Leadership Exam 1
The hospital administration is discussing the possibility of closing hospital beds in your unit because of a nursing shortage and the increased amount of overtime required to care for patients. As the leader on the unit, which of the following examples best demonstrates your transformational leadership style?
A group of your staff members goes to the administration to propose closing of a different unit.
Recruiting the emerging work force (18 to 35 year olds) is a challenge for healthcare agencies. Marketing brochures should address the leadership and vision of the healthcare agency. Which of the following workplace environments will attract applicants in the emerging work force?
A nurturing and receptive environment
What did the IOM Health Professions Education report highlight as a concern for patient safety?
A result of disciplinary silos.
The unit is shifting from primary nursing to a team model in an effort to contain costs. Staff members are upset about the change and ask for a meeting to discuss the new model. After hearing their concerns related to reduction in professional autonomy, what is the initial response by the manager to address the concerns?
Acknowledge the feeling of staff members
As the RN charge nurse on the night shift in a small long-term care facility, you've found that there is little turnover among your LVN and nursing assistant (NA) staff members, but they are not very motivated to go beyond their job descriptions in their work. Which of the following strategies might motivate the staff and lead to greater job satisfaction?
Allow the LVNs and NAs greater decision-making power within the scope of their positions in the institution.
After consulting with practice environments about quality and safety concerns in health care, a dean in a health care program implements what to improve quality and safety in health care?
An interdisciplinary program for nurses, pharmacists, and medical practitioners that emphasizes collaborative learning teams.
What would managers and staff review annually in order to ensure compliance with The Joint Commission (TJC) to improve patient safety?
Appropriateness of charting terms and abbreviations.
A grievance brought by a staff nurse against the unit manager requires mediation. At the first mediation session, the staff nurse repeatedly calls the unit manager's actions unfair, and the unit manager continues to reiterate the reasons for the actions. What would be the best course of action at this time?
Ask each party to examine their own motives and issues in the conflict.
A new graduate nurse wonders about the directions that her preceptor has given her regarding management of incontinent and confused patients. The new nurse brings the preceptor evidence-based information she located regarding incontinence interventions for confused patients and asks to talk about the guidance that given after the preceptor reviews the information in the article. What is the new nurse demonstrating in this situation?
Assertiveness and Followership
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?
Assessment/Data collection
Nancy is a staff nurse who works on a rehabilitation unit. Nancy tells you that the assistants are experiencing difficulty with the new lift and wonders what your thoughts are on organizing an in-service training. Nancy is exhibiting which trait of a follower?
Assumes responsibility for identifying a safety concern and concedes authority for solution to you
Which ethical principle is primarily involved in informed consent?
Autonomy
A patient refuses a simple procedure that you believe is in the patient's best interest. What two ethical principles are in conflict in this situation?
Autonomy and beneficence
In keeping with standards of The Joint Commission (TJC), the nurse manager organizes an orientation for new staff members. As part of the orientation, the nurse manager reviews the employee handbook. What is the basis that binds employers to statements in the employee handbook?
Based on the employee's or the employer's expectations
Three gravely ill patients are candidates for the only available bed in the ICU. As the supervisor, you assign the bed to the patient with the best chance of recovery. This decision reflects which of the following ethical principles?
Beneficence
Which of the following is not important in a positive work environment, as defined by the AONE?
Challenge and striving for excellence.
As a leader on a rehab unit, the manager encourages all staff members to see themselves as having a role in decision making and quality care. The manager sees their role as involving particular responsibilities in decision making but not as a hierarchal role. What is this view of the role consistent with in this situation?
Complexity theory
What does the SBAR approach to patient safety encourage?
Consistency in assessment and practices.
The manager of a unit is finding it difficult to work with a new graduate nurse. The new nurse has many ideas; however, his manner of presenting them irritates the manager. After reflection and discussion with others, the manager recognizes that she feels threatened by his behavior. She comes to understand that the new nurse is trying to establish his own role on the unit; is not trying to challenge her; and needs guidance, coaching, and affirmation. What is the nurse manager demonstrating in this situation?
Deepening self-awareness
A nurse manager has worked to bring the staff to participate in and then accept changes in the unit's mission, so that downsizing can be avoided. How is the nurse manager using change theory for this situation?
Determining accurately the direction of change in the institution
A staff nurse has been recently promoted to unit manager. During the time on the unit, the nurse formed a strong social network among staff, has promoted the development of relationships between staff and workers in other areas of the organization, and has formed relationships that generate ideas from patient organizations and the local nursing education program. What behavior does the unit manager show?
Development of networks
Sue, a nurse manager, has a staff nurse that has been absent a great deal for the past 3 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?
Do nothing now but possibly counsel the nurse if needed based on the policy.
Electronic health records (EHRs) are being instituted at a Valley Hospital. Some of the staff on Unit 4 complain to the manager that acquiring the technologic skills required is too time consuming. They question its value in patient care. The manager responds that:
EHRs will increase effectiveness of care by enhancing coordination and improving patient outcomes.
At a second negotiation session, the unit manager and staff nurse are unable to reach a resolution. What is the appropriate next step?
Elevate the next negation session to the next manager, one level above
In planning a new wing, the nurse manager complies with the workplace safety requirements of the Occupational Safety & Health Administration (OSHA). Which of the following groups is considered to be at high risk for violence in the workplace?
Emergency Department staff
You notice that Sally, a student on your unit, is giving information to an anxious young teen who seems very uncertain about preparation for an upper GI series. After Sally leaves the room, you ask her how she thought her conversation with the patient. What is the appropriate response for you to give Sally?
Encourage her to ask the patient if he has questions or concerns about the procedure.
The Rehabilitation Unit at a Hospital has a high number of falls. What interventions might assist to reduce the number of falls on the unit?
Encouraging involvement of nurses in education related to falls and safety
A nurse manager of a 20-bed medical unit finds that 80% of the patients are older adults. She is asked to assess and adapt the unit to better meet the unique needs of the older adult patient. Using complexity principles, what would be the best approach to take for implementation of this change?
Engage involved staff at all levels in the decision-making process.
How would a nurse manager and the staff prepare for redesignation as a Magnet®Hospital?
Ensure that there are empirical data to support review of patient outcomes, actions taken, and results of actions.
To achieve Nurse-Sensitive Care Standards developed by the NQF, you advocate for which of the following in your health facility?
Evidence-based practice to reduce the prevalence of pressure sores
After assessing an older adult patient in long-term care who has been slowly deteriorating for weeks, the nurse manager calls the family and asks them to come in, as the patient is dying. What is the most likely basis for the nurse manager's request?
Experience
The manager of a surgical area has a vision for the future that requires the addition of RN assistants or unlicensed persons to feed, bathe, and ambulate patients. The RNs on the staff have always practiced in a primary nursing-delivery system and are very resistant to this idea. What would be the best initial strategy for implementation of this change?
Exploring the values and feelings of the RN group in relationship to this change
The chief nursing officer has asked the staff development coordinator to facilitate the development of a clinical competency program for the facility. While making rounds on the units, the staff development coordinator overhears RN staff complaining that they feel it is insulting to be required to participate in a competency program. What behavior by the staff development coordinator is most appropriate in this situation?
Facilitate a meeting so nurses can articulate their values and concerns about a competency program.
In an effort to control costs and maximize revenues, the Rehabilitation Unit at a Hospital reduced the number of its managers and increased the number of units for which each manager was responsible. Within a year, the number of adverse events on the units had doubled. How does the increase in adverse events relate to decreased managers?
Fewer clinical leaders that facilitate best practice
The principle that requires nurses to uphold a professional code of ethics, to practice within the code of ethics, and to remain competent is which of the following?
Fidelity
A family is keeping vigil at a critically ill patient's bedside. The nurse approaches the unit manager with concern over the family dynamics for the patient concerned there are patient-family conflicts based on patient's wishes. The nurse suggests that the patient's provider may need to discuss the treatment plan with the family. The unit manager states he will arrange a discussion with the patient's provider and ask the nurse to support the provider's decisions. What is the role of the nurse in this situation?
Follower
The NQF provides a model for advancement of healthcare quality that could be used in healthcare organizations. What does the use of this model by the Centers for Medicare and Medicaid Services (CMS) specificity link with adverse patient events for healthcare facilities?
Funding
As a manager in a new nursing home, where might you consult for guidance and evidence to support the development of safe patient practices?
Hospitals
The risk manager informs the nurse manager of an orthopedic unit that her unit has had an increase in incident reports related to patients falling during the 11-7 shift. The nurse manager knows that the first way to resolve the problem is to:
Identify the problem.
The nurse manager wants to increase motivation by providing motivating factors for the nurse on the unit. What action would be appropriate to motivate the staff?
Implement a model of shared governance.
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?
Incorrect problem identification
As a nurse manager on a surgery unit, you are interested in increasing patient safety and reducing morbidity and mortality on your unit. What recommendations would be consistent with the IOM The Future of Nursing report?
Increase in the percentage of baccalaureate-prepared nurses to 80%
Mary, an 85-year-old patient with cognitive impairment and gross instability, wanders continuously. Lately, she has fallen twice, and the family demands that she be restrained. As the unit manager, you have initiated a least restraint practice. What is an appropriate action in this situation?
Initiating a multidisciplinary and family meeting to focus on Mary's needs
A nurse on your inpatient psychiatric unit is found to have made sexually explicit remarks toward a patient with a previous history of sexual abuse. The patient sues, claiming malpractice. What conditions do not apply in this situation and do not support malpractice?
Injury
As the manager on an acute care medical unit, you note that the incidence of medication errors has increased since the implementation of staffing changes. What is an important strategy to reduce errors?
Involve RN staff in determining reasons for errors and practice solutions to increase the safety of medication administration.
Which of the following nurses is MOST likely to inspire others to do their best?
Jim, RN, has been involved in nursing for several years and is well liked by patients and families. He continually searches for new knowledge and skills, and his sense of humor and optimism are infectious.
The manager calls the staff together to assess a situation in which the family of a seriously ill patient is anxious and is absorbing a great deal of staff time in consultation, discussion, and questioning of treatment decisions. Staff members are becoming distanced from the family. After inviting the concerns of staff, the manager explains that the organization values patient-centered care and that evidence supports that acting as an advocate and a listener is helpful to families. The manager asks the staff for ideas and strategies that are effectively patient-centered in dealing with families in similar situations. What is the role of the nurse manager in this situation?
Leadership
The adage "leaders are born and not made" reflects which of the following ideas around leadership?
Leadership is a natural skill that cannot be refined or developed.
An individual in a wheelchair is applying for the position of receptionist in an outpatient clinic. What does the nurse manager understand based on The Americans with Disabilities Act of 1990 requirements for employers?
Make reasonable accommodations for persons who are disabled.
Chart audits have revealed significant omissions of data that could have legal and financial guideline ramifications. The unit manager meets with the staff to discuss audit findings and to find approaches that will address the gaps in charting and achieve desired goals. What is the manager demonstrating?
Management
Budgeting and protection of revenues is a function of:
Management.
A family is keeping vigil at a critically ill patient's bedside. Distant family members call the unit continuously asking for updates and expressing concern. The nurse speaks with the distant family members and states she is referring them to the hospital social worker, whose role is to work with family in this situation. What role is the nurse assuming through this action?
Manager
The manager in the coronary care unit believes an important ethical consideration in performance evaluations is to include the employee's good qualities and give positive direction for professional growth. What ethical principle does this represent?
Nonmaleficence
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?
Optimizing model
In developing an orientation program, the hospital educator breaks essential organizational information down into chunks, which she develops as online modules. This is an application of which of Drucker's functions of management?
Organization of activities into manageable tasks
Role theory has its underpinnings in management theory. Management theories influence managers' leadership styles. Which of the following styles would a nurse manager be most likely to follow when redesigning the staffing schedule?
Participative.
A staff nurse in the area that you manage has excelled in the delivery of patient education. You are considering implementing a new job description that would broaden her opportunity to teach patients and orient new staff members to the value of patient education. What ethical principle is being reinforced?
Paternalism
A nurse manager is implementing strategies to support the steps in the AHRQ document "Five Steps to Safer Health Care." What does the manager include in the implementation?
Patients are actively encouraged to make decisions related to care.
In a telehealth organization, a nurse who is licensed in New York and Pennsylvania provides teaching to a patient who resides in Pennsylvania. The patient charges that the teaching failed to provide significant information about a potential side effect, which led to delay in seeking treatment and untoward harm. Under which state nurse practice act and standards would this situation be considered?
Pennsylvania
Jane, an experienced charge 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 and 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?
Post a blank schedule, and ask staff members to fill in their times by a given date.
A staff nurse, who was fired for reporting patient abuse to the appropriate state agency, files a whistleblower lawsuit against the former employer. What reason would the court provide to uphold a valid whistleblower suit claiming retaliation by the nurse?
Previously reported the complaint, in writing, to hospital administration
As a charge nurse, you counsel your RN staff member that they had their duty of care by notifying a child's physician regarding concerns about deterioration in the child's status at 3:30 am. The physician did not come in to assess the child and did not provide additional orders. The child died at 6:30 am. As the charge nurse, you could be held liable for what?
Professional negligence
Sarah is a second-year nursing student. The clinical instructor overhears Sarah telling a patient that she "always" checks patients' bracelets before giving medication and she is not sure how the nurses on the unit "get away with" not making more errors than they do. The clinical instructor pulls Sarah aside and explores with her how her communication might affect the patient and what it reflects about her beliefs related to the team. In what organization is this action outlined?
QSEN
As a nurse manager on a urology unit, you note that there has been a marked increase in medication errors on the unit. Which of the following actions would be consistent with the National Database of Nursing Quality Indicators (NDNQI) measures?
Recent changes in staffing mixes are examined to determine if the timing of changes coincides with the increase in errors.
A charge nurse on a busy 40-bed medical/surgical unit is approached by a family member who begins to complain loudly about the quality of care his mother is receiving. His behavior is so disruptive that it is overheard by staff, physicians, and other visitors. The family member leaves the unit abruptly, and the nurse is left feeling frustrated. Which behavior by the charge nurse best illustrates refined leadership skills in an emotionally intelligent practitioner?
Reflect to gain insight into how the situation could be handled differently in the future
What facilitate the development of decision-making skills related to safe patient care for a nurse manager?
Regular reflection on decisions.
A dispute arises between an RN and an LVN over a patient issue. The tension continues between the two and begins to affect other staff members, who are drawn into the conflict. Over time, the team becomes polarized toward either the RN or the LPN. How might this situation be prevented?
Responding to the initial dispute, once it became apparent that it could not be resolved by the two parties themselves
A local hospital has amended its safety practices and policies. What has the hospital elected to emphasize accordance with changes by The Joint Commission (TJC)?
Safety goals specific to the hospital.
According to the complexity theory, which of the following should be the focus of measurement?
Staff morale and budgets
A client requires an appendectomy. The surgeon explains the procedure and asks the client to sign the consent. The patient speaks very little English and looks worried. What is the appropriate action by the nurse?
Suggest that an interpreter explain the procedure to the client and answer any questions.
What would be the primary emphasis in designing and implementing a quality, safe healthcare environment?
The Patient
A nurse executive is hired to restore a unit's productivity, which has decreased as the result of low staff morale. The nurse executive should utilize which of the following leadership principles?
The leader declares the intent and goals to enhance productivity and assumes that the unit also wishes to increase productivity, which allows nurses to feel in control of the environment
The nurse is educating older adult patients on staying safe in the healthcare system. What information does the nurse include in the teaching?
The need to understand and record all medications being taken.
You overhear a new graduate RN telling a nurse colleague that leadership and management belong to the unit manager, not to her. As a nursing colleague, what do you know to be true in regard to the statement?
The new graduate would benefit from further understanding of her role as a professional, whose influence may affect the decision making of patients, colleagues, and other professionals
The director of nursing has been observing staff interactions in a 20-bed coronary care unit. Based on her observations, which of the following staff members is an obvious leader?
The staff nurse who persuades other staff members to practice by making evidence-based decisions
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?
The task and the outcome are relatively simple and defined.
While interviewing for a nurse manager position, Ann is asked to give an example of a situation in which she demonstrated leadership. Which of the following examples exemplifies leadership?
Through research and investigation of best practice and practice-based evidence, she proposed a change in the management of incontinence in older adult patients.
Kari, a charge nurse on the dialysis unit, has been informed during budget planning meetings that budget cuts are likely. She discusses this at the next unit meeting and tells staff members that unless they do their jobs well, their positions may be terminated, and there will be no replacement. Kari is enacting which management style?
Transactional
As the head of a nursing program, you consistently invite the ideas of your team about innovations in teaching, community partnerships, and curriculum design and invite participation in decisions. Many of these ideas have been implemented successfully, and your staff members are keen to try on other ideas. What is the leadership you are employing?
Transformational
The parents of a toddler who dies after being brought to the ER launch a lawsuit, claiming that the failure of nurses to pursue concerns related to their son's deteriorating condition contributed to his death. How is senior nurse executive or the hospital named in the suit?
Under the doctrine of respondeat superior
On a surgery unit, you want to institute a new system for checking armbands that evidence suggests may increase safety in medication administration. The system involves technology. What strategy may assist with rapid adoption of the technology and system?
Use early adopters among the staff as leaders and role models in implementation.
After being interviewed for the unit manager position, the staff nurse reflects on the interview process. The staff nurse is aware that leadership begins:
Within.
A unit manager of a 25-bed medical/surgical area receives a phone call from a nurse who has called in sick five times in the past month. He tells the manager that he very much wants to come to work when scheduled but must often care for his wife, who is undergoing treatment for breast cancer. According to Maslow's need hierarchy theory, what would be the best approach to satisfying the needs of this nurse, other staff, and patients?
Work with the nurse, staffing office, and other nurses to arrange his scheduled days off around his wife's treatments.
The nurse manager has been asked to implement an evidence-based approach to teach ostomy patients self-management skills postoperatively. The program is to be implemented across the entire facility. What illustrates effective leadership in this situation?
a. An RN who is already familiar with the new approach of volunteers to take the lead in mentoring and teaching others how to implement it.
Which patients would be considered "at risk" consumers during a healthcare visit? (Select all that apply.)
a. Clyde requires an anticoagulant. He tells the nurse about his medications. He does not include an herbal supplement. b. Sarah is a new parent who finds that nurses on the children's unit are very helpful. She is eager to accept all suggestions, including those that she does not yet understand. c. Claude is booked for bowel surgery. His doctor explains about the colostomy. Later, Claude tells his wife that he really doesn't know what the doctor meant by colostomy.
A nurse manager is discussing with unit staff the repeated lack of staff compliance in documenting exercise activity for post-cardiac surgery clients. The unit's licensed practical/vocational nurses are responsible for ensuring that clients carry out the prescribed exercise regimen and that the activity is documented. Identify appropriate functions for the nurse manager to use when addressing this situation:
a. Divide the necessary activities into manageable tasks, so clients adhere to the exercise regimen. b. Establish objectives and goals for each area and decide who is accountable for them. c. Engage in activities that motivate the team and communicate effectively with the responsible staff members. d. Analyze, appraise, and interpret the performance of responsible staff, and communicate these findings to staff management.
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. All listed are appropriate to consider.
One of your staff nurses asks for your advice because a patient refuses to sign a consent for surgery. The patient says that he won't sign because he doesn't understand the nature of the surgery. You advise that: (Select all that apply.)
a. consent must not be coerced. b. the patient has a right to choose not to consent. c. witnessing a consent is related only to the voluntary nature of the signature.
As a senior executive, you are keen to develop your hospital as a learning organization. Part of your purpose in translating this vision into practice is to:
a. develop leaders. b. maintain and/or improve quality of care. c. stay abreast of new knowledge and evidence.
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.
With regard to nursing practice, nurse managers are held responsible for: (Select all that apply.)
a. practicing within legal guidelines established under state law and nurse practice acts. ensuring that nursing staff under their supervision are currently licensed to practice.
To solve a problem, the nurse manager understands that the most important problem-solving step is:
accurate identification of the problem.
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:
assess the risk to the client and the agency before proceeding.
A new charge nurse on a unit has been the subject of a great deal of discussion and complaining during breaks. She is a competent nurse of tremendous integrity with approximately 30 years' experience. Her predominant method of problem solving and communication is through meetings, which can go over the allotted time. The staff may:
be presenting different generational values and attitudes than the head nurse.
A nurse manager's responsibility for financial management involves making budgetary decisions. Budgets that allow the nurse manager to allocate resources at the unit level allow:
budgetary decision making at the point-of-service (POS).
You volunteer at a free community clinic. A 13-year-old girl presents with chlamydia. The team leader at the clinic advises that:
care can be provided as long as consent is voluntary and information about treatment and options is provided.
Decision making is described by the nursing educator as the process one uses to:
choose between alternatives
A colleague asks you to give her your password access so that she can view her partner's healthcare record without using her login. This request violates the patient's right to:
confidentiality.
The hospital administrator approves a case management position for a new rehabilitation unit to help reduce costs. In developing the job description, the nurse manager understands that a key element of case management is:
coordination of resources for effective outcomes.
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:
crisis situations.
One means of ensuring that the nurses floated to other patient care areas in healthcare organizations are qualified to work in the areas they are floated is:
cross educating staff members to other areas of the institution
Select the statement that best defines the difference between problem solving and decision making:
decision making is a goal-directed effort; problem solving is focused on solving an immediate problem.
A manager who is concerned with ensuring that patients on her surgical unit have the necessary information to make informed choices is:
demonstrating respect for patient rights
Nurses on Unit 17 complain that their manager frequently "checks up on them" and encourages little involvement in decision making and yet, during performance reviews, praises them for their outstanding performance. Nurses on Unit 18 indicate that their experience is different from that of nurses on Unit 17. The manager on Unit 18 encourages active involvement in decision making and provides authentic, growth-promoting feedback. The practices on Units 17 and 18 reflect.
differences in the managers' expectations of their role.
While walking past a patient's room, you overhear one of the RN staff telling a patient that the patient has no right to refuse chemotherapy treatment because the family and the doctor think the treatment is the best option for the patient. This patient is 40 years of age and alert. When you meet later to discuss what you heard with the RN, it is important to:
discuss that statute law provides for patient autonomy and refusal of treatment.
To reduce the incidence of falls in a skilled nursing unit, the nurse manager contacts the risk manager. Risk management is a process that attempts to identify potential hazards and:
eliminate these risks before anyone else is harmed
John is interested in leadership positions within his nursing organization. Although he has been on the same unit for 10 years, he has attended two workshops during that time and has steadfastly refused opportunities to engage in leadership development opportunities or other learning offered as part of the hospital's succession planning strategy. He says that he is interested in a leadership role primarily because it will give him a more stable work schedule and will enable him to spend more time with his family. In coaching John, it would be important to:
encourage him to seek out new experiences and learning that will complement his existing strengths derived from experience and his interest in work-life balance.
After the nurses who work on an adolescent psychiatric unit have had a brainstorming session, they are ready to resolve the problem of unmanageable teenage patients. To maximize group effectiveness in decision making and problem solving, the nurse manager has:
encouraged equal participation among members.
As a nurse manager, you embrace the usefulness of resources such as Smart Bed. This behavior is important to:
encouragement of staff utilization of technology.
A nurse manager is experiencing considerable conflict among staff members because of weekend staffing coverage. During a called staff meeting, the nurse manager asks the disgruntled staff to meet as a group and determine the best staffing practices. In doing this, the nurse manager is using the concept of collaboration to:
focus all energies of staff members on a best possible strategy.
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:
generate as many solutions as possible.
The nurse manager is anticipating changes on the unit because of managed care. It is up to the manager to "sell" the staff on this care concept. A goal of managed care that the staff must understand is that managed care is:
grounded in business theory.
From the information supplied in this chapter, which statement best defines critical thinking? Critical thinking is a:
high-level cognitive process that includes creativity, problem solving, and decision making.
As a nurse manager, you identify that a shift in nursing care models might increase patient and staff satisfaction and avoid downsizing. Administration is reluctant to adopt this approach because downsizing is seen as critical to reduction of costs. To leverage your ideas, you:
identify influential members of your nurse manager group with similar ideas and request an opportunity to meet with administration to discuss options.
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:
identify the root causes of problems.
The agency in which you are a nursing leader makes a decision to reduce the number of RN positions in favor of LVN positions because agency data suggest that the clients in the agency can receive appropriate care from LVNs. Furthermore, the agency is facing a decline in funding, and without restructuring some clients might not receive services at all. You provide this information on this decision to the staff and ask them to advise you if they have any feedback, concerns, or alternative solutions. This decision-making style is known as:
informed
The nurse manager of a rehab unit wants to purchase a new antiembolic stocking for use with patients. To make a high-quality decision, the nurse manager would:
involve the rehab staff in the decision.
Susan, a new graduate on the dialysis unit, appears to take Kari's remarks (Kari is the unit manager) very seriously and works even harder, often volunteering for extra assignments. She also is often in Kari's office, advising of successes with her patients and of the extra effort that she is committing. This behavior suggests that Susan:
knows how to "play the game."
A nurse manager in a hospital is deeply concerned that senior administration makes decisions about budgetary directions that affect staffing and other resources without sharing the rationale for changes or demonstrating concern as to how these changes may affect patients or staff. She says she does not feel respected and is emotionally tired as a result. This situation represents:
lack of engagement by administration.
To retain supervisory staff members, the director of nursing develops a mentoring program. The best person to be a mentor for a new supervisor in a leadership position is someone who has:
leadership experience and time to spend communicating with the new supervisor about his or her experiences
During a discussion of concern about approaches used with aggressive patients in the Emergency Department, several staff members express concerns for their safety. As a leader, the nurse manager should:
look directly at speakers and acknowledge their comments.
During a staff shortage, you hire an RN from a temporary agency. The RN administers a wrong IV medication that results in cardiac arrest and a difficult recovery for the patient. Liability in this situation:
may depend on the patient's belief regarding the employment relationship
During the review of back injuries, it is determined that a large number of injuries are occurring in spite of mechanical lifts being used. Furthermore, it is determined that some lifts are outdated. In addressing this concern, the unit manager:
meets individually with nurses who are observed to be using the lifts incorrectly to review the correct procedure.
High-quality decisions are most likely to be made in nursing situations when:
members are actively involved.
A member of a patient's family calls the nurse manager of the palliative care unit to express concern that a member of the family, who died on the weekend, had requested analgesics from the RNs on duty. An RN came with the analgesic nearly 45 minutes later, just after the patient had died. The manager is aware that the unit was especially busy that weekend because many patients were seriously ill, staff had called in ill, and the staffing manager was unable to completely replace staff who were absent. The manager is deeply troubled that the patient had to die in pain because it violates what she knows should have been done. This manager is experiencing:
moral distress.
A group of managers is meeting to discuss ideas related to the successful implementation of evidence-based practice on their units. Susan has been asked by the director of care to assume leadership of these discussion groups. After two such sessions, Susan expresses disappointment to her mentor that the group seems disinterested in her ideas and that they are listening to Ken, who has much less experience with leadership. In discussing this with Susan, the mentor understands that leadership:
must be earned.
A long-term care facility has experienced numerous difficulties with staff relationships, despite its success in maintaining financial viability and judicious use of resources. Staff members complain that the primary concerns of the facility include applying policy, saving money, and ensuring that lawsuits are avoided. There is little trust in, and involvement of, staff members. This facility may be:
overly managed and not well led.
The senior executive praises John for the positive patient evaluations that his unit has received. As an effective leader, John:
points out the contributions of his staff to the outcomes and shares the praise with his staff.
Mr. Marrow complains to you that one of your staff asked him details about his sexual relationships and financial affairs. He says that these questions were probing and unnecessary to his care, but he felt that if he refused to answer, the nurse would be angry with him and would not provide him with good care. Mr. M.'s statements reflect concern with:
privacy
The successful integration of informatics into healthcare settings is key to:
quality decision making related to management of resources and patient care.
The nurse manager in the Emergency Department needs to implement new staffing patterns. As a transformational leader, the nurse manager would:
reinforce how this change will respond to the ideas and solutions generated by staff members.
In a rural hospital, the unit for which you are a 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 unlicensed assistant is available to assist. You must decide which patient situation you will take and where the new graduate 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:
satisficing.
The nurse manager, as the leader of the unit's "customer (client) first" initiative, has asked the staff nurses to develop and administer a survey to every client before discharge. In asking the staff nurses to accomplish this task, the nurse manager is demonstrating:
shared leadership.
As the clinical director of 24 employees, you have been asked to explain to staff members why they are not getting a raise this year, even though they have been working short-handed for many months and patient satisfaction scores have never been higher. Because you believe yourself to be a transformational leader, you will approach this problem by:
showing staff members the budget and asking for input about how to cut costs so that raises will be possible in the future.
The style of leadership that Kari is exhibiting is likely to:
stifle innovative thinking about ways to move out of financial jeopardy
Becky graduated 5 years ago and is keenly interested in pursuing leadership opportunities. She has been active in learning about leadership through workshops and Internet research, and recently began a graduate degree program with a focus on nursing administration. She has excellent clinical skills and eagerly accepts responsibility for various projects on the unit. Her sarcastic and sometimes aggressive behavior tends to alienate other staff members on the unit. In coaching Becky, you:
suggest that she reflect on situations in which she has had a positive influence and consider how her interactions contributed to the situation.
To satisfy duty of care to a patient, a nurse manager is legally responsible for all of the following except:
supervising the practice of the physician.
While explaining the importance of developing leadership skills among nurses to a group of first-year nursing students, Natalie, a nursing unit manager, emphasizes that:
the public depends on nurses to assume leadership in moving consumer advocacy concerns forward.
In working with Cheryl, her mentor suggests that it is really important for Cheryl to engage in self-appraisal and to know her strengths. This observation is based on an understanding that:
there is little external motivation and affirmation in leadership.
A nurse executive who considers herself a Baby Boomer will have the challenge of convincing the emerging work force of the necessity of committee meetings. One of the primary reasons that the Baby Boom generation appears to have so many meetings in the work environment is that:
they find that the journey to the solution is as important as the solution itself.
After a newly hired director of nursing has reviewed the hospital's strategic plans, she develops a time line for achieving those plans. The new leader is:
translating a global document into realistic plans for nursing.
Nurses in the CCU are unhappy and frustrated with their nurse manager. They complain that "nothing is ever good enough for him." These statements suggest that the nurse manager's goals may be:
unrealistic.
An outpatient surgery manager is evaluating new infusion pumps for purchase to use in the operating room. The manager should:
use a decision-making tool to evaluate brands.
A good nursing decision maker is one who:
uses various models to guide the process based on the circumstances of the situation.
