Leadership Chapter 3

The nurse manager has convened a staff meeting to discuss a change in the clinical ladder advancement system used by the organization. A staff nurse says, "Not again! It's just not fair." How should the manager respond? 1. "What do you mean, not again?" 2. "Please don't be negative." 3. "This is going to happen. We can't do anything about it." 4. Ignore the comment and continue the meeting.

ANS: 1. "What do you mean, not again?" Explanation: 1. The nurse manager should determine what is meant by the comment before addressing the concern. 2. This statement devalues the comment and the nurse who made it. 3. This statement makes it appear that the manager does not support the change. 4. Ignoring this comment will not help the meeting proceed.

What is a method used to describe performance over time and identify trends? 1. Graph 2. Cost-benefit analysis 3. W O T S-up 4. Solution analysis field

ANS: 1. Graph Explanation: 1. This is the definition of a graph. 2. This method focuses on comparing costs and benefits to arrive at the best option. 3. This method focuses on analysis of weaknesses, strengths, and so on. 4. This method compares alternative solutions.

The nurse manager is aware of a significant change that will occur sometime in the next six months. How can this manager begin to prepare the staff for this change? Select all that apply. 1. Keep the staff apprised of as much information about the change as is possible. 2. Attempt to keep the unit staffing as stable as possible during the time of change. 3. Insist that all discussions about the change be conducted in a respectful manner. 4. Let the initial information about the change come "through the grapevine." 5. Avoid surprises by telling the staff about how the change will increase workload very early in the process.

ANS: 1, 2, 3 Explanation: 1. Fear of the unknown is a primary reason people resist change. 2. Stability will help the staff cope with the idea of a change. 3. All discussions should be respectful and professional. 4. Being upfront with information will prevent staff from believing the manager is trying to hide the change. 5. Focusing on what the staff will lose (having to work harder) will likely increase resistance.

Which activities represent the eight-step process for organizational change? Select all that apply. 1. Management has created a sense of urgency for the change by publishing outcome data on the organization's intranet. 2. Management has worked to develop and communicate a vision that can be shared by all employees. 3. Management has empowered employees to make changes. 4. Management is engaged in "deep change." 5. Management has orchestrated and celebrated some short-term successes along the path to change.

ANS: 1, 2, 3, 5 Explanation: 1. The eight steps create a sense of urgency; create a guiding coalition and mobilize commitment; form a strategic vision and initiatives; enlist a volunteer army; enable action by removing barriers; generate short-term wins; sustain acceleration; and institute change. 2. The eight steps create a sense of urgency; create a guiding coalition and mobilize commitment; form a strategic vision and initiatives; enlist a volunteer army; enable action by removing barriers; generate short-term wins; sustain acceleration; and institute change. 3. The eight steps create a sense of urgency; create a guiding coalition and mobilize commitment; form a strategic vision and initiatives; enlist a volunteer army; enable action by removing barriers; generate short-term wins; sustain acceleration; and institute change. 4. This is not part of the eight steps. This is a coping strategy for what Quinn describes as "slow death." 5. The eight steps create a sense of urgency; create a guiding coalition and mobilize commitment; form a strategic vision and initiatives; enlist a volunteer army; enable action by removing barriers; generate short-term wins; sustain acceleration; and institute change.

You are using S W O T for a review of your unit. Which of the following would be part of this process? Select all that apply. 1. Identify strengths 2. Identify opportunities 3. Identify stakeholders 4. Identify weaknesses 5. Identify outcomes

ANS: 1, 2, 4 Explanation: 1. S W O T = strengths, weaknesses, opportunities, threats 2. S W O T = strengths, weaknesses, opportunities, threats 3. S W O T = strengths, weaknesses, opportunities, threats 4. S W O T = strengths, weaknesses, opportunities, threats 5. S W O T = strengths, weaknesses, opportunities, threats

The staff nurse is invited to join the organization's Strategic Planning Committee. Which topics can the nurse expect to address as part of this committee? Select all that apply. 1. Planning for the next 3-5 years 2. Changes in the core values of the organization 3. Changes in regulations governing the organization 4. Changes in the departmental structure of the organization 5. Suggestions about how to change the staff-mix ratios in a department

ANS: 1, 2, 4 Explanation: 1. Strategic planning is concerned with long-term issues and goals. 2. Long-term issues and core values are considered during strategic planning. 3. This is an example of policy planning. 4. Strategic planning is concerned with long-term issues and goals. This is an example of project planning

Critical thinking is key to successful planning. Which statements provide evidence that the nurse manager is a critical thinker? Select all that apply. 1. "I need to research the topic before I comment." 2. "Let's be fair in our consideration of this change." 3. "Let's go ahead and make the change; I have a feeling it is correct." 4. "I'm trying to understand your point of view." 5. "I have to take back something I said in the last meeting; it was wrong."

ANS: 1, 2, 4, 5 Explanation: 1. This is an example of intellectual humility or admitting what is not known. This is a trait of a critical thinker. 2. This is an example of intellectual courage or awareness of the need to confront ideas fairly. This is a trait of a critical thinker. 3. This statement reflects a jump to action and is not reflective of critical thinking. 4. This is an example of intellectual empathy or the person making a conscious effort to understand others. This is a trait of a critical thinker. 5. This is an example of intellectual integrity or admitting when one is wrong. This is a trait of a critical thinker.

1) The nurse manager is developing a staff education session on change in healthcare. Which concepts should be included in this information? Select all that apply. 1. Oftentimes, before one change in healthcare is completed, another is taking place. 2. Most changes are focused on the organization's structure. 3. Change has been the normal state for healthcare providers for some time. 4. Change disturbs the organization's equilibrium. 5. Sometimes multiple changes occur together in healthcare.

ANS: 1, 3, 4, 5 Explanation: 1. This is certainly a pertinent topic in today's healthcare environment. 2. Important examples of change are related to the organization's structure, but change is also affecting roles and responsibilities, communication methods and systems, policies and standards, culture, leadership and management approaches, and competencies and attitudes. 3. This is certainly a pertinent topic in today's healthcare environment. 4. The equilibrium does become disturbed, so staff must learn to tolerate this equilibrium in order to be effective. 5. This is certainly a pertinent topic in today's healthcare environment.

What are the common external factors that drive change in a healthcare organization? Select all that apply. 1. Changes in reimbursement by third-party payers 2. Changes in the demographics of employees in the facility 3. Changes in local, state, or national laws 4. Changes in professional standards of care 5. Changes in the organization's salary structure

ANS: 1, 3, 5 Explanation: 1. This is a common external factor causing change to be necessary. 2. This is an internal change. 3. Any changes in these laws acts as an external force necessitating change in the organization. 4. Changes in these standards will require change in the way the organization provides care. 5. This is an internal change.

1) The nurse manager has repeatedly tried to convince a staff nurse that changing to a new scheduling format is necessary. The staff nurse continues to be negative and argumentative about the need to change. How should the nurse manager interpret this response? Select all that apply. 1. Some staff will never be ready to change. 2. The change cannot go forward until this nurse is convinced. 3. The nurse is being negative for the sake of negativity. 4. The nurse will have to be terminated in order for the change to occur. 5. The nurse may be concerned about loss of routine in personal scheduling.

ANS: 1, 5 Explanation: 1. Some people are very threatened by the idea of change. This fear may make them respond negatively. 2. The change may go forward with or without this staff nurse's approval. 3. Generally, this is not the case if the nurse manager is genuinely trying to establish rapport with the staff nurse and explain why the change is necessary. 4. The change can go forward without terminating the nurse. If the nurse is indeed fearful of change, the nurse will probably not resign, as that is also a change. 5. Resisters to change are often fearful of losing something they value. Scheduling changes are a particular issue when nurses have established their personal schedules based upon a routine work schedule.

The nurse manager is coping with a staff member who is very resistant to change. Which strategy would be beneficial for this nurse manager? 1. Maintain open communication with this staff member to establish trust. 2. Help the staff member focus on parts of the change rather than on the whole change at one time. 3. Take over all of the processes of the change. 4. Ignore any hidden agendas brought by this staff member.

ANS: 1. Maintain open communication with this staff member to establish trust. Explanation: 1. Having an open and trusting relationship with staff will help to reduce resistance to change. 2. Focusing on parts and being unable to see the whole picture can result in territoriality. 3. Staff will not be innovative if managers overdirect, overobserve, or overreport. 4. Staff with hidden agendas or motives are barriers to change and should not be ignored.

A new management company has acquired a hospital. Since the acquisition, the hospital's name has changed, a new vision statement has been distributed, the department structure has changed, and the staff cafeteria discount has been eliminated. Management has plans for many additional changes. What should happen at this point? 1. Management should refrain from making any additional changes for a few months. 2. Management should continue to make changes, but at a rate no faster than 1 change a month. 3. Management should abandon plans for any additional changes. 4. Management should institute the remaining changes as quickly as possible.

ANS: 1. Management should refrain from making any additional changes for a few months. Explanation: 1. This staff has experienced significant changes and may need a break from change for a few months. 2. This option would have the effect of keeping the staff out of equilibrium. 3. It is not necessary to abandon plans for the changes, but staff needs to be free of changes for a period of time. 4. This quick strike method may result in irretrievable disequilibrium in the staff, which could adversely impact patient care and safety.

The manager of a maternal-child health unit announces that the unit will be redesigned to help meet the Institute of Medicine healthcare competencies. What scenario is one that the staff of this unit might expect? 1. Nursery, labor and delivery, and postpartum nurses will be cross-trained to work in each of these areas. 2. The nurses will be expected to participate in telehealth throughout a three-state region. 3. There will be a reduction in staff numbers. 4. The unit will be closed for remodeling.

ANS: 1. Nursery, labor and delivery, and postpartum nurses will be cross-trained to work in each of these areas. Explanation: 1. Cross-training is an example of redesign or reengineering of healthcare. 2. This would require reregulating professional practice. 3. This is an example of rightsizing. 4. This is not what is meant by redesign in this case.

A patient's fingerstick blood sugar registers 70. The nurse must follow the policy and procedure for caring for a patient with hypoglycemia. This is an example of what type of decision-making process? 1. Programmed decision making 2. Crisis decision making 3. Time-limited decision making 4. Nonroutine decision making

ANS: 1. Programmed decision making Explanation: 1. Programmed decision making is more repetitive and routine and typically related to a policy or procedure. 2. The situation is not a crisis. 3. This is not a time-limited situation. 4. Nonroutine decision making is not routine, can be crisis-oriented, and can require more time and consultation with others.

Which option best describes a change agent that demonstrates a transformational style of leadership during the change process? 1. The change agent describes the vision for the change, sets high expectations, and is a role model for the staff. 2. The change agent expresses personal views about the change and empathizes with the staff. 3. The change agent expects staff to follow the change agent's directions required to meet the goal. 4. The change agent provides the staff members with the resources needed to do their job.

ANS: 1. The change agent describes the vision for the change, sets high expectations, and is a role model for the staff. Explanation: 1. The charismatic change agent is an envisioning leader. 2. These actions describe an enabling change agent. 3. These actions describe a missionary change agent. 4. This is an instrumental or transactional change agent.

What is the first step in coping with changes that occur in the healthcare environment? 1. Understanding personal response to change 2. Identifying the change agent 3. Investigate the facility's history of change 4. Identify the purpose of the change

ANS: 1. Understanding personal response to change Explanation: 1. Some people have an immediate negative response to change. Other people are invigorated by change, whether the change is positive or negative. The nurse must understand personal response to the idea of change so that response to a particular change can be unbiased. 2. While this is important information, the nurse must first identify personal response to the concept of change. 3. While this is important information, the nurse must first identify personal response to the concept of change. 4. While this is important information, the nurse must first identify personal response to the concept of change.

In which situation would it be necessary to reregulate practice? Select all that apply. 1. Nurses are asked to cross-train to another specialty. 2. An insurance company opens a nationwide nurse call line. 3. The hospital hires unlicensed assistive personnel. 4. A nursing school revises its curriculum. 5. The healthcare organization goes national and hopes to encourage mobility among its administrative nurses.

ANS: 2, 5 Explanation: 1. This is a redesign practice used by many organizations to compensate for the nursing shortage. 2. The use of telemedicine requires reregulating professional practice because nurses can use this technology to provide care in situations in which the patient is in a different state from the one where the nurse is licensed and located. 3. This is a redesign practice used by many organizations to compensate for the nursing shortage. 4. This is an example of restructuring in which nursing education attempts to prepare nurses for the "real world." 5. This mobility would result in the nurses working in different states from where they live and are licensed.

1) A problem has been identified in the healthcare facility. What should the nurse who has been assigned the task of change agent do next? 1. Develop an alternative plan. 2. Gather data. 3. Collaborate with others. 4. Empower staff.

ANS: 2. Gather data. Explanation: 1. Developing alternative plans is done after a diagnosis is made. 2. After the first step of the change process of acknowledging the problem, then it is necessary to gather the data necessary to be able to define the problem and develop a plan of action. 3. Collaborating and empowering staff takes place throughout the change process after data are collected in the assessment phase. 4. Collaborating and empowering staff takes place throughout the change process after data are collected in the assessment phase.

What is the goal of the Center to Champion Nursing in America? 1. Advertise nursing 2. Mobilize stakeholders 3. Describe nursing education changes 4. Recognize importance of A P R N s

ANS: 2. Mobilize stakeholders Explanation: 1. This is important, but not the goal. 2. This is the goal for the initiative, which is associated with The Future of Nursing report. There is need to develop a collaborative effort and this requires participation from stakeholders. 3. This is important, but not the goal. 4. This is important, but not the goal.

What are the first three steps used in proactive leadership? Select all that apply. 1. Listen and learn, adjusting the nature of the solution and the speed of the process as needed. 2. Implement the proposed change by integrating it into organizational culture, structure, and strategy. 3. Engage in debate or dialogue about the need for change and the nature of the proposed solution. 4. Form a coalition to manage the change process. 5. Communicate consensus or decision to all stakeholders.

ANS: 3, 4, 5 Explanation: 1. This step occurs during and after implementation. 2. This is the fourth step. 3. This is one of the first three steps-the second step. 4. This is one of the first three steps-the first step. 5. This is one of the first three steps-the third step.

Which statements are true about the evaluation step of the decision-making process? Select all that apply. 1. Only the change agent is responsible for the evaluation phase. 2. Management is usually not involved in the evaluation phase. 3. Evaluation needs to be incorporated in all the steps of the change process. 4. All members of the team are required to evaluate the process at the end of the project. 5. Neglecting this step has long-term consequences.

ANS: 3, 5 Explanation: 1. All members of the team are involved. 2. All members of the team are involved, including management. 3. Evaluation does not happen just at the end of the project, but needs to be incorporated all the way through the project. 4. While all members of the team are involved in evaluation, this evaluation should take place throughout the project, not just at the end. 5. If the team does not evaluate the results of decisions, valuable information can be lost or mistakes can be made in the next change.

The hospital would like to decrease the number of medication errors made secondary to transcription errors. In order to accomplish this, it is hoped that all physicians will be trained in the use of computerized physician orders by the end of the fiscal year. This is an example of which stage of Lewin's model of change? 1. Refreezing 2. Unfreezing 3. Moving 4. Working

ANS: 3. Moving Explanation: 1. The refreezing stage is the implementing step in the model where change becomes a part of the work environment and its processes. 2. The unfreezing stage is the first step in Lewin's model of change and includes recognition of a problem. 3. This is an example of the moving stage, because the hospital has developed a goal and outcomes to help resolve the problem. 4. Working is not one of the stages of the model.

The nurse has been assigned to be a change agent for the facility's change to a computerized charting system. What type of planning will this require? 1. Strategic 2. Policy 3. Project 4. Both strategic and project

ANS: 3. Project Explanation: 1. Strategic planning will not be necessary because changes will not be made to the organizations' departments or services provided. 2. This change probably will not change the value system, nor will laws and regulations be changing. Therefore, policy planning will not be necessary. 3. Since this change involves a specific time-limited initiative for the nursing department, this requires project planning. 4. Strategic planning will not be necessary because changes will not be made to the organization's departments or services provided. Project planning will be required.

Which of the following data collection methods is not one of the three common data collection methods mentioned in the textbook? 1. Observation 2. Survey 3. Record review 4. Interview

ANS: 3. Record review Explanation: 1. Observation is a common data collection method. 2. Survey is a common data collection method. 3. Record review may be used, but is not one of the three common methods discussed in the textbook. 4. Interview is a common data collection method.

1) The team is using a P D S A cycle to test a proposed change to conduct an in-depth analysis of data with comparison to the predictions. In which step of the cycle is this team working? 1. P 2. D 3. S 4. A

ANS: 3. S Explanation: 1. In the Planning stage, the objective of the test is stated; predictions are made about what will happen and why; and a plan to test the change is developed. 2. In the Do stage, a small test is done with identification of problems encountered and first analysis of data. 3. In the Study stage, a more in-depth analysis of test data is done with comparison to predictions. 4. In the last step, Act, the change is revised based on what has been learned from the test.

Management has called a meeting to discuss the increase in negative patient satisfaction surveys. Which stage of Lewin's model of change does this represent? 1. Moving 2. Refreezing 3. Unfreezing 4. Working

ANS: 3. Unfreezing Explanation: 1. The moving stage is the planning phase of the model and focuses on the development of goals and outcomes. 2. The refreezing stage is the implementing step in the model where change becomes a part of the work environment and its processes. 3. The unfreezing stage is the first step in Lewin's model of change and includes recognition of a problem. 4. Working is not a stage of Lewin's model.

During the change process to implement an electronic medical record, a nurse manager says, "We are experiencing a 'slow death.'" What evidence would the manager have to not support this conclusion? 1. Work processes that seem scattered 2. Staff burnout with complaints increasing 3. Use of a detailed project plan 4. Staff refusing to assume more assignments

ANS: 3. Use of a detailed project plan Explanation: 1. Inability to do work effectively is a sign of 'slow death.' 2. Staff burnout is a sign of 'slow death.' 3. Using a detailed plan is a positive step and should not lead to 'slow death' during change. 4. Staff who are less enthusiastic is a sign of 'slow death.'

The staff of a healthcare organization is burned out and apathetic, and the organization is stagnant. The newly employed leader is working to empower staff, improve the organization's vision, and alter the culture of accepting the status quo. According to Quinn, what is this leader trying to create? 1. Unfreezing 2. A "slow death" 3. A force-field analysis 4. A "deep change"

ANS: 4. A "deep change" Explanation: 1. This is part of Lewin's theory of change and is not applicable to this scenario. 2. This is what the organization is experiencing. The leader is trying to turn this situation around. 3. This is a strategy of Lewin's theory of change. 4. Quinn says that in order to avoid a "slow death" leaders must create a "deep change."

1) A nurse manager is collecting staff views about a current unit problem to make a decision about actions to take. Which style of decision making is this manager employing? 1. Unilateral 2. Individual 3. Authoritarian 4. Consensus

ANS: 4. Consensus Explanation: 1. This style depends on a small amount of data, but arrives at one decision. 2. This style focuses on individuals. 3. This style tells the staff what will be done with the manager making the decision. 4. This style engages the staff to arrive at a consensus.

The nurse is working in a facility that is considering a major change by incorporating interprofessional teams in all departments and units. Which type of planning is required? 1. Policy planning 2. Strategic planning 3. Project planning 4. Strategic planning and project planning

ANS: 4. Strategic planning and project planning Explanation: 1. Policy planning is not required but may be part of project planning. 2. Strategic planning is required; policy planning is not required but may be included. 3. This proposed change requires planning at levels above project planning. 4. Both strategic planning and project planning are required, because the move toward an interprofessional approach rather than a single discipline-run unit requires a change to the organization's components (departments) and operational matters within the organization.