Leadership Ch 5- Managing Time and Stress

7. Methods to overcome procrastination include (select all that apply): a. delegating sections or portions of the task. b. determining personal benefit from completing the task. c. reassessing the purpose and goals of the task. d. waiting until motivated to begin the task.

ANS: A, B At its core, time management is self-management. One of the most effective methods of managing stress is to manage time. Suggestions to overcome procrastination include examining motivation and personal benefit, confronting your fears, positively reframing the task, gathering information to complete the task, or delegating it.

4. The impending demand for a sufficient number of nurses will occur when ___________ reach an age when they will consume the greatest number of health care services. a. baby boomers b. Generation Xers c. elderly adults d. children

ANS: A Baby boomers are currently over 77 million strong. A sufficient number of nurses must be ready to meet the demand when they reach the age when they will consume the greatest number of health care goods and services.

12. Nurses on the midnight shift are experiencing difficulty with receiving materials from the central supply department. Last night a patient was admitted to the unit from the emergency department with a heart dysrhythmia. The nurse requested that a temporary pacemaker kit be placed in the unit as a standby in case the patient required its use. The central supply unit did not comply until the patient required its emergent use. The nurse was stressed. This is an example of which type of stress? a. Operational failures b. Overload of role c. Resistant resources d. Role conflict

ANS: A Operational failures create added stressors for nursing staff at the bedside. The nurse is attempting to obtain a necessary piece of equipment that will create a safer condition for the patient

13. When a nurse leader is able to fully embrace the healthy work environment and engage others in its achievement, what is the leader demonstrating? a. Authentic leadership b. Meaningful recognition c. True collaboration d. Skilled communication

ANS: A The nurse leader is demonstrating authentic leadership when he or she is able to embrace and model the healthy work environment.

10. Nurse managers are in a position of impacting the stress levels of employees through improving work environments and creating a culture of enhanced staff satisfaction. What type of leader is most effective at creating such an environment? a. Transformational b. Authoritative c. Laissez-faire d. Transitional

ANS: A Transformational leaders are most effective at improving work environments by transcending their own self-interest. They act to inspire and create a culture of trust.

10. Max is a nurse on the 7 PM to 7 AM shift on the orthopedic floor. He is the most experienced nurse on the unit during this shift, with 6 years of nursing experience. Max usually acts as charge nurse during his shift while caring for a group of patients. Recently there has been an influx of new graduates working on his shift. Some nights, he is expected to orient a new nurse, act as the charge nurse, and mentor other new nurses working on the floor. He is concerned that with all of the new nurses, there are not enough mentors for all of them, resulting in less-than-optimal care delivery. Which type of stress is he experiencing (select all that apply)? a. Role ambiguity b. Role incongruity c. Role overload d. Role underload

ANS: A, B, C Max is experiencing role ambiguity as a charge nurse, preceptor, and mentor to other nurses on his shift. He is experiencing role incongruity because his professional values conflict with his role expectations. Max also is struggling with role overload as the charge nurse, preceptor, mentor, and bedside nurse. The challenge of meeting the expectations of the multiple roles of the nurse manager can produce stress that reveals itself as role strain, which is an unpleasant feeling of frustration and intense labile emotional state.

9. A staff RN is writing an article for a prestigious nursing journal. The deadline is in 1 week, and she is feeling overwhelmed about completing her work. She is unable to keep up with home management, and she is beginning to procrastinate on the project. She also has other responsibilities, such as taking her elderly mother grocery shopping and to health care appointments. She is married to a busy executive and has three children, all of whom are active in high school sports. Which of the following time management strategies would be helpful (select all that apply)? a. Break the project into smaller, manageable pieces. b. Contact an elderly nurse aide helper program to assist with shopping. c. Cut extra activities out of her schedule, such as her morning walk. d. Delegate some of the household chores to her family.

ANS: A, B, D Dividing the project into smaller, manageable pieces will help make the project seem less overwhelming. Delegating other responsibilities such as housekeeping and taking her mother shopping also will relieve some of the burden she is experiencing. Exercise is important to help the nurse deal with stress and would not be wise to delete from her schedule, if possible.

6. Senior leadership can assist managers in mitigating stress in the workplace. Which strategies will assist the manager in creating a more healthy work environment (select all that apply)? a. Celebrate successes as a team through rewards and recognition. b. Allow the manager to have decisional authority. c. Keep information confidential regarding safety concerns or initiatives. d. Maintain a positive approach that is focused on the patient, family, and staff. e. Ensure that the manager maintains responsibility for all aspects of unit functioning.

ANS: A, B, D Senior leadership can support the manager in creating a more healthy work environment through rewards and recognition, allowing the manager to have autonomy with decision making, and by being people focused. This environment is best created through an organization that is transparent in its sharing of information. In addition, leaders must be provided with the tools of knowing when and how to delegate some of the responsibilities for the functioning of the unit.

1. Definitions of stress are (select all that apply): a. a negative emotional experience that is associated with biological changes that trigger the body to make adaptations. b. the accomplishment of specified activities during an available time period. c. a physical, mental, psychological, or spiritual response to an experience. d. a response that is evaluated by the individual as a threat to one's sense of wellbeing.

ANS: A, C, D Stress is a negative emotional experience associated with biological changes that trigger the body to make adaptations. It can be a physical, mental, psychological, or spiritual response to an experience that is evaluated by the individual as a threat to one's sense of well-being.

2. Which of the following responses may occur related to stress (select all that apply)? a. Increased heart rate b. Decreased blood glucose levels c. Emotional distress d. Anxiety e. Chronic health conditions

ANS: A, C, D, E Stress has a variety of induced changes, including increases in heart rate and blood glucose levels, emotional changes, and anxiety, and it can lead to acute and chronic health problems.

4. What are some methods that nursing staff can use to manage personal stress levels (select all that apply)? a. Take personal time each day. b. Take on extra shifts to keep the mind occupied. c. Get enough sleep. d. Pay attention to diet and exercise. e. Have a strong support network of friends and family.

ANS: A, C, D, E While stress management is unique to each person, some of the tools that may be effective include taking personal downtime each day, getting enough sleep, eating right, exercising, and having a strong network of friends and family for support.

16. A staff nurse has kept a time log to assist her in developing her time management skills. After a week, she reviews the log with her nurse manager and notices that there were several times that she was waiting for supplies and missing medications. The nurse manager suggests which of the following? a. Notifying the pharmacy and central supply that there are delays in supply delivery b. Gathering supplies and checking for the availability of medications so they can be ordered prior to starting care c. Informing the prior shift that this is a problem d. Completing an occurrence report so quality assurance will investigate the problem

ANS: B Changes in patient conditions and medical orders occur frequently, which require new or different equipment and medications to be added or changed. It is always best, particularly if it is known that there are discrepancies in this area, to check to see whether all needed supplies are available before initiating care.

11. There is evidence of a link between work environments with increased patient satisfaction and better outcomes. a. stressful b. healthy c. financially focused d. noisy

ANS: B Evidence has linked healthy work environments to increased patient satisfaction, better patient outcomes, and fewer errors.

7. The first stage of the moral distress change process is for the nurse to become aware of their moral distress. This stage is known as _____: a. act. b. ask. c. affirm. d. assess.

ANS: B The first stage of the four-part cycle is known as ask. This is where the nurse asks himself or herself if what he or she is feeling is moral distress. The nurse can only address it if he or she is aware of the internal distress. The following steps are known as affirm, assess, and act.

15. In developing a "things to do list," it is important to do which of the following? a. Write down all tasks that need to be completed. b. Arrange an order of priority. c. Limit outside interruptions. d. Color-code the list by category

ANS: B When writing a "things to do list," it is unrealistic to write down all the tasks that need to be completed. However, it is important that the list be prioritized so that the most important or time-sensitive things are completed. Limiting outside interruptions will help complete the tasks on the list but is not essential when developing the list. Color-coding could be helpful, but the categories must have some significance, which is not stated that option.

5. What are some potential reasons that nurses experience higher levels of stress (select all that apply)? a. Nurses are skilled at setting boundaries. b. Nurses often put others' needs ahead of their own. c. Staff nurses are under pressure to do more with less. d. There are support staff cuts. e. There are fluctuations in staffing levels

ANS: B, C, D, E Staff nurses are under constant pressure to do more with less, and this can cause professional and personal stress for staff as well as managers. Support staff have been cut, jobs are fewer, and staffing levels fluctuate. Nurses may have a difficult time dealing with stress, because they often put others' needs ahead of their own and need to be able to create healthy boundaries.

Which of the following statements are true regarding job stress (select all that apply)? a. Job stress is related more to external demands that are brought into the workplace. b. Job stress can lead to burnout. c. Job stress is manifested as emotional and/or physical exhaustion. d. Job stress increases productivity. e. Levels of job stress that are too low or too high decrease individual productivity.

ANS: B, C, E Job stress is a tension that arises related to the environmental demands of a person's role or job. Job stress can accumulate to levels that are too high, reach the point of burnout, and manifest as emotional and/or physical exhaustion. Levels of job stress that are too low or too high decrease individual productivity.

6. A staff nurse has a concern about a co-worker who may be diverting medications. The staff nurse would like to report the concern to a supervisor, but she is fearful of retaliation from her colleagues. The staff nurse knows that the ethical thing to do is report the concern for the sake of patient safety. This nurse is experiencing: a. stress. b. procrastination. c. moral distress. d. burnout.

ANS: C Moral distress occurs when clinicians know what is the ethical action to take, yet are prevented by either external or internal obstacles. Moral distress will contribute to stress and eventual burnout if the staff nurse does not take action.

14. A first-year nursing student has received a midterm grade of "D" and is disappointed. She says to the instructor, "I just don't have enough time to do all the reading and assignments. I have to work; I have two children; I have to do grocery shopping, make the meals, and participate in a carpool; and I just don't have enough time to study." The nursing instructor suggests which of the following to her? a. Setting priorities b. Obtaining counseling and tutoring c. Developing a time plan and schedule d. Dropping out of school for the semester

ANS: C Often, management strategies surround the analysis, setting of priorities, internal motivation, and planning for effective time management. Developing action plans and schedules can help align time use better with desired outcomes.

1. ___________ is defined as the accomplishment of specified activities during the time available. a. Stress b. Mismanagement of resources c. Time management d. Self-management

ANS: C Time management is defined as the accomplishment of specified activities during the time available. It is the process of managing the things an individual does with his or her available time. At its core, time management is self-management.

8. A new nurse manager is provided with a smartphone in order to efficiently manage her time. What is the most effective method of managing stress related to e-mail? a. Create an auditory cue that alerts the manager to incoming messages so they can be processed immediately. b. Set aside time during meetings to read and respond to messages. c. Sort and flag e-mails that need follow-up. d. Delete e-mails that require a more lengthy response.

ANS: C Time management will not be effective if the manager is expected to respond to messages as soon as they arrive. Managers can set a rule to check e-mails two to three times per day rather than constantly and should use a sorting a flagging methodology to effectively manage the need for follow-up. Managers should not utilize meetings in order to read and respond to messages.

9. Time management is an essential skill for nurse managers. This can be effectively managed through the creation of to-do lists and is an example of: a. delegation. b. motivation. c. negotiation. d. prioritization.

ANS: D Prioritization is an essential skill of managing to-do lists.

8. Job stress can accumulate into (select all that apply): a. better time management skills. b. feelings of elation. c. burnout. d. physical exhaustion.

ANS: C, D Chronic stress can lead to acute and chronic health problems. Job stress is a tension that arises related to the person-in-environment demands of a person's role or job. Job stress, or "disquieting influences," can accumulate into levels that are too high, reach the point of burnout, and manifest as emotional and/or physical exhaustion and lowered job productivity. Levels of job stress that are too low or too high decrease individual productivity.

2. Nurses who are successful at time management: a. display an ability to set measurable goals and objectives. b. frequently volunteer for new and creative projects. c. hesitate to delegate because of perfectionist characteristics. d. tend to accomplish specific activities within a time frame.

ANS: D Time management is accomplishing specific activities during the time available. It is a process of managing the things an individual does with his or her available time.

5. Managing and leading nursing staff through difficult times can be accomplished through implementation of: a. Institute of Medicine Coalitions. b. health care reform. c. the Troubled Asset Relief Program. d. Healthy Work Environment (HWE) standards.

ANS: D According to the American Association of Critical Care Nurses, HWE standards should be put into place in order to assist organizations in managing and leading nursing staff through difficult and stressful times.

3. Jay, a nurse on the medical-surgical unit, has been caring for a patient with chronic renal failure, congestive heart failure, and a history of myocardial infarctions. The client has been extremely irritable with the nursing staff. After working with the client for 4 days, trying various strategies to help the client work through his anger, Jay asks to have another assignment when he comes back to work in 2 days. This depicts __________: a. confrontational conflict. b. time management. c. burnout. d. resolving conflict.

ANS: D Jay is using an effective method of resolving conflict and maintaining a positive nurse-patient relationship. He did so in a nonconfrontational manner that was effective in managing his personal stress.