Leadership CBA 2 (updated)

Before beginning a continuous quality improvement project, a nurse should determine the minimal safety level of care by referring to the: a. Procedure manual. b. Nursing care standards. c. Litigation rate of unsafe practice. d. Job descriptions of the organization.

*b. Nursing care standards* Standards establish the minimal safety level of care. Procedure manuals provide information about how standards are to be achieved.

Ali, an RN on your unit, is consistently late to work and makes remarks such as "Do you really want me to do that?" when patients and care are assigned to her. You have spoken with her frequently about her: a. Ability b. Skills c. Attitude d. Personal issues

c. Attitude

Elizabeth is an example of a(n): a. Early adopter b. Late majority c. Laggard d. Resister

c. Laggard Laggards - prefer keeping traditions alive ("We've always done it this way") & openly express resistance to ideas (speaking out against the change)

You are in the process of designing a patient education program that will provide education and monitoring for patients with hypertension. To support your planning, you draw out and present patient data from: a. A clinical database. b. Biomedical technologies. c. E-mail. d. Internet sources.

a. A clinical database Clinical databases are collections of elements organized and structured for the processing, organization, and presentation of data for interpretation as information, which, in this particular instance, includes outpatient data.

A nurse manager wants to decrease the number of medication errors that occur in the department. The manager arranges a meeting with the staff to discuss the medication error concerns. How does the manager convey a philosophy of total quality management? A) Explaining to the staff that disciplinary action will be taken for further errors B) Recommending that a multidisciplinary team assess the root cause of the medication errors C) Suggesting that the pharmacy department explore their role in the problem D) Changing the unit policy to allow a certain number of medication errors per year without penalty

*B) Recommending that a multidisciplinary team assess the root cause of the medication errors* The goal of quality management is to improve systems and processes, not to assign blame. Assembling an interprofessional team to assess the root cause of medication errors allows an avenue to comprehensively explore a systems problem and collectively identify a course of action firmly grounded in data that can be embraced by all involved disciplines.

The nurse educator of a pediatric unit determines the patients returning from surgery are often not having vital signs documented. According to total quality improvement, to correct the problem, what action would the educator in consultation with the patient care manager take? A) Talk to the staff individually to determine why this is occurring B) Call a meeting of all staff to discuss this issue C) Have a group of staff nurses review the established standards of care for postoperative patients D) Document which staff members are not recording vital signs and write them up

*C) Have a group of staff nurses review the established standards of care for postoperative patients* The educator should request the manager provide time for select unit staff to participate in quality improvement measures, including reviewing the established standards of care for postoperative patients. Having the entire unit involved is inefficient and premature.

A new graduate is asked to serve on the hospital's Quality Improvement Committee. What does the nurse know is the first step in the quality improvement process? A) Collect data to determine if standards are met B) Implement a plan to correct the problem C) Identify the standard D) Determine if the findings warrant correction

*C) Identify the standard* The 1st step in the quality improvement process is to identify the needs most important to the consumer of healthcare services, which includes identifying the standard to be measured.

The maintenance department wishes to have the nursing lounge renovated, so the lounge will be more "user-friendly." The department asks the nursing staff to make a wish list of everything that they would like to see in the new lounge. This process is an example of which part of the decision-making process? a. Assessment/Data collection b. Planning c. Data interpretation d. Generating hypotheses

*a. Assessment/Data collection* In this particular model (a model similar to the nursing model), data collection is the first step toward identifying important alternatives or determining if there is a problem or problems

An example of an effective patient outcome statement is: a. Eighty percent of all patients admitted to the Emergency Department will be seen by a nurse practitioner within 3 hours of presentation in the Emergency Department. b. Patients with cardiac diagnoses will be referred to cardiac rehabilitation programs. c. The hospital will reduce costs by 3% through the annual budget process. d. Quality is a desired element in patient transactions.

*a. Eighty percent of all patients admitted to the Emergency Department will be seen by a nurse practitioner within 3 hours of presentation in the Emergency Department* Patient outcomes must be measurable, specific, and patient-centered.

Hospital ABCD is a Magnet™ hospital. This designation has been applied to Hospital ABCD because it: a. Facilitates active staff participation in decision making related to quality nursing care. b. Has implemented a graduate nurse orientation program. c. Espouses commitment to excellence in patient care. d. Is establishing career ladders for nurses.

*a. Facilitates active staff participation in decision making related to quality nursing care* Magnet™ hospitals are particularly successful in implementing excellence in patient care through use of standards, evidence, and participatory decision making in quality improvement. Organizations that cannot pursue Magnet™ status can implement strategies such as career ladders.

Through the QI process, the need to transform and change the admissions process across administrative and patient care units is identified. In this particular situation, what method of data organization will be most effective? a. Flowchart b. Histogram c. Narrative d. Line graphs

*a. Flowchart* Flowcharts are useful in identifying and visualizing sequential steps, such as the admissions process.

Examples of sentinel events include (select all that apply): a. Forceps left in an abdominal cavity b. Patient fall, with injury c. Short staffing d. Administration of morphine overdose e. Death of patient related to postpartum hemorrhage

*a. Forceps left in an abdominal cavity* *b. Patient fall, with injury* *d. Administration of morphine overdose* *e. Death of patient related to postpartum hemorrhage* Sentinel events are serious, unexpected occurrences involving death or physical or psychological harm.

A nursing unit is interested in refining its self-medication processes. In beginning this process, the team is interested in how frequently errors occur with different patients. To assist with visualizing this question, which organizational tool is most appropriate? a. Histogram b. Flowchart c. Fishbone diagram d. Pareto chart

*a. Histogram* Histograms are bar graphs that are useful in outlining and identifying frequency.

In a busy rehabilitation unit, the team manager decided that the best way to reward the staff was to give them a monetary bonus rather than time off. The staff was very concerned about the decision and went to the administration with a number of complaints. Critical thinking is a process that entails a number of steps. What steps did the manager omit? She should have: (select all that apply) a) Identified what assumptions were underpinning the issues. b) Considered why it was important to make this change or the context for the change. c) Considered how this change might affect staff relationships. d) Attained a majority consensus of all staff.

*a. Identified what assumptions were underpinning the issues* *b. Considered why it was important to make this change or the context for the change* *c. Considered how this change might affect staff relationships* Taking a majority consensus is not a step in the critical thinking process. Points A, B, & C are "what," "why," & "how" questions that are part of effective critical thinking processes.

The risk manager wants to evaluate the reasons for an increased number of falls on the rehab unit. The risk manager devises a fishbone diagram. A fishbone diagram is a useful tool to: a. Identify the root causes of problems. b. List possible solutions to problems. c. Help leaders select the best options. d. Evaluate the outcomes of decisions made.

*a. Identify the root causes of problems* A fishbone diagram, also known as a cause-and-effect diagram, is useful for determining the reasons (causes) for an effect (falls).

The nurse manager of a rehab unit wants to purchase a new anti-embolic stocking. To make a high-quality decision, the nurse manager would: a. Involve the rehab staff in the decision. b. Involve the sales representative. c. Make the decision alone. d. Involve administration in the decision.

*a. Involve the rehab staff in the decision* In a shared decision model, the decisions are made through an interactive, deliberate process and the staff may express and discuss options and preferences. The shared decision model has been shown to increase work performance and productivity, decrease employee turnover, and enhance employee satisfaction.

A nursing-led classification system that has led to greater reliability and standardization in data utilized for QI processes is: a. NANDA b. AHRQ c. NIOSH d. Nursing process

*a. NANDA* NANDA has been developed by nurses and uses standardized terminology that enables study of health problems across populations, settings, and caregivers.

Knowing when to have the entire team participate in the decision-making process or when to have only the team leader make the decisions depends on the situation and the desired outcomes. The autocratic process is used in which of the following situations? a. The task and the outcome are relatively simple and defined b. It is unlikely that the group will reach a consensus. c. A decision has to be discussed thoroughly. d. A number of options need to be considered.

*a. The task and the outcome are relatively simple & defined* An autocratic style is appropriate when rapid decision making is required and in situations where the task and the potential outcome are well-defined.

Hospital Magnet™ decides against creating a separate department to lead and monitor quality activities because: a. Total organizational involvement is critical to QI. b. Data generated by a single, separate department are generally flawed. c. Monitoring and commitment to QI can come only from senior-level managers. d. Staff resent suggestions for improvement that originate outside of their unit.

*a. Total organizational involvement is critical to QI* Decentralized approaches are effective in developing unit-level solutions, as well as commitment to strategies and implementation of changes.

A good nursing decision maker is one who: a. Uses various models to guide the process based on the circumstances of the situation. b. Adopts one model and uses it to guide all decision making. c. Decides not to use any models because they are all useless. d. Develops a new model each time a decision has to be made.

*a. Uses various models to guide the process based on the circumstances of the situation* The decision model that a nurse uses depends on specific circumstances. Is the situation routine and predictable or complex and uncertain? Is the goal to make a decision that is "just good enough" (conservative) or one that is optimal?

A new RN staff member asks you about the difference between QA and QI. You explain the difference by giving an example of QI. a. "Last year, the management team established new outcomes that addressed issues such as medication errors." b. "At a staff meeting last year, two of our staff commented on the number of recent falls and asked, 'What can we do about it?'" c. "A process audit was done recently to determine how much time was being spent on patient documentation." d. "Errors are reported on our new computerized forms, and I follow up with staff to make sure that they understand the seriousness of their error."

*b. "At a staff meeting last year, two of our staff commented on the number of recent falls and asked, 'What can we do about it?'"* In QI, followers invest in the process by continually asking "What makes this indicator important to measure?" "What has been done to improve it?" "What can I do to improve it?"

The nurse educator of the pediatric unit determines that vital signs are frequently not being documented when children return from surgery. According to quality improvement (QI), to correct the problem, the educator, in consultation with the patient care manager, would initially do which of the following? a. Talk to the staff individually to determine why this is occurring. b. Call a meeting of all staff to discuss this issue. c. Have a group of staff nurses review the established standards of care for postoperative patients. d. Document which staff members are not recording vital signs, and write them up.

*b. Call a meeting of all staff to discuss this issue* Leadership must identify safety shortcomings and must locate resources at patient care levels to identify and reduce risks. One method of doing this is to invite all staff into a discussion related to solutions to an identified concern. This approach encourages teamwork.

Decision making is described by the nursing educator as the process one uses to: a. Solve a problem b. Choose between alternatives c. Reflect on a certain situation d. Generate ideas

*b. Choose between alternatives* The hallmark of decision making is choosing among options. Generating options is one phase of decision making, and solving a problem refers to problem solving, which is problem centered. Decision making does not always begin with problems, but rather is defined as a purposeful, goal-directed effort that uses a systematic process to choose among options.

During a fire drill, several psychiatric patients become agitated. The nurse manager quickly assigns a staff member to each patient. This autocratic decision style is most appropriate for: a. Routine problems. b. Crisis situations. c. Managers who prefer a "telling" style. d. Followers who cannot agree on a solution.

*b. Crisis situations* An autocratic style is appropriate when rapid decision making is required, such as in a crisis situation.

With the rise of violence in the psychiatric department, the nurse manager decides that she should work with the risk manager in violence prevention. The nurse manager should: a. Request all staff to accept new risk management practices. b. Hold staff accountable for safe practices. c. Document inappropriate behavior. d. Hire more police security.

*b. Hold staff accountable for safe practices* Active involvement of staff in risk management activities is key to prevention of adverse events. Nursing has a primary role in leadership in optimizing patient outcomes, preventing patient care issues, and mitigating adverse events. Accountability for safety can be one aspect of performance evaluations.

The outcome statement "Patients will experience a ten percent reduction in urinary tract infections as a result of enhanced staff training related to catheterization and prompted voiding" is: a. Physician-sensitive and nonmeasurable. b. Measurable and nursing-sensitive. c. Precise, measurable, and physician-sensitive. d. Patient care-centered and nonmeasurable.

*b. Measurable and nursing-sensitive* Nursing-sensitive outcomes refer to outcomes that are affected by nursing activity and are precise, measurable, and patient-centered.

A nurse manager wants to decrease the number of medication errors that occur in her department. The manager arranges a meeting with the staff to discuss the issue. The manager conveys a total quality management philosophy by: a. Explaining to the staff that disciplinary action will be taken in cases of additional errors. b. Recommending that a multidisciplinary team should assess the root cause of errors in medication. c. Suggesting that the pharmacy department should explore its role in the problem. d. Changing the unit policy to allow a certain number of medication errors per year without penalty.

*b. Recommending that a multidisciplinary team should assess the root cause of errors in medication* Quality management stresses improving the system, and the detection of staff errors is not stressed. If errors occur, reeducation of staff is emphasized rather than imposition of punitive measures such as disciplinary action or blaming.

Healthcare organization X is committed to improving patient outcomes and, as part of the QI process, examines its executive structure and organizational design. This approach recognizes: a. The importance of decentralized structure in QA. b. That structure influences nurse burnout and participation in quality improvement initiatives. c. The need to ensure sufficient supervisory staff to respond in a corrective manner when mistakes occur. d. That a narrow hierarchy ensures accountability for errors and outcomes.

*b. That structure influences nurse burnout and participation in quality improvement initiatives* Common organizational characteristics of Magnet™ hospitals include structure factors (e.g., decentralized organizational structure, participative management style, and influential nurse executives) and process factors (e.g., professional autonomy and decision making, ongoing professional development/education, active quality improvement initiatives). ANCC Magnet™ designated hospitals and other high-reliability organizations in the United States and Europe generally have lower burnout rates, higher levels of job satisfaction, and provide higher levels of quality care resulting in greater levels of patient satisfaction

John Smith, one of 3 managers at BSG Labs, drafted a policy that would allow his department to do more testing in his lab. This policy included the times for regular collection as well as a new process for emergency laboratory testing. The policy and procedures were never followed. The reason was that: a. The policy was too lengthy & overwhelms readers with too much detail b. The policy made decisions for other departments in the company. c. The staff did not believe that the new policy would be effective. d. Testing should not be done in the lab.

*b. The policy made decisions for other departments in the company* Two primary criteria make for effective decisions. First, the decision must be of a high quality; that is, it achieves the predefined goals, objectives, and outcomes. Second, those who are responsible for its implementation must accept the decision. Higher-quality decisions are more likely to result if groups are involved in the decision-making and problem-solving process. Taking ownership of the process and outcome provides a smoother transition in changes.

To solve a problem, the nurse manager understands that the most important problem-solving step is: a. The implementation phase. b. Identification of numerous solutions. c. Accurate identification of the problem. d. Evaluation of the effectiveness of problem resolution.

*c. Accurate identification of the problem* To proceed effectively, it is important to determine if a problem exists and to accurately identify a problem. Failure to resolve problems is most often linked to improper identification of the problem.

Your institution has identified a recent rise in postsurgical infection rates. As part of your QI analysis, you are interested in determining how your infection rates compare with those of institutions of similar size and patient demographics. This is known as: a. Quality assurance b. Sentinel data c. Benchmarking d. Statistical analysis

*c. Benchmarking* Benchmarking is a widespread search to identify the best performance against which to measure practices and processes.

Select the statement that best defines the difference between problem solving and decision making: a. Decision-making skills require critical thinking; problem-solving skills do not. b. Problem-solving skills require critical thinking; decision-making skills do not. c. Decision making is a goal-directed effort; problem solving is focused on solving an immediate problem. d. Problem solving is a goal-directed effort; decision making is focused on solving an immediate problem.

*c. Decision making is a goal-directed effort; problem solving is focused on solving an immediate problem* Problem solving is focused on solving immediate problems, whereas decision making is a goal-directed process that is aimed at selecting appropriate actions from among options. Not all decisions begin with a problem

Several nurses on an adolescent psychiatric unit complain that the teens are becoming unmanageable on the 0700-1900 shift. To resolve this problem, the nurse manager decides that the staff should have a brainstorming session. The goal of brainstorming is to: a. Evaluate problem solutions. b. Critique the ideas of others. c. Generate as many solutions as possible. d. Identify only practical and realistic ideas.

*c. Generate as many solutions as possible* Brainstorming encourages creativity when one is beginning to problem-solve and avoids premature shutting down of ideas through early evaluation. The goal is to generate ideas, no matter how seemingly unrealistic or absurd.

High-quality decisions are most likely to be made in nursing situations when: a. Team leaders make the crucial decisions. b. Individuals are advised of the problems. c. Group size is neither too small nor too large. d. Members are passively involved.

*c. Group size is neither too small nor too large* Research has shown that group size is important. Too small a group means a limited number of options generated. Too large a group can mean lack of structure or lack of meaningful discussion.

From the information supplied in this chapter, which statement best defines critical thinking? Critical thinking is a: a. High-level cognitive process. b. Process that helps to develop reflective criticism for the purpose of reaching a conclusion. c. High-level cognitive process that includes creativity, problem solving, and decision making. d. Discussion that guides the nursing process.

*c. High-level cognitive process that includes creativity, problem solving, and decision making* It is generally accepted by many authors and researchers that this statement best defines critical thinking.

The nurse manager is concerned about the negative ratings her unit has received on patient satisfaction surveys. The first step in addressing this issue from the point of view of quality improvement is to: a. Assemble a team. b. Establish a benchmark. c. Identify a clinical activity for review. d. Establish outcomes.

*c. Identify a clinical activity for review* In theory, any and all aspects of clinical activity could be improved through the QI process. However, QI efforts should be concentrated on changes to patient care that will have the greatest effect.

A new graduate is asked to serve on the hospital's quality improvement (QI) committee. The nurse understands that the first step in quality improvement is to: a. Collect data to determine whether standards are being met. b. Implement a plan to correct the problem. c. Identify the standard. d. Determine whether the findings warrant correction.

*c. Identify the standard* Before further action (data collection, decision making related to correction, and implementation of a plan) can occur, it is necessary to identify the standards against which data collection and decision making will occur. Institutions may or may not adopt standards that are already established by organizations such as the ANA.

A nurse is explaining the pediatric unit's quality improvement (QI) program to a newly employed nurse. Which of the following would the nurse include as the primary purpose of QI programs? a. Evaluation of staff members' performances b. Determination of the appropriateness of standards c. Improvement in patient outcomes d. Preparation for accreditation of the organization by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

*c. Improvement in patient outcomes* The primary purpose of QI is improvement of patient outcomes, which relates to prevention of error, quality patient care, and patient satisfaction.

The chief executive officer asks the nurse manager of the telemetry unit to justify the disproportionately high number of registered nurses on the telemetry unit. The nurse manager explains that nursing research has validated which statement about a low nurse-to-patient ratio? It: a. Promotes teamwork among healthcare providers. b. Increases adverse events. c. Improves outcomes. d. Contributes to duplication of services.

*c. Improves outcomes* Studies related to staffing and patient outcomes suggest that patient outcomes are improved with a low nurse-to-patient ratio and especially with a low registered nurse-to-patient ratio.

Justin is a nurse manager in a rehabilitation unit in a small urban center. There is a high turnover rate among rehab-assistants because of the heavy work assignments. Despite his need for staff, Justin decides to review each application thoroughly and interview candidates carefully because he recognizes that it is important to hire staff who can best provide high-quality care and who will fit well with the team. Which of the following decision-making models did Justin use in making his decision? a. Subjective model b. Objective model c. Optimizing model d. Satisficing model

*c. Optimizing model* Optimizing is a decision style in which the decision maker selects the option that is best, based on an analysis of the pros and cons associated with each option. A better decision is more likely when using this approach, although it takes longer to arrive at a decision.

Patient perceptions are useful in: a. Determining disciplinary actions in QI. b. Establishing the competitive advantage of QI decisions. c. Providing one source of data for QI initiatives. d. Establishing blame for poor-quality care.

*c. Providing one source of data for QI initiatives* Customers define quality and patient dissatisfaction as useful indicators of which areas are of greatest concern to patients and of what matters then to nurses and organizations. Patient perceptions guide areas of inquiry; however, they do not establish what disciplinary decisions will be made.

A clinic nurse has observed another nurse deviating from agency policy in performing wound care. The best approach for the clinic nurse to take is to: a. Stay out of it. b. Inform the nursing supervisor. c. Fill out a notification form (incident report). d. Assess the risk to the client and the agency before proceeding.

*d. Assess the risk to the client and the agency before proceeding* If the situation is subjective, non-routine, and unstructured or if outcomes are unknown or unpredictable, the nurse leader and manager may need to take a descriptive or behavioral approach. More information (such as degree of risk to the client and to the agency) needs to be gathered to address this situation effectively.

A method commonly used in Quality Assurance to monitor adherence to established standards is: a. A Pareto chart b. Brainstorming c. Patient interviews d. Chart audit

*d. Chart audit* Chart audits are a common method of addressing process standards. Chart audits over time yield trend charts.

Justin is a nurse manager in a rehabilitation unit in a small urban center. There is a high turnover rate among rehab-assistants because of the heavy work assignments. Despite his need for staff, Justin decides to review each application thoroughly and interview candidates carefully because he recognizes that it is important to hire staff who can best provide high-quality care and who will fit well with the team. Which of the following decision-making solutions should Justin consider to have a more efficient department a. Replace staff only with qualified applicants. b. Determine what the problem or problems are before hiring new staff. c. Consult with the human resources department and develop a plan for hiring new staff. d. Consider all the options listed.

*d. Consider all the options listed* Decision making involves a goal-oriented consideration of many options that are objectively weighed according to their possible risks, consequences, and positive outcomes. The options should be ranked in the order in which they are likely to result in the desired goals or objectives. The solution selected should be the one that is most feasible and satisfactory and has the fewest undesirable consequences. In this instance, all of the options listed might be considered and weighed.

Sue, a nurse manager, has a staff nurse that has been absent a great deal for the past three months. A whistleblower gives some information to Sue indicating that the staff nurse will be resigning and returning to school. Because of this, Sue decides to do which of the following? a. Immediately fire the staff nurse. b. Speak to the whistleblower and elicit more information. c. Speak to the staff nurse and ask her to resign. d. Do nothing.

*d. Do nothing* Doing nothing is often warranted because of lack of energy, time, or resources to solve the real problem adequately, and because the benefits are not seen as sufficiently compelling to commit to an action

After the nurses who work on an adolescent psychiatric unit have had a brainstorming session, they are ready to resolve the problem of teenagers who are unmanageable. To maximize group effectiveness in decision making and problem solving, the nurse manager has: a. Prevented conflict. b. Formed highly cohesive groups. c. Used majority rule to arrive at decisions. d. Encouraged equal participation among members.

*d. Encouraged equal participation among members* Groups are more likely to be effective if members are involved, the group is cohesive, communication is encouraged, and members demonstrate some understanding of the group process. The nurse leader or manager should provide a nonthreatening and positive environment in which group members are encouraged to participate actively.

The risk manager informs the nurse manager of the orthopedic unit that her unit has had an increase in incident reports of pts falling during the 11-7 shift. The nurse manager knows that the best way to resolve this problem is to: a. Use creativity. b. Obtain support from the 7-3 shift. c. Use institutional research. d. Identify the problem.

*d. Identify the problem* Identification of a problem is the first step in problem solving & occurs before any other step. The most common cause for failure to resolve problems is the improper identification of the problem/issue; therefore, problem recognition and identification are considered the most vital steps

When confronted with the controversy and the apparent poor morale of the evening staff, the unit manager decided the staff needed to take some time off. He scheduled holidays for the staff without consulting them. A couple of the staff nurses approached the manager and indicated that the problem was not scheduling, but rather the team leader and her patient assignments. What was the unit manager's first missed step in problem solving? a. Not using a problem-solving model b. Not considering a number of alternatives c. Poor evaluation of outcomes d. Incorrect problem identification

*d. Incorrect problem identification* The unit manager did not begin with an accurate identification of the problem. Problem solving needs to begin with "why?"

The agency in which you're a nursing leader makes a decision to reduce the number of RN positions in favor of PN positions bc agency data suggests that clients in the agency can receive appropriate care from PN staff. Furthermore, the agency is facing a decline in funding & without restructuring, some clients may not receive services at all. You provide the info on this decision to the staff & ask them to advise you if they have any feedback, concerns, or alternative solutions. This decision-making style is known as: a. Paternalistic b. Shared c. Reasoned d. Informative

*d. Informative* The informative model offers the staff the ability to make a decision after the information has been shared and without the active involvement of the manager.

At Hospital Ajax, there has been a 20% increase in instruments and sponges being left in patients during surgery and surgeries on the wrong limbs. These are known as: a. Sentinel events b. Medically sensitive events c. Nurse-sensitive events d. Never events

*d. Never events* The NQF and CMS define never events as errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients and that indicate a real problem in the safety and credibility of a healthcare facility. Examples of never events include surgery on the wrong body part, foreign body left in a patient after surgery, mismatched blood transfusion, major medication error, severe pressure ulcer acquired in the hospital, and preventable postoperative deaths.

As a nurse manager, you know that the satisfaction of patients is critical in making QI decisions. You propose to circulate a questionnaire to discharged patients, asking about their experiences on your unit. Your supervisor cautions you to also consider other sources of data for decisions because: a. The return rate on patient questionnaires is frequently low. b. Patients are rarely reliable sources about their own hospital experiences. c. Hospital experiences are frequently obscured by pain, analgesics, and other factors affecting awareness. d. Patients are reliable sources about their own experiences but are limited in their ability to gauge clinical competence of staff.

*d. Patients are reliable sources about their own experiences but are limited in their ability to gauge clinical competence of staff* Patients are reliable and motivated sources of their own experience but often do not have sufficient knowledge of clinical procedures to provide feedback about clinical competence.

Jane, an experienced head nurse, is given the task of completing the summer vacation schedule for the pediatric unit. She is fully aware of the hospital's restrictions on time off & the number of staff on vacation at any given time, as well as its issues regarding seniority. She weighs the options of allowing staff choice, such as it takes more time but gives employees options. However, if choice is allowed, this could cause arguments. Which of the following is the best alternative? a. Ask for requests for vacation time in advance, and post the times. b. Post the completed vacation schedule. c. Post a tentative schedule, and request feedback. d. Post a blank schedule, and ask staff members to fill in their times by a given date.

*d. Post a blank schedule, and ask staff members to fill in their times by a given date* This is based on a decision-making model that allows experience and knowledge to predict whether a decision will or will not work. The experience of the head nurse suggests that it is important to involve staff in decisions that affect them the most.

The nurse gives an inaccurate dose of medication to a patient. After assessment of the patient, the nurse completes an incident report. The nurse notifies the nursing supervisor of the medication error and calls the physician to report the occurrence. The nurse who administered the inaccurate medication understands that: a. The error will result in suspension. b. An incident report is optional for an event that does not result in injury. c. The error will be documented in her personnel file. d. Risk management programs are not designed to assign blame.

*d. Risk management programs are not designed to assign blame* QM stresses improving the system, and the detection of staff errors is not stressed. If errors occur, reeducation of staff is emphasized rather than imposition of punitive measures such as disciplinary action or blaming.

A nurse manager is excited by the possible use of speech recognition (SR) systems for documentation of patient care, especially during crisis situations when staff members need to focus on performing rapid assessments and implementation of procedures. She learns, however, that SR systems would be impractical at this point. What would lead to this conclusion? A) SR systems are not available outside pilot projects. B) The type of speech required for voice recognition is unlikely to occur in a pressured situation. C) The hands-free function has not been perfected in SR technology. D) Wireless communications are prone to unreliability in transmission.

B) The type of speech required for voice recognition is unlikely to occur in a pressured situation Speech recognition systems rely on staccato-like speech, pauses between words, and programming for each user, any and all of which would be unlikely in a pressured crisis situation. SR is being used primarily for therapeutic purposes and in situations where data entry is stable.

A nurse manager was orienting new staff members to computerized charting. To understand computerized charting, staff members must understand informatics. The three core concepts in informatics are: A) hardware, software, and printers. B) data, information, and knowledge. C) decision making, data gathering, and reporting. D) wireless technology, voice recognition, and handheld devices.

B) data, information, & knowledge Informatics is the application of technology to all fields of nursing to facilitate and extend nurses' decision-making abilities and to support nurses in the use, storage, and linkage of clinical information to provide effective and efficient patient care.

What observation by the charge nurse indicates a new nurse needs additional education regarding the safe use of the electronic health record? A) The nurse logs off the computer before walking away. B) The nurse using a computer outside of the patient room minimizes the screen when a family member approaches. C) Before leaving the patient's room, the nurse minimizes her documentation on the computer screen. D) The care assistant needs to document and asks to use the nurse's computer; before the care assistant begins documentation, the nurse logs out of the system.

C) Before leaving the patient's room, the nurse minimizes her documentation on the computer screen While minimizing the documentation removes it from immediate view, it is not a secure method to lock down patient information. Logging off or password-locking the system is the best process for securing patient information.

When administering medications to a patient utilizing bar-code technology, what is the most important first step? A) Scan patient's identification band. B) Scan medication. C) Administer medication. D) Check the five rights.

D) Check the five rights Although all steps are imperative in the medication administration process, it is most important to remember technology does not replace standard nursing practice (five rights) and safely caring for the patient.

A nurse manager understands that the typical first step in handling an employee with a disciplinary problem is a: a. Verbal reprimand. b. Written reprimand. c. Reminder of employment standards. d. Day off without pay.

Reminder of employment standards The progressive model of discipline advocates that the first step of the disciplinary process is the informal reprimand or verbal admonishment. The nonpunitive discipline model advocates reminding the employee of the employment policies and procedures of the agency.

Mobilizing others to accomplish extraordinary things requires what leadership behaviors? (Select all that apply) a) Celebrating the successes of others b) Demonstrating exceptional technical skills c) Imagining possibilities d) Establishing a sense of "being in this together"

a) Celebrating the successes of others c) Imagining possibilities d) Establishing a sense of "being in this together" Leaders who inspire teams to accomplish extraordinary things or to display synergy model the way, inspire shared vision, challenge the status quo, and encourage the heart by celebration of success.

During unit staff meetings, you observe that Marg rolls her eyes and snorts whenever Julia makes a comment. Your first response as a unit manager is to: a. Discuss what you have observed with Marg. b. File immediate documentation in Marg's personnel file. c. Ask Julie to monitor Marg's behavior during meetings. d. Ignore the behavior, as Marg is one of your strongest nurses.

a) Discuss what you have observed with Marg Incivility must be addressed. The initial step in addressing it is discussion with Marg, and if the behavior continues, then written documentation should be filed in Marg's personnel file. Monitoring and follow-up are your responsibility as the unit manager.

All of the following are grounds for immediate dismissal except: a. Failing to pursue further medical help for a patient; patient dies. b. Selling narcotics obtained from the unit supply of narcotics. c. Restraining a patient in bed for 7 hours, unsupervised, as punishment for hitting a staff member. d. Grabbing the unit manager and threatening further physical harm after a poor performance appraisal.

a) Failing to pursue further medical help for a patient; patient dies Situations that may warrant immediate dismissal include theft, violence in the workplace, and willful abuse of the patient.

In keeping with guidelines of the organization, the nurse manager documents staff problems. Documentation of disciplinary problems should: a. Include a plan to correct them and to prevent future occurrences. b. State a detailed history of past problems that are related to the current one. c. Be written at the convenience of the manager. d. Accumulate until the evaluation period begins

a) Include a plan to correct them and to prevent future occurrences In documenting staff problems, it is important to specifically indicate what rules were broken or violated, consequences if behavior is not altered, employee's explanation of the incidents, and the plan of action to achieve and to reach new goals.

Nathan has been on the cardiac unit for 6 months and has found it difficult to adjust to the expectations of his team. Which of the following behaviors would most likely signal that Nathan is intending to resign from his position on the unit? a. Increased absenteeism over the past month b. Increased attempts to discuss his concerns with his colleagues c. Testing of workplace guidelines d. Frequent defensiveness

a) Increased absenteeism over the past month Many employees increase their absenteeism just before submitting their resignation. If the healthcare worker is experiencing some form of role stress, it might be manifested through absenteeism. Role strain may be reflected by (1) withdrawal from interaction; (2) reduced involvement with colleagues and the organization; (3) decreased commitment to the mission and the team; and (4) job dissatisfaction. Testing of workplace guidelines and defensiveness are associated with immaturity

When assessing the appropriateness of adopting WL PDAs for a nursing unit, you need to consider the advantages, which include: a) Lower cost relative to PCs b) Small display screen c) Font size d) Speed of operation

a) Lower cost relative to PCs (old book) - PDAs offer a lower-cost method of documentation and communication than PCs, as well as easy portability. Disadvantages of PDAs include small screen size, suboptimal readability, and slowness in situations when speed is most needed.

When assessing the appropriateness of adopting WL COWs for a nursing unit, you need to consider the advantages, which include: a. Mobility of the carts b. Small display screen c. Font size d. Speed of operation

a) Mobility of the carts (new book) Installing computers on mobile carts, also known as computers on wheels or COWs, may increase work efficiency and save time. However, if the cart is cumbersome to move around or if concern about infection risk is associated with moving the cart from one room to another, some organizations favor keeping one cart stationed in each patient care room or installing hardwired bedside computers.

Susan, a new graduate, is upset that so many staff have been absent lately from the unit. She declares to you that all absenteeism could be eliminated with proper management. Your response is based on understanding that: a. Not all absenteeism is voluntary. b. High personal control contributes to absenteeism. c. Direct discussions with employees who have high levels of absenteeism are not recommended. d. All absenteeism is related to personal issues and needs.

a) Not all absenteeism is voluntary Not all absenteeism is voluntary or preventable, which means that absenteeism can never be fully eliminated. Absenteeism can result from personal issues and needs, work dissatisfaction, and involuntary reasons such as jury duty.

An example of a nursing care activity that would not be delegated by an RN to a UNP is: (Select all that apply) a) teaching self-catheterization to a patient with paraplegia who has limited English b) basic care for a patient with a head injury who is rapidly deteriorating c) one-to-one observation with a suicidal patient d) assessment of patients being admitted through the ED e) basic hygienic care for a patient who is post MI and stable

a) teaching self-catheterization to a patient with paraplegia who has limited English b) basic care for a patient with a head injury who is rapidly deteriorating d) assessment of patients being admitted through the ED

Clinical incompetence is one of the more serious problems facing a nurse manager. Joyce, the nurse manager, is not aware of the problems of Sarah, a novice nurse. After she investigates, it is obvious that Sarah's peers are covering for her. Which of the following might Joyce include in her meeting with the nurses? (Select all that apply) a. "It is a nurse's professional responsibility to maintain quality control" b. "All instances of clinical incompetence are to be reported" c. "It is not considered being disloyal when one nurse reports another for poor care" d. "Patient care is the number one concern. Meeting standards is mandatory and necessary"

a. "It is a nurse's professional responsibility to maintain quality control" b. "All instances of clinical incompetence are to be reported" c. "It is not considered being disloyal when one nurse reports another for poor care" d. "Patient care is the number one concern. Meeting standards is mandatory and necessary" The nurse leader must remind employees that professional responsibility is to maintain quality care, and thus they are obligated to report instances of clinical incompetence, even when it means reporting a co-worker. Ignoring safety violations or poor practice is unprofessional and jeopardizes patient care.

As a manager, you are interested in developing behavioral questions for an interview. Knowing that there is team conflict at times on your unit, which of the following questions would satisfy your interest in behavioral questions? a. "Tell me about a time you were involved in a conflict related to a project. What was your role in the conflict? In the resolution of the conflict?" b. "If you were to employ one strategy for managing conflict, what would it be?" c. "What is your preferred style of conflict resolution?" d. "How effective are you in working in a group? In dealing with conflict?"

a. "Tell me about a time you were involved in a conflict related to a project. What was your role in the conflict? In the resolution of the conflict?" Behavioral questions seek demonstrated examples of behavior from the candidate's past experiences; behavioral-based interviewing can be a strong predictor of a future employee.

Which of the following are examples of application of the Leadership Rounding Tool? (select all that apply) a. "What is working well for you during bedside reporting?" b. "What has not worked for you today?" c. "Is there someone on your team who deserves special recognition for her efforts in the implementation?" d. "Did you have a good vacation?"

a. "What is working well for you during bedside reporting?" b. "What has not worked for you today?" c. "Is there someone on your team who deserves special recognition for her efforts in the implementation?" d. "Did you have a good vacation?" The Leadership Rounding Tool suggests establishing & maintaining rapport and asking what is working well, what was a barrier, and who should be recognized, as well as answering tough questions.

The difference between a nurse practitioner's charge of $45 for an office visit & the insurance company's payment of $34 is: a. A contractual allowance b. A profit c. A flat rate d. Revenue

a. A contractual allowance Because the amount that is allowed for an office visit is less than the amount that the NP charges, this is known as a contractual allowance or discount. If the amount allowed were more than what the NP charges, then a profit would be realized. All of the answers represent sources of revenue.

What is not a key concept in a well-functioning team? a. Absence of disagreement or conflict b. Special work that is understood and supported by all c. Willingness to work together respectfully d. Dedication to a mission

a. Absence of disagreement or conflict

The nurse on the 7-7 shift is assigning a component of care to an unlicensed nursing personnel (UNP) employee. The night nurse should remain: a. Accountable b. Responsible c. Authoritative and liable d. Responsible and task-oriented

a. Accountable

The nurse educator was giving a workshop on team building. She noted that effective communication is essential for team building. One of the key questions in the workshop was, "What is the best way to check to see if what you have communicated to a team member is understood the way you meant it to be understood?" The correct response is which of the following options? a. Active listening and feedback b. Cues from nonverbal communications c. Content and context clues d. Reliance on paralanguage

a. Active listening & feedback Active listening is a skill in listening in which one listens with the full intention of understanding what is being communicated, listening to the degree that you are able to repeat exactly what was said. Feedback helps to verify that the message you received was the one that was sent. Paraphrasing and restating the message are important feedback skills ("What you meant was....").

Because of the complexity of reimbursement systems and its implications for the services available to patients, the nurse has a key role in: a. Advocacy for patients with regard to services required and services utilized. b. Increasing the volume of services and decreasing the number of patients served. c. Accomplishing more with each visit and decreasing the volume of services used. d. Decreasing the volume of services used and the number of return visits.

a. Advocacy for patients with regard to services required and services utilized The specific strategies employed by organizations and nurses to contain costs and increase revenues depend on the reimbursement system(s) within which the organization operates and therefore on whether the volume of services is increased or whether the volume of services is decreased by placing greater emphasis on efficacy in each visit and reducing the number of return visits. Because of the complexity of the reimbursement environment, the nurse is placed in a position of advocacy in terms of what the patient needs and how those needs can be best met within the funding structures.

Which of the following would NOT be a characteristic of an effective team nurse leader? a. An autocratic perspective b. Excellent communication skills c. Awareness of everyone's abilities d. A genuine interest in team members

a. An autocratic perspective In ineffective teams, leadership tends to be autocratic and rigid, and the team's communication style may be overly stiff and formal. Members tend to be uncomfortable with conflict or disagreement, avoiding and suppressing it rather than using it as a catalyst for change. When criticism is offered, it may be destructive, personal, and hurtful rather than constructive and problem-centered. Team members may begin to hide their feelings of resentment or disagreement, sensing that they are "dangerous." This creates the potential for later eruptions and discord.

Based on data from the patient satisfaction survey, the nurse manager decides that a change should be made in communication with family members. What would be important for a nurse manager to consider when instituting a change to improve customer service? a. Assess the perceptions of the nursing staff regarding the particular service problem. b. Include community representatives on a planning committee to address the change. c. Involve physicians, other healthcare professionals, and ancillary staff. d. Review all patient complaints with the nursing staff.

a. Assess the perceptions of the nursing staff regarding the specific service problem. Nurses are the healthcare providers who spend the most time with the consumer and are in an opportune position to understand the issues, structures, and processes that affect patients. The nurse acts as the primary person to be alert to circumstances that may prevent a successful outcome for the patient and to intervene on the patient's behalf. As a nurse manager, it is important to support staff in their use of power to be in control and to make decisions at the consumer-staff level of interaction.

Mr. Cruiser has been surfing the Web. He is looking for healthcare information on low back pain. He shows the clinic nurse a webpage he thinks is great and tells her that he has been following the exercises recommended by the author. He wants to know what she thinks about the site. When the clinic nurse evaluates this site, she discovers that its author is a personal trainer. No credentials are listed. In several testimonials on the page, people (their pictures are included) say how wonderful they feel after having done these exercises. The exercises all have animated demos when you click on the pertinent highlighted text or icon. They seem easy to follow. The site was posted 5 yrs earlier & was last updated 3 yrs before. The clinic nurse advises Mr. Cruiser to: a. Avoid this site b. Check with his primary healthcare provider c. Continue with the exercises d. Contact the author for additional exercise and feedback

a. Avoid this site Patients need coaching as to how to use and decipher information that is available through the Internet. In this situation, the provider on the site lacks credibility because no credentials are listed, and the information is not current.

In an ICU, you order new devices to measure heart rhythm and rate, respiratory rate, oxygen levels, and intracranial pressure. These devices involve: a. Biomedical technology b. Telecommunications c. Retrieval of patient history information d. Internet

a. Biomedical technology Physiologic monitoring devices and patient surveillance systems involve biomedical technology.

From the information presented in this chapter, which of the following statements best defines an accomplished team? Effective teams: a. Can create a form of synergism in which the outcome is greater than the sum of the individual performances. b. Do not necessarily need goals, objectives, vision, and a clearly stated purpose. c. Do not always have effective communication patterns. d. May or may not have a clear plan that is followed and revisited and has an ongoing evaluation scheme.

a. Can create a form of synergism in which the outcome is greater than the sum of the individual performances. Research on team-building over many years has established that high-functioning teams are characterized by synergy that takes the team from a collection of individuals to an outcome that is greater than the sum of the parts.

A survey of staff satisfaction is conducted. The survey indicates that staff members are satisfied, are loyal to the organization, and feel that they have reasonable control in their individual responsibilities. The findings best exemplify: a. Clarity in roles and valuing of contributions b. Satisfaction but not empowerment c. Effective coaching of new staff d. Role attachment

a. Clarity in roles and valuing of contributions Commitment, a sense of control, and satisfaction are linked to clear role expectations and a feeling that contributions are valued.

A recent nursing graduate in a busy ED triages a patient who has sustained a large, deep puncture wound in his foot while working at a construction site. He is bleeding & in pain. The nurse enters the triage data that she has obtained from the pt into a computerized, standard emergency patient-classification system. After she enters the assessment data, she notices an alert on the computer screen that prompts her to ask the pt about the status of his tetanus immunization. What system of technology is involved in generating the alert? a. Clinical decision support b. WL technology c. Computerized provider order d. Electronic health record

a. Clinical decision support Clinical decision support (CDS) is a clinical computer system, computer application, or process that helps health professionals make clinical decisions to enhance patient care. The clinical knowledge embedded in computer applications or work processes can range from simple facts and relationships to best practices for managing patients with specific disease states, new medical knowledge from clinical research, and other types of information.

The state of being emotionally impelled, demonstrated by a sense of passion & dedication to a project or event, describes: a. Commitment b. Control c. Willingness to cooperate d. Communication

a. Commitment Commitment is described as having a sense of passion and commitment to a project without necessarily having a need to control.

Complex change situations require that the change leader promote ongoing visioning among staff members. One strategy is to: a. Consciously evaluate invisible mental models b. Allow for individual outcomes c. Encourage cooperative activities d. Operate between order and disorder

a. Consciously evaluate invisible mental models Senge theory on change suggests that each individual or organization bases activities on a set of assumptions, or a set of beliefs, or mental pictures about the way that the world should work. When these invisible models are uncovered and consciously evaluated, it is possible to determine their influences on work accomplishment.

After a major flu vaccination campaign, an agency bills a private insurance company for allowable costs for administration of each vaccination according to the schedule established by the insurance company for reimbursement. This is an example of which major payment method? a. Cost-based reimbursement b. Charges c. Contractual allowance d. Prospective reimbursement

a. Cost-based reimbursement Because the agency is submitting costs after the campaign is completed and in accordance with an established schedule of allowable costs, a retrospective, cost-based reimbursement payment method is being utilized. If a desire for profit was indicated, then the answer would be "charges."

As a nurse manager, you see an opportunity for patients to be well serviced through the medical home concept. You recognize that the concept of medical homes: a. Currently does not include nurses in its vision of multifaceted primary care. b. Includes nurses as part of an interdisciplinary and multidisciplinary team. c. Restricts nurses to services related to direct care and procedures. d. Cannot encompass nurses within this framework.

a. Currently does not include nurses in its vision of multifaceted primary care. The concept of medical homes encompasses the idea of multifaceted medical homes that provide a usual source of health care. Current discussions have focused on physician-directed care even though nurses in advanced practice are well suited to lead teams in this model.

The nurse manager frequently interacts with staff and other hospice facility employees. Communication is purposeful because the manager assesses current issues, such as specific satisfactions and dissatisfactions with the newly implemented computerized documentation system. Informally, the manager gathers available staff members to address similar learning needs. Many times, staff members are found coaching other staff about improving use of the new system. According to Senge (1990), the activities demonstrated in this example are: a. Dialogue, team learning b. Resilience, personal mastery c. Shared vision, systems thinking d. Mental models, teachable moments

a. Dialogue, team learning Building shared vision occurs when leaders involve all members in moving personal visions of the future into a consolidated vision common to members and leaders.

To improve outcomes on the stroke recovery unit, the unit manager leads an evidence-based practice (EBP) project. The goal of this project is to: a. Enable detection of variations in clinical outcomes from well-researched standards that are supported by confirmatory evidence. b. Gain quick access to literature based on studies of patients and families who have experienced stroke. c. Develop a list of articles that could be accessed to address clinical issues and problems with stroke patients. d. Advance the development of staff who are able to conduct independent nursing research on stroke outcomes.

a. Enable detection of variations in clinical outcomes from well-researched standards that are supported by confirmatory evidence Several "intelligent" clinical information systems are in place that collect good data and then translate nursing knowledge, such as well-researched standards, into reference materials at the point-of-care. In addition, computer applications assist nurses to take action and provide patient care based on the best evidence for practice.

The biggest challenge in the recruitment of staff is: a. Finding well-qualified candidates who can function well within your particular work culture. b. Recruiting individuals with the appropriate qualifications and experience. c. Screening out candidates who are unable to function well within a team. d. Determining if candidates have had previous negative experiences in a work environment.

a. Finding well-qualified candidates who can function well within your particular work culture. Choosing the right individual is the challenge for managers and involves finding qualified candidates who will work well within your culture.

The nurse manager understands that the three Ps associated with client education are philosophy, priority, & performance. Effective client education programs start with a shared philosophy that such programs are worth the investment. Evidence of a philosophic commitment to client teaching is best represented by: a. Investing time and energy in teaching clients. b. Developing teaching skills among the nursing staff. c. Assuming that clients lack the knowledge they need. d. Having a teaching checklist on clients' charts.

a. Investing time and energy in teaching clients. A philosophy that patient education is an investment with a significant positive return is one of the three Ps of a successful consumer education focus. Money invested in teaching is money well spent.

As a nurse manager representative on a clinical information system selection team, you would be particularly concerned if the favored system: a. Involves screen displays that are best configured for non-clinical users. b. Requires an upgrade to servers in the facility. c. Requires staff orientation and training during implementation of the software. d. Minimizes the amount of data entry necessary.

a. Involves screen displays that are best configured for non-clinical users An ideal hospital information system should include as much instrumentation as possible to minimize data entry. As a clinical end user, you would expect orientation and training on how the screen display can be configured so as to suit the purposes and preferences of users in clinical areas.

To engage your staff in awareness of their current practice and how it is affirmed or not by evidence, you plan a short series of learning presentations on evidence and use of heparin and saline to maintain IV patency. You meet with the educator to plan out the goals for each session with the overall purpose of increasing knowledge and awareness of staff in readiness to consider questions related to the IV practice. This learning approach is an example of which change management approach? a. Linear b. First-order c. Facilitative d. Integrative

a. Linear In the second stage, the moving or changing stage of Lewin's first-order, planned change process, planned interventions and strategies are executed to support the implementation of the change. One commonly used method is educating staff about the need for the change.

The validity of comments and ratings related to performance is enhanced by: a. Maintenance of anecdotal notes over the entire evaluation period. b. Quantity of information gathered for appraisal purposes. c. Agreement of the employee with the ratings and comments. d. Whether or not other individuals have contributed to the observations.

a. Maintenance of anecdotal notes over the entire evaluation period Anecdotal notes compiled consistently over the entire rating period are a much more equitable method of providing an accurate summary of the employee's performance

An example of an initiative that may reduce total healthcare costs would be: a. Offering nurse practitioner-led clinics that educate parents about non-pharmacologic strategies for managing ear infections. b. Educating seniors about the comparative costs of medications that are prescribed to them. c. Lowering copayments for prescription drugs for seniors. d. Advocating for more readily available MRI services to ensure early diagnosis.

a. Offering nurse practitioner-led clinics that educate parents about non-pharmacologic strategies for managing ear infections. Total healthcare costs are a function of prices that are established for various services and the volume or quantity of services used. Utilization of high-tech diagnostic services and lowering of copayments have been implicated in increasing total healthcare costs (thus C and D would not be correct), as well as attitudes and behaviors of consumers of health care. In general, consumers prefer to "be fixed" when something goes wrong rather than to practice prevention. Many consumers still believe that the physician knows best, so they do not seek much information related to costs and effectiveness of different healthcare options. When information is sought, it is not readily available or understandable. Also, consumers are not accustomed to using other, less costly healthcare providers, such as nurse practitioners.

The nurse manager schedules evaluations of staff members using a newly developed performance appraisal tool. The development of a performance appraisal tool should include: a. Organizational mission, philosophy, and position requirements. b. A generalized overview of the duties of a position. c. A skills checklist and accreditation requirements. d. An ordinal scale that ranks all employees.

a. Organizational mission, philosophy, and position requirements Performance appraisal tools and processes should reflect the organizational mission and philosophy, as well as position requirements.

Leaders in nursing must advocate for information & knowledge systems that support nursing practice. This is best accomplished by: a. Participating in organizational information technology committees. b. Submitting written requests for needed information systems. c. Requesting budgetary funds needed for systems. d. Sending staff nurses to conferences that discuss cutting-edge technologies.

a. Participating in organizational information technology committees Nurse leaders and direct care nurses must be members of the selection team, participate actively, and have a voice in the selection decision. The information system must make sense to the people who use it and fit effectively with the processes for providing patient care.

The chief nursing officer is pleased with the nurse manager's strategy of improving patient satisfaction in the pediatric intensive care unit. She decides to implement these changes throughout the hospital. What would be important to consider in implementing a new program focused on improving relationships with consumers? a. Recognition of the nursing staff for excellence in promoting consumer relationships b. Holding the staff accountable for resolving patient complaints c. Selecting a staff nurse leader to implement the program d. Identifying key staff members who have already demonstrated excellence in consumer relationships

a. Recognition of the nursing staff for excellence in promoting consumer relationships The nurse leader should allow professionals more influence over their practice;give staff opportunities to learn new and varied skills; give recognition and reward for success and support and consolation for lack of success; and foster motivation and belief in the importance of each individual and the value of his or her contribution.

An outpatient clinic advertised for RN positions. Before authorizing an open position, the nurse manager should: a. Review the position description and performance expectations for the opening. b. Place an ad in the local newspaper and on the telephone job line. c. Review all current applications on file. d. Look for employees within the system who might best fill the position.

a. Review the position description and performance expectations for the opening. The position description provides the basis for this position within the organization and communicates expectations for the role. When applying for a position, researching the facility and position description will help an applicant gain insight into the organization; therefore, the position description should be current and communicate expectations.

You have hired Chelsea as a new staff member on your unit. Although she is an experienced ICU nurse, this is her first educator role. A month into her new position, she confides that she feels really incompetent in her new position and bursts into tears. Your response is based on application of your understanding of: a. Role acquisition b. Role conflict c. Role complexity d. Performance appraisal

a. Role acquisition Acquisition of a role is time dependent and involves application of life experiences to each role and interpretation of the role within one's own value system. As roles become more complex, an individual may take longer to assimilate the components of each role.

Which of the following is not a necessary requirement for formation of a team? In forming a team, the leader should keep in mind that the team: a. Should include only members with similar personalities b. Is responsible for creating its own vision c. Should decide the goals and objectives d. Should encourage participants to be actively involved

a. Should include only members with similar personalities In forming a team, it is helpful to ask the following: 1. Why would you want a homogeneous group? 2. What purpose would it serve if all members were similar? 3. What if all members were introverts?

Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effects." You follow up with Elizabeth and discover that she is really quite angry about the information sessions because she feels that you are implying that "what she has been doing all these years means that she is incompetent and doesn't care about her patients." After speaking with Elizabeth, a few days later you discover that she is now fine with the change but is concerned that other areas of the organization might resist the change because of perceptions related to patient safety and cost. She suggests that it is important to bring pharmacy on board as they have had previous concerns about the use of heparin. In relation to change theory, this is indicative of: a. Systems level thinking b. Linear thinking c. Interprofessional collaboration d. First-order change

a. Systems level thinking Senge complexity theory, Bevan Seven Change Factors, & general systems theory all highlight connectivity & the idea that changes are not isolated events.

Physicians in a small urban hospital are reluctant to discharge older adult patients because many of the patients lack private insurance and the resources to travel distances for follow-up care. The hospital administration pressures the physicians to discharge patients sooner and to be more consistent with the number of hospitalization days specified within the DRGs. Which of the following would most likely prompt the action of administrators? a. The hospital is incurring a deficit related to a gap between the PPS and the DRGs and costs of care. b. Local home care services are expressing concern about the increased acuity of patients being discharged into their care. c. The resource-based relative scale for physicians does not account for the increased length of stay. d. Acute care patients are being denied entry to the hospital because of the increased stay of patients.

a. The hospital is incurring a deficit related to a gap between the PPS and the DRGs and costs of care Length of stay (LOS) is the most important predictor of healthcare costs and extra days are a cost to the organization in terms of both the extra days and decreased patient volume. The situation, as outlined, does not indicate that there is a bed shortage and therefore, there is no evidence that other patients are being denied access to services or that additional patient volume is not being captured. The hospital would be concerned about the impact on its income because of the additional, uncompensated care costs incurred for patients who exceed the usual length of stay explicitly calculated under PPS and the DRGs.

Which of the following would be most in line with Hersey and Blanchard's concepts? a. The team of caregivers on day shift are familiar with their roles and with the patients. The nurse manager decides to work on the unit budget in her office b. After a year of working on the unit, Shari, an LPN, is still hesitant about many policies and procedures. The charge nurse decides to challenge Shari with more difficult patients. c. The nursing supervisor asks one of her charge nurses to lead a technology integration project. The supervisor continuously demands involvement in decisions that the charge nurse is making in the project. d. Team members complain that Alysha, an RN, is unmotivated, and that she refuses assignments that are complex or difficult. The charge nurse suggests that Alysha is relatively new and that she needs time to adjust.

a. The team of caregivers on day shift are familiar with their roles and with the patients. The nurse manager decides to work on the unit budget in her office

Of the following, which is the most effective strategy that a nurse manager could employ to reduce unnecessary costs in specific healthcare settings? a. Training nurses on accurate documentation of supplies used for patient care b. Reducing the number of overtime hours worked by staff c. Reducing the number of staff on a unit d. Making decisions for patients about which care is important to their health

a. Training nurses on accurate documentation of supplies used for patient care Reducing overtime hours needs to be carefully assessed against the reasons for overtime (e.g., staff overload, recent illnesses, increased acuity) in terms of whether this reflects an ongoing or temporary situation and therefore whether it is a necessary variance or not. Reducing staff may or may not be effective, depending on the services being provided. Making decisions for the patient misses an important opportunity to invite the patient into discussion about patient priorities and needs and relative costs of options, which may lead to improved adherence with regimens and less waste of resources. An effective approach to cost containment is ensuring that supplies are accurately accounted for and charged in a timely manner.

As a new manager, you are shocked to learn that your unit is still using heparin in heparin locks. You are aware of evidence related to this practice and want to change this practice as quickly as possible on your unit. You are in which stage of Lewin's stages of change? a. Unfreezing b. Experiencing the change c. Moving d. Refreezing

a. Unfreezing Although you may be at a higher level of change in relation to your individual practice and knowledge of the use of change, in this situation, you are recognizing the need for change in relation to practice on the unit that you are managing. This phase is the initial phase in first-order change and will involve listening to staff to see if they perceive a similar problem.

Which of the following activities would represent a customer-friendly approach in a healthcare setting? (Select all that apply) a. Using a local anesthetic before inserting a needle into a child's arm b. Repeating patient history information to the admitting clerk, the admitting nurse, and the ultrasound technician c. Ensuring that birthing preferences are on file and available when a laboring mother comes in d. Providing support to families when a family member is brought into trauma

a. Using a local anesthetic before inserting a needle into a child's arm c. Ensuring that birthing preferences are on file and available when a laboring mother comes in d. Providing support to families when a family member is brought into trauma A service orientation means delivering services in a manner that is least disruptive. When possible, services should come to the patient and should be as easy, comfortable, pleasant, and effective as possible. Meeting the emotional, psychosocial, and spiritual needs of the patient is important.

In designing a program for young adults regarding safe sexual practices, which of the following might reach the greatest number in your target group? a. Web-based applications b. Print-based media such as newspapers c. Television advertisements d. Brochures in kiosks in malls

a. Web-based applications Mobile technology is changing the digital divide, with young adults, minorities, those with no college experience, and those with lower household incomes being more likely to indicate that phones are their main source of Internet access (Zickuhr & Smith).

The mediator noticed that tension was still evident between the nurse manager and staff members. He informed the chief nursing officer that to begin team-building, it would be important that everyone: a. Work together in a respectful, civil manner. b. Use avoidance techniques when confronted with a conflict. c. Develop a personal friendship with each other. d. Socialize frequently outside of work.

a. Work together in a respectful, civil manner For team-building to occur, team members need to be able to listen actively and respect one another's opinions, while feeling comfortable in assertively expressing their own.

A mediator suggested that the nurse manager and staff members decide on a method to resolve conflicts. It is important to have agreements about how team members will work together because: a. if there are no agreements, each member will make up rules about how to handle disagreements and relationships. b. People are naturally difficult and will not work well together without such agreements. c. People will naturally ask for agreements about how to be together. d. A way to eliminate nonproductive team members must be available.

a. if there are no agreements, each member will make up rules about how to handle disagreements and relationships People must agree on the goals and mission with which they are involved. They have to reach some understanding of how they will exist together. Tenets or agreements such as "I will respectfully speak promptly with any team member with whom I have a problem" go a long way to avoid gossiping, backbiting, bickering, and misinterpreting others. Without agreement, people have implicit permission to behave in any manner they choose toward one another, including angry, hostile, hurtful, and acting-out behavior.

A staff nurse regularly works two 12-hour shifts each week and one 8-hour shift every other week. How many FTEs is this position? a) 0.6 b) 0.7 c) 0.8 d) 1

b) 0.7 Assuming that a full-time RN works 2080 hrs/yr (40 hrs X 52 weeks), the nurse works (24 hrs x 52 weeks + 8 hrs x 26 weeks)/2080 = 0.7 FTE

The unit manager discusses absenteeism with the unit clerk. She indicates that it is a serious problem on the unit. Which of the following points would they have likely discussed? (Select all that apply.) a. Employee morale is at a high level b. Care will suffer and standards will be lowered c. Existing staff have experienced little effect from the absenteeism d. Replacement staff usually needs little supervision

b) Care will suffer and standards will be lowered e) Unit costs have increased because of staff replacements and overtime

The unit manager on 4E is concerned about the performance of Jean, a staff nurse. She is not involved directly with Jean, so she has not been able to determine whether the problem is one of motivation, ability, or both. If Jean lacks ability, which of the following strategies might the head nurse use? a. Dismiss or transfer Jean. b. Document all problem areas and then discuss them with Jean. c. Develop appropriate solutions and make recommendations to Human Resources. d. Smooth over the problems if they are minor in nature.

b) Document all problem areas and then discuss them with Jean For the employee to change and grow, specific corrective measures need to be taken. Consultation with the employee is necessary, and documentation is key to determining the issues.

Before terminating an employee, a nurse manager must: a. Be an expert in all legal aspects of termination and discipline practices. b. Know the organization's specific policies for addressing disciplinary problems and termination. c. Function as a counselor for problem employees. d. Do everything to assist and protect the employee by adjusting standards and policies.

b) Know the organization's specific policies for addressing disciplinary problems and termination It is important to know the policies of the organization to address disciplinary issues fairly and equitably, as well as to know the model that is employed to address employee problems.

A nurse manager understands that the second step in handling an employee with a disciplinary problem is to document the incident. Which of the following is best for documentation of personnel problems? a. Use of the performance appraisal on an annual basis b. Notes made immediately after an incident that include a description of the incident, actions taken, plans, and follow-up c. A tally sheet of medication errors and other specific problems that will be used at annual review d. Copies of reports, placed in his or her file, of all unusual occurrences involving the employee

b) Notes made immediately after an incident that include a description of the incident, actions taken, plans, and follow-up In documenting staff problems, it is important to specifically indicate what rules were broken or violated, consequences if behavior is not altered, employee's explanation of the incidents, and the plan of action to achieve and to reach new goals.

Nurse Stacey is a self-admitted drug addict and has been a heavy abuser of codeine. Stacey and the unit manager decide that changes have to occur. Stacey enrolls in an addiction program, and the manager has her transferred to a drug-free area. What other strategies might be appropriate? a. The manager could refer Stacey to the Human Resources Department. b. The manager could assist in monitoring Stacey's progress. c. The manager could counsel Stacey if Stacey has formed a trusting relationship with her. d. Stacey needs to be asked not to involve her family in the recovery program because this is a work-related situation.

b) The manager could assist in monitoring Stacey's progress Effective management demands that the organization take an active role in helping employees with special needs. Humanistic strategies that counsel and assist employees are cost-effective and necessary

The mediator suggested to the unit staff that a group agreement needed to be made so meetings could become productive. For example, the group agreement, "We will speak supportively," prevents: a) expression of opposing ideas b) gossip and making negative comments about absent team members c) efforts to ensure that everyone thinks alike d) votes that oppose motions

b) gossip and making negative comments about absent team members This is an example of a rule that a team can implement to prevent certain negative behaviors such as gossip, backbiting, and bickering that undermine the productivity and functioning of a group.

On your unit, despite efforts to build a strong sense of team, conflict between some of the staff is ongoing. Nonetheless, you want to proceed with developing a systematic and effective performance appraisal system. Which of the following approaches would be most appropriate for you to implement? a. Peer review b. A combination of tools c. Anecdotal notes d. Rating scale

b. A combination of tools A combination of tools is likely superior to any one method in any situation.

Which of the following indicates safe delegation? a. The nurse supervisor for a large urban acute care department asks the unit manager to accept two new acutely ill patients, which the manager does. The unit is short two staff, and the replacement is inexperienced. b. A unit manager agrees to release a staff from her unit to Unit B. The staff member she agrees to release is experienced on Unit B and is agreeable to the change. The unit manager's unit is fully staffed and patients are stable. c. The nurse supervisor asks the head nurse for Unit A to make do without a replacement for an ill staff member because Unit A was originally overstaffed anyway. Patient acuity levels are very high on Unit A and two staff are orientating. d. The nurse supervisor asks the charge nurse on Unit B to cover Unit F, which is two floors up, because the charge nurse for Unit F is ill. The charge nurse for Unit B is an experienced manager but has no experience with the nursing care required on Unit F.

b. A unit manager agrees to release a staff from her unit to Unit B. The staff member she agrees to release is experienced on Unit B and is agreeable to the change. The unit manager's unit is fully staffed and patients are stable

By following a shared leadership model, the nurse manager believes that staff members will learn to function synergistically. Some teams function synergistically because members: a. Do not volunteer unwanted information b. Actively listen to each other c. Listen to the person who believes he or she is an expert d. Do not speak unless they are absolutely sure they are correct in their views

b. Actively listen to each other Active listening in a group creates synergy in that team members really hear one another's ideas and share in decision making.

19. You ask Evelyn, a new UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. Before assigning Evelyn to Mrs. N.'s care, the most appropriate action of the care coordinator would have been to: a. Determine Evelyn's educational background and preparation for this role. b. Ask Evelyn if she has worked with inhalers before and to describe what she knows about them. c. Advise that if Evelyn has any questions about what to do with the inhaler, she should come to the coordinator. d. Advise Evelyn that working the inhaler is not really complicated and that she should ask the patient how to check medication levels in the inhaler.

b. Ask Evelyn if she has worked with inhalers before and to describe what she knows about them

A 27-year old woman is admitted to your ICU in a coma, following an accident. The family of the patient, who is a Native American, places a medicine pouch in the bed with the young woman. As the nurse in this situation, it is important to: a. Explain to the family that the medicine pouch may contain herbs that may bother other patients. b. Ask the family about the significance of the medicine pouch for them. c. Remove the pouch when the family is not present. d. Put the medicine pouch on the shelf beside the bed.

b. Ask the family about the significance of the medicine pouch for them. Diversity encompasses more than differences in nationality or ethnicity and may include a variety of ways that patients are different from their healthcare providers. Nurses need to recognize the culture of their work setting, realizing that it may differ markedly from the culture of the consumer, and move beyond ethnocentrism to provide culturally competent care. This competence includes cultural knowledge, which involves actively learning about a community; cultural sensitivity, which entails valuing and respecting beliefs, norms, and practices of the people being served; and collaboration within a community. In this instance, it is important to understand the meaning of the pouch for the family; removal from the bed without discussion does not demonstrate respect for the values and beliefs of this family.

In orienting new staff nurses to a pediatric intensive care unit, the nurse manager asks the staff nurses to answer the following question: "What is an important consideration in providing information to parents of a critically ill child?" a. Making sure that they receive complete information during each encounter with a member of the nursing staff b. Assessing parents' preferences for the amount of information desired c. Allowing parents to observe key aspects of their child's nursing care d. Making sure that patient education brochures explaining ICU protocols are readily available

b. Assessing parents' preferences for the amount of information desired Consultation with the parents regarding the amount of information that they desire reflects a service orientation, in which preferences and needs of the consumer are placed first. The other answers reflect nurse-directed decisions in which the nurse decides what information and how much information is needed and how it is to be delivered.

You ask Evelyn, a new UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. Determination of Evelyn's educational preparation and certification is related to the concept of: a. Accountability b. Authority c. Role performance d. Assignment

b. Authority

Within a healthcare environment, where the gap between revenues and costs can mean the difference between sustainability of an organization and nonsustainability of an organization or services, it is critical for nurse managers to: a. Maintain a clear vision of how to trim healthcare costs. b. Balance value-added services against costs and revenues. c. Consistently delete programs that are of high cost. d. Implement programs that bring in additional revenues.

b. Balance value-added services against costs and revenues To achieve and maintain financial viability, nurse managers must be able to think strategically financially and in terms of nursing care. Cutting costs by deleting programs and bringing in additional revenue through new programs and services are not in themselves strategic unless the decisions made lead to quality care, have positive outcomes, and are efficient in terms of cost.

Anecdotal notes: a. Should be completed only when there are performance concerns. b. Can be used to support and justify fairness in termination discussions. c. Are unnecessary if the evaluation instrument is thorough. d. Need to be completed at the end of a performance period.

b. Can be used to support and justify fairness in termination discussions. Anecdotal notes should be kept consistently throughout the evaluation period and should reflect both negative and positive behaviors if they are to provide an accurate assessment of performance. Anecdotal notes provide documentation to support rating scales and narrative evaluation summaries.

At a newly built outpatient surgical center, an integrated information system has been purchased. The chief nursing officer creates a series of staff development classes to orient the staff to this new system. One of the advantages of an integrated information system is that client-care data from all sites can be stored in and retrieved from a: a. Nursing information system b. Central data repository c. Nurse expert system d. Handheld device

b. Central data repository Computer information systems manage large volumes of data, examine data patterns and trends, solve problems, and answer questions. In other words, computers can help translate data into information from both within and among organizations. Data from all patient encounters with the healthcare system are stored in a central data repository, where they are accessible to authorized users. Patient information in a centralized database is organized, legible, and easily retrievable from a variety of sources and reflects a variety of data.

A nurse manager is planning to request three new infusion pumps at a cost of approximately $1500 each. What would BEST support the capital request? a. Number of patient care hours anticipated for the year b. Cost comparisons; how much and how often infusion pumps are used; condition of existing pumps c. Outline of cost for each pump d. Estimation of total cost; no further details

b. Cost comparisons; how much and how often infusion pumps are used; condition of existing pumps Complete well-documented justifications are needed because the competition for limited resources is stiff. Justifications should be developed using the principle of any business case and should include, at minimum, projected amount of use; services duplicated or replaced; safety considerations; need for space, personnel, or building renovation; effect on operational revenues and expenses; and contribution to the strategic plan.

As a head nurse, you are concerned about the service orientation on your unit. Which of the following findings and approaches might provide useful information for you? a. Patients find nurses friendly and accessible; data are aggregated for the institution as a whole. b. Data indicate that nurses are responsive to requests for assistance; data are available for the unit and the institution. c. Specific questions related to management of comfort are included for the institution as a whole. d. The survey asks for a range of responses for the unit and the organization, with a focus on facilities, such as cleanliness and responsiveness of administrative services.

b. Data indicate that nurses are responsive to requests for assistance; data are available for the unit and the institution. The National Database of Nursing Quality Indicators (NDNQI®) is a national repository for unit-based quality data that can be used by organizations to benchmark the outcomes of care against those of other institutions (ANA, n.d.). Unit-based quality indicators, including satisfaction with nursing care, are a key feature of the NDNQI®. In addition to hospitals being provided with their own and comparison data, researchers are able to access de-identified data in order to answer important questions about nursing care quality. Pain management, the discharge process, and post-discharge patient callbacks are specific areas where nurses can make significant improvement in patient satisfaction. Because patients and nurses may differ in what they see as factors that produce satisfaction, total reliance on nursing perceptions of patient satisfaction may not provide a complete picture.

During the budgeting process, nurse managers are typically responsible for which of the following? (Select all that apply) a. Determining inflationary rates for the upcoming year b. Developing unit operation objectives c. Justifying capital equipment requests d. Predicting cash flow e. Negotiating budget with other managers and administration

b. Developing unit operation objectives c. Justifying capital equipment requests e. Negotiating budget with other managers and administration Although involvement in budget processes will vary from institution to institution, these are typical responsibilities for nurse managers during the budget process.

You are charged with developing a new nursing curriculum and are committed to developing a curriculum that reflects the needs of the profession and of the workplace. To address deficits that may already be present in nursing curricula related to the workplace, you include more content and skills development related to: a. Therapeutic communication with patients b. Effective communication in the workplace c. Increased emphasis on sender-receiver dyads d. Generational differences in communication

b. Effective communication in the workplace Nursing programs teach therapeutic communications with patients and their families. However, little focus is placed on effective communication in the workplace, although communication is essential to building and maintaining smoothly functioning teams.

You ask Evelyn, a new UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. This incident is an example of: a. Incompetence of the UNP b. Failure to follow through c. Skills but no motivation d. Lack of accountability

b. Failure to follow through

John is an older adult patient who comes regularly to the multigroup practice in which you are a nurse practitioner. He says that he doesn't understand what he is supposed to be doing about his medications, because every time he comes to the clinic, he sees someone else who has different ideas. John's experience represents what aspect of the current consumer experience? a. Nurses are well-trusted members of the healthcare team. b. Fragmentation of care results in lack of respect and trust. c. Care providers often have conflicting ideas about care. d. The public does not trust care providers other than nurses.

b. Fragmentation of care results in lack of respect and trust When consumers visit a multigroup practice, they do not have the option of selecting a specific healthcare provider, and thus, there is less opportunity to build a trusting relationship with a provider.

After reviewing her monthly budget report, the nurse manager sees that she has a negative variance, which prompts her to change the staffing schedule. A negative or unfavorable variance in a monthly expense report may result from: a. Overestimation of inflation b. Higher than expected client acuity c. Net revenue exceeding net expenses d. Not replacing staff who called in sick

b. Higher than expected client acuity Variance reflects the difference between what was projected and the actual performance in a budget. When the variance is negative or unfavorable, the amount spent is more than what was budgeted (expenses exceed revenue); this may be a result of higher acuity. To help managers interpret and use variance information better, some institutions use flexible budgets that automatically account for census variances.

The nurse manager has to develop a patient satisfaction survey. What is one of the critical elements in selecting a patient satisfaction instrument? a. Being able to use the same instrument for all clinical units b. Including items that are important from the patient's perspective c. Being able to administer the instrument before a patient's discharge from the hospital d. Being sure that the reading level is no higher than third grade

b. Including items that are important from the patient's perspective Because satisfaction is a measure of service and service is a measure of perception of what matters to the patient, to measure satisfaction, surveys must include items that reflect the perspective of the patient. The quality of human contacts becomes the measure by which the consumer forms perceptions and judgments about nursing and the health agency. Consumers may not be able to evaluate the quality of interventions, but they always can evaluate the quality of the relationship with the person delivering the service.

The nurse manager analyzes the data from the patient satisfaction surveys. What can a nurse manager do to strengthen service recovery and improve consumer relationships? a. Post comparisons of patient satisfaction scores with those of other units on a monthly basis. b. Involve the staff in resolving consumer issues quickly and effectively. c. Ensure that staff members apologize to patients when they complain about services. d. Ask that patients with complaints about services place them in a written format.

b. Involve the staff in resolving consumer issues quickly & effectively Consumers need to be treated with fairness, given explanation, and provided with information about how errors will be prevented in the future. Staff can be assisted to respond to patient concerns through scripting, support, and an atmosphere that places an emphasis on learning and solutions rather than on blaming.

To engage your staff in awareness of their current practice and how it is affirmed or not by evidence, you plan a short series of learning presentations on evidence and use of heparin and saline to maintain IV patency. You meet with the educator to plan out the goals for each session with the overall purpose of increasing knowledge and awareness of staff in readiness to consider questions related to the IV practice. Staff nurses who gain information on current IV therapy practices are engaging in which phase of Rogers' decision-making process? a. Persuasion b. Knowledge c. Confirmation d. Decision

b. Knowledge Rogers' innovation-decision process involves five stages for change in individuals, the first of which is knowledge.

John, a new graduate, reviews the employee evaluation for his new position. The first section requires that he list his own specific objectives to be accomplished. This is an example of: a. The traditional rating scale. b. Learning goals, or management by objectives. c. A forced distribution scale. d. A behavior-anchored rating scale.

b. Learning goals, or management by objectives In management by objectives, the employer and the employee jointly establish clear and measurable objectives for the next performance period.

The chief nursing office of a Magnet™ hospital has conducted a study of ways to improve healthcare services. Healthcare services that add value for clients: a. Accomplish healthcare goals b. Minimize costs c. Decrease the number of services used d. Use high-technology treatments

b. Minimize costs Models of reimbursement affect which services and approaches (e.g., decreasing the number of services used) might be financially viable and add value for clients. It is critical to determine and advertise the value of nursing care. Services that add value are of high quality, affect health outcomes positively, and minimize costs.

Which of the following strategies might be effective in empowering staff? a. Communication book in which new information on policies and processes is communicated and mistakes are highlighted. b. Monthly staff meetings during which a portion of the agenda is devoted to sharing ideas and presentations on best practices for implementation on the unit. c. Once-yearly summative evaluations based on what the manager best likes about the individual. d. Focus on discussion of errors in care with direction as to how errors are to be prevented in the future.

b. Monthly staff meetings during which a portion of the agenda is devoted to sharing ideas and presentations on best practices for implementation on the unit. Empowerment is a process that acknowledges the values and judgments of others and trusts their decisions. It allows freedom for making decisions while retaining accountability and provides an environment that is safe in which to explore.

Based on Elizabeth's insights and suggestions, you involve pharmacy, only to discover that the change in practice involves practice committees, a medical practice committee, and concerns from administration about potential costs and safety of the proposed change to the IV protocols. The change process at this point is: a. Linear b. Nonlinear c. Sabotaged d. Neutralized

b. Nonlinear Complex change involves nonlinear processes and a variety of strategies to negotiate influences on change. Complexity theories alter the traditional systems thinking approach by asserting that system behavior is unpredictable. This theory views change as emergent, nonlinear, and highly influenced by all individuals and subsystems in an organization

When goals/outcomes are somewhat unclear in early preparation for a complex change, the manager and the change management team develop several acceptable goals/outcomes. This change in management approach is termed: a. Unfreezing b. Nonlinear c. Cybernetic d. Linear

b. Nonlinear While Lewin's theory was designed to describe planned or first-order changes, many scholars think the theory is too simplistic to address how unplanned or second-order change occurs. In complex situations with an uncertain change environment, a nonlinear approach that involves flexibility improves overall outcomes. Linear change is appropriate to stable, less complex, and more predictable situations

Functions such as "delegates tasks to assistive personnel" that are outlined in a position description for an RN Team Leader would be considered: a. Active delegation b. Passive delegation c. Passive accountability d. Active responsibility

b. Passive delegation

With delegation, responsibility and accountability remain with the: a. Physician b. Professional who delegates c. Individual who receives the delegation d. Individual who previously performed the task

b. Professional who delegates

A primary care clinic in a small urban center sees a high volume of cardiology pts. Patients who attend the clinic have smart cards that they use at hospitals, clinics, & ED within that region of the state. A primary benefit of the smart card for these patients would be: a. Rapid and accurate treatment in emergency situations. b. Reduced wait times to see specialists. c. E-mail notification of test results. d. Readily available information regarding medications.

b. Reduced wait times to see specialists Credit card-like devices called smart cards store a limited number of pages of data on a computer chip and serve as a bridge between the clinician terminal and the central repository of the electronic health record (EHR), making patient information available to the caregiver quickly and cheaply at the point-of-service. Smart cards provide information to healthcare providers regarding the patient's demographic and contact information, allergies, immunizations, lab results, and past patient care encounters and are presented at the point-of-service.

Joanne, a new nurse manager, writes certain assumptions regarding the organization's objectives into her budget. Her supervisor tells her that the objectives implied in her assumptions are not entirely consistent with the organization, and that she needs to clarify these objectives with her supervisor. Joanne apologizes and says she had more latitude with the budget where she previously worked. This is an example of: a. Role complexity b. Role ambiguity c. Role conflict d. Time-dependent roles

b. Role ambiguity Role ambiguity in the workplace creates an environment for misunderstanding and hinders effective communication. Without clear expectations of performance, missteps in performance can occur.

An example of one strategy used to improve participation in the change process by staff fitting the behavioral description of innovators and early adopters is to: a. Repeat the benefits of the change b. Share change experiences early in the process c. Initiate frequent interactions among staff d. Provide select information to the staff

b. Share change experiences early in the process Connecting innovators and early adopters to new ideas and with new peers keeps them at the cutting edge.

The chief nursing officer establishes a shared governance model to help empower the nursing staff, thus empowering the organization. Common characteristics of empowered organizations are: a. Shared values, high salaries, and a human focus. b. Shared values, flexibility, and a human-capital focus. c. Commitment to communication, high salaries, and flexibility for evaluations. d. Creation of community and of effective stress management in the midst of divergent goals.

b. Shared values, flexibility, and a human-capital focus. Shared governance involves valuing the contributions of each member of the team, releasing the need to control, and understanding that accountability rests with members of the team.

In a nurse managers' meeting, the chief nursing officer encourages the managers to brainstorm ways to reduce costs. Nurse managers have the greatest impact on reducing costs by managing: a. Supplies b. Staffing c. Fixed costs d. Medication costs

b. Staffing Because staffing constitutes the largest portion of any healthcare budget, managing the mix and numbers of staff required for patient care to meet identified outcomes will have the largest impact on budgets.

During staff development programs, staff nurses verbalize their frustration about their workloads and having to delegate so many tasks to others. One of the main reasons that delegation has emerged as an issue is because of: a. The amount of paperwork required to complete care b. The complexity of client care c. Earlier discharge practices d. The numbers of other disciplines present on a given unit

b. The complexity of care required by patients

During a fire drill, the nurse manager becomes very assertive and directive in her communications with staff. This type of situational leadership depends on: a. Supportive behavior by the leader and immature followers b. The development level of the followers and the type of behavior of the leader c. Well-developed followers combined with a strong leader who acts quickly d. The leader's ability to evaluate personnel and communicate that evaluation

b. The development level of the followers and the type of behavior of the leader

Sue, a nurse manager, discusses her concerns about the hospital's employee appraisal system with her work group, noting that it includes only one rating scale and that it means nothing unless the manager has effective relationship skills. Sue's concerns reflect which best practices associated with performance appraisal? a. Rating scales are too generalized to be considered valid or reliable. b. The effectiveness of appraisal is enhanced by a combination of methods and effective communication skills. c. BARS is considered superior to simple rating scales in terms of performance appraisal. d. Rating scales need to be designed by users to be well accepted.

b. The effectiveness of appraisal is enhanced by a combination of methods and effective communication skills. A combination of several methods is probably superior to any one method. The primary success of any performance appraisal lies in the skills and communication abilities of the manager.

As an experienced nurse manager who is new to an organization, it would be important to: a. Know the difference between operating and capital budgets. b. Understand the budget timetable and level of involvement expected of individual managers in budget preparation. c. Know why a budget is essential to the well-being of an organization. d. Understand what factors drive up healthcare costs in the healthcare system.

b. Understand the budget timetable and level of involvement expected of individual managers in budget preparation. Although all of the answers reflect knowledge that is critical to budgeting for nurse managers, an experienced nurse manager would likely be already familiar with general knowledge related to budgeting. The nurse manager, however, would need to become familiar with budget timetables and level of involvement expected in this specific organization because these elements of budgeting vary from work environment to work environment.

Technology is integral to a cardiac ICU. Sue, the nurse manager, implements a patient-centered approach that focuses on the meaning of the experience for the patient and family, primary nursing, and a health literacy approach. Sue is: a. Using high-tech-low-touch approaches. b. Using high-tech-high-touch approaches. c. Providing products. d. Providing tangible products of satisfaction.

b. Using high-tech-high-touch approaches The provision of humanistic care within a high-tech environment is characteristic of high tech-high touch approaches and reflects the idea that the more that high-tech is used, the more patients also desire high-touch.

During a performance appraisal, Joanne, the nurse manager, indicates that Alysha has difficulty mentoring students on the unit. Alysha responds that this is not her responsibility. In responding to Alysha, Joanne needs to consider: a. Alysha's level of confidence. b. Whether mentoring is included in the position description. c. Whether mentoring is an essential component of the position description. d. Whether mentoring can be accurately observed and measured.

b. Whether mentoring is included in the position description Employees must have clear role expectations, clearly understand what is expected of their performance, and understand the ramifications of not meeting those expectations. Position descriptions provide written guidelines detailing the roles and responsibilities of a specific position within the organizational context.

In preparing her budget, a nurse manager determines that she needs to budget for six FTE RN positions in the upcoming year. The nurse manager determines that RN 1 has 5 weeks of vacation and 3 days of education and has averaged 3 sick days a year. RN 2 has 6 weeks of vacation, has asked to attend a 3-day conference and a 2-day workshop, and has no history of sick time. RN 3 is new, and you anticipate 3 weeks of orientation, as well as 4 weeks of vacation. RN 4 has 6 weeks of vacation and has an ongoing health condition, so you anticipate 2 weeks of sick time, as well as 3 days for education. RN 5 has 5 weeks of vacation, has no education planned, and averages 5 sick days per year. RN 6 has 6 weeks of vacation, has no educational opportunities planned, and has been off ill for 4 weeks. How many hours of productive paid time can be anticipated for the budget? a) 12,480 b) 11,200 c) 10,848 d) 10,688

c) 10,848

Nurses generally experience difficulty in identifying behaviors and actions that could signal chemical dependency in a co-worker. Which of the following is not a behavioral change that occurs with chemical dependency? a. Personality and behavioral changes b. Job performance changes c. Changes in educational involvement and pursuit d. Absenteeism

c) Changes in educational involvement & pursuit A manager needs to be alerted when suspicions of chemical dependency are raised by behavioral changes in the employee. These include mood swings, changes in hygiene and appearance, heightened interest in the pain control of patients, frequent changes in shifts, increases in absenteeism, and increases in tardiness.

A nurse manager must be familiar with the agency's policies regarding termination. Termination procedures include which of the following? a. Following specific procedures from other organizations b. Having an attorney present at the termination meeting c. Having adequate written documentation to support the action d. Having a friend present during the termination meeting

c) Having adequate written documentation to support the action All steps should be followed, including full appropriate detailed documentation and following the procedures of the organization.

The nurse manager places a staff member on probation because of reports of chemical dependency. The nurse manager should be aware that which of the following statements is true regarding chemical dependency? a. The chemically dependent employee usually hides any changes in behavior. b. When confronted with the issue, the affected employee is usually relieved to have someone to talk to about the problem. c. The chemically impaired nurse affects the entire healthcare organization. d. Hospital policy, state laws, and nurse practice acts address procedures for the chemically dependent employee in the most general terms

c) The chemically impaired nurse affects the entire healthcare organization A chemically impaired nurse jeopardizes patient care through impaired skills and judgment. She or he also compromises teamwork and continuity as peers attempt to cover deficiencies in work performance for their impaired team member

As a nurse manager, you notice that one of your new nurses has provided exceptional care for a patient with especially complex needs. What would be the MOST effective way of recognizing the nurse's performance? a) At the next performance review, note specifically what the nurse did to make the patient comfortable. b) To avoid embarrassing the nurse in front of others, find a way to compliment the nurse in private. c) When the nurse comes out of the room, tell the nurse specifically what you appreciated about the care that was provided. d) Encourage the patient to note the care on the patient feedback form so that the institution can recognize the nurse's efforts.

c) When the nurse comes out of the room, tell the nurse specifically what you appreciated about the care that was provided. Acknowledgement is most effective when it is specific, timely, given in public, sincere, and on an eye-to-eye basis. The more time that elapses between the event and acknowledgement, the less effective it becomes.

Team Member A and Team Member B engage in heated disagreements on a frequent basis in team meetings. Their behavior is characterized by insistence on their points of view and refusal to back down or to negotiate alternative solutions once their ideas have been expressed. This behavior is characteristic of: a) autocratic leadership b) constructive conflict c) dualism d) creativity

c) dualism Our society tends to be dualistic in nature. Dualism means that most situations are viewed as right or wrong, black or white. Answers to questions are often reduced to "yes" or "no." As a result, we sometimes forget a broad spectrum of possibilities actually exists. Exercising creativity and exploring numerous possibilities are important. This allows the team to operate at its optimal level

The SBAR system of communications is one of the most used communication systems in health care because: a) It deals with all aspects of communications in patient care except with the physician. b) The nurse is on the same communication level as administration. c) it honors a familiar, structured transfer of information among health professionals d) It honors an unstructured transfer of information.

c) it honors a familiar, structured transfer of information among health professionals (old) c - It focuses on a system in which information is provided and gleaned in an honorable way. The SBAR system was developed by professionals in the Colorado Kaiser Permanente System and involves direct, respectful communication skills among professionals with the aim of quality patient care.

Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effects." You follow up with Elizabeth and discover that she is really quite angry about the information sessions because she feels that you are implying that "what she has been doing all these years means that she is incompetent and doesn't care about her patients." Which of the following would be the most effective response to Elizabeth? a. "I understand how you feel, but you are going to have to change." b. "It is unfortunate that you feel this way. Others seem quite excited about the new information." c. "It is difficult sometimes to change what we know very well. Sometimes it can be frightening." d. "Perhaps I can arrange some more information sessions for you, so you can see just how important this change is to patient safety."

c. "It is difficult sometimes to change what we know very well. Sometimes it can be frightening." Dialogue can reveal areas where individuals feel inept or overwhelmed, providing the leader with an understanding of what programs need to be developed to increase personal ability to change and what educational initiatives need to be implemented to support change. To promote dialogue, leaders must serve as facilitators, promoting the sharing of ideas, fears, and honest reactions to the change proposal.

In determining the fit of a candidate with the culture on your unit, which of the following interview questions might be asked? a. "Could you review your resume for us, highlighting your certifications and experience?" b. "If we were to ask your references, what would they list as your strengths? Weaknesses?" c. "We have a number of older adult patients on this unit. If you noticed another staff member addressing one of these patients impatiently, how would you respond?" d. "Tell us about your work and academic experiences and qualifications."

c. "We have a number of older adult patients on this unit. If you noticed another staff member addressing one of these patients impatiently, how would you respond?" The nurse manager wants the most qualified individual for the position who also fits the culture of the organization. Asking behavioral questions in the interview allows you to assess how a candidate may function in real-life situations and to assess if this behavior is compatible with the culture on the unit.

In preparing a budget, the nurse manager needs to anticipate the cost of benefits (e.g., health, life insurance, pension and retirement plans). Based on the usual cost of benefits, how much should a nurse manager include for a total full-time salary cost of $312,000? a. $78,000-$93,600 b. $62,400-$78,000 c. $46,800-$93,600 d. $31,200-$46,800

c. $46,800-$93,600 The average cost of benefits is approximately 25% to 30% of a full-time employee's salary. In this example, the correct response is obtained by multiplying the total full-time salary cost by .25 and .30.

In preparing her budget, a nurse manager determines that she needs to budget for six FTE RN positions in the upcoming year. Based on a 40-hour week, this means that the nurse manager has determined that the budget will provide for _____ hours. a. 12,480 productive b. 10,820 productive c. 12,480 paid d. 10,800 patient care

c. 12,480 paid From the information given, it is not possible to determine how many non-productive hours (vacation, holiday, sick time, education) the nurse manager has accounted for in her budget calculations and therefore whether the total # of hours (40 hrs × 52 weeks × 6 staff = 12,480 paid hrs) is productive (paid time that is worked) or non-productive hrs. 12,480 accurately reflects the total number of hours of work paid per year.

You document your patient's vital signs into a bedside documentation device and are able to compare your patient's vital signs with patients who have similar diagnoses and similar medications, and who are of a similar age. You are accessing: a. E-mail b. Telecommunications c. A database d. Technology

c. A database A database is a collection of data elements stored and organized together for the purposes of interpreting information such as vital signs.

Which of the following actions best exemplifies advocacy? a. Developing a list of agencies that will provide free services for the homeless b. Working in a needle exchange program for individuals in an inner-city environment c. Acting on behalf of a patient to promote end-of-life wishes to an ethics committee d. Working in a free clinic for immigrant workers

c. Acting on behalf of a patient to promote end-of-life wishes to an ethics committee Advocacy means making known and defending and protecting the rights and interests of others, as well as ensuring the dignity and respect due to others. Simply being employed in an environment where this might be a focus of practice does not necessarily ensure that advocacy is actually occurring.

County Hospital has position descriptions for all staff, including RN Team Leaders. Sarah, a team leader on the rehab unit, assesses the needs of the patients in her area, assesses the skills and backgrounds of each of the individuals on her team, and then assigns and delegates the appropriate care provider to each patient and task. Sarah's activity in the example described is termed: a. Passive delegation b. Passive accountability c. Active delegation d. Active responsibility

c. Active delegation

During review of a patient's progress, the healthcare team determines that a patient requires treatment that is generally accepted at that time in the usual illness trajectory of a patient. The patient is unable to pay. As the head nurse, you persist in ensuring that this patient receives the treatment. You are: a. Empowering the patient b. Avoiding litigation c. Advocating for the patient d. Supporting the clinical pathway

c. Advocating for the patient Advocacy means defending the rights and interests of others and, in this situation, the right of a patient to receive care, as determined by standards utilized in a critical pathway.

As part of performance appraisal, the nurse manager designs strategies to acknowledge staff members. What practices by the nurse manager best acknowledge staff accountability and contribution? a. Providing new and varied learning experiences for staff members b. Fostering group cohesiveness through standardization of unit activities c. Allowing professionals greater influence over their practices d. Giving recognition for success and support for failure to staff members

c. Allowing professionals greater influence over their practices Facilitating greater control over practices implies trust and acknowledges expertise and performance.

The clinical coordinator expects the position description of the new wound care specialist to change nurses' responsibilities in caring for clients with skin integrity problems. The best approach to address this need for change, yet to have the best outcomes for clients, staff nurses, and the organization, is to: a. Select one of the change models b. Use Lewin's model and principles of change c. Apply both planned and complexity theory approaches d. Form a task force of nursing staff and wound care specialists

c. Apply both planned and complexity theory approaches In the second stage, the moving or changing stage of Lewin's theory, planned interventions and strategies, such as education, vision building, and incremental steps towards the change, are executed to support the implementation of the change. This situation potentially also involves complexity theories that recognize that change involves engagement of individuals and subsystems throughout the unit and organization.

Marcy, a new staff nurse, is very concerned about "fitting in" on the rehabilitation unit. She addresses her concerns and speaks with the head nurse. The head nurse speaks with the rest of the staff and reminds them how important it is for a staff member to feel that he or she is part of the group. Which of the following statements would she not include in her talk? "Staff members who feel included: a. Are more cooperative." b. Are harder workers." c. Are part of the 50% who feel their strengths are used." d. Bring enthusiasm and commitment to the group."

c. Are part of the 50% who feel their strengths are used." Less than 20% of employees feel their strengths are used every day (Wagner & Harter, 2006). When nurses do not feel their skills are utilized, they are more prone to be in the "out group." This leads to being unengaged and even disengaged in the workplace. This is not supportive of a positive, creative work environment. Researchers have demonstrated that those who feel "in" cooperate more, work harder and more effectively, and bring enthusiasm to the group.

The charge nurse is making patient assignments for the next shift on the unit. There is one critical patient on the unit, who is going to require more care than the other patients. Before delegating this patient in an assignment, what is the appropriate action by the charge nurse? a. Delegate the admission assessment to the LPN. b. Review the employee's performance assessment for the most recent period. c. Assess the amount of guidance and support needed in a particular situation d. Create a task analysis of critical behaviors for the individual.

c. Assess the amount of guidance and support needed for the nursing care of the patient

County Hospital has position descriptions for all staff, including RN Team Leaders. Sarah, a team leader on the rehab unit, assesses the needs of the patients in her area, assesses the skills and backgrounds of each of the individuals on her team, and then assigns and delegates the appropriate care provider to each patient and task. Sarah provides Colleen, her RN colleague with details regarding the patients to whom Colleen has been assigned on the day shift. This is an example of: a. Accountability. b. Responsibility c. Assignment d. Delegation

c. Assignment

The nurse manager used a mediator to help resolve conflicts on the unit. During the mediation process, the nurse manager saw signs of potential team building. One key concept of an effective team is: a. Conflict b. Task clarity c. Commitment d. A designated leader

c. Commitment Team-building involves moving toward a common vision, which requires commitment. Conflict and clarification of tasks are components in the development of this commitment.

The complexity of the healthcare environment for consumers is increased by: a. Falling levels of education among the public. b. Increased levels of poverty. c. Complex compensatory systems and a variety of delivery systems. d. Increased numbers of uninsured or underinsured.

c. Complex compensatory systems and a variety of delivery systems. The complexity of options in health care and the processes and policies involved in funding health services for patients, as well as fragmented relationships with a growing variety of healthcare providers, contribute to the complexity of the system for patients, especially for those who might need it most, such as the poor, uninsured or underinsured, and homeless.

The mediator asked each staff member to reflect on his or her communication style. Which of the following best describes communication? Communication: a. Is a reflection of self-analysis b. Is a result of thoughtful consideration c. Consists of thoughts, ideas, opinions, emotions, and feelings d. Focuses on the sender of the message

c. Consists of thoughts, ideas, opinions, emotions, & feelings Communication involves both senders and receivers and may or may not be a reflection of self-analysis and thoughtful consideration. It always, however, involves thoughts, ideas, opinions, emotions, and feelings.

The home health agency hired an expert in financial management to evaluate and propose a plan for reversing growing expenses and decreasing revenues. The expert is well respected, both personally and professionally, by members living in this small community. To be effective, staff will need to perceive this change agent as: a. Trusted, quiet b. Flexible, informal c. Credible, enthusiastic d. Communicative, personable

c. Credible, enthusiastic To influence the decision, the expert must be seen as having knowledge of what matters to the people that they lead and of the change area itself. The expert also must be enthusiastic and communicative and have referent power.

A nurse manager discovers that the actual number of visits per patient in a home health service is 3.8 visits per day when the standard is 5 visits per day. Based on this information, the nurse manager: a. Concludes that the complexity of care in each visit has arisen. b. Concludes that patient volume has been decreased. c. Decides that more information is needed before a conclusion can be reached. d. Initiates a training session regarding the importance of ensuring that visits are made.

c. Decides that more information is needed before a conclusion can be reached Variance from measures of productivity or ratio of outputs to inputs does not necessarily offer an explanation of whether or not care was delivered as needed. Before proceeding to any further conclusion, the nurse manager will need to investigate reasons for the decreased output.

You anticipate that your region will soon move toward an e-health record system. You begin to discuss this with your staff and are disappointed that you receive little positive response from the staff about this possibility. One staff member, in particular, seems to sum it up by saying "e-health? Won't happen in my working life! There are too many problems with it, like privacy issues." This response is most likely motivated by: a. Lack of urgency regarding the need to change b. Lack of evidence to support importance of technology c. Deficits in education and experience d. Lack of organizational support for change

c. Deficits in education and experience For leaders to inspire change, they must have intimate knowledge of what matters to the people they manage. Kotter (2012) characterizes this as establishing a sense of urgency, and this involves overcoming complacency. This is especially hard when there doesn't seem to be any visible crisis, or the crisis seems irrelevant to the people being asked to change (Kotter, 2012).

The chief nursing officer decided that the nurse managers need a series of staff-development programs on team building through communication and partnerships. She understood that the nurse managers needed to build confidence in ways of handling various situations. The greatest deterrent to confidence is: a. Lack of clarity in the mission b. Lack of control of the environment c. Fear that one can't handle the consequences d. Fear that the boss will not like one's work

c. Fear that one can't handle the consequences Fear of not being able to manage consequences undermines confidence and a sense of competency.

An older adult couple with limited means and on Medicare is considering options after the hospitalization of Mrs. A. with a fractured hip. Mrs. A. is stable but requires assistance with bathing, transfer, and mobility, and this will present stress for Mr. A., who was hospitalized with a mild myocardial infarction last year. Considering their means and health concerns, which of the following might be the best option? a. Hospice care b. Custodial nursing home care c. Home care d. Hospital care

c. Home care Custodial nursing care is not covered under Medicare and therefore, the financial burden of this option may cause further stress for the couple. Medicare Part A is an insurance plan for hospital, hospice, home health, and skilled nursing care that is paid for through Social Security. Because Mrs. A. is stable and not terminal, she does not require hospice care. The assistance provided through home care is covered under Medicare and provides assistance for needs such as those of Mrs. A.

Nurses need to know how to operate a computer, compare data across time, and look for patterns in client responses to treatments. These are examples of: a. JCAHO standards b. Information systems c. Informatics competencies d. Requirements for nursing licensure

c. Informatics competencies The Quality and Safety Education for Nurses (QSEN) project identified informatics competency as a necessary component of the knowledge, skills, and attitudes for quality patient care. Nurses are anticipated to be able to use information and technology to communicate, manage knowledge, mitigate error, and support decision making. Nurses must utilize hospital database management, decision support, and expert system programs to access information and analyze data from disparate sources for use in planning for patient care processes and systems.

The oncology clinic manager and the educational coordinator asked nursing staff to complete a brief written survey to assess their attitudes and knowledge related to having used the new infusion equipment for 6 weeks. The stage of change in this situation is: a. Developing awareness b. Experiencing the change c. Integrating the change d. Perceiving awareness

c. Integrating the change This particular initiative assesses the success with which the change has been integrated into everyday practice after it has been experienced, or the degree to which staff members have accepted using the new infusion equipment.

A nurse is admitted to a psychiatric unit. The staff expresses frustration with her because they have explained several times her medication regimen, and yet, when she goes on passes, she fails to follow it. The staff believe that, as a nurse, she should be able to understand what is expected. The nurse's failure to follow the regimen indicates: a. Early cognitive impairment b. Lack of motivation c. Lack of health literacy d. Worsening health state

c. Lack of health literacy What is evident from the response is that she lacks health literacy or the capacity to obtain, process, and understand basic health information and services. Using a Health Literate Care Model involves weaving health literacy strategies into care by assuming that patients do not understand their health conditions or what to do about them, and then, subsequently assessing patients' understanding (Koh, Brach, Harris, & Parchman, 2013). For example, a nurse who is an expert clinician in a specialty practice area, when diagnosed with a serious chronic illness, may not have the appropriate background to make informed healthcare decisions.

Despite the implementation of bar-code medication administration (BCMA) on your busy medical unit, you notice that the number of medication errors has not significantly decreased. Which of the following reasons might explain the lack of change in errors? a. A number of new medications have been introduced into the hospital pharmacy that are not yet recognized in the CDS. b. There have been an unusually high number of patients on the unit who have been unable to confirm their identity at the time of medication administration. c. Lack of staff understanding and support for BCMA has led to overrides or failures to scan bar codes during busy times. d. Clinical data that have been entered into the system to guide administration of the medications are outdated.

c. Lack of staff understanding and support for BCMA has led to overrides or failures to scan bar codes during busy times Most errors related to technology involve mislabeled bar codes on medications, mistakes at order entry because of confusing computer screens, or issues with management of information. Errors also are related to dispensing devices and human factors, such as failure to scan bar codes or overrides of bar-code warnings.

The unit manager is working in a large metropolitan facility and is told that two UNPs are to be assigned to work with her. Delegation begins with: a. Acknowledging the arrival of the second UNP on the unit b. Providing clear directions to both UNPs c. Matching tasks with qualified persons d. Receiving reports from the prior shift

c. Matching tasks with qualified persons

In writing the patient satisfaction survey, the nurse manager is aware of the education levels of the families. What is the most critical element in the concept of health literacy? a. Providing instructional materials at appropriate reading levels b. Facilitating access to translators for persons with language barriers c. Obtaining, processing, and understanding basic health information so appropriate decisions can be made d. Knowing that most people have limited health literacy skills

c. Obtaining, processing, and understanding basic health information so appropriate decisions can be made The definition of health literacy used by the federal government is "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions" (U.S. Department of Health and Human Services, 2010).

A nurse manager approves two staff nurses to attend a national conference. When reviewing the budget, the nurse manager looks at which line item? a. Cash budget b. Capital budget c. Operating budget d. Supply and expense budget

c. Operating budget The operating budget includes a personnel budget, which takes into account productive and nonproductive paid work hours. Education hours are covered under nonproductive paid work hours in the operating budget.

Which of the following exemplifies accountability? Karen, the nurse manager on 5E: a. Consistently submits her budgets on time b. Gets along well with her staff and with other managers c. Outlines her rationale for reduction of RN coverage on nights to the Nursing Practice Committee after serious patient injury d. Actively solicits ideas regarding scheduling from her staff

c. Outlines her rationale for reduction of RN coverage on nights to the Nursing Practice Committee after serious patient injury

Edith has been vocal about her negative concerns related to a new charting system and frequently expresses the view that keeping the "old system" would have been "just fine." In facilitating change, your best approach to Edith would be to: a. Put her in the pilot planning group for the change. b. Determine if she has considered retirement. c. Schedule her work assignment so that it coincides with those of two staff members who are confident with technology and the change. d. Avoid discussion of the change, and trust that with sufficient training and information, she will change.

c. Schedule her work assignment so that it coincides with those of two staff members who are confident with technology and the change. Laggards - prefer keeping traditions & openly express resistance to new ideas. Having a group of change agents and innovators on board to champion an idea builds what Patterson et al. call "social motivation" and "social ability." This group can help staff, such as laggards, who are less adept at change.

After staff meetings lately, Sharon, the head nurse, observes her staff in small groups, having animated discussions that end abruptly when she approaches. Sharon reflects on this observation and realizes that: a. Two very outspoken members tend to dominate discussions in meetings. b. This behavior is indicative of a high level of communication among her staff. c. Staff members are very committed to the team and have strong opinions. d. Ongoing discussion outside of meetings is conducive to creativity.

c. Staff members are very committed to the team and have strong opinions When team communication is dominated by a few members, leaving others uninvolved or bored, disagreement is not expressed openly. As a result, team members "stuff" their feelings and wait until after meetings to voice their opinions.

A home health nurse has been assigned to cover a 300-square-mile area of remote Montana. Mrs. Baker has just been discharged home following bowel surgery and has a new colostomy. She will need daily contacts for at least 2 weeks & then regular weekly contact following that week. Because it is not possible to visit Mrs. Baker in person every day and see all of the other clients, the nurse gives her a laptop computer with net meeting software installed. Each morning, both dial in at an agreed-upon time and discuss her progress. The home health nurse assesses whether or not the client needs to be seen that day and is able to view the colostomy site. This type of technology is called: a. Distance learning b. Knowledge software c. Telecommunications d. Biomedical technology

c. Telecommunications Telecommunications and systems technology facilitate clinical oversight of health care via telephone or cable lines, remote monitoring, information links, and the Internet. Patients sitting in front of the teleconferencing camera can be diagnosed, treated, monitored, and educated by nurses and physicians. EKGs and radiographs can be viewed and transmitted.

As the nurse manager on a rehab unit, you are asked to come to the tub room immediately because two nursing assistants are having a loud disagreement in front of a patient. You ask the nursing assistants to meet you outside and after ensuring that a third nursing assistant is able to care for the patient, you speak with the two nursing assistants. Which of the following would you ask first? a) "How long have you two been working together?" b) "Have you experienced disagreements like this before?" c) "How do you think this patient's perception of her care has been changed?" d) "What happened to bring on this disagreement today?"

d) "What happened to bring on this disagreement today?" Conflicts are usually based on attempts to protect a person's self-esteem or to alter perceived inequities in power. When a nurse recognizes upset & reaction, the following steps can be helpful: 1) Identify the triggering event ("What happened to bring on this disagreement today?") 2) Discover the historical context for each person. 3) Assess how interdependent each person is on the other. 4) Identify the issues, goals, and resources involved in the situation.

Ellen is a novice nurse on your unit. Even though she has come to you highly recommended, as her supervisor, you have noticed some knowledge and skill deficiencies. These deficiencies have been noticed by her peers as well, who cover for her because she is new and they like her. Which of the following is likely to be the greatest asset to Ellen in improving her performance? a. Ignore Ellen's errors until she has more experience. b. Instruct staff to avoid working with Ellen until she learns to how do things herself. c. Ask Ellen to complete a self-assessment, using a standard skills checklist. d. Encourage staff to report every behavior of Ellen's that is different from theirs.

d) Encourage staff to report every behavior of Ellen's that is different from theirs

In the cardiac intensive care unit, there has been simmering discontent about the new nurse manager, who avoids any discussion about her scheduling and practice decisions. The staff have begun to sort into "different camps" depending on how they feel about the manager or the decisions. Which of the following statements MOST accurately describes this situation? a) The tension that has been generated will result in creative solutions. b) Staff will become a cohesive group that takes a stand against the manager. c) The conflict will result in increased dialogue about practice and scheduling options. d) Patient care may suffer because attention and energy is being diverted toward the unit relationships.

d) Patient care may suffer because attention and energy is being diverted toward the unit relationships. Destructive conflict polarizes groups, saps group morale, deepens differences in values, and diverts energy from more important activities, such as patient care. Constructive conflict opens up issues of importance, results in solutions to problems, and enables authentic communication.

When progressive discipline is used, the steps are followed progressively only for repeated infractions of the same rule. On some occasions, rules that are broken are so serious that the employee is: a. Transferred to another unit b. Suspended indefinitely c. Asked to attend a union grievance meeting d. Terminated after the first infraction

d) Terminated after the first infraction Behaviors that include violence, theft, and purposeful abuse of a client are sufficiently serious to warrant immediate dismissal with the first incident

Incivility is a disruptive behavior or communication that creates a negative environment and interferes with quality patient care and safety. The manager can implement steps that help to alleviate uncivil behavior on a unit. Which of the following would NOT be an appropriate first step? a. Suspending the staff member from work b. Providing written admonishment that is discussed and placed in the employee's file c. Providing verbal admonishment d. Terminating the staff member Arrange the strategies from Question 16 in the order in which they should occur in progressive discipline. a) A, B, C, D b) B, A, C, D c) C, B, A, D d) C, A, B, D

d) Terminating the staff member Dismissal does not enable the present organization to attempt remediation of the behavior and is not consistent with first steps in progressive discipline. c) C, B, A, D

The nurse manager knows that the most serious effect that absenteeism has on the nursing unit is that: a. Using replacement personnel with new ideas may be beneficial. b. Salary costs are lower because personnel are fewer, and outcome is favorable. c. Absence on the part of the rest of the staff is decreased. d. Unacceptable patient care may result.

d) Unacceptable patient care may result Reduced staffing adversely affects patient care. Employee morale suffers, care standards may be lowered, and additional stress is placed on working staff

Sarah, RN, is one of your most enthusiastic staff members and has been to a workshop on preparing educational materials for patients. On the basis of this workshop, she would like to develop an information website for pts who are being admitted to the ward. An appropriate response to Sarah's suggestion would be: a. "That is a great suggestion, but we have no resources for such an expensive undertaking right now." b. "Perhaps you can keep that in mind as we redesign our charting system." c. "We have too many seniors as patients, and you know that they don't use technology." d. "There is a great group here that meets to look at technology pilots. Let's see if you can join them and discuss your idea further."

d. "There is a great group here that meets to look at technology pilots. Let's see if you can join them and discuss your idea further." Involving Sarah with others who enjoy new ideas and who are able to try out new ideas in pilot projects enables her to remain on the cutting edge and to try out innovative solutions with the least amount of disruption.

The final section of a performance appraisal is a rating scale. This scale is very detailed and relates to competency standards specific to surgical clients. The scale is a summary of performance directly observed or documentation reviewed and is specific to client care situations in which the employee has been involved. This type of evaluation is most commonly known as: a. A traditional rating scale b. Management by objectives/learning goals c. A forced distribution scale d. A behaviorally anchored rating scale

d. A behaviorally anchored rating scale BARS contain both quantitative (rating scales) and qualitative data. They are specific to situations and positions.

Which of the following exemplifies a service orientation for a facility? a. Staff members on the unit are encouraged to chart details about family support networks. b. Chart audit reveals that details related to assessment of family history are missing. c. The palliative care unit organizes a "tree of light" fundraiser each year to highlight the importance of palliative care. d. A children's preoperative holding area is implemented in response to requests from families and staff nurses for development of an area.

d. A children's preoperative holding area is implemented in response to requests from families and staff nurses for development of an area. A service orientation needs to translate caring into appropriate, timely action that meets the needs of patients. Activities such as documentation of details or promotion of services may remain at the technical or conceptual level without a commitment to caring interactions. The institution of a holding area where families can be with children represents a caring action that arises out of interactions and knowledge of patient needs and thus, is service oriented.

The turnover rate for RNs in the ICU is high. You discuss this situation with existing staff and you find out that because of the rapid turnover, new staff are frequently required to assume full responsibilities soon into the position and before training is completed. In considering approaches that will reduce turnover rates, the staff and you decide to implement: a. An employee recognition program b. Coaching for new staff c. A new performance appraisal system d. A committed orientation and training program

d. A committed orientation and training program Retention of new nursing personnel begins on the day of their hire. This includes an effective, appropriate orientation and training program, which has a measurable impact on reducing turnover.

John notes that the next section is specific to the organizational philosophy and has a four-point ordinal scale that describes performance from "always meets expectations" to "does not meet expectations." This type of evaluation is most commonly known as: a. A behavior-anchored rating scale. b. Management by objectives/learning goals. c. The forced distribution scale. d. A graphic rating scale.

d. A graphic rating scale Graphic rating scales are commonly used in evaluation and reflect generalizations rather than specific behaviors.

The nurse manager was upset with the staff nurse and said, "You did not understand what I said." Which element in the communication process was she referring to? a. Feedback between receiver and sender b. A message channel c. A receiver who decodes the message d. A set of barriers that may occur between sender and receiver

d. A set of barriers that may occur between sender and receiver Problems can occur at any point in communication and result in miscommunication. In this instance, it can be assumed that there was a sender, a receiver, a channel, and feedback. In this scenario, barriers such as distractions, inadequate knowledge, differences in perceptions, and emotions and personality may have resulted in misunderstanding between the manager and the staff nurse.

Sally is an experienced nurse on the unit and is very experienced with ICP monitoring. She is assigned David, a patient who has been admitted with a severe head injury. In communicating with Sally, you would: a. Provide a detailed explanation of what she needs to do with ICP monitoring. b. Tell her when she needs to provide an update about David's status. c. Ask her to tell you what she knows about ICP monitoring and share expectations about reporting. d. Advise her that you are available if she needs you.

d. Advise her that you are available if she needs you

A nurse manager is experiencing conflicts between herself and staff members. She had tried to develop a team by using a shared leadership model to empower the staff. Staff members are functioning: a. As a team b. Independently c. Interdependently d. As a group

d. As a group A group is a collection of interconnected individuals working together for the same purpose. A team is a unified group that is committed to a common purpose, performance goals, and approach, for which they hold themselves mutually accountable. The conflict indicates that the staff may not be united in a common purpose.

A nurse manager in the ICU works with his staff to develop an appraisal instrument that includes quantitative data and respects standards for an RN working on that unit. This type of appraisal is a: a. Rating scale b. Collaboratively based appraisal system c. Narrative instrument d. Behaviorally anchored rating scale

d. Behaviorally anchored rating scale Behaviorally anchored rating scales (BARSs) describe performance quantitatively and qualitatively.

Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effects." According to Havelock (1973), this comment may originate from failure in which phase of the six phases of planned change? a. Generating self-renewal b. Choosing the solution c. Diagnosing the problem d. Building a relationship

d. Building a relationship The first phase of this model of planned change involves building a relationship as a basis for later phases, which include diagnosing the problem and choosing the solution. At this point, as a new manager, the relationship may not have yet developed sufficiently with Elizabeth.

A nurse manager is planning to request three new infusion pumps at a cost of approximately $1500 each. This item would typically be included in which budget? a. Operating b. Strategic c. Unit of service d. Capital

d. Capital Items that have a useful life of longer than a year, which is likely with the pumps, and that have a cost that usually exceeds $300 to $1000 (specific amount is set by the organization) are considered capital items. Operating budget items include what is used on a day-to-day basis, such as staffing.

Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effects." You follow up with Elizabeth and discover that she is really quite angry about the information sessions because she feels that you are implying that "what she has been doing all these years means that she is incompetent and doesn't care about her patients." Your response to her indicates that: a. Elizabeth will never adopt the change. b. Elizabeth is insecure in her practice. c. Elizabeth requires more information about the practice. d. Change involves emotions.

d. Change involves emotions Change, whether proactively initiated at the point of change or imposed from external sources, affects people. Responses to all or part of the change process by individuals and groups may vary from full acceptance and willing participation to outright rejection or even rebellion. It is critical to be able to "read" people and to recognize that communication should involve people's emotions and feelings.

You have hired a new RN to replace a well-respected and experienced nurse in your outpatient department. The new RN recently graduated and is nervous about stepping into a role that was previously filled by someone who was so competent. You recognize anxiety and set up regular, frequent meetings during which you explore how she is dealing with her anxiety, provide feedback, and discuss strategies/ideas that will enhance her performance. What development approach are you using? a. Performance appraisal b. Counseling c. Empowerment d. Coaching

d. Coaching The overall evaluative process can be enhanced if the manager employs the technique of coaching. Coaching is a process that involves the development of individuals within an organization. This coaching process is a personal approach in which the manager and the employee interact on a frequent and regular basis with the ultimate outcome that the employee performs at an optimal level.

The unit manager was addressing nursing students in the lounge area and was discussing team leadership and team effectiveness. She stated, "One can agree to disagree with another team member's perspective even when one doesn't necessarily see that perspective as being the correct one." In being creative, what did she mean? a. Listening actively b. Being compassionate c. Being flexible d. Committing to resolution

d. Committing to resolution Caregivers must listen to the other person's perspective, listen to the message accurately, identify differences, and creatively seek resolutions.

The night nurse understands that certain factors need to be considered before delegating tasks to others. These factors include the: a. Complexity of the task and the age of the delegatee b. Potential for benefit and the complexity of the task c. Potential for benefit and the number of staff d. Complexity of the task and the potential for harm

d. Complexity of the task and the potential for harm

As the unit manager, you spend a day performing direct patient care and work with a new system that is designed to capture patient documentation at the bedside. During discussions with staff while giving care, you discover that the number of screens that need to be opened during documentation makes charting more complex and time consuming than traditional manual charting approaches. On the basis of this feedback, you: a. Assume that the system is doing what it needs to do. b. Provide reassurance to staff that the unit has achieved its goals in implementation of the system. c. Ask some of the staff if they have had similar experiences with the system. d. Consult chart audit data and end user consultation reports to determine if errors and problems are occurring.

d. Consult chart audit data and end user consultation reports to determine if errors and problems are occurring In Kotter's eight-step change model, removing obstacles means keeping alert for barriers in structure and processes that limit the ability to change and then removing those barriers once they have been found.

Corrine, a student nurse, often hears that nurses are gatekeepers and wonders what that term means. As a nurse leader, you explain that this is a reference to the: a. Assessment and admission of patients into care. b. Orientation of patients to services once they are admitted. c. Function of controlling which patients see the physician and which do not. d. Coordination of care, services, advocacy, and access for patients within the healthcare system.

d. Coordination of care, services, advocacy, & access for patients within the healthcare system. As gatekeepers to the system, nurses advocate for and coordinate care, services, and access for patients across all providers, settings, and levels of care.

The staff development educator developed strategies to help nurse managers actively listen. Guidelines for active listening include which of the following? a. Speed up your internal processes so that you can process more data. b. Realize that the first words of the sender are the most important. c. Be prepared to make an effective judgment of the communication sender. d. Cultivate a desire to learn about the other person.

d. Cultivate a desire to learn about the other person Active listening means suspending judgment about what is about to be said and listening to all that is said (and not just the first or last words). It is motivated by a genuine desire to learn about the other person.

An example of one strategy to improve participation in the change process by staff fitting the behavioral descriptions of laggards, early majority, late majority, and rejecters is to: a. Encourage teamwork b. Transfer to a different unit c. Require attendance at staff meetings d. Delegate the roles and tasks of change

d. Delegate the roles and tasks of change According to Rogers's work, the individual's decision-making actions pass through five sequential stages. The decision to not accept the new idea may occur at any stage. However, peer change agents and formal change managers can facilitate movement through these stages by encouraging the use of the idea and providing information about its benefits and disadvantages.

The primary reason for calculating productive hours paid instead of simply calculating work paid per year is that productive hours enable the manager to: a. Anticipate total costs for patient care. b. Know how much time staff will likely be unavailable because of illness. c. Determine when orientation needs to occur for new staff. d. Determine the number of hours available for patient care.

d. Determine the number of hours available for patient care Total hours are critical for determining the total number of hours that need to be paid for the year. Productive hours are needed to determine what hours are actually available for patient care. The number of FTEs required is determined by dividing the total patient care hours required by the number of productive hours.

As part of an information technology implementation team, you are implementing a clinical decision support system. Particular considerations for successful implementation of this project include: a. Ensuring that the system is reliable. b. Ensuring that patient information is reliable. c. Developing unique identifiers for individuals. d. Developing rules that support inferences.

d. Developing rules that support inferences Clinical decision support systems provide support for novice nurses, in particular, as they enable entry of real-time data from patient situations and inferences that apply the logic that expert nurses would use. These inferences require rules to be developed for the system.

You are involved in designing a clinic for women in an inner-city neighborhood. A goal of this clinic might be: a. Development of services that are identified in various studies as important for this target group. b. Partnership with area city councilors and health professionals to provide services that are consistent with their vision and funding sources. c. Provision of immunization and addictions services and health screening services for women in the area. d. Development of services that have been identified by the women and neighborhood advocates as necessary for their health care.

d. Development of services that have been identified by the women and neighborhood advocates as necessary for their health care. Involvement of persons in their own health care is a cornerstone of healthcare reform and is important for improving health outcomes and patient experiences. While studies and partnership with key informants are important sources of information in the design of services, engagement of the women through their neighborhood advocates may increase activation and resulting behavior. Patient activation refers to patients' willingness and ability to take independent actions to manage their health and care.

A nurse makes a medication error that is not serious and does not cause harm to the patient. As the head nurse, your best action would be to: a. Call attention to it by posting the critical incidents report at the nursing station. b. Include the mistake on the nurse's performance appraisal. c. Apologize to the patient for the error, and indicate that discipline has occurred. d. Educate the nurse on how to provide an apology to the patient.

d. Educate the nurse on how to provide an apology to the patient Service recovery ensures responsiveness to the patient, and as part of service recovery, it is important to address an error in the most productive way, which also includes the nurse who made the error offering an apology to the patient.

The chief nursing officer decides to establish a client advocacy position in an oncology unit. Advocacy is best represented by: a. Establishing private and professional networking systems. b. Asking social services to handle clients' concerns. c. Identifying community support groups. d. Empowering others by promoting self-determination.

d. Empowering others by promoting self-determination. Advocacy involves empowering and promoting self-determination in others.

As part of orientation to your unit, you decide to administer Kolb's Learning Style Inventory (LSI) to new staff. The most likely reason for your decision is that the use of Kolb's LSI: a. Reduces the cost of orientation. b. Determines if there is fit between learner and organizational values. c. Develops the strengths of the new staff member. d. Enables individualization of learning to the learner's needs.

d. Enables individualization of learning to the learner's needs Administration of Kolb's LSI enables identification of the learning styles of new employees, which assists in focusing the implementation of orientation goals and in individualizing learning to the needs and learning style of the employee.

The nursing manager of a surgical unit has been asked by administration to evaluate client outcomes post cardiac catheterization. Using data about client outcomes post cardiac catheterization for the past 6 months so as to modify practice is an example of: a. Information. b. Cost-effective care. c. Meeting standards. d. Evidence-based practice.

d. Evidence-based practice Technology enables evidence-based practice by collecting good clinical knowledge, translating nursing knowledge into reference materials that can be accessed at the point-of-care, and, potentially, assisting nurses to take action based on best evidence for practice

The chief nursing officer works with her nurse managers by helping them understand how to develop and implement a budget. A nurse manager can best describe a budget as a: a. Day-to-day plan for operations b. Unit of service c. Statement of revenues and services d. Financial plan

d. Financial plan The budget is an overall financial plan that reflects organizational assumptions, objectives, and standards, and various types of budget planning, including operational and capital budgets, which, in turn, reflect revenues and costs.

An example of a factor that would impede a patient's learning is: a. Poverty. b. Limited health insurance. c. Being an older adult. d. Heavy sedation.

d. Heavy sedation Nurses need to be sensitive to the teaching needs of those at risk for disparities in health care: persons of a different race or ethnic group, women, children, older adults, rural residents, and those with limited or no health insurance, low health literacy, and/or low socioeconomic status. It is important that lower expectations for persons who are disadvantaged, have a low literacy level, or have limited English proficiency are not unintentionally communicated.

As a nurse manager, one challenge is to orient new staff to your agency's policies & procedures, as well as to provide training across various shifts. A cost-effective & effective learning strategy would be: a. Development of new learning modules and software to support document retrieval. b. E-mail distribution to staff home e-mail addresses regarding important policies. c. Preparation of DVDs that can be viewed on computers at the nursing station during "down times." d. Linking policies and procedures to the network for access when required at the point-of-care.

d. Linking policies and procedures to the network for access when required at the point-of-care Knowledge technology consists of systems that generate or process knowledge and provide clinical decision support (CDS). The clinical knowledge embedded in computer applications can range from simple facts and relationships to best practices for managing patients with specific disease states, new medical knowledge from clinical research, and other types of information. The most accessible and cost-effective approach would be utilization of what is already available in the work environment, such as the systems that provide CDS.

Ellen is a novice nurse on your unit. Even though she has come to you highly recommended, as her supervisor, you have noticed some knowledge and skill deficiencies. These deficiencies have been noticed by her peers as well. Which of the following is likely to be the greatest asset to Ellen in improving her performance? a. Giving her a book on nursing related to your area b. Having her spend time with the hospital's manager of education c. Sending her to a conference d. Making arrangements for practice time for her in the hospital's skills lab

d. Making arrangements for practice time for her in the hospital's skills lab Active learning and engagement in learning, such as lab practice, are useful in assisting Ellen to improve her skills and knowledge

You are working in a home health service and have three unlicensed nursing personnel (UNPs) assigned to your team. You have worked with two of them for 2 years; the third is new. The two experienced UNPs have patients with complex illnesses for whom they provide basic care. The third member of the team has been assigned to patients with less complex illnesses. Your best approach to supervising their care is to: a. Remain in the office and ask each UNP to check in with you upon arrival at their first patient care site. b. Ask another RN to supervise the two experienced assistants so you can be with the new person full time. c. Meet the new staff member at the first patient care site and ask the others to call if anything is unusual. d. Meet the new staff member at the first patient care site and call the others with questions to determine whether anything is unusual

d. Meet the new staff member at the first patient care site and call the others with questions to determine whether anything is unusual

The nurse manager on a pediatric intensive care unit wants to evaluate patient satisfaction. The nurse manager understands that ultimately, positive relationships with consumers of care are evaluated by the: a. Cultural sensitivity of staff. b. Cost-effectiveness of care delivery. c. Economic value of service. d. Outcomes for clients and their perceptions of care.

d. Outcomes for clients and their perceptions of care. Trend-setting organizations such as MagnetTM organizations need to demonstrate excellence in outcome data such as patient satisfaction. Patient satisfaction and perception of the quality of care are affected by the quality of the nurse-patient relationship. Valid measurement of patient satisfaction is an evolving science; nurses do not always accurately gauge what factors are most important to patients. Satisfaction measures are often skewed in a positive direction with scores clustered at the top of the scale.

The wound care nurse decided to involve those to be affected by change early in the change management process. This can positively result in: a. Coordination b. Resistance c. Anticipation d. Participation

d. Participation Successful change means persistence and advancement of the change, which requires the undivided focus of all team members. Early involvement and participation are critical to capturing the undivided focus of team members.

Healthcare agencies and hospitals expect their practitioners to be effective team members. Two key players in the healthcare team are nurses and physicians. Which of the following statements accurately defines the roles and responsibilities of nurses and physicians? a. Doctors are the hub of the team, whereas nurses are peripheral members. b. Nurses are considered to be the hub of the team, and doctors are peripheral members. c. Doctors focus on the holistic needs of the patient, whereas nurses focus on the condition that caused the patient to seek healthcare services in the first place. d. Physicians are the first point of contact. They focus on the disease process, whereas nurses focus on the holistic needs of patients.

d. Physicians are the first point of contact. They focus on the disease process, whereas nurses focus on the holistic needs of patients Physicians diagnose and treat diseases, prescribe drugs, and perform medical and surgical specialties. The admitting physician provides the initial medical diagnosis. Nurses develop and implement comprehensive nursing care in all settings and provide leadership for healthcare teams. The admitting nurse establishes the initial nursing care plan and works with other professionals.

As the head nurse involved in leading determination of which patient surveillance systems to acquire for your unit, one of your aims is to avoid adverse events through the implementation of appropriate technology. This particular aim recognizes that: a. Human error is significant in contributing to adverse events. b. Documentation of patient data is often illegible and therefore, misinterpreted. c. Data systems provide backup documentation with adverse events that staff cannot provide. d. Physiologic monitoring systems enable detection of early changes before an adverse event occurs.

d. Physiologic monitoring systems enable detection of early changes before an adverse event occurs Data about adverse events suggests that a majority of physiologic abnormalities are not detected early enough and may be present hours before the event actually occurs. Physiologic monitoring aids in early detection of changes.

You are a member of a team assigned to care for 15 general medical/surgical clients. You have all worked well together in the past in this same type of care. If you are assigned to coordinate this team's work, your best strategy, based on the Hersey and Blanchard model, would be to: a. Have a list of tasks to be accomplished and tell each member of the team what he or she must do b. Encourage people to discuss their frustrations in providing this care c. Ignore them—they've done it before d. Provide minimal direction and let them come to you with questions

d. Provide minimal direction and let them come to you with questions

Leslie, a UNP, transfers a patient while using improper technique. The patient is injured, and as a result, a suit is launched in which both Sarah (the delegator) and Leslie (the delegatee) are named. Sarah is named in the suit because she: a. Retains accountability for the care of the patient b. Worked the same shift as Leslie c. Has passive accountability for delegation d. Retains accountability for the outcomes of care for the patient

d. Retains accountability for the outcomes of care for the patient

Which of the following factors is NOT implicated in rising healthcare costs? a. Rising expectations of consumers for cure and care b. Marketing of drugs to consumers c. Large administrative staffs to process medical billings d. Rising Medicare costs

d. Rising Medicare costs Unintentional injuries, socioeconomic conditions (e.g., poverty and violence), marketing of pharmaceuticals, and the rising expectations of consumers with regard to what should be done to manage health concerns all contribute to rising healthcare costs. The costs of Medicare are not considered in relation to rising costs of health care.

The nursing director calls a meeting with one of the new unit managers. She is very concerned about a report of substance abuse on the manager's unit, and she reviews the procedures involved in dealing with chemically dependent staff. Which of the following statements would not be included in the discussion? "As a manager, you: a. Need to be aware of ADA issues." b. Should check with Human Resources regarding chemically dependent employees and employment practices." c. Check the nurse practice acts for the state in which the nurse resides." d. Should realize that the nurse is a professional embarrassment and should be kept out of sight of other staff."

d. Should realize that the nurse is a professional embarrassment and should be kept out of sight of other staff" As a manager, you need to be familiar with state and professional regulatory and reporting requirements regarding chemical use and abuse, as well with Human Resource practices and guidelines

To effectively achieve a change goal/outcome in a change situation, the wound care specialist will: a. Preserve the status quo b. Diminish facilitators and reinforce barriers c. Weigh the strength of forces d. Strengthen facilitating forces

d. Strengthen facilitating forces For change to be effective, the facilitators must exceed the force of the barriers; thus, strengthening the facilitating forces would achieve this aim.

A necessary, basic condition for successful integration of clinical information systems is: a. Software b. Standard medical nomenclature c. Confirmatory evidence from nursing-led studies d. Strong interdisciplinary cultures

d. Strong interdisciplinary cultures An integrated clinical information system draws on specific knowledge from many involved disciplines that interface at the patient. Successful integration of clinical information systems requires that the various disciplines work together collaboratively to transform the data into meaningful knowledge.

The chief nursing officer understands that to be able to compare data across client populations and sites, it is important that nurses use: a. Similar settings b. Information systems c. Knowledge systems d. Structured nursing languages

d. Structured nursing languages (old book) Data are standardized and use structured terminology, which enables cross-site comparisons.

Which of the following are considered variable costs? (Select all that apply) a. Salaries for the minimum number of staff b. Utilities and rent c. Managed care d. Supplies e. Medication and treatment supplies

d. Supplies e. Medication and treatment supplies The total fixed costs in a unit are those costs that do not change as the volume of patients changes. In other words, with either a high or a low patient census, expenses related to rent, utilities, loan payments, administrative salaries, and salaries of the minimum number of staff to keep a unit open must be paid. Variable costs are costs that vary in direct proportion to patient volume or acuity. Examples include nursing personnel, supplies, and medications.

A key advantage that a nurse manager has in terms of delegating is that: a. Clients receive less attention because too many staff make it difficult to coordinate care. b. Nurses report less pressure to perform necessary tasks themselves. c. Administration can predict overtime more accurately. d. Team skills can be used more effectively

d. Team skills can be used more effectively

Sally (RN) and Melissa (RN) have shared an ongoing conflict since the first day that Melissa worked on the unit. Sally has confided to another colleague that she doesn't even know why the conflict started or what it was about. This is an example of: a. How expectations and objectives need to be made clear in team situations. b. The need to encourage open discussion of disagreements in opinions. c. The importance of involving all staff in discussions in group settings. d. The enduring nature of first impressions.

d. The enduring nature of first impressions First impressions are lasting and, as Sally indicates to her colleagues, are often an unconscious response.

"I really wish that my supervisor would realize and acknowledge all the things I do well." In nursing, this has been identified as a problem. Which statement is part of the solution? Focus on: a. New staff b. Care assignments with which the individual is not familiar c. Making corrections d. The strengths of the individual rather than the weaknesses

d. The strengths of the individual rather than the weaknesses The research of Rath (2007) included many recommendations, one of which was that focusing on mediocre behaviors and on a person's weaknesses will not lead to excellence. Focusing on weaknesses tends to decrease the appreciation, and thus the acknowledgements.

Resistance is most likely when change: a. Is not well understood b. Involves many layers in an organization c. Involves nonprofessional workers d. Threatens personal security

d. Threatens personal security Resistance & reluctance commonly occur when personal security is threatened and may involve loss of confidence in abilities or loss of job or financial security.

In determining the relationship between injury-producing falls and proposed preventive measures as part of the QI process, a QI team might turn to which of the following for confirmatory evidence? a. NDNQI b. NANDA c. NIOSH d. AHRQ

*a. NDNQI* The National Database of Nursing Quality Indicators is a national, nursing quality measurement program from the American Nurses Association that provides hospitals with unit-level performance reports with comparisons to national averages and rankings.

An outpatient surgery manager is evaluating infusion pumps for the operating room. The manager should: a. Select the least expensive brand. b. Use a decision-making tool to evaluate brands. c. Ask the nursing staff which brand they prefer. d. Select the vendor the institution usually buys from.

*b. Use a decision-making tool to evaluate brands* Decision-making tools such as decision grids and SWOT analyses are most appropriate when information is available and options are known.

In a rural hospital, the unit for which you are charge nurse has a particularly busy morning. A 52-year-old patient is complaining of left-sided chest pain and a multiparous patient is about to deliver. A child with asthma is experiencing early signs of an attack. The other RN on the unit is a recent graduate who has not yet been orientated to the labor room and has limited cardiac nursing experience. An unregulated assistant is also available. You must decide which patient situation you will take and where the RN's skills can best be used. Given the limitations in skills and experience, number of staff available, and time constraints, you must make a decision that involves: a. A higher-order thinking process. b. Selecting the best option for reaching a predefined goal. c. Optimizing. d. Satisficing.

*d. Satisficing* With this approach, the decision maker selects an acceptable solution, one that may minimally meet the objective or standard for a decision. This approach allows for quick decisions and may be the most appropriate when lack of time is an issue.

As a nurse manager, you want to institute point-of-care devices on your unit. The rationale that you provide to support the POC devices include: (select all that apply) A) reduction in incidents of medication error B) immediate documentation of care C) comparison of patient data with previous data D) immediate access to staffing schedules

A) reduction in incidents of medication error B) immediate documentation of care C) comparison of patient data with previous data Point-of-care devices that allow documentation of assessment, care, and teaching at the bedside reduce the gap in time between care and documentation, thereby reducing error, increasing accuracy, and improving communication of care. Medication devices and patient databases enable accurate clinical decision making.

Trust is an important aspect of helping relationships, therapeutic communications, and the positive communications model. Which statement does NOT involve or define trust? Trust: a) involves decisions to manipulate situations to gain advantage over another. b) is the basis by which leaders facilitate the activities and progress of a team. c) is low among members and leaders in poorly performing teams. d) involves what we say and not necessarily what we do.

a) involves decisions to manipulate situations to gain advantage over another Trust is high in high-performing teams and involves not consciously taking advantage of others and behaving in a way that inspires trust. It is the basis by which leaders facilitate the activities and progress of a team.

During the performance appraisal session, the manager should: (Select all that apply) a) maintain a relaxed and professional manner. b) inquire about the employee's personal life and how it is affecting performance. c) allow the employee to express opinions orally and in writing. d) plan to give specific examples only for poor performance.

a) maintain a relaxed and professional manner c) allow the employee to express opinions orally and in writing During a performance appraisal, it is important to provide examples of both strong and problematic performance and to provide opportunities to express opinions. The supervisor needs to maintain a relaxed professional manner.

The education consultant for the hospital is presenting a workshop titled "Documentation: A Manager's Responsibility." Which of the following points would she not include in her PowerPoint presentation? Documentation: a. Cannot be left to memory. A notation must be placed in the personnel file. b. Should avoid discussion of the problem. c. Should include what was done about the problem when it occurred. d. Needs to include date, time, and place.

b) Should avoid discussion of the problem Documentation of personnel problems is one of the most important aspects of the nursing manager's role. Through carefully detailed and timely documentation of the problem and plan, the manager decreases the burdensome problems that can ensue from improper or inadequate documentation.

John's performance was satisfactory during the first month, but after that time, he was found to be very inconsistent in the provision of nursing care. One month before the end of the rating period, he cared for a very wealthy and influential client, who is best friends with the clinical manager. This client donated new furniture for the staff lounge in John's name to show appreciation for his care. John's subsequent performance appraisal resulted in outstanding ratings in all areas. This is an example of: a. A performance rating based on justifiable evidence. b. A bias related to recent events. c. The impact of personality on the appraisal of performance. d. The effective use of a behaviorally anchored rating scale.

b. A bias related to recent events To gain and to provide an accurate evaluation of performance over time, anecdotal notes need to be maintained throughout the evaluation period. This process assists in avoiding bias related to recent or sensational events that make a particularly strong impression.

The day shift nurse asks an LPN/LVN to complete a component of care for a client. The day shift nurse is engaging in what function? a. Delegating b. Assigning c. Sharing d. Authorizing

b. Assigning

The chief nursing office continues to seek ways to improve healthcare services to clients and to save the hospital money. However, with the federal guidelines of paying agencies based on capitation, the chief nursing office faces a challenge. Capitation provides incentives for healthcare providers to control costs by: a. Providing fewer services to fewer clients b. Using fewer services per client c. Using high-technology treatments d. Requiring second opinions

b. Using fewer services per client In a capitated environment, a single fee is paid for all services provided. To be financially viable under this reimbursement model, organizations would be interested in decreasing the volume of services used and increasing the volume of patients. High-technology treatments and second opinions may increase the number of services used.

The most important approach that a nurse manager can take with an emotionally troubled employee is to: a. Act as a therapist for the employee. b. Adjust the standard of care to assist the employee. c. Assist the employee in obtaining professional help. d. Adjust the employee's work schedule to decrease stress

c) Assist the employee in obtaining professional help Emotional difficulties are usually beyond the scope of skills that a nurse manager would normally employ. A referral needs to be made to a professional who is specifically prepared to deal with this kind of difficulty.

An RN colleague, who is a long-standing and collaborative member of your team, is performing a complex and novel dressing for the first time for the patient to whom she has been assigned. Which of the following would be the most appropriate communication with her? a. "How do you usually do this kind of dressing?" b. "The dressing needs to be done today and tomorrow with the supplies on this cart." c. "Here is what you need for the dressing, and I will show you what needs to be done." d. "I know you know what you are doing. Let me know if you have any problems."

c. "Here is what you need for the dressing, and I will show you what needs to be done."

Which of the following might best conclude an interview? a. "Thank you for your interest. Someone will be in touch with you soon." b. "Before you go, we will make sure that we have your contact information. Thank you for coming." c. "I will be in contact with all candidates by telephone by next Friday. It has been a pleasure to meet you." d. "We have several excellent candidates so I am not sure about the outcome of the interview, but I will let you know. Thank you for coming."

c. "I will be in contact with all candidates by telephone by next Friday. It has been a pleasure to meet you." An employment interview should always conclude with information as to how and when follow-up to the interview will occur.

As the unit manager on the unit that is leading changes to heparin locks, you find that Elizabeth is very valuable in terms of her observations about other units and her knowledge of organizational processes, and now in discussing the new procedure with others. Elizabeth might be considered an: a. Engager b. Innovator c. Informal change agent d. Informant

c. Informal change agent Informal change agents are those who do not have formal, positional power but who have credibility through expertise and can model the new way of thinking, or who offer suggestions, ideas, and concerns

A 39-year-old patient awaits a kidney transplant. Because he must immediately arrange to get to the hospital when a donor kidney is available, it is important that he can be reached anywhere and at any time. To ensure that he receives the message, what type of technology is most effective? a. Internet b. Telecommunications c. WL pager d. CDS

c. WL pager Wireless (WL) communication is an extension of an existing wired network environment and uses radio-based systems to transmit data signals through the air without any physical connections. Patients awaiting organ transplants are provided with WL pagers so that they can be notified if a donor is found.

The chief nursing officer understands that clinical incompetence is best prevented by a: a. Flexible protocol for evaluating competency skills. b. Standardized clinical skills checklist. c. Administration of personality tests and competency assessments at point of hire. d. Formalized competency program with established standards for practice.

d) Formalized competency program with established standards for practice The competency program with established standards of practice outlines what the nurse must do to achieve desired competencies in her current position. Competency assessment and goal-setting should help the nurse identify how to excel and which competencies the nurse wants to achieve in the future.

The chief nursing officer reviews the policy about "progressive discipline process." The progressive discipline process includes which of the following? The manager: a. Is a counselor and friend to the employee. b. Should reprimand and suspend the employee as a last resort. c. Should rehire the employee after a reasonable length of time. d. Should terminate the employee if the problem persists.

d) Should terminate the employee if the problem persists Termination can be defined as the discharge of an employee who is performing at an unsatisfactory level or who is not a good match for the organization. Termination is always considered to be the last resort when dealing with poor performance.

The clinic nurse has just accessed a client's chart on the computer. The resident comes over and asks her to stay logged on because he needs to add a note to that client's chart. She should say: a. "No problem. Just log me off when you're done." b. "I'll put the note in for you. What do you want to say?" c. "Just make sure that you sign your note because it's under my password." d. "I'm sorry, but you will have to enter the information using your own password."

d. "I'm sorry, but you will have to enter the information using your own password" System users must never share the passwords that allow them access to information in computerized clinical information systems. Each password uniquely identifies a user to the system by name and title, gives approval to carry out certain functions, and provides access to data appropriate to the user. All users must be aware of their responsibilities for the confidentiality and security of the data they gather and for the security of their passwords.

In delegating to a UNP in a home health setting, which of the following represents the most appropriate delegation communication? a. "You will be taking care of Mrs. S., who needs assistance with her bath." b. "You will need to help Mrs. S. get into and out of her shower. Ensure that you check the condition of her feet, and let me know if you have any concerns when you check in." c. "I am not sure that you know how to do this, but I am giving you Mrs. S. She is quite obese and needs skin care." d. "Mrs. S. needs help to get into and out of her bathtub. Her bath will need to be completed by 10:00. When you are helping her to dry, please check between her toes and toenails, and phone me by 10:30 if you notice nail discoloration or redness."

d. "Mrs. S. needs help to get into and out of her bathtub. Her bath will need to be completed by 10:00. When you are helping her to dry, please check between her toes and toenails, and phone me by 10:30 if you notice nail discoloration or redness."

A rural-urban health consortium enables physicians in a rural remote setting to consult with specialists in care through electronic conferencing, which includes consultation using intranet radiology images. This system may be in which phase of electronic medical technology adoption, according to the Healthcare Information and Management Systems Society (HIMSS)? a. 0 b. 1 c. 3 d. 6

d. 6 According to the HIMSS, this healthcare organization may be in phase 6, which includes the capacity to transmit all radiology images through intranet or another secure source. Level 1 refers to the installation of major ancillary clinical systems (such as radiology) and level 3 to the retrieval of radiology images from picture archives and communication systems.