueprint for operating a business, establishing a competitive position, ensuring customer satisfaction, and reaching strategic objectives or goals.

1. Culturally competent organizations benefit from meeting the diverse health care needs of the population it serves. What are the social benefits to the organization? (Select all that apply.) a. Increases mutual respect. b. Increases community participation. c. Meets regulatory guidelines. d. Assists patient and families in their care. e. Increases cost savings.

ANS: A, B, D Becoming culturally competent has social, health, and business benefits for health care organizations, according to a report from the Equity of Care initiative and the American Hospital Association's Health Research & Educational Trust and Hospitals in Pursuit of Excellence. Becoming a Culturally Competent Health Care Organization (Health Research & Educational Trust, 2013) outlined 16 benefits of organizations' ability to meet the health care needs of patients with diverse backgrounds, grouped into three broad categories of social, health, and business benefits. Social benefits include increases mutual respect and understanding between patient and organization, increases trust, promotes inclusion of all community members, increases community participation and involvement in health issues, assists patients and families in their care, and promotes patient and families responsibilities for health.

6. An organizational chart is used to depict: (Select all that apply.) a. a visual display of the organization s positions. b. the intentional relationships among positions. c. open positions within human resources. d. flow of authority. e. advisory committees.

ANS: A, B, D Hierarchy reflects the formal structure of the organization, which can be identified on an organizational chart. An organizational chart is a visual display of the organization's positions and the intentional relationships among positions. The organizational chart reflects the various positions and the formal relationships between and among the positions and, by extension, the people who are a part of the organization.

4. In order to make a positive contribution to care of patients, it is critical that nurses recognize which of the following aspects of culture? (Select all that apply.) a. Culture of the clinician b. Culture of the patient and family c. Spiritual beliefs of the clinician d. Culture of co-workers e. Spiritual beliefs of the patient

ANS: A, B, D In order to make a positive contribution to the effective treatment of patients, it is critical that nurses or clinicians first recognize that they are dealing with a multiplicity of cultures. They include the clinician's own culture, the culture of the patient and patient's family, the culture of co-workers, and the health care institution's culture.

Negotiation is a form of conflict resolution. Which of the following terms are associated with negotiation? (Select all that apply.) a. Conciliation b. Distributive bargaining c. Arbitration d. Mediation e. Collective bargaining

ANS: A, B, D Conflict resolution involves eliminating all forms of conflict. Negotiation, mediation, and arbitration are often referred to in discussions of conflict resolution. These terms are also included under the umbrella of alternative dispute resolution (ADR). According to Knickle and colleagues (2012), the resolution continuum includes negotiation, mediation, arbitration, and litigation as a spectrum of third-party dispute resolution. A conciliator is like a third friend who might attempt to intercede in an argument between two other friends. Conciliators attempt to diffuse the negative emotions that are often involved in the conflict, and they strive to establish more effective communications between the parties.

6. The nurse manager of a nursing unit is a White, female working with a high percentage of Middle Eastern nursing staff. Which of these statements are true about the communication and leadership style of a low-context culture? (Select all that apply.) a. Rules are clear and tend to be followed. b. Low-context cultures require extensive, detailed explanations. c. Verbal communication is less explicit. d. Decisions are made in face-to-face conversations. e. Decisions are focused around tasks.

ANS: A, B, E From a global perspective, the cultural context of the Western world is low context. In places such as North America and Western Europe, the explicit verbal or written message carries the meaning. Low-context cultures require extensive detailed explanations, information, and contracts because they are making up for the context that may be missing in a given situation. Decisions are focused around tasks and activities that need to be accomplished. Rules are very clear and tend to be followed precisely.

Organizational change is associated with both direct and indirect costs for which leaders must be prepared. Which of the following are examples of indirect costs associated with conflict? (Select all that apply.) a. Loss of team morale b. Disrupted communication c. Disability or stress claims d. Decreased management productivity related to time spent resolving conflict e. Loss of motivation for achieving team goals

ANS: A, B, E Dysfunctional outcomes of conflict include development of discontent, reduced group effectiveness, disrupted communication, reduced group cohesiveness, and infighting among group members, which then overrides the focus on group goals.

What are the two major content dimensions of power? (Select all that apply.) a. Influence b. Integrity c. Authority d. Dominance e. Control

ANS: A, C Authority and influence are two major content dimensions of power. Influence, dominance, and control may occur in separate dimensions

Which of the following are factors that influence the way conflict is handled within an organization? (Select all that apply.) a. Behavioral predispositions of individuals b. Bureaucratic hierarchy c. Social pressure in the environment d. Rules and procedures e. Position power

ANS: A, C, D A structural model of conflict exists that examines four factors that seem to influence the way conflict is handled in organizations: behavioral predispositions of individuals, social pressure in the environment, the organization's incentive structure, and rules and procedures.

Effectiveness and sustainability of change is based on the skilled communication of leadership and stakeholders endorsing the change process. What are some barriers that can interfere with change? (Select all that apply.) a. Inwardly focused cultures b. Transformational leadership c. Fear of the unknown d. Arrogant attitudes e. Safety culture

ANS: A, C, D Kotter (1996) suggested the following are needed to empower people to make change: communicate the vision to employees, make structures compatible with the vision, provide the training employees need, align information and personnel systems, and confront supervisors who undercut needed change. Further, he suggested that structures, skills, systems, and supervisors are generally the four barriers to any transformational process.

Empowerment for nurses may consist of three components. Which three of the following components may help nurses become empowered to use their power for better patient care? (Select all that apply.) a. A state in which a nurse has assumed control over his or her own practice b. A social relationship between two or more people c. A workplace that promotes opportunities for growth d. A nurse's sense of meaning as expressed in values and work role e. Interdependence of personnel

ANS: A, C, D Nurse empowerment was defined as a state in which an individual nurse has assumed control over his or her practice, enabling him or her to successfully fulfill professional nursing responsibilities within an organization. Organizational antecedents to nurse empowerment include the "opportunities for mobility and growth and access to resources, support, and information provided within the nurse's work environment." The organizational and individual antecedents lead to psychological empowerment, including a nurse's sense of meaning as expressed in values and work role.

Effective communication is fostered through which of the following ingredients? (Select all that apply.) a. Trust b. Humility c. Respect d. Empathy e. Sympathy

ANS: A, C, D Trust, respect, and empathy are the three ingredients needed to create and foster effective communication.

E-mail is a great tool for communication. When should e-mail not be used? (Select all that apply.) a. When you are mad. b. When scheduling a meeting c. When you are canceling or apologizing d. If there is any chance your words could be misunderstood e. When rebuking or criticizing

ANS: A, C, D, E Electronic communication has assisted us to be better informed regarding our patients. However, within the professional health care realm, there is a tendency to rely on these modes of communication when other methods would be preferable and more appropriate. For instance, there are definite times when a face-to-face conversation is preferred to an e-mail. Warrell (2012) noted that there are four times you should never use e-mail: (1) when you are mad, (2) when rebuking or criticizing, (3) if there is any chance your words could be misunderstood, or (4) when you are canceling or apologizing. In our busy professional lives, it is easier to send off a quick e-mail than to pick up the phone or walk down the hall; however, e-mail distances us from others and is really only the preferred means of communication when information is simply being conveyed.

Characteristics of strategic management include: (Select all that apply.) a. alignment with the external environment. b. helps identify best practices on the nursing unit. c. future orientation. d. engagement of the entire workforce in organizational leadership. e. use of change management strategies to achieve performance goals. f. facilitation of decision making with well-communicated decisions.

ANS: A, C, D, E, F According to Jasper and Crossan (2012), the five characteristics of strategic management are engagement of the entire workforce in organizational leadership, alignment with the external environment, future orientation, use of change management strategies to achieve performance goals, and facilitation of decision making with well-communicated decisions.

Which of the following statements accurately describe the varying mechanisms of power? (Select all that apply.) a. Connection power is based on the perception that the influencer has access to powerful people or groups. b. Legitimate power is based on fear. c. Expert power results from expertise, special skill, or knowledge. d. Information power refers to skill in making rational appeals. e. Referent power is based on admiration for a person.

ANS: A, C, E Connection power is based on another's perception that the influencer has access to powerful people or groups. Expert power results from expertise, special skill, or knowledge. Referent power is based on admiration for a person.

The Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine have assessed progress made on recommendations for the future of nursing. What are the recommendations for nurses? (Select all that apply.) a. Remove barriers to practice and care. b. Maintain current leadership roles. c. Promote diversity. d. Transform education. e. Improve data

ANS: A, D, E In 2014 the Robert Wood Johnson Foundation asked the Institute of Medicine (IOM, now called the National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division) to convene a committee to assess progress made on implementing the recommendations of The Future of Nursing (IOM, 2010) and identify areas that should be emphasized over the next 5 years. This report outlines specific areas to accelerate implementation of the IOM recommendations for nurses: (1) removing barriers to practice and care, (2) transforming education, (3) collaborating and leading, (4) promoting diversity, and (5) improving data.

6. An organizational chart with one line of management and one line of staff reflects which of the following types of organizational structures? a. Authoritarian structure b. Flat structure c. Power structure d. Vertical structure

ANS: B A flat or horizontal structure has few administrative layers between management and employees. Employees have more decision-making power in this type of hierarchy.

11. The variation among groups of people with respect to habits, values, preferences, beliefs, taboos, and rules for behavior determined to be appropriate for individual and societal interaction is known as: a. bias. b. diversity. c. culture d. stereotyping.

ANS: B Culture refers to the variation among groups of people with respect to habits, values, preferences, beliefs, taboos, and rules for behavior determined to be appropriate for individual and societal interaction.

16. This generational cohort was the first generation of latchkey kids who had to be resourceful at an early age. They are skeptical of traditional practices and beliefs. They strive for a balanced life. This group is known as: a. baby boomers. b. Generation X. c. Internet Generation. d. Mature Generation.

ANS: B Generation X members, born between 1965 and 1980, were the first generation of latchkey kids who had to be resourceful at an early age. They are skeptical of traditional practices and beliefs. They strive for a balanced life.

A new cancer center is being built in the local hospital. A patient survey has revealed that patients are not certain which caregiver is the registered nurse (RN) during their hospital stay. A group is formed to recommend methods to help patients identify which caregiver is their RN for the new cancer center. Which of the following groups best represents those who should be involved in forming recommendations? a. Chief medical officer, public relations vice president, and human resources b. Oncology clinical nurse specialist, nurse's aides, and RNs c. Physicians, unit secretaries, and vice president of finance d. Vice president of nursing, decentralized pharmacist, and licensedpractical/vocational (LPN/LVN) nurses

ANS: B Involving individuals at all levels of the organization will ensure a variety of perspectives and more buy-in to the final product. Including the patient's perspective may provide additional insight about the issue. Ideally, those involved in all levels of patient care, such as the vice president of nursing, nurse manager, oncology clinical nurse specialist, LPN/LVNs, and nurses' aides, as well as patients of the RN, may need to be included to gain additional perspective

10. The ways in which work is divided and coordinated among members and the resulting network of relationships, roles, and work groups is the: a. organization. b. organizational social structure. c. structure. d. formal relationship.

ANS: B Organizational social structure is defined as the ways in which work is divided and coordinated among members and the resulting network of relationships, roles, and work groups (e.g., units, departments).

14. Standardization of _____ provides a uniform structure for information delivery and flow in order to facilitate exchange among those involved in common work processes. a. physician orders b. communication c. work processes d. work outputs

ANS: B Standardization of communication methods coordinates work by providing a uniform infrastructure of information to facilitate exchange among those involved in common work processes

A nurse manager enjoys implementing new programs and beginning new projects. She is beginning to find herself overwhelmed and needs to decrease her workload. Which of the following ideas might best help decrease her workload? a. Comparing her vision with that of the institution b. Following the strategic objectives and mission of the hospital c. Reviewing the action plan and vision of the hospital system d. Using her intuition to determine which project should continue

ANS: B Strategic objectives provide a way of converting the rather abstract mission of an organization into concrete terms. Following the mission of the hospital will help keep the nurse manager focused.

9. The patient is a 69-year-old woman who has a history of diabetes mellitus, peripheral vascular disease, and myocardial infarctions. She was admitted to the hospital with a stroke and is being transferred to a subacute facility and then to a rehabilitation facility. At every transfer she must review her entire history, provide telephone numbers of family members, list all 30 of her medications, and list all home care and medical supply companies. Which of these processes could improve the fragmentation in work flow? a. Departmentalization b. Standardization c. Specialization d. Subdivision

ANS: B Subdividing work may create breaks or fragmentation in work flow, which can be addressed in organizations by integrating work processes across roles and subunits using coordination devices (Hatch & Cunliffe, 2013). At the work group level, coordination may involve specific roles, standardization (programming), groups, or feedback devices. For example, handoff communication and techniques such as situation, background, assessment, and recommendation (SBAR) are used to coordinate between units or providers in the delivery of care.

The concept of strategic management includes strategic planning and the implementation of: a. core values. b. strategy. c. tactics. d. objectives.

ANS: B The concept of strategic management includes strategic planning and strategy implementation

A hospital with a large surgery department is concerned about surgeons starting their own surgical centers. In relation to the environmental assessment process, this is an example of: a. an economic monopoly. b. an external threat. c. marketplace competition. d. political strength.

ANS: B The external components are described as opportunities and threats, and they are identified in the same manner as the internal factors. Opportunities and threats may include changes in industry, marketplace, economy, political climate, technology, and competition

2. A client of Vietnamese background is admitted to the unit after a hysterectomy. She has an order for clear liquids. When her tray is brought to her, she refuses the lime Jell-O. Which response by the nurse is most appropriate? a. "I don't blame you. I don't like lime Jell-O either." b. "Tell me about your cultural beliefs to best help you." c. "Why don't you want to eat the lime Jell-O?" d. "It is important for you to eat so that you will heal."

ANS: B The first step toward multicultural competence is to recognize one's own prejudices and learn about other people's differences. The problem is that many Americans are afraid to ask people about their culture because of the idea that "we don't want to offend anyone." The challenge with this thinking is that if nurses do not ask about people's differences, then the only option is to make assumptions.

8. A nurse believes that she should provide optimal care to all clients, regardless of their cultural background. She is struggling with her emotions when caring for a client with a violent criminal background. What would be the best course of action for this nurse? a. Avoiding the client as much as possible but providing care b. Identifying her biases but providing care c. Requesting another patient assignment d. Taking sick days while the patient is hospitalized

ANS: B The first step toward multicultural competence is to recognize one's own prejudices and learn about other people's differences. The problem is that many Americans are afraid to ask people about their culture because of the idea that "we don't want to offend anyone." The challenge with this thinking is that if nurses do not ask about people's differences, then the only option is to make assumptions.

The guiding framework that describes the organization's purpose and future direction is the: a. futuristic guidelines. b. mission and vision. c. strategic plan. d. core purpose.

ANS: B The organizational mission and vision collectively is a guiding framework that describes the organization's purpose and future direction

7. Recognizing one's own prejudices and learning about other people's differences is the first step toward: a. cultural diversity. b. multicultural competence. c. social change. d. valuing.

ANS: B To reduce cross-cultural miscommunications and improve patient satisfaction, the multicultural competence of health care practitioners needs to be improved. The first step toward multicultural competence is to recognize one's own prejudices and learn about other people's differences.

A hospital nurse manager is involved in conflict management between two staff members. The process of collaborating occurs when: a. one person seeks to satisfy his/her own interests. b. both sides strive to meet the interests of both parties. c. a person chooses to withdraw from conflict. d. one party seeks to appease the other.

ANS: B Collaborating ensues when the parties to conflict each desire to fully satisfy the concerns of all parties. The intention is to solve the problem by clarifying differences rather than by accommodating.

The process in which information, perception, and understanding are transmitted from person to person is: a. articulation. b. communication. c. evaluation. d. pronunciation.

ANS: B Communication is the process in which information, perception, and understanding are transmitted from person to person.

_____ communication patterns exist between colleagues and serve to contribute to a hostile work environment, high turnover, burnout, and job dissatisfaction. a. Defensive b. Disruptive c. Negotiating d. Humanizing

ANS: B Documentation in literature is extensive regarding disruptive and distracting communication interactions not only between nurses and colleagues but also between nurses and patients. The research indicates that nursing personnel experience high turnover rates, job dissatisfaction, and burnout; many registered nurses are leaving the profession. The work environment is described as hostile to nurses, and patient outcomes of increased severity of illness and mortality have been directly related to poor communication skills of the staff.

The transformational leader engages staff by: a. punishing errors. b. sharing vision and decision making c. taking a top-down approach to leadership. d. making unilateral decisions for the team.

ANS: B Effective transformational nurse leaders will engage their staff through role modeling and mentorship of inclusion behaviors such as developing rapport, sharing vision and decision making, providing constructive feedback, and communicating successful outcomes. The communication of transformational leaders is focused on positive interchanges, rather than punishment, and inclusion in decision making versus authoritarianism.

_____ is an influence tactic where another person is given praise or sympathy in an effort to make the other person feel important a. Assertiveness b. Ingratiation c. Rationality d. Upward appeal

ANS: B Ingratiation means trying to make the other person feel important—giving praise or sympathizing. Ingratiation is attempting to advance oneself by trying to make another person feel important

A staff nurse frequently is providing positive comments to get the manager in a good mood before asking about additional vacation time. This influence tactic is known as: a. consultation. b. ingratiation. c. inspiration appeals. d. rational persuasion.

ANS: B Ingratiation occurs when the agent uses praise, flattery, friendly behavior, or helpful behavior to get the target in a good mood or to think favorably of him or her before asking for something

A disagreement or differences between the members of two or more groups over authority, territory, and resources is called _____ conflict. a. intragroup b. intergroup c. interpersonal d. intrapersonal

ANS: B Intergroup conflict refers to disagreements or differences between the members of two or more groups or their representatives over authority, territory, and resources.

Which of the following is true about negotiation? a. It commonly results in a win-lose situation. b. It is aimed at solving problems, conflicts, or disputes. c. It is used only in contract and labor union disputes. d. It is the exchanging of favors or trading activity.

ANS: B Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue. It is used to solve problems, conflicts, or disputes.

Nurses derive much of their power from being: a. authority figures in emergent situations. b. central to the delivery of health care services. c. organized through public associations. d. the care coordinator of the health care team.

ANS: B Professional nurses have a high degree of centrality within health care organizations. They are critical to the operation of most health care organizations, and without nurses, many health care facilities would not be able to offer services. Nursing maintains power by being central to the actual delivery of health care services, which is the core business function

A nurse on a medical-surgical floor has been asked to join a research committee. She agrees to this request because of her great admiration for the vice president of nursing. This is an example of _____ dimension of power. a. dependence b. relational c. subversive d. tactical

ANS: B Relational dimension of power is a property of a social relationship. Many classic definitions indicate that power has to do with relationships between two or more actors in which the behavior of one is affected by the other

Subunit power is derived from: a. being independent within the organization. b. providing resources on which the organization most depends. c. supplying multiple cross-trainable functions within the organization. d. voicing unique opinions and values within the organization

ANS: B Subunit power is derived from providing resources on which the organization most depends. Subunit power also is derived from dependence, coping with uncertainty, being irreplaceable, having the ability to affect the decision process, and having shared consensus within the organizational subunit.

The number one cause of preventable medical errors is: a. hostile work environments. b. poor communication. c. ineffective leadership. d. staff competency.

ANS: B The Agency for Healthcare Research and Quality (AHRQ) has collected data regarding patient safety over many years. They discovered that poor communication was the number one cause of preventable medical errors (Kleiner et al., 2014). After discovering the staggering number of preventable medical errors and recognizing that communication problems were cited as the number one contributor, the AHRQ partnered with the Department of Defense (DOD) and developed the TeamSTEPPS program

Which communication format was developed to address the communication arm of the TeamSTEPPS model? a. NVC (nonviolent communication) b. SBAR (situation, background, assessment, and recommendation) c. VERA (validation, emotion, reassurance, activity) d. MI (motivational interviewing)

ANS: B To address the "communication arm" of the TeamSTEPPS model strategies such as SBAR have been created to enhance teamwork communication. One of the strategies that has been well documented and is familiar to nurses is SBAR, which stands for situation, background, assessment, and recommendation.

Which of the following are examples of patient privacy or security breaches? (Select all that apply.) a. Encrypted e-mail communications b. Fax transmission sent to incorrect physician office c. Prescription given to patient with wrong label attached d. Case management coordinator obtaining information about a patient's diagnosis e. Discharge summary given to patient's spouse

ANS: B, C Fax transmissions sent to the incorrect physician's office or prescriptions given to a patient with the wrong label attached are examples of privacy or security breaches under HIPAA. Electronic transmissions should be end-user encrypted for data security.

A client's wife is concerned about her husband's declining health. He has been admitted with an acute myocardial infarction and has had two myocardial infarctions before this admission. He is not a candidate for surgery. She and her husband have discussed "no breathing machine" for long-standing care, but she is unsure of his wishes if he were to need a "breathing machine" for a short period. The nurse discusses his current condition and care with the client and his wife. She also organizes a team meeting consisting of the client's physicians, social worker, pastoral care person, and nursing staff. During this meeting, the nurse helps the wife share her concerns and the client's concerns with the rest of the team. What type of communication technique is being utilized by the nurse? (Select all that apply.) a. Bargaining b. Negotiation c. Persuasion d. Spiritual assessment e. Collective action

ANS: B, C Persuasion is the conscious intent by one individual to modify the thoughts or behaviors of others. Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue. Persuasion and negotiation are used to ensure that all members of the teamwork together in a co-operative manner. The nurse, the patient, and the spouse all communicate the wishes of the patient to convince the team to abide by the autonomous decisions of the patient and spouse.

What are the consequences or outcomes of nurse empowerment? (Select all that apply.) a. Increased compensation and benefits b. Decreased burnout c. Decreased job strain d. Increased job satisfaction and work effectiveness e. Increased trust in the workplace

ANS: B, C, D Rao (2012) summarized the consequences or outcomes of nurse empowerment as (1) the potential for improved nurse and patient outcomes, (2) decreased burnout, (3) decreased job strain, (4) increased trust in the workplace, and (5) increased job satisfaction and work effectiveness.

NVC communication processes are grounded in: (Select all that apply.) a. confrontation b. empathy c. compassion d. honesty e. assertiveness

ANS: B, C, D NVC communication utilizes a four-part communication process grounded in compassion, empathy, and honesty. The four parts include making an observation, expressing a feeling, expressing a need, and making a request without demanding.

2. When communicating health information with diverse populations, miscommunication and misunderstanding can lead to: (Select all that apply.) a. cultural competence. b. malpractice claims. c. informed consent. d. errors. e. increased cost.

ANS: B, C, D, E The literature illustrates the vital role communication plays in avoiding cases of malpractice due to diagnostic and treatment errors. When communicating with culturally and linguistically diverse populations, the opportunity for miscommunication and misunderstanding increases, which subsequently increases the likelihood of errors. These errors, in turn, can cost millions of dollars in liability or malpractice claims.

Which of the dimensions of spirituality should nurses assess for in care delivery? (Select all that apply.) a. Culture b. Beliefs c. Values d. Social e. Religious

ANS: B, C, D, E Nurses need to assess for social, spiritual, religious, and cultural values and beliefs because they may affect individual patients' health care decisions and preferences.

Group readiness levels can be assessed in four stages. Which of the following statements is accurate regarding group readiness? (Select all that apply.) a. Members are organized and secure about their roles in the forming stage. b. At the forming stage, the group needs direction in defining goals. c. During the storming period, there is more willingness to accept the group goals. d. The group becomes self-managing during the norming period. e. During the performing period, the members willingly perform the task.

ANS: B, C, E At the forming readiness level, the group needs direction in defining task goals and objectives as opposed to personal goals. The members are uncertain and insecure about their role in the group. This initial period is chaotic. During the storming period, there is more willingness to accept the group goals and objectives but there are still differences of opinion, competition for recognition, and attempts to influence the group. During the norming period, there is greater agreement on the task goals as the group develops cohesiveness and adjusts to the group and task. Finally, during the performing period, the members are thinking as one and willingly performing the task. There is camaraderie and team spirit as the group becomes self-managing.

Which of the following are the formal dimensions of power? (Select all that apply.) a. Social aspect b. Relational aspect c. Dependence aspect d. Independent aspect e. Sanctioning aspect

ANS: B, C, E The three formal dimensions of power are the relational, dependence, and sanctioning aspects of power. The relational aspect of power suggests that power is a property of a social relationship. The dependency aspect of power suggests that power resides implicitly in the other's dependency. The sanctioning aspect of power is the active component of the power relationship, referring to the direct manipulations of the other's outcomes.

For organizational strategy to be implemented successfully it must be: (Select all that apply.) a. specific and inflexible. b. applied in a timely manner. c. agreed upon by all stakeholders. d. executed proficiently and efficiently. e. aligned with the organizational culture.

ANS: B, D, E Strategy must be implemented proficiently and efficiently, as well as in a timely manner, if it is to be effective. For this to occur, the organization must attend to its capabilities, the reward structure, available support systems, and the organizational culture. If any of these characteristics are not in place, implementation of the strategy will surely fail.

Transformational leadership focuses on engaging staff to become stakeholders in a shared mission and vision. Which of the following are correct statements? (Select all that apply.) a. Transformational leaders have an authoritarian style of communication. b. Effective transformational nurse leaders engage their staff through role modeling and mentorship of inclusion behaviors. Communicating is a process competency. c. Transformational leaders have a rigid bureaucratic one-way communication network. d. The communication of transformational leaders is focused on positive interchanges. e. Effective transformational leaders listen more than they talk, are open to all new ideas, and create a culture of safety.

ANS: B, D, E Effective transformational nurse leaders will engage their staff through role modeling and mentorship of inclusion behaviors such as developing rapport, sharing vision and decision making, providing constructive feedback, and communicating successful outcomes. The communication of transformational leaders is focused on positive interchanges, rather than punishment, and inclusion in decision making versus authoritarianism. Transformational leaders also know how to share vision and mission and how to motivate the workforce. This is accomplished by communicating the vision with passion and commitment that is contagious. Transformational leaders need to listen more than they talk, be open to all new ideas, and create a culture of safety, transparency, and empathy

The main effects of conflict are individual effects, interpersonal relationships, and organizational effects. What are some of the positive effects of conflict within an organization? (Select all that apply.) a. Absenteeism b. Team cohesiveness c. Disrupted communication d. Stimulation of creativity and innovation e. Improved quality of decisions

ANS: B, D, E Positive outcomes of conflict include stronger relationships and team cohesiveness, stimulation of creativity and innovation, and improved quality of decisions

Which of the following statements describe structural determinants of power within an organization? (Select all that apply.) a. Power is derived from independence. b. Power is derived from providing resources. c. Power is derived from certainty. d. Power is derived from being irreplaceable. e. Power is derived from the ability to affect the decision process.

ANS: B, D, E The following are structural determinants of power within organizations: Power is derived from dependence; power is derived from providing resources; power is derived from coping with uncertainty; power is derived from being irreplaceable; power is derived from the ability to affect the decision process; and power is derived if there is a shared consensus within the organizational subunit.

Addressing the strategic planning process questions involves considering environmental factors. An example of an external environmental factor to be considered is: a. financial factors. b. human resources. c. political climate. d. organizational culture

ANS: C A key component of the strategic planning process is to assess the environment. This assessment, called environmental scanning, consists of analyzing both internal and external environmental factors. External opportunities and threats may include changes in industry, marketplace, economy, political climate, technology, and competition

1. Which of these statements are true about culture? a. Culture remains consistent. b. Individuals identify with one culture during their lifetime. c. Culture is complex. d. Culture excludes religion.

ANS: C Culture is dynamic in nature, and individuals may identify with multiple cultures over the course of their lifetimes. There is a complex nature to culture, which has been defined and studied across many disciplines.

13. When nurses portray an attitude that their cultural group is superior to another, it is known as practicing the concept of cultural: a. diversity. b. egocentrism. c. ethnocentrism. d. prejudice.

ANS: C Ethnocentrism is characterized or based on an attitude that one's own cultural group is superior to another.

12. What is the most modifiable factor in the provision of equitable health care? a. Availability of services b. Socioeconomic status c. Care that is responsive to cultural needs d. Education level

ANS: C Health inequities are directly related to the existence of historical and current discrimination and social injustice, and one of the most modifiable factors is the lack of culturally and linguistically appropriate services, broadly defined as care and services that are respectful of and responsive to the cultural and linguistic needs of all individuals.

The statement, "We will increase our profit by 8% each year," is an example of a(n): a. strategic plan. b. mission statement. c. organization objective. d. implementation strategy.

ANS: C Objectives are defined as the targets an organization wants to achieve. These can be financial or performance based with short-range or long-range targets.

18. Eliminating ___________ can be accomplished through access to high-quality care, promoting patient-centered care and maintaining accurate data to monitor the quality of care provided. a. diversity b. cultural incompetence c. health disparities d. miscommunication

ANS: C Principles of eliminating racial and health disparities include providing insurance coverage and access to high-quality care, promoting a diverse health care workforce, delivering patient-centered care, maintaining accurate, complete race and ethnicity data to monitor disparities in care, and setting measurable goals for improvement of quality of care.

5. Which of the following ethnic populations has seen the fastest growth? a. African Americans b. Iranians c. Hispanics d. Vietnamese

ANS: C Results from the 2010 census show that racial and ethnic minorities accounted for 91.7% of the nation's growth since 2000. Most of that increase, from 2000 to 2010 (56%), was due to Hispanics.

SWOT is an acronym for: a. stability, wealth, opportunistic, and timeliness. b. strategies, work ethic, oppositions, and team. c. strengths, weaknesses, opportunities, and threats. d. strong, worthy, oppositional, and tactical.

ANS: C SWOT is an acronym for strengths, weaknesses, opportunities, and threats. SWOT analysis is used in developing strategic plans for an organization.

4. A nurse manager is responsible for a unit consisting of 40 nurses who report to two clinical supervisors. In addition, there are 10 support staff who report to an administrative supervisor. The subordinates reporting to this manager are known as which dimension of organizational design? a. Division of labor b. Hierarchy c. Span of control d. Decentralization

ANS: C Span of control is the number of subordinates a manager can efficiently and effectively direct.

3. The nursing chief executive officer (CEO) works in a major rehabilitation and subacute facility network. Her span of control refers to the number of: a. miles in which the network resides. b. ancillary staff accountable to her. c. nurses and non-nurses reporting to her. d. inpatients that the facilities service.

ANS: C Span of control refers to the number of nurses and non-nurses reporting to a manager.

Answering questions such as "What business are we in?" and "What business do we want to be in?" can lead the organization to define the: a. mission. b. objectives. c. core purpose. d. strategic plan.

ANS: C The core purpose can be defined and refined by asking, "Why are we in business?" As a result, the initial response, "We are in the business of health care," may be further refined to "We want to contribute to the community in which we exist." Thus asking "why" may result in the core purpose of providing needed health care services to the community in which the organization is located.

17. The network or pattern of social relationships and friendship circles within an organization is known as the: a. clique. b. formal structure. c. informal structure. d. hierarchy.

ANS: C The informal structure is simply the network or pattern of social relationships and friendship circles that are outside the formal structure. It is an interconnected web of relationships that operate in and around the formally designated lines of communication.

1. Which of the following factors influences the structure of an organization? a. Age of the building b. Brand of computer system c. Number of employees d. Square footage of the facility

ANS: C The number of employees influences the structure of an organization. Organizational structure is a consequence of both the division of and the coordination of labor, which results in a formal set of interrelated and interdependent roles and work groups.

5. A staff nurse has been working in the neonatal critical care unit for 10 years. She believes that a professional nurse is a lifelong learner. Many staff members come to her for clinical problem solving and advice. This nurse has: a. decisional authority. b. formal power. c. informal power. d. quantum authority.

ANS: C This nurse has informal power. She is a staff nurse with a great amount of expertise, with many relationships and alliances in the organization.

9. Which of the following supports successful workplace diversity? a. Being a "devil's advocate" b. Holding tight to one's cultural values c. Respect for differences d. Withholding judgment of others

ANS: C To reduce cross-cultural miscommunications and improve patient satisfaction, the multicultural competence of health care practitioners needs to be improved. The first step toward multicultural competence is to recognize one's own prejudices and learn about other people's differences.

A common source of conflict in nursing occurs when the nurse wants to perform patient teaching or counseling, but there are competing priorities and the nurse has inadequate time to spend with the patient. This type of conflict is related to: a. interpersonal conflict. b. intergroup conflict. c. intrapersonal conflict. d. intragroup conflict.

ANS: C Intrapersonal conflict means discord, tension, or stress inside—or internal to—an individual that results from unmet needs, expectations, or goals. It often is manifested as a conflict over two competing roles. A nursing example occurs when the nurse determines that a patient needs teaching or counseling, but the organization's assignment system is set up in a way that does not provide an adequate amount of time. When other priorities compete, an internal or intrapersonal conflict of roles exists.

Which communication technique is most effective when handling patient complaints? a. Persuasion b. Bargaining c. Negotiation d. Non-verbal cues

ANS: C Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue.

Unspoken affective or expressive behaviors best describe which type of communication? a. Effective communication b. Ineffective communication c. Non-verbal communication d. Verbal communication

ANS: C Non-verbal communication is unspoken. It is composed of affective or expressive behaviors.

A human communication activity designed to influence another to change attitudes or alter behaviors by the use of techniques such as argument, reasoning, or pleading is known as: a. advisement. b. consultation. c. persuasion. d. suggestion

ANS: C Persuasion is a human communication activity designed to influence another to change attitudes or alter behaviors by the use of techniques such as argument, reasoning, or pleading.

Subunit or _____ power refers to relationships across departments. a. vertical b. organizational c. horizontal d. exertional

ANS: C Subunit or horizontal power pertains to relationships across departments. DIF

3. According to the contingency theory of organizational performance, an organization must structure and adapt its nursing units to complement which two factors? (Select all that apply.) a. Skill set b. Patient population c. Environment d. Technology e. Finances

ANS: C, D Mark and colleagues (1996) applied contingency theory to the evaluation of nursing care delivery system outcomes. The basic premise was that, to perform effectively and produce quality outcomes, an organization must structure and adapt its nursing units to complement the environment and technology.

1. The nursing staff on a critical care unit thought that professional growth could be enhanced. Which of the following interventions would support empowerment of the nursing staff? (Select all that apply.) a. Eliminating computers and reverting back to paperwork b. Increasing pay wages for ancillary and professional staff c. Providing various methods for ongoing education and continuing education units d. Working to make equipment and medications readily available

ANS: C, D Social structures important to the growth of empowerment are having access to information, receiving support, having access to resources necessary to the job, and having the opportunity to learn and grow.

5. Dividing work by occupation leads to a functional organization where services are arranged by the type of work performed. What are some benefits of the functional form within the health care organization? (Select all that apply.) a. Professional silo b. Fragmented care delivery c. Cost reduction d. Enhanced performance and quality e. Promotion of professional development

ANS: C, D, E By dividing personnel according to the type of work performed, organizations can capitalize on the expertise, experience, efficiency, and professional standards that each discipline offers. Other benefits include cost reduction through shared resources; enhanced monitoring of cost, performance, and quality; and promotion of professional development, identity, autonomy, advocacy, and career advancement (Charnes & Tewksbury, 1993). Disadvantages of the functional form are its potential to overemphasize professional silos, discourage informal relationships across disciplines, and fragment care delivery.

Most strategic plans result in a written document. Strategic plan documents generally contain which of the following sections? (Select all that apply.) a. Forward b. Glossary c. Goals and strategies d. Executive summary e. Mission, vision, and values

ANS: C, D, E Generally, strategic plan documents contain an executive summary; background; mission, vision, and values; goals and strategies; and appendixes.

7. Which of the following statements are accurate when describing responsibility and accountability? (Select all that apply.) a. The assignment of responsibility assumes accountability. b. A manager is assigned responsibility by a subordinate. c. Accountability is the liability for task performance. d. The assignment of responsibility and the granting of authority create accountability. e. Accountability flows upward or outward.

ANS: C, D, E Responsibility is the allocation and acceptance of a task. Responsibility is the obligation to take on and accomplish work and to secure the desired results. In accepting the obligation of an assigned task, the staff person is accepting responsibility to accomplish the task. Accountability is the liability for task performance and is determined in a retrospective analysis of what occurred. The assignment of responsibility and the granting of authority create accountability. Accountability flows upward or outward: from staff to manager or from provider to client.

Strategic management is useful for nursing leaders and managers because it: (Select all that apply.) a. helps identify best practices on the nursing unit. b. rewards those who carry out strategy successfully. c. can be used to set measurable, achievable goals and plans. d. can be used to analyze the environment for opportunities and threats. e. can help determine the future of the nursing area, such as a department or unit.

ANS: C, D, E Strategic management is useful for nursing leaders and managers because it can be used to analyze the environment for opportunities and threats; to set measurable, achievable goals and plans; and to help determine the future of the nursing area, such as a department or unit. Success in strategic planning and implementing that strategic plan will position nursing well in an institution. The process provides an opportunity for nursing to shine, because the similarities between the nursing process and the strategic planning process allow nurses to shortcut the learning curve and begin to move forward with the implementation phase while others may still be grappling with the planning process.

Nurses must use which of these to facilitate change in health care organizations? (Select all that apply.) a. Actualization b. Authorization c. Influence d. Ratification e. Power

ANS: C, E As the largest health care profession, nursing must use power and influence as a legitimate tool to facilitate change in health care organizations and the health care system.

A highly respected staff RN on the medical-surgical unit has volunteered to be the champion for the implementation of a new nursing protocol. What does champion mean in this situation? The staff nurse will: a. accept an award on behalf of her unit regarding this protocol. b. display a winning attitude in support of the new protocol. c. educate others in continuous quality improvement protocols. d. passionately commit to the implementation of the process and inspire others.

ANS: D A champion is an individual who is passionate and committed to the implementation process and who can inspire others. Often a champion appears as the strategic planning process unfolds; generally, this individual that contributes freely, is engaged in the work groups, and expresses interest in the process. Champions can be selected as well, but those who volunteer are usually more enthusiastic about the work than those who are "drafted."

17. A patient from the Philippines has been admitted to the ICU after a motor vehicle accident. The patient has a very large group of family and friends wanting to visit, hold vigils, and provide meals to the visitors and staff. This is an example of: a. inflexible attitude b. ambiguity c. ethnocentrism d. collectivism

ANS: D Collectivism is a tightly knit societal framework where people are integrated into cohesive and strong in-groups, often extended families, to look after them in exchange for unquestioning loyalty. Nurses from collectivist cultures tend to look to the team before taking action. The most collectivist culture on Hofstede's scale is Guatemala at 6, China is 20, and the Philippines is 32. It's not unusual with patients from collectivist cultures to have large groups of relatives and friends visit at the same time, which can create challenges for nursing staff to accommodate, especially in crowded shared rooms.

19. Members of a generation who are linked through shared life experiences in their formative years are known as: a. baby boomers. b. generational markers. c. generation gaps. d. cohorts.

ANS: D Generational groups are categorized into cohorts. These cohorts are members of a generation who are linked through shared life experiences in their formative years.

16. The structure of authority in an organization is known as the: a. authority. b. centralization. c. bureaucracy. d. hierarchy.

ANS: D In bureaucratic and classical management theory, hierarchy is the structure of authority in an organization. Authority is equated with the enforcement of regulations.

2. Within nursing practice, the use of advanced practice roles is an example of: a. cross-training. b. departmentalization. c. fragmentation. d. specialization.

ANS: D In health care, specialist roles have emerged to address the increasing complexities of care and technology. Within nursing, specialist roles have also evolved to address particular areas of nursing practice and include advanced practice roles such as clinical nurse educators, nurse practitioners, and nurse anesthetists.

Objectives are: a. bylaws used to govern the organization. b. financial minimums needed to operate. c. performance-based criteria for accreditation. d. targets that the organization wants to achieve.

ANS: D Objectives are defined as the targets that an organization wants to achieve.

20. A 17-year-old male has presented to the emergency department with appendicitis. He speaks English, but his mother speaks Spanish. The mother needs to consent for the surgery since the patient is a minor. The doctor determines that the consent is not needed due to the emergent nature of the case. If the doctor proceeds without obtaining consent, he may face: a. cultural competence. b. linguistic competence. c. miscommunication concerns. d. liability claims.

ANS: D The National Center for Cultural Competence (n.d.a) noted that health professionals who lack cultural and linguistic competency can be found liable under tort principles in several areas such as treatment in the absence of informed consent. In addition, providers may be presumed negligent if an individual is unable to follow guidelines because they conflict with his or her beliefs and the provider neglected to identify and try to accommodate the beliefs. Additionally, if a provider proceeds with treatment or an intervention based on miscommunication due to poor quality language assistance, he or she and his or her organization may face increased civil liability exposure.

4. Which of these is the fastest growing minority group in the United States? a. Asians b. Caucasians c. Blacks d. Hispanics

ANS: D The U.S. Census Bureau (2014) estimates that minorities (anyone who is not a single-race non-Hispanic White) will be the majority in America by 2044 as a result of both immigration and growth rate. The nation's racial and ethnic minority groups, especially Hispanics, are growing more rapidly than the non-Hispanic White population, fueled by both immigration and births.

The first step of the strategic planning process is to: a. develop strategic goals. b. survey the environment. c. implement the action plan. d. formulate the organization's mission and vision

ANS: D The first step of the strategic planning process is to formulate or review and update as needed the organization's mission and vision in alignment with the organization's core purpose and values. The mission delineates what the organization does, while the vision articulates the preferred future state of the organization.

The 2011 Future of Nursing report published by the Institute of Medicine (IOM), calls for: a. an improved educational system that promotes seamless academic progression. b. the baccalaureate in nursing to be established as the minimal educational level for entry into practice. c. the master's degree to be established as the minimal requirement for a leadership position in nursing. d. increased participation in leadership among nurses.

ANS: D The leadership role of nurses has become an area of increasing focus since the Institute of Medicine (IOM, now called the National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division), in its 2011 Future of Nursing report, called for increased leadership development and participation in leadership among nurses.

12. Which organizational theory emphasized the informal aspects of organization social structure and was influenced by the Hawthorne experiments? a. Bureaucratic theory b. Scientific management school c. Classical management theory d. Human relations school

ANS: D Theorists in the human relations school emphasized the informal, rather than formal, aspects of organization social structure. Hawthorne experiments were influential in this school of thought.

A communication system developed originally to address communication patterns in critical situations is: a. VERA framework. b. NVC model. c. crucial conversations. d. TeamSTEPPS.

ANS: D Communication effectiveness becomes crucial in times of emergency or disaster. TeamSTEPPS was initially developed to address communication issues between nurses and providers during critical patient events.

Management offers a day of pampering at a spa if nurses agree to work 3 out of 4 weekends over the summer. This type of power is known as: a. coercive. b. expert. c. legitimate. d. reward.

ANS: D French and Raven's five sources of power (1959) include reward, coercive, expert, referent, and legitimate. When reward power is used, most people comply because of the positive benefits of doing so.

Over lunch in the cafeteria, student nurses are sharing educational information about the patients for whom they are caring. This is a(n): a. breach of beneficence. b. example of maleficence. c. potential assault and battery charge. d. violation of the Health Insurance Portability and Accountability Act (HIPAA).

ANS: D HIPAA provisions have heightened awareness about and encouraged strategies to protect a patient's privacy in health care transactions. This is an example of breach of confidentiality.

Interpersonal communication is defined as: a. the conscious intent by one individual to modify the thoughts or behaviors of others. b. a combination of written and spoken communication. c. a theory used to describe a manner of communicating. d. communication between two or more individuals involving face-to-face interaction.

ANS: D Interpersonal communication is defined as communication between two or more individuals involving face-to-face interaction while all parties are aware of the others on an ongoing basis.

A well-known talk show host presents information to a congressional committee to garner support for cancer research. This type of power refers to _____ power. a. coercive b. expert c. legitimate d. referent

ANS: D Referent power is based on admiration for a person who has desirable resources or personal traits

A nursing manager is leading a recruitment and retention committee. She manages in a laissez-faire style. Her co-leader is a staff nurse who is very detail oriented. The nurse manager usually leads the meetings. During the meeting, the staff nurse frequently needs to interject information that has not been presented. She also creates the agenda and communicates information with other team members. This scenario depicts which type of conflict? a. Competitive b. Disruptive c. Organizational d. Task

ANS: D Task conflict is an awareness of differences in viewpoints and opinions pertaining to a group task.

A key component of the strategic planning process is to assess the environment. Place the steps of the assessment process in order: a. Identify strengths and weaknesses internal to the organization. b. Shape strategies into a strategic plan on which strategic management is based. c. Establish priorities for the critical issues so that strategies are based on the priority issues. d. Analyze strengths, weaknesses, opportunities, and threats for their impact on the organization. e. Analyze internal components for the purpose of drafting a picture of the critical features of the organization.

ANS:A, E, D, C, B

Institutions organize and structure themselves by defining departmental function and authority to achieve a more coordinated effort. In institutions where the executive leader retains more decision-making authority, the operation takes on a more _____ philosophy. a. Centralized b. Decentralized c. Autocratic d. Democratic

a. Centralized Centralization and decentralization are organizational philosophies about power distribution that pertain to the hierarchical level of decision-making authority in the institution. Centralization means that decisions are made at the top levels. Decentralization means that decision making is diffused throughout the organization.

The charge nurse is making assignments on a surgical unit. Which client should be assigned to the least experienced nurse? a. Client who had a vaginal hysterectomy and still has an indwelling catheter b. Client who had an open cholecystectomy and has gray drainage in the T-tube drainage tube and bag c. Client who had a hip replacement and stated that something popped while walking d. Client who had a Whipple procedure and is reporting being thirsty all the time

a. Client who had a vaginal hysterectomy and still has an indwelling catheter The delegation process, as outlined by the ANA/NCSBN joint statement (2005) and the NCSBN national guidelines (2016), begins with the preparation/assessment phase and then goes on to outline a five-step process. These steps are (1) the right task, (2) under the right circumstance, (3) to the right person, (4) with the right directions and communication, (5) under the right supervision and evaluation. The right person is the one who has the education and competency to perform the element of care. Options b, c, and d indicate the possibility of postoperative complications, but option a does not. The least experienced nurse should have the client who is not displaying the possibility of postoperative complications.

With regard to delegation, what organizational principles are considered? (Select all that apply.) a. Legal guidelines and policies b. Patient safety and accountability c. Relationship management and patient support d. Cost containment e. Knowledge and education

a. Legal guidelines and policies b. Patient safety and accountability e. Knowledge and education At the core of the five rights of delegation and the roles of the UAP and nurse are three organizational principles that are present in many health care settings today. These principles include organizational and legal guidelines and policies, patient safety and accountability, and knowledge and education (Craftman et al., 2012).

Which of the following colleagues would a nurse typically delegate to in the health care setting? (Select all that apply.) a. Nurse apprentices b. Personal care attendants c. Family members at bedside d. Physicians e. Nursing assistants

a. Nurse apprentices b. Personal care attendants e. Nursing assistants Nurses often delegate to unlicensed assistive personnel (UAPs). UAPs include a number of health care disciplines, such as nursing assistants, medical assistants, nurse apprentices, and personal care attendants. A nurse would not delegate to a family member or a physician.

When making a decision to delegate a nursing task, which of the following factors are assessed? (Select all that apply.) a. Potential for harm b. Complexity of the task c. Amount of problem solving required d. Predictability of the outcome e. Level of patient interaction

a. Potential for harm b. Complexity of the task c. Amount of problem solving required e. Level of patient interaction In making a decision to delegate nursing tasks, the following five factors can be assessed: potential for harm, complexity of the task, amount of problem solving and innovation required, unpredictability of the outcome, and the level of patient interaction.

Leadership style may be a significant barrier to effective delegation. Which of the following describes the "invincible" style? (Select all that apply.) a. Prefers to do everything themselves so as not to transfer control. b. Wants to be everyone's friend. c. Comes across as a pushover. d. Often stays late to complete documentation. e. Micromanages the UAP.

a. Prefers to do everything themselves so as not to transfer control. d. Often stays late to complete documentation. Many nurses fall into the "invincible" nurse style; they prefer to do everything themselves so as not to risk delegating to the UAP or transfer some control to someone else. This nurse often stays late after the shift completing documentation and may miss some cares that should have been completed due to trying to do everything him- or herself. The "pal" is the nurse who wants to be everyone's friend. These nurses do not want to be viewed as pushy or demanding. This type of delegator may come across as a pushover to the UAP. The "watchdog" nurse views delegation as a real risk and is constantly monitoring and micromanaging the UAP to the point that resentment may enter the nurse/UAP team and lead to poor teamwork and outcomes.

A unit manager is utilizing her staff as a resource for educational presentations. An RN in her unit has been requested to create a PowerPoint on delegation and supervision. What resources should she include for staff to obtain additional information on delegation and supervision? (Select all that apply.) a. State nurse practice act b. Organization's policies and procedures c. The Joint Commission (TJC) d. American Nurses Association (ANA) e. Board of Registered Nursing

a. State nurse practice act b. Organization's policies and procedures d. American Nurses Association (ANA) e. Board of Registered Nursing Nurses are accountable for following their state nurse practice act, standards of professional practice, policies of the organization, and ethical-legal models of behavior. The ANA and each state's board of nursing regulate nursing practice.

When the licensed nurse makes a determination to delegate a task, which of the following occurs in the process? (Select all that apply.) a. The nurse assesses the situation and need for delegation. b. A plan for specific task delegation is established. c. The needs of the nurse are considered. d. The nurse determines the available resources and patient safety. e. Accountability is transferred to the manager.

a. The nurse assesses the situation and need for delegation. b. A plan for specific task delegation is established. d. The nurse determines the available resources and patient safety. With the qualifications of both the delegator and the delegatee as a baseline in place, the licensed nurse enters the continuous process of delegation decision making. The situation is assessed, and a plan for specific task delegation is established, considering patient needs, available resources, and patient safety. The nurse needs to ensure accountability for the acts and process of delegation.

Who is ultimately accountable for the appropriateness and supervision of the delegated task? a. The nurse who delegated the task b. The UAP who accepted the task c. The nursing manager d. The hospital CEO

a. The nurse who delegated the task Accountability in delegation means being obligated to answer for one's actions, including the act of supervision. The nurse is ultimately accountable for the appropriateness and supervision of the delegated task. Thus the nurse may be found liable if found negligent in the process of delegating and supervising. The delegatee is accountable for accepting the delegation and for the actions in carrying out the delegated task.

In Magnet organizations, shared governance needs to be manifested through what mechanisms for nurses' decision making? a. Unit practice councils b. Democratic leaders c. Authoritarian leaders d. System-wide practice councils

a. Unit practice councils In a national study of the nursing practice environment, Clavelle and colleagues (2013) found that in Magnet organizations, the primary governance structure was shared governance, which was significantly and positively related to an improved professional practice environment. To be real and make a difference for nurses, the shared governance needs to be manifested through point-of-care structures where direct-care nurses make decisions about patient care and unit operations. Unit practice councils (UPCs) are an example.

At its start, shared governance requires the education and support of organizational executives, managers, and point-of-care staff. Organizational benefits include: (Select all that apply.) a. accountability of the nurse. b. reduction in liability claims. c. reduction in workers' compensation claims. d. improved financial outcomes. e. more expert involvement at the point of care.

a. accountability of the nurse. d. improved financial outcomes. e. more expert involvement at the point of care. Shared governance has far-reaching implications for leaders in today's health care environment, in which the focus is to provide patient care safely, efficaciously, and efficiently. Organizational benefits include increased commitment of staff to the organization; accountability of the nurse; a new level of professional autonomy; a more efficient model for point-of-service decision making; more expert involvement at the point of service; a more assured, confident patient advocate; and improved financial outcomes. Patients benefit from a more efficient model of health care service, more committed health care professionals, quicker responses at the point of service, and a more assured, confident patient advocate.

Being answerable to oneself and others for one's own choices, decisions, and actions as measured against a standard is: a. accountability. b. authority. c. supervision. d. delegation.

a. accountability. The National Council of State Boards of Nursing (NCSBN, 2016) defined accountability as being answerable to oneself and others for one's own choices, decisions, and actions as measured against a standard.

The nurse has asked a nurse's aide to greet a postoperative patient who has just arrived on the unit and to determine whether he is in stable condition. This act of delegation is an example of a nurse inappropriately delegating: a. assessment of the patient. b. evaluation of an intervention. c. nursing judgment. d. teaching to a delegate.

a. assessment of the patient. The RN is responsible for assessment, evaluation, and nursing judgment, and should not delegate these professional responsibilities.

If an error occurs as a result of delegation, the nurse is accountable for supervision, follow-up, intervention, and: a. corrective action of the event. b. documentation of the event. c. evaluation of the process. d. summation of the occurrence.

a. corrective action of the event. The nurse is also responsible for corrective action in case of an error.

In an organization that has a decentralized organizational philosophy, decision-making authority rests in levels closer to the point of service rather than in the executive levels. Benefits of a decentralized organizational philosophy include: (Select all that apply.) a. encouraging more input. b. supporting greater innovation. c. facilitating faster response times. d. permitting a narrower span of control. e. allowing for more levels of management.

a. encouraging more input. b. supporting greater innovation. c. facilitating faster response times. Decentralization encourages and facilitates greater innovation, more input, and faster response times. Centralized decision making results in a narrower span of control and more levels of management, while decentralized decision making generally means that the span of management is larger for each manager.

An employee satisfaction survey is conducted annually and shows that nurses in a particular unit are committed to their jobs and feel that they make positive contributions. These nurses are: a. engaged. b. disengaged. c. unproductive. d. at retirement age.

a. engaged. An ongoing challenge among U.S. employers, including health care systems, is to keep employees engaged. A Gallup poll (2014) indicated that only 31.5% of employees in the United States report they are "engaged at work," meaning they are committed to their job and making positive contributions. Fifty-one percent reported they are "not engaged at work," meaning they are not likely to put effort into organizational goals. Seventeen and a half percent are "actively disengaged," described as unhappy, unproductive, and likely to spread negativity. Shared governance is the gold standard for engaging nurses in solving problems at the point of care.

Organizational benefits of a culture of shared governance include: (Select all that apply.) a. improved financial outcomes. b. interdependence among staff nurses. c. increased commitment of staff to the organization. d. more senior leadership involvement at the point of service. e. a more efficient model for point-of-service decision making.

a. improved financial outcomes. c. increased commitment of staff to the organization. e. a more efficient model for point-of-service decision making. Organizational benefits include increased commitment of staff to the organization; accountability of the nurse; a new level of professional autonomy; a more efficient model for point-of-service decision making; more expert involvement at the point of service; a more assured, confident patient advocate; and improved financial outcomes.

In organizations that practice shared governance, the responsibility for unit outcomes rests with the: a. nursing team. b. nurse manager. c. individual nurse. d. chief nursing officer (CNO).

a. nursing team. In organizations that practice shared governance, staff as well as nurse managers and leaders are responsible for innovation. Innovation is considered crucial to safely and effectively solve complex care problems. The entire team is responsible for unit outcomes, not just the individual manager.

Participative leadership was first introduced in the late 1970s. It was adapted by health care organizations to form the basis of shared governance and has evolved to define the roles of nurses and resolve issues related to: a. patient care. b. nursing liability c. nursing salaries. d. nursing turnover.

a. patient care. Participative leadership—the notion of leaders turning to their team for input and ideas—was first introduced to the business world in the 1970s. It was adapted by health care organizations and nursing leaders in the early 1980s, and formed the basis of shared governance, which today has evolved to define the role of nurses as well as to resolve issues related to patient care (Gray, 2013).

The primary purpose of unit practice committees in a health care organization is to improve: (Select all that apply.) a. practice. b. processes. c. outcomes. d. reimbursement. e. turnover.

a. practice. b. processes. c. outcomes. The purpose of the unit practice council is described as being "part of the shared governance structure to promote shared decision making at the unit/clinic/program of care level. To make and implement recommendations to improve practice, processes, and outcomes" (Jordan, 2016, p. 16).

Shared governance has far-reaching implications for today's health care environment. Patients benefit due to: (Select all that apply.) a. quicker responses at the point of service. b. more committed health care professionals. c. a more stringent model of health care service. d. better decisions being made by upper management. e. nurses being more assured, confident patient advocates.

a. quicker responses at the point of service. b. more committed health care professionals. e. nurses being more assured, confident patient advocates. The focus of a health care environment that supports shared governance is to provide patient care safely, efficaciously, and efficiently. Patients benefit from a more efficient model of health care service; more committed health care professionals; quicker responses at the point of service; and a more assured, confident patient advocate.

Which principles are important to consider when an RN delegates tasks to UAP? (Select all that apply.) a. Tasks are delegated that will challenge the UAP to use critical thinking. b. Assess the condition and stability of the patient. c. Delegate tasks that are within the expertise of the RN, particularly if the UAP is a student. d. Evaluate the complexity of the task. e. Determine the potential for harm to the patient.

b. Assess the condition and stability of the patient. d. Evaluate the complexity of the task. e. Determine the potential for harm to the patient. When considering whether to delegate a task, the nurse needs to assess the patient and determine whether the action delegated is complex or if the plan of care of the patient could change rapidly (Catalano, 2015). In making a decision to delegate a nursing task, the following five factors should be assessed: 1. Potential for harm: The nurse must determine how much risk the activity carries for an individual patient. 2. Complexity of the task: The more complex the activity, the less desirable it is to delegate. 3. Amount of problem solving and innovation required: If an uncomplicated task requires special attention, adaptation, or an innovative approach, it should not be delegated. 4. Unpredictability of outcome: When a patient's response to the activity is unknown or unpredictable it is not advisable to delegate that activity. 5. Level of patient interaction: It is not advisable to delegate so many tasks that the amount of time the nurse spends with the patient is decreased to the point that a therapeutic relationship cannot be established between the nurse and the patient (AACN, 2004, p.10).

The nurse manager should use which of the following behaviors when implementing a shared governance structure? a. Autocratic decision making of the manager b. Coaching the staff to be successful c. Harboring the vision within the team d. Reimbursing the staff for overtime

b. Coaching the staff to be successful To be successful, shared governance structures need leaders who are role models and mentors. Staff and management must be dedicated to coaching and continuous learning.

Delegating requires clear and skillful _____ to avoid liability. a. Negotiation b. Communication c. corrective action d. Planning

b. Communication Delegating requires skillful written and verbal communication to avoid liability. If an activity is not documented, it is considered that it was not done. Clear documentation of assignments and additional clarification of the delegated tasks for each health care team member are required when delegating.

The process of delegation may be undermined in the health care setting as one member of the team moves work in a downward direction. What are some of the reasons for delegatees to resist responsibility? (Select all that apply.) a. Lack of ability to direct b. Fear of criticism for mistakes c. Overwhelming workload d. Lack of confidence e. Lack of resources

b. Fear of criticism for mistakes c. Overwhelming workload d. Lack of confidence e. Lack of resources The delegatee may resist responsibility for a number of reasons, including fear of criticism, overwhelming workload, lack of confidence, and lack of resources.

If a licensed practical/vocational nurse (LPN/LVN) provides discharge teaching, who is ultimately responsible? a. Chief executive officer b. Institution where the LPN/LVN works c. Risk manager d. UAP

b. Institution where the LPN/LVN works Organizational leadership in building the skills related to delegation enhances individuals and builds high-performing teams, as well as enhancing team member awareness of roles and responsibilities and their individual capabilities and limitations (Lanfranchi, 2013). The organization is accountable for the delegation processes in place and for upholding values of safe patient care and staff development.

Nurses' involvement in shared governance is an important component of: a. practice models. b. Magnet recognition. c. increased reimbursement. d. physician satisfaction.

b. Magnet recognition. Nurses' involvement in governance is an important component of the American Nurses Credentialing Center's Magnet Recognition Program®.

Which of the following are the responsibilities of the delegatee in a situation? (Select all that apply.) a. Corrective action b. Own acts c. Accepting the delegation d. Appropriate notification and reporting e. Accomplishing the task

b. Own acts c. Accepting the delegation d. Appropriate notification and reporting e. Accomplishing the task The delegatee accepts accountability for his or her own acts, accepts the delegation, uses appropriate notification and reporting, and accomplishes the task.

The process for a nurse to direct another person to perform nursing tasks and activities is: a. authorization. b. delegation. c. empowerment. d. supervision.

b. delegation. In their Joint Statement on Delegation (NCSBN, 2005b), the ANA and the NCSBN defined delegation in nursing as "the process for a nurse to direct another person to perform nursing tasks and activities."

Shared governance is a model of organizational structure in which staff nurses are: a. employed to establish mutual goals with clients. b. empowered through autonomy and accountability.c . engaged in problem-solving strategies and techniques. d. equipped with evaluative thinking methodologies.

b. empowered through autonomy and accountability. Shared governance is a model of organizational structure in which staff nurses are empowered through autonomy and accountability.

The legal and ethical standards to consider when questioning if delegation is appropriate include: (Select all that apply.) a. Accountability b. good faith c. cost efficiency d. Reasonable e. Prudent

b. good faith d. Reasonable e. Prudent Nurses are held to a standard of patient care in which they use their expertise, knowledge, and skill in decision making (Wilkinson, 2016). When considering a questionable situation, the standards of "reasonable," "prudent," and "good faith" form the foundations for legal and ethical decision making.

When considering whether to delegate a task, the nurse needs to assess the patient and: a. how many nurses are available to supervise. b. how complex the delegated action is. c. the severity level of the patient population. d. the expiration date of the license.

b. how complex the delegated action is. When considering whether to delegate a task, the nurse needs to assess the patient and determine whether the action delegated is complex or if the plan of care of the patient could change rapidly (Catalano, 2015).

Research about shared governance suggests that it is: a. enhancing the role of the nurse's aide within the organization. b. improving organizational and patient outcomes. c. not a cost-effective program when examining all areas of care. d. too much additional work for the already overwhelmed RN.

b. improving organizational and patient outcomes. Shared governance has far-reaching implications for leaders in today's health care environment, in which the focus is to provide patient care safely, efficaciously, and efficiently. Organizational benefits include increased commitment of staff to the organization; accountability of the nurse; a new level of professional autonomy; a more efficient model for point-of-service decision making; more expert involvement at the point of service; a more assured, confident patient advocate; and improved financial outcomes. Patients benefit from a more efficient model of health care service, more committed health care professionals, quicker responses at the point of service, and a more assured, confident patient advocate.

One obstacle in the implementation of a shared governance model is that nurses have: a. empowered participation in committee meetings. b. limited time to work on projects. c. the same basic educational foundation. d. traditionally worked in decentralized structures.

b. limited time to work on projects. Implementing a shared governance structure can take years; it does not happen overnight. It takes commitment, ongoing education, transparency, time, and dedication. "Shared Governance is not easy to develop... It takes time to be effective. Neither staff nor leaders/managers should assume that the approach relieves leaders and managers of their responsibility to do their jobs" (Finkelman & Kenner, 2016, p. 457). "The biggest barrier to shared governance is having dedicated time for meetings and for work on projects" (Mathias, 2015).

In organizations that practice shared governance, the nurse manager's role is to: (Select all that apply.) a. hire new employees. b. mentor the nursing staff. c. train new nurses in patient care. d. support the decisions of the nursing team.e. enable the staff to become effective leaders.

b. mentor the nursing staff. d. support the decisions of the nursing team. e. enable the staff to become effective leaders. The nurse manager is primarily responsible for mentoring, facilitating, enabling, and supporting the staff personnel. Sustainable change can occur at the unit and organizational level if the nurse manager works within the framework of transformational leadership, shared governance, and action processes.

A nurse works in the critical care unit (CCU). She enjoys being on the unit charge nurse team, the recruitment and retention team, and the peer evaluation team. The recruitment and retention team is responsible for hiring new employees into the CCU. The five-member team, consisting of three registered nurses (RNs), a unit clerk, and a nurse's aide, conduct the interviewing process with key questions that were developed by the team. This is an example of: a. centralized power. b. shared governance. c. span of control. d. vertical authority.

b. shared governance. For shared governance to be effective, decision making must be shared by empowered staff at the point where patients receive care.

The local hospital has a new specialty unit for women and children. The nursing staff has created a family advisory council to assist in reviewing educational materials used at discharge. This shared governance structure is an example of: a. interprofessional education. b. whole-system integration. c. engagement. d. collaboration.

b. whole-system integration. Some see the benefits of decentralization and the shared governance model extending beyond nurses and all care providers to all employees. "As for the future of Shared Governance, Susan Allen PhD, RN (assistant vice president, Cincinnati Children's Hospital) says it would be ideal to see whole-system integration involving all hospital staff. Clearly, the next steps in this vision are to include patients and the community more deliberatively into the shared governance model. Allen says Cincinnati Children's Hospital has a family advisory council and a teen council that get involved in projects, including reviewing potential educational materials and designing a new learning center (Gray, 2013).

Shared governance is a vehicle for engaging organizations and creating the necessary forums and intersections that assure the decisions and actions remain dynamic and as close to the point of service as possible. Shared governance promotes: a. dependence. b. non-punitive culture. c. Collaboration d. executive decision making.

c. Collaboration Shared governance is an accountability-based model through which nurses actively engage in making decisions regarding nursing practice, quality of patient care, education, nursing peer issues, and issues in the work environment. In a shared governance environment, staff take ownership of decision making. This is "a dynamic staff-leadership partnership that promotes collaboration, shared decision making, and accountability for improving quality of care, safety, and enhancing work life" (Mathias, 2015).

Which of the following leadership styles is best suited for implementation of a shared governance structure? a. Authoritarian b. Autocratic c. Participative d. Laissez-faire

c. Participative Participative leadership—the notion of leaders turning to their team for input and ideas—was first introduced to the business world in the 1970s. It was adapted by health care organizations and nursing leaders in the early 1980s, and formed the basis of shared governance, which today has evolved to define the role of nurses as well as to resolve issues related to patient care.

Which staff member should be assigned to a dying client who is experiencing symptoms of emotional distress? a. UAP who can be spared to sit with the client b. LPN/LVN who has grown attached to the family c. RN who has experience as a hospice nurse d. Newly graduated RN

c. RN who has experience as a hospice nurse The delegation process, as outlined by the ANA/NCSBN joint statement (2005) and the NCSBN national guidelines (2016), begins with the preparation/assessment phase and then goes on to outline a five-step process. These steps are (1) the right task, (2) under the right circumstance, (3) to the right person, (4) with the right directions and communication, (5) under the right supervision and evaluation. The right person is the one who has the education and competency to perform the element of care. A hospice nurse has experience in managing symptoms associated with the dying process. This is the best nurse to care for this patient.

The nurse manager determines that communication style is contributing to problems with delegation on her unit. What tool is used to teach principles of communication, leadership, situation monitoring, and mutual support? a. American Nurses Association (ANA) b. Agency for Healthcare Quality and Research (AHRQ) c. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) d. Institute for Healthcare Improvement (IHI)

c. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) Invariably there will be potential problems as the use of delegation expands in health care. The nurse leader will need to be aware of techniques to address these potential problems. One such method is the TeamSTEPPS 2.0 (Team Strategies and Tools to Enhance Performance and Patient Safety) program. The framework followed is based on a foundation of team competencies including knowledge, attitudes, and performance. The principles the program abides by include team structure and the teachable principles of communication, leadership, situation monitoring, and mutual support.

The __________ of an organization is the formulation of ideas, plans, or dreams that help shape the future and ability to persuade colleagues and associates to share those dreams. a. Mission b. core values c. Vision d. organizational chart

c. Vision The mission, core values, and vision are the instruments that give voice to the organization's philosophy. "The mission is a simple and direct expression of a company's goals and objectives. It defines what a company stands for" (Kurian, 2013, p. 186). The vision is the formulation of ideas, plans, or dreams that "help shape the future and ability to persuade colleagues and associates to share those dreams."

The instruments that give voice to the organization's philosophy include which of the following? (Select all that apply.) a. Goals b. Focus c. Vision d. Mission e. Core values

c. Vision d. Mission e. Core values The mission, core values, and vision are the instruments that give voice to the organization's philosophy. The mission is an aim to be accomplished. It influences the philosophy, goals, and objectives of an organization. The vision is a mental image or the power of imagination to see something that is not actually visible.

According to the American Association of Critical-Care Nurses, there are five factors that a nurse should assess when making a decision to delegate nursing tasks. These factors are assessing the potential for harm, the complexity of the task, the amount of problem solving and innovation required, the unpredictability of the outcome, and the: a. amount of time that the task will take. b. degree of comfort the delegatee has with the task. c. level of patient interaction. d. method of measuring outcomes.

c. level of patient interaction. The level of patient interaction is the fifth factor that nurses should assess when making delegation decisions.

The five rights of delegation are right task, right circumstance, right person, right direction and communication, and right: a. interaction. b. outcome. c. supervision. d. time.

c. supervision. The delegation process, as outlined by the ANA/NCSBN joint statement (2005) and the NCSBN national guidelines (2016), begins with the preparation/assessment phase and then goes on to outline a five-step process. These steps are (1) the right task, (2) under the right circumstance, (3) to the right person, (4) with the right directions and communication, (5) under the right supervision and evaluation.

Decentralization occurs when: a. equipment is being purchased from approved vendors. b. hiring decisions are made at the executive level. c. power is distributed to those closest to the work of caregiving. d. supplies are distributed from one central supply area in the hospital.

d. It shows organizational positions and relationships in a visual representation. The organizational chart is a diagrammatic representation that displays "the flow of authority, chain of command, titles, and functions.

When determining that delegation of an element of patient care needs to occur, the nurse delegates with a clear, concise description of the task, including its objectives, limits, and expectations. The nurse allows the delegate to clarify without fear of repercussion. Which of the following five rights of delegation is being demonstrated? a. Right task b. Right circumstance c. Right person d. Right direction/communication e. Right supervision/evaluation

d. Right direction/communication The right direction/communication of delegated elements of care will be a clear, concise description of the task, including its objective, limits, and expectations. The nurse allows for clarification without the fear of repercussions.

In organizations that practice shared governance, staff, managers, and leaders are responsible for: a. technology. b. budgeting. c. education. d. innovation.

d. innovation. In organizations that practice shared governance, staff as well as nurse managers and leaders are responsible for innovation. Innovation is considered crucial to safely and effectively solve complex care problems. The entire team is responsible for unit outcomes, not just the individual manager. The manager is primarily responsible for mentoring, facilitating, enabling, and supporting.

The purpose of an organization's philosophy is to: a. influence the goals and objectives of an organization. b. display how the parts of an organization are connected. c. be an instrument that gives voice to the organization s mission. d. serve as the institutional framework that shapes the direction of knowledge and skill acquisition.

d. serve as the institutional framework that shapes the direction of knowledge and skill acquisition. Hospitals are organized and their work is structured around a guiding philosophy. The philosophy serves as the institutional framework that shapes the direction of knowledge and skill acquisition. It is the pivotal factor in the long-term development of the institution.

The provision of guidance or direction, evaluation, and follow-up by the licensed nurse for accomplishment of a nursing task delegated to unlicensed assistive personnel (UAP) is: a. authorization. b. delegation. c. observation. d. supervision.

d. supervision. Supervision is the provision of guidance or monitoring of a delegated nursing task. It may occur in a variety of ways, including written and verbal communication (such as giving or receiving reports), observation of the performance of the delegated task, or assessing the patient for evidence that the delegated task has been completed successfully.

Traditionally, nurses have worked in strong, hierarchical institutions with centralized decision making and clear authority structures, rigid approval mechanisms, and extensive policies and procedures that have resulted in barriers to creating a shared governance system. One such barriers is: a. lack of role clarity. b. lack of time management. c. poor time management skills. d. that development takes a long time.

d. that development takes a long time. Effective shared governance is an ongoing process. Both staff and unit managers need to become comfortable with how governance is shared. Development is gradual and time consuming. To be successful, shared governance structures need leaders who are role models and mentors. Staff and management must be dedicated to coaching and continuous learning.

Individuals who are trained to help the registered nurse (RN) in the provision of patient-client care activities as delegated by and under the supervision of the RN are known as: a. certified assistive personnel. b. health care assistive personnel. c. medical assistive personnel. d. unlicensed assistive personnel.

d. unlicensed assistive personnel. The NCSBN (2016) defined unlicensed assistive personnel (UAP) as any unlicensed personnel trained to function in a supportive role and to whom a nursing responsibility can be delegated.