Leadership end of chapt questions 5/7/8

Theory Y emphasizes: 1. Guidance, development, and reward 2. Leadership, not management 3. Supervision, monitoring, and reprimands 4. Evaluation, budgeting, and time studies

Answer: 1 Rationales: 1. A Theory Y manager employs staff guidance, staff development, and rework as opposed to Theory X's emphasis on control, close monitoring, and punishment, if needed. 2. Theory Y is a management theory, not a leadership theory. 3. These are the focus of Theory X, not Theory Y. 4. Time studies are used primarily by those managing in the scientific management mode.

What is brainwriting? 1. A strategy to encourage the free flow of ideas 2. A mutually beneficial negotiation result 3. A winning approach to formal negotiation 4. A devaluation reaction to negotiation

Answer: 1 Rationales: 1. Brainwriting is a creative approach to problem-solving. Similar to brainstorming, it offers everyone a chance to share ideas; however, by writing their ideas before the discussion, there is less likelihood of being influenced by early ideas. 2. Brainwriting is a tool that may be used for different types of negotiation; however, it is not a result of negotiation. 3. Brainwriting is not an approach to formal negotiation, but it may inform the negotiation. 4. Brainwriting is not a reaction to negotiation.

Differences in status and authority within the health-care team can generate conflict. What is the most common cause of conflict? 1. Disrespect and incivility 2. Inappropriate language and sarcasm 3. Blaming and finger pointing 4. Physical violence

Answer: 1 Rationales: 1. Disrespect and incivility are the leading cause of conflict within health-care teams. 2. Answers 2, 3, and 4 are less likely to cause conflict when compared with disrespect and incivility.

Mara Z. wants to become a nurse manager. She has been offered an opportunity to take a nursing management course. Which topic is most important for her to learn? 1. Managing people 2. Managing the unit's budget 3. Planning for the future 4. Redesigning the unit's workflow

Answer: 1 Rationales: 1. Managing people is probably the most challenging task for nurse managers. It is fundamental to good management. 2. The unit budget is important but not as complex as managing people. 3. Planning for the future is also important but not as fundamental as managing people. 4. Redesigning the unit's work flow is usually a task that should be done only after gaining familiarity with all aspects of the unit's operation.

Nursing management and the nursing union are having differences on several issues. There may be a need for negotiation. Which of the following is a serious disadvantage to using collective bargaining to resolve this conflict? 1. Protecting the right to fair treatment 2. Creating an adversarial relationship between staff and management 3. Lacking professionalism on the part of the collective bargaining unit members 4. Failing to uphold important standards of care

Answer: 2 Rationales: 1. Staff rights to fair treatment are protected by personnel policies, state and federal law, and the current union contract. This item is a regular part of collective bargaining. 2. Discussion between management and union representatives about the issues may create conflict, which can be constructive or become emotional and competitive. If emotions are not managed, the interaction can become adversarial and delay resolution. 3. Individual members of the bargaining team may display unprofessional behavior during bargaining sessions; however, this usually occurs between management and the union at the bargaining table. 4. Organization and nursing policies and procedures and nursing professional practice standards ensure that standards of care are met. Collective bargaining centers on employee rights rather than those of the patient or management.

The EMR has many advantages compared with paper charting. It helps track data through time and can help monitor things such as preventative care in primary care practices. Jane is the office nurse in a local practice. She is mecting a new patient for the very first time who informs her that he was recently hospitalized. Jane pulls up the patient's EMR and sees no information regarding his recent hospital stay. How could this have happened? 1. The patient's discharge was so recent that it is not available yet. 2. EMRs are usually practice or hospital specific, so the patient's information would not be accessible to Jane. 3. The patient was hospitalized out of state. 4. The patient has not signed the necessary consents to give Jane access.

Answer: 2 Rationales: 1. The emergency medical responder (EMR) is readily available at the hospital where the patient was treated. Only electronic health records (EHRs) contain a comprehensive accounting of health encounters regardless of the location. 2. EMRs are usually hospital or practice specific, so Jane would not have access to the patient's hospital EMR. Recent changes in technology and the creation of health information exchanges are making EMR information available to hospital and practice affiliates. 3. EHRs can capture patient information from anywhere within a health information exchange. 4. General consents for treatment and release of information are part of primary care practice and hospital paperwork.

When should a new graduate consider taking on management responsibilities? 1. As soon as they are offered 2. After developing clinical expertise 3. After 15 years on the job 4. Before developing leadership expertise

Answer: 2 Rationales: 1. Very few new graduates have either the preparation or experience to assume management responsibilities soon after graduation. 2. Development of clinical expertise is an essential part of preparing to be a nurse manager. 3. It is the amount of preparation and experience gained, not the number of years, that is critical in making this decision. 4. Nurse managers need to have leadership expertise.

TJC attributes 80% of all medical errors to: 1. Poor hygiene and hand washing 2. Poor hand-off communication 3. Poor work environment 4. Lack of care

Answer: 2 Rationales: 2. Ineffective hand-off communication or miscommunication between caregivers during the transfer of care is estimated to contribute to 80% of serious medical errors. Poor hand-offs can lead to delays in treatment, inappropriate treatment, and prolonged hospital stays. Answers 1, 3, and 4 contribute to medical error but not to the same degree as ineffective hand-off communication.

Jane is a new nurse manager who will be holding her first staff meeting tomorrow. She has learned that the staff members have not been following important patient care policies. What is the most important communication skill that she should use at the meeting? 1. Talking to the staff 2. Laughing with them 3. Listening 4. Crying

Answer: 3 Rationales: 1. Although answer 1-talking to the staff--is important, the best answer is 3. 2. This is incorrect. Laughing with staff can confuse the audience and cause them to misconstrue the seriousness of the message from Manager Jane. 3. Listening to staff is the most critical communication skill because it helps the manager understand the situation and the staff's rationale for their actions. It also demonstrates empathy and openness, which can lead to agreement on better adherence to the policies. 4. This is incorrect. Demonstrating emotions such as crying can confuse the audience and cause them to misconstrue the seriousness of the message from Manager Jane.

Servant leadership focuses on: 1. Helping patients care for themselves 2. Removing incompetent managers 3. Creating a supportive work environment 4. Resolving conflicts quickly

Answer: 3 Rationales: 1. Helping patients care for themselves is a nursing care approach, not a management approach. 2. Removal or demotion is sometimes necessary but not the focus of servant leadership. 3. Servant leadership employs a "people first" approach to improving how employees are treated. 4. Resolving conflicts as quickly as possible would not be the goal of a servant leader or manager, who would try to come to a resolution that is best for all, even if it takes some time.

Which of the following is a major reason why newly licensed nurses resign? 1. Poor pay scales 2. Needlestick injuries 3. Unsupportive management 4. Lack of advancement opportunities

Answer: 3 Rationales: 1. Newly licensed nurses face many challenges, but poor pay is usually not the reason for resignation. 2. Needlestick injuries are a concern, of course, but most facilities have developed adequate prevention programs. 3. Newly licensed nurses, in particular, need supportive management and may resign if it is not present. 4. A lack of advancement opportunities becomes more important after the initial adjustment to this new role.

If an informal negotiation session becomes too highly emotional, what should the nurse manager do? 1. Let the feelings flow. 2. Cancel the negotiation. 3. Deal with the feelings first. 4. Tell them to ignore the feelings and deal with the issues.

Answer: 3 Rationales: 1. The free flow of feelings can cause participants to begin to feed off of each other's emotions, which can get out of control and even lead to emotional outbursts, personal attacks, and physical violence. 2. The manager should not cancel the negotiation. Canceling the negotiation will delay resolution to the problem, and underlying anger or frustration could result in outward hostility on the unit. Instead, the manager may choose to take a short recess so that people can get their feelings under control and then resume the session. 3. The first step in any negotiation is to manage emotions. Emotions should be acknowledged and never responded to with added emotion. Once acknowledged, the team can move forward. 4. Ignoring feelings can cause an individual to focus on his or her anger rather than identifying the issues causing the conflict. When left unchecked, these emotions may follow the person into the work environment and manifest themselves in emotional outbursts and personal attacks.

Who is responsible for accepting, transcribing, and implementing physician orders? 1. Unit clerk 2. Medical intern or resident 3. Professional nurse 4. Medical assistant

Answer: 3 Rationales: 1. Unit secretaries may enter orders into a patient record; however, it is the responsibility of the professional nurse to accept or sign off on the order before it is implemented. 2. Medical students may write orders; however, they must first be signed off by the faculty physician before being accepted by the professional nurse, who can then ensure they are implemented. 3. The professional nurse is responsible for accepting, transcribing, and implementing health-care provider orders. 4. Medical assistants may not accept or implement physician or health-care provider orders without being accepted by a professional nurse.

What is the most desirable result of a problem resolution? 1. Win-lose 2. Lose-lose 3. Win-win 4. None of the above

Answer: 3 Rationales: 1. Win-lose infers competition; the aim of conflict resolution is to work together more effectively, not win. 2. Lose-lose makes everyone a loser and can make people angry or heighten their need to win next time. Both of these situations take attention away from the work and place it on the need to win. 3. Win-win allows both sides to come together to identify the issue, and each side gains some benefit from the solution. Both sides walk away winners. 4. None of the above

ISBARR provides a framework for communicating critical client information. ISBARR is an acronym for: 1. Identify, Study, Background, Assess, Recognize, Readback 2. Issue, Situation, Better, Advise, Refer with Recommendations 3. Introduce, Situation, Background, Assess, Recommend, Readback 4. None of the above

Answer: 3 Rationales: The ISBARR is an acronym for a concise review of the client with other team members to ensure timely intervention and feedback. It includes introducing the patient, the current situation, any pertinent background that could be contributing to the situation, a clinical assessment with recommendations, and finally, a readback of the instructions or orders to ensure accuracy.

Informational aspects of a nurse manager's job include: 1. Evaluation 2. Resource allocation 3. Being a coach 4. Being a spokesperson

Answer: 4 Rationales: 1. Evaluation is one of the decisional activities of a nurse manager. 2. Resource allocation is also a decisional activity. 3. Being a coach is one of the interpersonal activities of a nurse manager. 4. Being a spokesperson for staff, patients, and administration is an informational activity.

Implicit bias affects our understanding in an unconscious manner. A person's ability to of the following statements is true about implicit bias? recognize these biases can improve communication with patients and colleagues alike 1. Implicit bias forms during a lifetime. 2. Implicit bias can influence clinical decision making and treatment. 3. Implicit bias contributes to an individual's social behavior. 4. All of the above

Answer: 4 Rationales: 1. Implicit bias is formed during a lifetime because it is formed based on an individual's culture, which shapes attitudes, beliefs, and actions. 2. Implicit bias is automatic and subconscious during our interactions with others and can influence our clinical decision making and even treatment. 3. Implicit bias contributes to social behavior because it is derived from an individual's cultural norms. 4. All of the above

Scientific management focuses on: 1. Interpersonal relations 2. Servant leadership 3. Staff development 4. Efficiency

Answer: 4 Rationales: 1. Interpersonal relations are not the focus of scientific management. 2. Servant leadership is also more focused on interpersonal relations than is scientific management. 3. Likewise, staff development is not emphasized in scientific management. 4. The focus on increasing efficiency is the hallmark of scientific management.

The hospital has recently reorganized; therefore, several departments were closed. The patient census on the unit has increased. The staff have always had a strong team spirit, but the nurse manager knows that workflow changes can cause conflict. What can the nurse manager do to reduce the possibility of conflict among her team? 1. Monitor the quality of patient care. 2. Ensure that supplies and equipment are readily available. 3. Assess the equity of nursing assignments. 4. All of the above

Answer: 4 Rationales: 1. Observing daily unit activity will allow the nurse manager to see that no patient care is missed because of extraneous duties that her staff may be asked to perform because of the reorganization. 2. The reorganization may create a scarcity of supplies or change delivery times, which could cause hoarding or competition for limited resources. 3. Keeping the patient care assignments equitable will allow for prompt intervention should workloads become unmanageable or breaks are missed. 4. All of the above

Social media is commonly used to update friends and groups on things we have going on in our lives. Health-care organizations routinely use social media to promote medical facts, services, and recognitions. What is important for nurses to remember when deciding to post something work related on a social media site? 1. Nurses should never post protected health information on a social media site. 2. Stories with good outcomes can be posted to your media page. 3. Stories and photos can always be shared if the patient's name or face is not visible. 4. Posting stories on personal time is OK because the nurse is not working.

Answer: 1 Rationales: 1. Protected health information (PHI) must be protected and never shared without expressed written permission. A patient's privacy and confidentiality are paramount. 2. Nurses and other health professionals should never post stories about patients or work on social media sites. People familiar with you may easily put 2 and 2 together and surmise the situation and patient involved, which could be a breach in patient privacy. This could be grounds for disciplinary action. 3. Photos of patients or work areas should not be shared on social media. Although innocent, a photo may include an assignment board or other information that could inadvertently display PHI. 4. The time of social media posting is irrelevant; the issue is the confidentiality and privacy of the patients and the staff caring for them.

Effective nurse managers have: Select all that apply. 1. Leadership capabilities 2. Clinical expertise 3. Business sense 4. Budgeting savvy

Answer: 1, 2, 3, 4 Rationales: 1, 2, 3, and 4. To be maximally effective, nurse managers need a constellation of skills: people skills (leadership), expertise (clinical experience), and financial skills (business sense and budget savvy).

Bedside shift report is one of the things that Jane reviews at the staff meeting. She stresses the way she would prefer the report to start. Which of these would be the least important to share with the oncoming nurse? 1. Telling the oncoming nurse what happened on the unit during the shift 2. Introducing the client and his or her diagnosis to the oncoming nurse 3. Sharing the nurse's personal opinion of the client 4. Reviewing new medication orders and the medication administration record (MAR)

Answer: 2 Rationales: 1, 4. Although answers 1 and 4 should be included in the bedside shift report, they are not the best answer. 2. Introducing the client and his diagnosis ensures that the sender and receiver of the communication are familiar with the client and share pertinent care needs, nursing interventions, and client progress with goals of care. 3. This is incorrect. Personal opinions may prejudice the oncoming nurse's view of the patient, which could compromise care.

What is the difference between management and leadership? 1. Management focuses on budget. 2. Management is an assigned position. 3. Leadership is not concerned with getting work done. 4. Leadership is more focused on people.

Answer: 2 Rationales: 1. Budgets are a concern of nurse managers but not their major focus. 2. Everyone can exert leadership at various times, but manager is a designated position, assigned by upper-level administration. 3. Nurse leaders are definitely concerned that the work of the team gets done. 4. Both management and leadership focus on people.

The purpose of learning how to negotiate conflict is to: 1. Eliminate conflict entirely 2. Resolve conflicts more effectively 3. Win 4. Reduce stress

Answer: 2 Rationales: 1. Conflict does have a positive side; when managed constructively, people can develop more open, cooperative ways of working together. 2. The use of negotiating skills can resolve conflicts more effectively by helping differing parties see each other as people with similar needs, concerns, and dreams instead of as competitors or blocks in the way of progress. Being involved in successful conflict resolution can be an empowering experience. 3. Winning more negotiations is counterintuitive. The purpose of negotiation is to build consensus and agreement between parties, not win more for your side. 4. Negotiations by themselves can be stressful; however, the outcome of a good negotiation would be reduced stress caused by the conflict.

Florence has two team members who continually criticize each other despite being told to stop. Which approach is the most appropriate for this situation? 1. Refer each of them for employee counseling. 2. Engage in problem resolution. 3. Bring in a union representative. 4. Engage in a formal negotiation process.

Answer: 2 Rationales: 1. Employee counseling may further exacerbate the conflict because employee counseling will deal with each staff member individually rather than bringing them all together to resolve the issue. 2. Problem resolution is the best answer. Florence has addressed both of her staff members about their behavior, and there has been no improvement. Problem resolution will help the two parties identify the issue and agree on a solution to the problem. 3. This is not a union issue. A union representative is usually only engaged when there is a dispute between employees and management, not between employees. 4. Formal negotiation would be too complex for this situation. The two team members are openly critical of one another, but the overall climate of the unit is supportive and collegial.

George S. has just become a nurse manager in a long-term care facility. He knows he has a lot to learn--what should he tell his staff? 1. Nothing; he should pretend he has experience 2. That he is still learning, too, and values their input 3. That the staff needs to manage themselves 4. How little he knows about management

Answer: 2 Rationales: 1. Pretending to have experience is likely to cause him to lose credibility and the trust of his staff. 2. This is an accurate description of his situation and is likely to engage staff in supporting his growth and development as a nurse manager. 3. Staff need to contribute to the leadership of the team but are not expected to "manage themselves." 4. It is preferable to take a positive approach, emphasizing a willingness to learn.

You are working on the trauma unit today, and your new patient with a femur fracture complains of leg pain and seems a little diaphoretic and short of breath. You assess the patient and prepare to contact the surgeon. In preparation for contacting the physician, you: 1. Immediately page the MD; it could be a pulmonary embolism, and time is of the essence. You will give him the particulars when the MD arrives. 2. Wait for the MD to round on his patient because it should be within the next hour or so. 3. Medicate the patient for pain and plan to contact the MD when he rounds. 4. Jot down notes about the situation as it is presented to you, review the patient's history, focus your assessment, and determine what you need for the patient.

Answer: 4 Rationales: 1. Paging the MD to the bedside without any information may cause the MD to just add visiting the patient to his list rather than conveying the urgency of the patient's change in condition. 2. Placing a STAT page to the MID may get the MD there quickly; however, without the necessary information about the patient, the MD may think that you overreacted and dismiss the severity of the clinical change. 3. Rather than bother the MD, you medicate the patient for pain and continue to observe the patient. 4. Describing the situation, background, assessment, and recommendations (SBAR) is best. Reporting on situational change is designed to provide concise, pertinent, and factual information to members of the health-care team. This approach to a sudden change in patient condition allows you to communicate information, your concerns, and the need for action.

As Jane speaks with the team, she learns why the staff members have had difficulty following policies. Which of these would be considered barriers to effective communication? 1. The charge nurse is unavailable to help the nurses when they have questions about policies. 2. Some staff are afraid to ask particular charge nurses for help for fear of retribution. 3. The use of acronyms is confusing to staff members who are new to the unit. 4. All of the above

Answer: 4 Rationales: 1. Physical barriers--such as the absence of the charge nurse to answer questions-could prevent the staff from following policies. 2. Emotional barriers- -such as a nurse's fear of retribution from a colleague can cause nurses to seek out answers, which can delay care or compromise safety. 3. Semantic barriers-such as acronyms or nicknames--can confuse or mislead staff unfamiliar with their meaning. 4. All of the above

Nursing and respiratory departments both experienced job cuts. The nurse manager notices that members of his staff are having more trouble getting a fast response from a respiratory therapist. What source of conflict is probably operating here? 1. Union-management conflict 2. Interpersonal problem 3. Cultural differences 4. Work intensification

Answer: 4 Rationales: 1. There is no union or management involvement in the scenario presented. 2. Although this change in workload may eventually cause some interpersonal problems, the job cuts were an organizational decision, not a personal one. 3. This was an organizational decision, not one made because of a cultural difference. 4. Work intensification causes everyone involved to increase their workloads to accommodate the job cuts. Nurses and respiratory therapists adjusting to this change may be unable to request service or respond to a request for service in a timely manner.

Which of the following issues may be addressed in a collective bargaining agreement? 1. Shift differentials 2. Safe working environment 3. Grievance procedures 4. All of the above

Answer: 4 Rationales: 1. When a union has been designated as the official bargaining unit for your staff, shift differentials and salary increases are addressed as part of the collective bargaining. 2. Issues concerning safe working environments are usually included. They may include things such as the provision or availability of lift equipment, personal protective equipment, or protocols on the reduction of workplace violence. 3. Grievance procedures are part of collective bargaining agreements. These procedures ensure that staff issues are heard and reduce the possibility of unfair labor practice. 4. All of the above