Leadership Final Exam Review

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Which of the following indicates safe delegation?

A unit manager agrees to release a staff from her unit to Unit B. The staff member she agrees to release is experienced on Unit B and is agreeable to the change. The unit manager's unit is fully staffed and patients are stable. When span of control (number of individuals for whom a manager is responsible) is compromised by geographic factors such as lack of proximity, instability in patients' conditions, or lack of experience, the span of control that is being delegated may lead to unsafe care.

Which of the following would be most effective in implementing the findings to staff nurses regarding a new clinical treatment for an identified problem?

An interactive in-service for the nurses that involves discussion of sample case studies and application of evidence Current research suggests that translation of research into practice is best facilitated through interactive learning such as workshops. Least effective strategies included didactic learning and distribution of learning materials.

Nurses generally experience difficulty in identifying behaviors and actions that could signal chemical dependency in a co-worker. Which of the following is not a behavioral change that occurs with chemical dependency?

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

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

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

The definition of follower has historically referred to a person who is subservient and submissive. The new principles of followership offer a different perspective. What is NOT considered an attribute of followership in nursing?

No influence over leaders A followership in nursing does have influence over the leaders in an organization. The followers are an integral part of the healthcare team in nursing and provide support, patient care, critical thinking, and decision-making skills.

During an interview for a manager's position, you find the supervisor and staff unfriendly. Responses to questions are met with vague responses. After the interview, you decide not to pursue the position. What follow-up, if any, is most appropriate?

You should send a thank-you note to the interviewer, indicating appreciation for her time. Even if you are disinterested in the position or think that the interview has gone badly, an appropriate follow-up is a thank-you note to the interviewer. This recommended follow-up creates a positive impression and may leave open the possibility of future interactions.

The nurse on the 7-7 shift is assigning a specific component of care to an unlicensed nursing personnel (UNP) employee. The night nurse would remain:

accountable. When a registered nurse delegates care to a UNP, responsibility is transferred; however, accountability for patient care is not transferred. Thus, "accountability rests within the decision to delegate while responsibility rests within the performance of the task" (Anthony and Vidal, 2010, p. 3).

To effectively delegate in a team nursing environment, the RN team leader must be familiar with the legal and organizational roles of each group of personnel and must:

be able to adapt to daily changes in staffing. A particular challenge in team nursing is that staff mixes and staff may change daily because of individual schedules and shortages.Team nursing delivers care to a small group of patients, using a mix of licensed and unlicensed personnel. Team nursing uses the strengths of each caregiver.

Decision making is described by the nursing educator as the process one uses to:

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

A new manager can avoid role straining by doing with of the following?

clarifying nurse executive expectations of manage role Clarification of implicit and explicit expectations regarding the role assists in avoiding role ambiguity and role strain.

As the unit manager, you spend a day performing direct patient care and work with a new system that is designed to capture patient documentation at the bedside. During discussions with staff while giving care, you discover that the number of screens that need to be opened during documentation makes charting more complex and time consuming than traditional manual charting approaches. On the basis of this feedback, you:

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

Which of the following provides systematic learning opportunities that augment (aids) existing skills and knowledge for delivery of quality care and advancement of career goals.

continuing education. Continuing education provides systematic learning opportunities that augment existing skills and knowledge for delivery of quality care and advancement of career goals. Graduate and certification courses provide advanced knowledge and skills.

In determining the fit of a candidate with the culture on your unit, which of the following interview questions might be asked?

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

Which of the following interview questions would be best to ask when determining if a candidate is an appropriate fit for the unit's culture?

"We have a number of patients with dementia on this unit. If you noticed healthcare professional speaking one of these patients harshly, what would you do?" The nurse manager wants the most qualified individual for the position who also fits the culture of the organization. Asking behavioral questions in the interview allows you to assess how a candidate may function in real-life situations and to assess if this behavior is compatible with the culture on the unit.

As a unit manager, you chair the unit meetings. For each meeting, you consider and establish the purpose of the meeting. Second, you prepare an agenda. Arrange the following steps in an order that would make the meetings productive and successful. 1. Distribute an agenda. 2. Distribute minutes. 3. Select team members. 4. Start on time. 5. Keep the meeting focused and directed toward accomplishing the set objectives. Select the correct order from the following options:

3, 1, 4, 5, 2 Planning, organizing, and keeping the group on task are critical in ensuring that meetings are productive and that time is managed well.

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?

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. Followership occurs when there is acquiescence to a peer who is leading in a setting where a team has gathered to ensure the best clinical decision making, and actions are taken to achieve clinical or organizational outcomes. Followership promotes good clinical decisions and use of clinical resources.

What best describes evidence-based practice?

Applying best research evidence to care of patients Evidence-based medicine is derived from evidence-based medicine and involves integration of the best research evidence with clinical expertise and the patient's unique values and circumstances in making decisions about the care of individual patients. It is focused on searching for, appraising, and synthesizing the best evidence to address a specific clinical practice problem.

Factors that influence the ease with which conflict is resolved include all except which of the following?

Avoidance of the issue or concern Conflict involves a level of interdependence and is a condition for conflict but not necessarily for continuance of the conflict. Expression of one's ideas and concerns is considered assertive and effective in resolving conflict if the concerns and needs of the other are also considered. Interprofessional collaboration has been shown to be effective in resolving conflict. Avoidance tends to prolong and sometimes escalate conflict.

A nurse manager is planning to request three new infusion pumps at a cost of approximately $1500 each. What would BEST support the capital request?

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

What is the first step to gather evidence for guiding practice?

Develop the clinical question. Identifying the question may be the most challenging part of the process. Once the clinical question has been identified, writing it down will help in moving on to the next step of gathering evidence.

The nurse manager is working with a group of new nurses. The new nurses ask questions about leadership and the role of a manager in leading nursing. The manager shares the desire to have engaged staff nurses who participate in a team environment. What is the manager describing?

Effective follower The manger has described the role of an effective follower on the unit. The effective follower identifies and engages and participates as member of the team to work to achieve the team goals.

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 Nurse managers have responsibility for both patient and staff safety. High-risk areas, such as the Emergency Department, require special attention.

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 Fidelity refers to promise keeping or upholding one's promise to practice as a reasonable and prudent nurse would do and in an ethically competent manner.

Which of the following might best conclude an interview?

Inform the interview of when and how the decision will be made An employment interview should always conclude with information as to how and when follow-up to the interview will occur.

High levels of work-related stress affect all but which of the following? (Select all that apply.)

Job satisfaction Absenteeism and turnover Nurses' health Client welfare

The charge nurse walks into Mr. Smith's room and finds him yelling at the LPN. He is obviously very upset. The charge nurse determines that he has not slept for three nights because of unrelieved pain levels. The LPN is very upset and calls Mr. Smith an "ugly, old man." The charge nurse acknowledges the LPN's feelings and concerns and then suggests that Mr. Smith's behavior was aggressive but was related to lack of sleep and to pain. The charge nurse asks, "Can you, together with Mr. Smith, determine triggers for the pain and effective approaches to controlling his pain?" This situation is an example of what?

Leadership behavior The situation between Mr. Smith and Miss Jones is a complex situation involving unrelieved patient symptoms and aggressiveness toward a staff member. Providing engaged, collaborative guidance and decision making in a complex situation where there is no standardized solution reflects leadership.

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 As a manager, you are concerned with managing and coordinating resources to achieve outcomes in accordance with established clinical processes. Referral to a social worker alleviates demand on staff time and is consistent with hospital procedures.

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 Nonmaleficence refers to "doing no harm." For a nurse manager following this principle, performance evaluation should emphasize an employee's good qualities and give positive direction for growth. Destroying the employee's self-esteem and self-worth would be considered doing harm under this principle.

A nurse manager approves two staff nurses to attend a national conference. When reviewing the budget, the nurse manager looks at which line item?

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

What is the primary purpose of QI programs?

Patient outcome improvement The primary purpose of QI is improvement of patient outcomes, which relates to prevention of error, quality patient care, and patient satisfaction.

The chief nursing officer is pleased with the nurse manager's strategy of improving patient satisfaction in the pediatric intensive care unit. She decides to implement these changes throughout the hospital. What would be important to consider in implementing a new program focused on improving relationships with consumers?

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

As a nurse manager, you have to be effective in managing a culturally diverse staff. Which of the following nurse manager attributes would assist you in addressing the cultural needs of your staff? (Select all that apply.)

Respecting others Understanding the importance of language Encouragement of potential in all staff Cultural competence involves knowledge of diverse cultural and ethnic groups, including knowledge of staff members and respect for others and their cultural differences.

What would be the primary emphasis in designing and implementing a quality, safe healthcare environment?

The patient Focusing on the patient moves care from concern about who controls care to a focus on what care is provided to and with patients, which was an aim identified in the IOM report Crossing the Quality Chasm.

A nurse is interviewing for a manager's position. Which of the following actions is considered a role preview?

Touring the unit Touring the unit enables the candidate to assess further whether this organization will assist in growth and also to make a positive impression on the potential employer.

Of the following, which is the most effective strategy that a nurse manager could employ to reduce unnecessary costs in specific healthcare settings?

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

To solve a problem, the nurse manager understands that the most important problem-solving step is:

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

Sarah is a nurse manager in a surgical unit. She is concerned about a conflict between Lucy (a staff nurse) and one of the maintenance personnel. Sarah explains to Lucy that unsatisfactory resolution of the conflict is typically destructive and will result in:

decreased productivity on her part. Productivity decreases with destructive conflict, whereas constructive conflict strengthens relationships.

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

A mediator suggested that the nurse manager and staff members decide on a method to resolve conflicts. It is important to have agreements about how team members will work together because:

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

Data, information, and knowledge are core concepts in:

informatics Informatics is the application of technology to all fields of nursing to facilitate and extend nurses' decision-making abilities and to support nurses in the use, storage, and linkage of clinical information to provide effective and efficient patient care. The three core concepts are data, information and knowledge.

A nurse staffing plan takes into account:

participation of nurses in projecting staffing needs. Nurse staffing plans employ nursing judgment and flexibility that is based on acuity, nurse experience, and unit configuration rather than set nurse-to-patient ratios. The American Nurses Association has opted to support the nurse staffing committee as the approach to ensure safe staffing. In 2013, national legislation was introduced that requires all acute care hospitals to establish a committee made up of 55% direct care RNs.

A résumé does which of the following?

reflects your skills, knowledge, and background in relation to a specific position. A résumé is a short, customized overview of your professional life that relates to the qualifications of specific positions and how you are able to match your background to the qualifications that are desired. Provision of contact information is common to both the résumé and the CV. Résumés are more effective if details of particular positions that have been held are highlighted as compared with a detailed listing of positions held.

The education consultant for the hospital is presenting a workshop titled "Documentation: A Manager's Responsibility." Which of the following points would she not include in her PowerPoint presentation? Documentation:

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

Certification is designed to recognize:

special knowledge beyond basic licensure. Certification is an expectation in some settings for career advancement in advanced practice or in specialized areas and goes beyond basic preparation.

To maintain a positive relationship with your former organization and colleagues, a nurse should do which of the following?

submit a well-written letter of resignation A well-written resignation letter outlines your intent to leave the organization and your appreciation of the organization but should follow an initial meeting with your manager to first discuss your intention. A well-written letter maintains a positive relationship with the organization.

To prepare staffing schedules, a nurse manager needs to calculate paid non-productive time. When calculating paid non-productive time, the nurse manager considers:

vacation time, holiday time, and sick time. Non-productive hours are hours of benefit time and include vacation, holiday, and personal or sick time.

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage. Sarah finds a mentor, Amy, who has been in the role of unit manager for 3 years and has a similar interest in clinical excellence. During their frequent meetings, Amy provides assistance with learning aspects of the manager's role, including technical aspects, such as how to interpret budget printouts and to achieve budget outcomes. The success of Amy's coaching depends on:

willingness of Sarah to receive feedback. Coaching provides information about how to improve performance and learning aspects of the role. Coaching requires willingness on the part of the mentee to accept feedback.Counseling provides opportunity for the mentee to share personal concerns. For counseling to be successful, confidentiality must be assured.

As a manager, you are interested in developing behavioral questions for an interview. Which of the following questions would satisfy your interest in behavioral questions?

"Tell me about a time you worked in a team. What was your role in the team? What was the result of the team effort?" Behavioral questions seek demonstrated examples of behavior from the candidate's past experiences; behavioral-based interviewing can be a strong predictor of a future employee.

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 loss. Visioning involves engaging with others to assess the current reality, specify the end point, and then strategize to reduce differences. This requires trusting relationships that acknowledge the differences in values and ideas. When done well, the nurse manager and the nurses within a unit experience creative tension that inspires working in concert to achieve desired goals.

The nurse manager analyzes the data from the patient satisfaction surveys. What can a nurse manager do to strengthen service recovery and improve consumer relationships?

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

Which of the following factors is not implicated in rising healthcare costs?

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

Sue, a nurse manager, discusses her concerns about the hospital's employee appraisal system with her work group, noting that it includes only one rating scale and that it means nothing unless the manager has effective relationship skills. Sue's concerns reflect which best practices associated with performance appraisal?

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

A nurse manager uses many sources of data when planning the unit's workload for the year. Which of the following data must be considered in the planning?

Trends in acuity on the unit Acuity levels are determined through classification systems, which determine the nursing resources required.

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

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

The team is providing emergency care to a client who recieved an excessive dose of opioid pain medication. Which task is best to assign to the LPN.LVN?

applying oxygen per nasal cannula as ordered The LPN/LVN is well trained to administer oxygen per nasal cannula. This client is considered unstable: thereforee, the RN should take responsibiltiy for administering drugs and monistoring the response to therapy, which includes the effects on the respiratory system. The RN should also take responsibility to communicate with the HCP for ongoing treatment and therapy.

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

assignment. When an RN assigns care to another RN, it is termed an assignment and not delegation, because both accountability and responsibility are transferred.

A nurse educator is giving a workshop on conflict. During the sessions, he makes various statements regarding conflict. All of the statements are true except:

conflict can decrease creativity, thus acting as a deterrent for the development of new ideas. The opposite is true because research has shown that conflict, like change, increases creativity and allows for the development of new ideas.

To reduce reliance on overtime hours, an organization develops a strategy for floating nurses during staff shortages. To maximize patient safety and reduce costs, the healthcare organization:

develops a centralized pool of float nurses. A centralized pool usually includes experienced nurses who maintain a broad range of competencies. Other approaches are less satisfying for nurses, are less efficient, and may be less safe.

All of the following are grounds for immediate dismissal except:

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

The biggest challenge in the recruitment of staff is:

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

After using a mediator to resolve a conflict between the nurse manager and two staff nurses, the chief nursing officer decides to:

observe to make sure the conflict has been resolved. The nurse leader should follow up to determine if the conflict has been resolved because, in professional practice environments, unresolved conflict among nurses is a significant issue that results in job dissatisfaction, absenteeism, and turnover, as well as in decreased patient satisfaction and poorer quality in patient care.

Two staff nurses are arguing about whose turn it is to work on the upcoming holiday. In trying to resolve this conflict, the nurse manager understands that interpersonal conflict arises when:

people see events differently. By definition, conflict involves a difference in perception between two or more individuals.

To maintain patient safety, studies suggest that scheduling should avoid:

rotating shifts. Rotating shifts and overtime past 12 hours (mandatory or not) are being shown to increase nurse error and jeopardize patient safety.

In a job interview for a staff position, which of the following indicates your knowledge of patient safety?

"Is there a strategy in place to reduce the number of overtime hours on the unit?" Overtime, whether voluntary or mandatory, to fill staff vacancies is seen as a risk to both patients and nurses because it is more likely to lead to compromised decision making and technical skills because of fatigue.

Clinical incompetence is one of the more serious problems facing a nurse manager. Joyce, the nurse manager, is not aware of the problems of Sarah, a novice nurse. After she investigates, it is obvious that Sarah's peers are covering for her. Which of the following might Joyce include in her meeting with the nurses? (Select all that apply.)

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

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

As a manager, you are interested in developing behavioral questions for an interview. Knowing that there is team conflict at times on your unit, which of the following questions would satisfy your interest in behavioral questions?

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

Sarah, RN, is one of your most enthusiastic staff members and has been to a workshop on preparing educational materials for patients. On the basis of this workshop, she would like to develop an information website for patients who are being admitted to the ward. An appropriate response to Sarah's suggestion would be:

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

The American Nurses Association has advocated for the Registered Nurse Safe Staffing Act. This legislation is based on ANA Safe Staffing Principles and takes what factors into consideration for planning staffing on a nursing unit?

All factors listed are to be considered ANA has opted to support the nurse staffing committee as the approach to ensure safe staffing. For the last decade, the ANA has advocated for a Registered Nurse Safe Staffing Act. The legislation is based upon the ANA Safe Staffing Principles (Box 13-2) and considers the following:RN educational preparation, professional certification, and level of clinical experience The number and capacity of available healthcare personnel Geography of the unit Available technology Intensity, complexity, and stability of patients

Which of the following would not be a characteristic of an effective team nurse leader?

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

A new graduate nurse has accepted a position in an intensive care unit. The nurse is assigned a preceptor with several years of experience. The new nurse also notices the other staff seek this nurse out for answers to questions and as a resource to the unit. What does the new nurse consider the role of the mentor nurse?

An informal leader Formal leaders, positional leaders, and official leaders hold positions of leadership or titles. In this scenario, the nurse is the formal leader of the unit. The nurse is noted to be an informal leader is one who does not hold an actual leadership title, but leads from an informal position based on experience and behavior.

Which of the following exemplifies the predominant conflict management style of nurse managers?

Ann, RN, asks her head nurse if she can go on the permanent evening shift. The head nurse, Rajib, agrees, as long as Ann agrees to be involved in assisting to mentor evening staff in the use of the new clinical information system. Compromise involves trading and negotiation and is the predominant conflict management style of managers.

The chief nursing officer at a local hospital seeking Magnet® status creates staff development classes concerning translation of research into practice (TRIP). What best describes TRIP?

Applying strategies that aid in adoption of research in practice The science of how research is adopted is known as translation science, the science of translating research into practice (TRIP). The primary aim of research utilization is to activate the change process to move research findings into practice to improve patient outcomes.The National Institutes of Health identified translational research or getting research into the hands of practitioners to improve patient care, as a priority.

Based on data from the patient satisfaction survey, the nurse manager decides that a change should be made in communication with family members. What would be important for a nurse manager to consider when instituting a change to improve customer service?

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

The day shift nurse asks an LPN/LVN to complete a task for a patient. The day shift nurse is engaging in what function?

Assigning Delegation refers to transfer of responsibility for work; the day shift nurse retains accountability for the outcomes of patient care therefore is using assigning of the task rather than delegation.

As a nurse manager and the leader of the unit, you are aware of multiple avenues for learning leadership traits. Which avenues would you pursue for learning leadership traits? (Select all that apply.)

Attending professional conferences Reading books on leadership Joining professional organizations Connecting with other leaders in the organization We can learn leadership through multiple avenues. For example, attending professional association meetings, reading, and connecting with others at a local, state, or national level allow us to learn from others about their development as a leader.

Incivility is a disruptive behavior or communication that creates a negative environment and interferes with quality patient care and safety. The manager can implement the following steps that help to alleviate uncivil behavior on a unit. (A) Suspending the staff member from work, (B) Providing written admonishment that is discussed and placed in the employee's file, (C) Providing verbal admonishment, (D) Terminating the staff member

C, B, A, D The steps in progressive discipline are followed from the least severe (counseling the employee) to the most severe (termination). Studies have shown that following this sequence provides a fair and effective plan for discipline and remediation.

A nurse manager is planning to request three new infusion pumps at a cost of approximately $1500 each. This item would typically be included in which budget?

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

During times of nursing shortages and increased nursing costs in health care, which of the following nursing care delivery models might come under greatest scrutiny?

Case method The case method may involve total patient care provided by a registered nurse, which, in today's costly healthcare economy, is very expensive. In times of nursing shortages, there may not be enough resources or nurses to use this model.This model is especially useful in the care of complex patients who need active symptom management provided by an RN, such as the care of the patient in a hospice setting or an intensive care unit. This method would be justifiable delivery in the pediatric intensive care unit, where the status of patients can change rapidly and where complex functions of care involve both patients and families.

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

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

Jill is the head nurse on a unit in a large hospital. Two of the staff nurses are constantly arguing and blaming each other, and a resolution has not occurred in months. To solve the existing conflict, which is the most creative conflict resolution?

Collaborating Collaboration, although time consuming, is the most creative stance. The collaboration technique involves both sides in the conflict working together to develop an optimal outcome. This results in a win-win solution.

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

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

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 Stepping outside oneself to envision the situation while assuming ownership is a component of emotional intelligence. This is an example of self-awareness to identify the resolve to self-conflict in this situation.

After several months of heavy patient loads in the Emergency Department and inability to secure sufficient and experienced staff, the department is especially taxed by a train accident that brings in many seriously injured individuals. You observe that Rama ignores the requests of several of the injured, even when time is available to care for them and is rude to two older adult patients. You are concerned that Rama is evidencing which state?

Depersonalization A characteristic of burnout is depersonalization, a state characterized by distancing oneself from the work itself and developing negative attitudes toward work in general (Greenglass et al., 2001). Depersonalization is commonly described as a feeling of being outside one's body, feeling as if one is a machine or robot, an "unreal" feeling that one is in a dream or that one "is on automatic pilot." Generally, subjective symptoms of unreality make the nurse uneasy and anxious. Nurses pushed to do too much in too little time may distance themselves from patients as a means of dealing with emotional exhaustion.

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. According to complexity theory, what principle is being engaged?

Development of networks According to complexity theory, social networks evolve around areas of common interest and are able to respond to problems in creative and novel ways.

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. Complexity theory suggests that systems interact and adapt and that decision making occurs throughout the systems, as opposed to being held in a hierarchy. In complexity theory, every voice counts, and therefore, all levels of staff would be involved in decision making.

In reviewing the job description of a nurse manager, the staff becomes aware that a nurse manager's role is complex. Which of the following duties are required of a nurse manager? (Select all that apply.)

Ensure unit productivity reports. Prepare a unit budget that reflects unit staffing needs. Monitor nurse-sensitive indicators such as falls and incidence of infections. A nurse manager manages financial resources by developing business and staffing plans.

Which of the following is the most effective method an organisation to ensuring that EBP is incorporated into nursing care?

Formation of a network of individuals doing research and/or interested in research utilization Collaboration, partnerships, and consideration of a variety of evidence appropriate to the clinical questions are important in ensuring translation of evidence into practice. Collaboration is considered particularly critical and can occur through practice-based networks.Journal clubs provide opportunities for engagement in reading research and considering how it might be applied to clinical practice problems, which is considered very effective in behavioral change.

John is an older adult patient who comes regularly to the multigroup practice in which you are a nurse practitioner. He says that he doesn't understand what he is supposed to be doing about his medications, because every time he comes to the clinic, he sees a different provider. John's experience represents what aspect of the current consumer experience?

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

A nurse manager must be familiar with the agency's policies regarding termination. Termination procedures include which of the following?

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

The nurse manager must develop a patient satisfaction survey. What is one of the critical elements in selecting a patient satisfaction instrument?

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

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

As a nurse manager on the West 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% The Future of Nursing advocates for having 80% of the nursing population at a baccalaureate-prepared level. This recommendation reflects research that suggests that improved mortality and morbidity rates occur with a better educated work force.

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 Crossing the Quality Chasm emphasizes the importance of rendering care with the client (client-centered) rather than to the client. In this situation, the patient includes family in transparent discussions about quality needs and takes a team approach that involves healthcare professionals, the family, Mary's needs, and evidence associated with safe practice.

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 By virtue of employment, the nurse owes a duty of care to the patient; this care has been breached by a nurse, who would be expected to know that this behavior violates usual standards of care. The resultant injury, the fifth malpractice element, must be physical, not merely psychological or transient. In other words, some physical harm must be incurred by the patient before malpractice will be found against the healthcare provider, which is not evident in this situation where the action did not involve physical harm.

Despite the implementation of bar-code medication administration (BCMA) on your busy medical unit, you notice that the number of medication errors has not significantly decreased. Which of the following reasons might explain the lack of change in errors?

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

A staff nurse is taking leadership classes in an advanced degree program with a goal to become a nurse manager. The nurse is studying the leader-follower relationship. What has the nurse discovered as accurate part of the leader-follower relationship?

Leaders are also followers. In the leader-follower relationship, it is important to be aware the leaders are also followers. In reality, a core part of leadership is being an effective follower as well. There is no linear structure any longer and followers have as much input in decision making as is needed based on the topic. The older days of dictatorship as leadership are antiquated and no longer valid in true leader-follower relationships.

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 As a leader, the manager is providing and communicating vision and direction based on evidence and experience. The manager is engaging others in decision making that moves them toward the vision with a reasonable level of risk taking.

A client has severe pain and bladder distention related to urinary retention and possible obstruction. An experienced unlicensed assistive personnel (UAP) states that she received training in indwelling catheter insertion at the previous job. What task can be delegated to this UAP?

Measuring the urine output after the catheter is inserted and obtaining a specimen. Measuring output and obtaining a specimen are within the scope of practice of the UAP. Insertion of the indwelling catheter in this client should be done by an experienced RN because clients with obstruction and retention are usually very difficult to catheterize, and the nurse must evaluate the pain response during the procedure. The UAP's knowledge of sterile technique or catheter insertion is not the issue.

Kala, a unit manager, in discussing a role the CEO would like her to perform, makes the following statement, "I will sit on the hospital task force on improving morale if you send me to the hospital's leadership training classes next week, so I can further develop my skills and thus be more effective." Which of the following conflict management styles is Kala using?

Negotiating Negotiation involves an exchange of concessions (membership on a committee in return for attendance at a workshop) or trading. This strategy supports a balance of power.

A nurse manager understands that the second step in handling an employee with a disciplinary problem is to document the incident. Which of the following is best for documentation of personnel problems?

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

Nurses entering the work force today are faced with which of the following relationships that could create organizational conflict? (Select all that apply.)

Nurse-physician relationship Nurse-nurse relationship Nurse-patient relationship Nurse-chief nursing officer relationship Nurse-auxiliary personnel relationships By nature, conflict is potentially present in all interpersonal situations. The nurse manager should create an environment that recognizes and values differences in staff, physicians, patients, and communities.

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 The principle of paternalism allows one person to make partial decisions for another and is most frequently deemed to be a negative or undesirable principle. Paternalism, however, may be used to assist persons to make decisions when they do not have sufficient data or expertise. Paternalism becomes undesirable when the entire decision is taken away from the employee.

A nurse belongs to several professional organizations, serving on a state-level committee of one group and on two task forces at work. The nurse is committed to a range of health issues and knows the state senator from the nurse's district, as well as the name of the representative in Washington, DC. This nurse exemplifies which of the following?

Political astuteness Political involvement/astutenss is a professional responsibility and nurses' perspectives of the critical issues for improving the healthcare system can shape the policy agenda of the nation's political leadership. This nurse exemplifies several of the skills associated with political astuteness.Collaboration refers to working with others for a common goal; while this collaboration can and does occur when working in professional organizations and committees, the example is specifically referring to being involved politically within and on behalf of the nursing profession. The same refers to power sharing and empowerment.

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. An employer is unable to fire an employee who, in good faith, reports what is believed to be a violation of a law, rule, or state or federal law.

As a charge nurse, you counsel your RN staff member that they have has their duty of care by notifying a child's physician regarding concerns about deterioration in the child's status at 0330 hours. The physician does not come in to assess the child and does not provide additional orders. The child dies at 0630 hours. As the charge nurse, you could be held liable for what?

Professional negligence Professional negligence can be asserted when there is failure to do what a reasonable and prudent nurse would do in the same situation. In this situation, the charge nurse might have advocated further for the patient in light of the evident seriousness of the child's condition.

In assisting new graduates to make the role transition to graduate nurse, Ted, the unit manager initiates which of the following?

Self-check list to assess competencies that have been strengthened Transition to the new role is facilitated through reflection and ongoing development of awareness of strengths (as compared with a focus on weaknesses) and of weaknesses. The value of the employee may not depend on quickness in making the role transition.

Which one of the following statements has been proven to be true?

Stressors that are identical do not necessarily have similar effects on each individual. Stressors may be unique to certain environments, situations, and persons or groups, and individuals may respond to the same stressor in different ways.

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. The Five Steps to Safer Patient Care identifies that encouraging patients to ask questions when there are doubts and concerns and ensuring understanding before surgery is performed are ways in which nurses can support patients in having greater influence in their own care. In this situation, asking an interpreter to help enables access to information for the patient and active assessment of his understanding.

Which of the following are considered variable costs? (Select all that apply.)

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

Incivility is a disruptive behavior or communication that creates a negative environment and interferes with quality patient care and safety. The manager can implement steps that help to alleviate uncivil behavior on a unit. Which of the following would not be an appropriate first step?

Terminating the staff member Dismissal does not enable the present organization to attempt remediation of the behavior and is not consistent with first steps in progressive discipline.

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. Care coordination that involves the intersection of individual, family, and community-based needs requires that nurses have self-confidence, knowledge of organizations and health systems, and an inner desire to lead and manage. There is often a view that leadership is isolated to those holding managerial positions, and that a direct care nurse is subject to following by adhering to the direction of others. Such views fail to acknowledge that to be a nurse requires each licensed individual to lead, manage, and follow when practicing at the point-of-care and beyond.

A nurse is participating in a baccalaureate course. For the class, she has to attend the legislative session regarding the new role of medication assistants. Why is it important for nurses to be involved in shaping public policy?

They are closest to the front line of health care and see how it affects clients and families. Nurses can no longer be passive observers of the political world. Political involvement is a professional responsibility. Nurses' perspectives of the critical issues for improving the healthcare system can shape the policy agenda of the nation's political leadership.

In trying to achieve Magnet® status, the chief nursing officer establishes a shared governance model to help nurses experience job satisfaction. However, some nurses who have enjoyed working with less autonomy resist this change and begin to criticize and make rude comments about managers who embrace this model, as well as colleagues who support it. The comments are largely ignored because those who are making them are well established nurses who are often vocal about their displeasure with the organization. Organizational conflict is arising from which of the following?

Tolerance of incivility Organizational conflict arises from discord related to policies and procedures (such as staffing policies and practices and allocation of resources), personnel codes or conduct or accepted norms of behavior (such as incivility), and patterns of communication. A major source conflict in organizations stems from strategies that promote more participation and autonomy of staff nurses.

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 Transformational leadership involves attending to the needs and motives of followers, which results in creativity, improvement, and employee development.

Which of the following activities would represent a customer-friendly approach in a healthcare setting? (Select all that apply.)

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

The turnover rate for RNs in the ICU is high. You discuss this situation with existing staff and you find out that because of the rapid turnover, new staff are frequently required to assume full responsibilities soon into the position and before training is completed. In considering approaches that will reduce turnover rates, the staff and you decide to implement:

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

Scheduling is a function of implementing the staffing plan by assigning unit personnel to work specific hours and specific days of the week. To retain nursing staff, the nurse manager must incorporate into the schedule plan:

a variety of scheduling options. Creating a flexible schedule with a variety of scheduling options that leads to work schedule stability for each employee is one mechanism likely to retain staff, which is within the control of nurse managers.

active delegation. When a position description contains functions that are considered to be the normal practice of the person in that role, then it is considered a passive delegation act. When Sarah decides what is best for the patients in her care in terms of who should perform the care and then holds the person accountable, she is engaging in active delegation.

Because of the complexity of reimbursement systems and its implications for the services available to patients, the nurse has a key role in:

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

In the past year, you have noticed an increase in patient falls on your unit. In reading studies related to staffing and patient outcomes, you realize that you will need to plan for:

an increased number of RN positions. Lower fall rates are shown to be related to higher total nursing hours and a higher percentage of nursing hours supplied by RNs.

The clinical coordinator expects the position description of the new wound care specialist to change nurses' responsibilities in caring for clients with skin integrity problems. The best approach to address this need for change, yet to have the best outcomes for clients, staff nurses, and the organization, is to:

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

The most important approach that a nurse manager can take with an emotionally troubled employee is to:

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

An RN on the dementia unit, is discussing the treatment of a patient who can be agitated and combative at bedtime. The physician orders a strong sedative to "knock the patient out". The nurse questions the order, based on her knowledge of the patient's history and of other medications that the patient has been given. The physician reiterates the order and the nurse refuses to comply. In this instance, the nurse is demonstrating:

autonomy. Participation in decision making regarding one's practice is an appropriate expectation for professional nurses, provides for greater autonomy and authority over practice decisions, contributes to supporting the professional nurse, and is a major component of job satisfaction. Autonomy is encouraged through supportive management and through unit-level support of changes without the need for complex, multilevel approval of changes that can be made locally.In this situation, the nurse is exemplifying autonomy, which is the act of making independent decisions in the best interests of the patient, based on her knowledge and experience. Key to the concept of autonomy is decision making and the level of independence that is given. Accountability refers to achievement of outcomes, and authority refers to the capacity to make decisions.

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

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

Within a healthcare environment, where the gap between revenues and costs can mean the difference between sustainability of an organization and nonsustainability of an organization or services, it is critical for nurse managers to:

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

Mr. T. Jones and Mr. R. Smith are both going to become residents in Sunny Haven Lodge. Mr. Jones views it as an opportunity to socialize and meet new friends. Mr. Smith views this as abandonment by his family and is worried that the care will be inadequate. Each senior perceives the situation differently. This is a good example of stress that is:

both a positive stressor and a negative stressor. Some researchers have determined that stress is a person-environment process in which the person appraises the situation as taxing or not. Appraisal is an important concept that explains why two people react in different ways to the same situation. Stress can be viewed as positive (eustress) or negative (distress).

The head nurse and a staff nurse are having a conflict over how to use and apply a new procedure for dressings in the medical/surgical area. The staff nurse wishes to use the new procedure based on newly released nursing research. The head nurse wishes to use a protocol that has been used in the department for a number of years. The head nurse later makes comments to other staff on her unit about the credibility of the staff nurse. This behavior is associated with:

bullying. Bullying involves aggressive or destructive behavior or psychological harassment of a recipient who is in a position of power differential with the perpetrator (the head nurse). Bullying is closely related to lateral or horizontal violence and involves such behaviors as incivility or intimidation.

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

A factor evaluation system:

combines interventions and time required for interventions to determine levels of care required. A factor evaluation system considers tasks, thought processes, and patient care activities and gives them a time or rating. These are then used to determine the number of patient care hours required.

Nurses need to know how to operate a computer, compare data across time, and look for patterns in client responses to treatments. These are examples of:

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

The complexity of the healthcare environment for consumers is increased by:

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

Complex change situations require that the change leader promote ongoing visioning among staff members. One strategy is to:

consciously evaluate invisible mental models. Senge theory on change suggests that each individual or organization bases activities on a set of assumptions, or a set of beliefs, or mental pictures about the way that the world should work. When these invisible models are uncovered and consciously evaluated, it is possible to determine their influences on work accomplishment.Senge theory on change has 5 organizational disciplines (box, og 329):shared vision - the process of creating a common view about where the organization is goingmental models - the practice of helping individuals become aware of how they think, what they value, and how that affects organizational performancepersonal mastery - the fostering of openness in the face of change by managing self-awareness and using reflectionteam learning - the promotion of teams thinking together, collaborating, and sharing ideas, knowledge and perspectivesystems thinking - the development of frameworks that see the oganization as a complex entity whose many parts affect outcomes

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. Nurses should be floated to units as similar as possible to their own to decrease the potential for liability. Negotiating cross-training, a proactive approach to temporary staffing problems, reduces the potential for liability.

A nurse manager questions the true difference between primary nursing and total patient care. After careful consideration of both models, the nurse manager concludes that primary nursing differs significantly from total patient care in:

degree of task orientation. Significant overlap can be seen between primary nursing and total patient care in terms of breadth of assessment and knowledge required to provide holistic care. A primary difference is that nurses in the total care model assume accountability while on shift, whereas primary nurses assume responsibility from time of admission to discharge and 24 hours a day.

A nurse manager must consider a number of external variables when preparing the personnel budget and projecting the unit's staffing needs. An external variable to be considered is:

department of Health licensing standards. Licensing regulations of the state can determine staffing models. Staffing regulations can dictate the number of professional nurses required on a unit at any given time.

During unit staff meetings, you observe that Marg rolls her eyes and snorts whenever Julia makes a comment. Your first response as a unit manager is to:

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

"Stress-buffering" behaviors can be elicited to reduce stress. All of the following behavioral coping responses can be used by nurse managers to reduce and manage stress except:

distancing oneself from work. Achieving balance between work and leisure is a useful strategy for stress reduction. Distancing, however, can be a sign of depersonalization that includes negative attitudes as well and is a characteristic of burnout.

A nurse makes a medication error that is not serious and does not cause harm to the patient. As the charge nurse, your best action would be to:

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

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. Risk management involves taking proactive steps to identify and eliminate risks and liability.

The chief nursing officer decides to establish a client advocacy position in an oncology unit. Advocacy is best represented by:

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

As part of orientation to your unit, you decide to administer Kolb Learning Style Inventory (LSI) to new staff. The most likely reason for your decision is that the use of Kolb LSI:

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

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

Workplace Advocacy is designed to assist nurses working in an emergency department by:

equipping them to practice in a rapidly changing environment. Workplace advocacy encompasses a number of activities that enable nurses to control the practice of nursing and to address challenges that they face in the practice setting. These activities include career development, employment rights, employment opportunities, and the labor-management relationship. The aim of workplace advocacy is to proactively equip nurses to practice within a rapidly changing environment, rather than to negotiate contracts or provide representation in employment disputes.

After beginning a new management position, a nurse finds that they are spending a great deal of time in direct patient care. The unit staff begins to complain that they are never able to find the new manager when needed, and that some aspects of the manager's responsibilities have fallen fall behind, such as scheduling. The new manager is most likely:

experiencing difficulty in unlearning old roles. Role transition involves transforming one's identity. Although any of the answers listed might be correct, as a new manager, her confidence in her clinical skills suggests that she is having difficulty in the transformation process and in unlearning her role as a clinician.According to Hardy's role theory, role strain is the subjective feeling of distress that occurs when role stress or a social condition of conflicting demands or difficult conditions is present.

A staff nurse approaches the unit manager and indicates to her that because of her father's death in the previous month, she is now finding it very difficult to do her work effectively. This would be considered a(n) ________ stress.

external External stress is outside and removed from the work setting, but it is considered work-related stress because of the impact it has on the worker.

The chief nursing officer works with her nurse managers by helping them understand how to develop and implement a budget. A nurse manager can best describe a budget as a:

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

Knowing your professional strengths is important to:

find your fit in positions and a career path. Being aware of your strengths is critical in determining what you will bring to a position and can be used to find your fit and possible career path. Knowledge and experience are important in maintaining the privilege of belonging to a profession and of behaving ethically and legally.

Before terminating an employee, a nurse manager must:

follow the organization's specific policies for addressing disciplinary problems and termination. It is important to know the policies of the organization to address disciplinary issues fairly and equitably, as well as to know the model that is employed to address employee problems. Human resource departments and legal departments are important sources for consultation, advice, and support.

The chief nursing officer understands that clinical incompetence is best prevented by a(n):

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

The chief nursing officer plans a series of staff development workshops for the nurse managers to help them deal with conflicts. The first workshop introduces the four stages of conflict, which are:

frustration, conceptualization, action, and outcomes. Thomas (1992) determined that conflict proceeds through these four stages in this particular order.

A patient complains to the charge nurse that she has no idea who "her nurse" is on any given day. "I ask one nurse for my pills and she says, 'That's not my job.' I ask the pill nurse about my lab tests and she says that I should ask another nurse." The nursing care delivery model most likely employed in this situation is:

functional nursing. Functional team nursing involves licensed and unlicensed personnel who perform specific tasks for a large number of patients. A disadvantage of functional team nursing is the fragmentation of care. The physical and technical aspects of care may be met, but the psychological and spiritual needs may be overlooked. Patients become confused with so many different care providers per shift. These different staff members may be so busy with their assigned tasks that they may not have time to communicate with each other about the patient's progress.Although repetition of tasks increases confidence and competence, it can also lead to boredom. Rotation of tasks can assist specifically in this model to reduce the boredom that is a potential disadvantage of this model.

The nurse manager decides to use a mediator to help resolve the staff's conflict. A basic strategy for truly addressing this conflict is to:

have a clear understanding of the differences between the parties in conflict. It is important for each person in the conflict to clarify the conflict as "I see it" and how "it makes me respond" before all the persons involved in the conflict can define the conflict, develop a shared conceptualization, and resolve their differences.

In helping nurse managers to manage their time, the chief nursing officer suggests that they:

have good information literacy skills. Time can be saved by using information technology effectively, as it assists with effective data retrieval and information gathering and with communication related to a variety of needs in the management setting.

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. It is generally accepted by many authors and researchers that this statement best defines critical thinking.

In keeping with guidelines of the organization, the nurse manager documents staff problems. Documentation of disciplinary problems should:

include a plan to correct them and to prevent future occurrences. In documenting staff problems, it is important to identify the incident with an objective statement of facts and record actions taken to correct/prevent future problems.

What are the positive factors influencing healthcare consumers and their relationship with healthcare organizations?

increased engagement of patients with their healthcare healthcare professionals are held more accountable for patient outcomes giving people a voice for changes they desire to achieve in healthcare recognition and certification provides status and feedback for healthcare institutions on needed improvements and maintenance Social -positive factors - increased engagement of patients with their healthcare; healthcare professionals are held more accountable for patient outcomes negative factors - patients use unofficial/non-professional websites to research pathology; disgruntled patients can still accuse healthcare professionals on social media with incorrect narrative Economic -positive factors - redesigned roles in healthcare and restructure of healthcare; access to care and quality management are essential components of cost control negative factors - delivery of cost effective quality care is achieved by preparing nurses with a higher level of education in the ever-changing healthcare environment Political -positive factors - giving people a voice for changes they desire to achieve in healthcare negative factors - not having adequate healthcare professionals discussing legislation bills related to healthcare; uninsured, under-insured Regulatory -positive factors - education to provide knowledge and healthcare competency for patients and staff; EBP to provide safe and competent patient care; recognition and certification provides status and feedback for healthcare institutions on needed improvements and maintenance negative factors - difficulty in implementing cost-effective changes; management may place gaining approval and certification by deeming authorities above staff needs

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

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

The oncology clinical manager and the educational coordinator asked nursing staff to complete a brief written survey to assess their attitudes and knowledge related to having used the new infusion equipment for 6 weeks. The stage of change in this situation is:

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

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage. Sarah finds that she is comfortable with the expectations of staff and her supervisor regarding her management role and responsibilities and has been able to effect a strong commitment to quality clinical care on the unit. At this point, Sarah has likely attained this role:

internalization. Role internalization is achieved when the manager experiences performance of the role as being congruent with his or her own beliefs. Role acceptance refers to accepting the contract and making a public announcement of the acceptance.Role discrepancy is an experience that includes a gap between what is expected and what is occurring and can lead to disillusionment, discomfort, and frustration. If the unit manager values the relationship and sees the differences between performance and expectations as correctable, then the manager is likely to stay in the role.

Elizabeth is an example of a(n):

laggard. Laggards prefer keeping traditions alive ("We have always done it this way") and openly express their resistance to ideas (speaking out against the change). Late majority individuals are openly negative but will engage with new ideas when most others adopt the change.

During the performance appraisal session, the manager should: (Select all that apply.)

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

The unit manager is working in a large metropolitan facility and is told that two UNPs are to be assigned to work with her. Delegation begins with:

matching tasks with qualified persons. In delegating to the UNPs, the nurse must consider what cannot be delegated, as well as the factors of safety, time, critical thinking, and stability of patients.

The chief nursing office of a Magnet® hospital has conducted a study of ways to improve healthcare services. Healthcare services that add value for clients:

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

One day, at coffee, your co-worker suggests that you and she sit with unit members of the hospital research committee. She suggests that this would be an excellent way to get to know people who share her interest in research. Her actions are an example of:

networking. Meeting individuals outside the normal work group to share ideas and gain support and encouragement is an example of networking.

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

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

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

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

Before beginning a continuous quality improvement project, a nurse should determine the minimal safety level of care by referring to the:

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

An example of an initiative that may reduce total healthcare costs would be:

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

On your nursing unit, you employ LPNs, RNs, and advanced practice nurses. You will need to be familiar with at least:

one nursing practice act. In all states, you will need to be familiar with at least one nursing practice act. In some states, there may be two nursing practice acts if RNs and LPNs/LVNs come under different licensing boards.

A nurse manager must also consider a number of internal variables that will affect staffing patterns. An internal variable to be considered is:

organizational staffing policies. State licensing standards outline what a nurse can do. Internal policies determine what a nurse may do in a particular setting as well as the amount of flexibility that is allowed to manage times of high and low volumes, as well as changes in acuity. Organizational policies can put the nurse manager in a situation where patient safety cannot be maintained or financial obligations met.

The nurse manager on a pediatric intensive care unit wants to evaluate patient satisfaction. The nurse manager understands that ultimately, positive relationships with consumers of care are evaluated by the:

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

Staff members on your unit raise concern that there is rising acuity on the unit and lack of responsiveness in addressing these needs through appropriate staffing. They point to increased incidences of adverse and sentinel events on the unit. To address this concern, your hospital organization would do best to:

participate in databases that compare the outcomes and staffing levels versus those of similar institutions. Staff morale suffers both when acuity models indicate a gap between staffing and acuity and when there is no model but perceived acuity that is not being addressed. A truer approach is to monitor patient outcomes and participate in national databases that measure staffing levels through comparison with like institutions.

The wound care nurse decided to involve those to be affected by change early in the change management process. This can positively result in:

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

In an acute care unit, the nurse manager utilizes the functional nursing method as the care delivery model. The nurse manager's main responsibility is the needs of the:

patient. The functional model of nursing is a method of providing patient care by which each licensed and unlicensed staff member performs specific tasks for a large group of patients. In a functional nursing model, where other team members are focused on performing specific tasks, the nurse manager assumes primary responsibility for patient outcomes.

A group of staff nurses is dissatisfied with the new ideas presented by the newly hired nurse manager. The staff wants to keep their old procedures, and they resist the changes. Conflict arises from:

perceptions of incompatibility. Conflict involves disagreement in values or beliefs within oneself or between people that causes harm or has the potential to cause harm. Conflict may result from the interaction of interdependent people who perceive incompatibility and the potential for interference.

Which of the following specifically provide opportunities for career networking and support.

professional associate Professional associations are frequently, although not always, voluntary groups whose members provide leadership in issues and policies of interest to nurses. Professional associations also offer networks of nurses with similar interests.

With delegation, responsibility and accountability remain with the:

professional who delegates. Even though the delegatee (the one who receives the delegation) receives direction from the professional who delegates a task and must have the authority to complete it, the delegator retains accountability for the overall outcome and completion of the activity. The delegatee has responsibility (obligation to engage in the task) and authority for the task.

The goal of creating a curriculum vitae is to:

provide potential employers with information about where you are in your career. A curriculum vitae provides an all-inclusive but not detailed listing of your professional life. This approach allows a prospective employer to find the most recent information quickly and gain a sense of where you are in your career.

The difference between staffing and scheduling is that staffing:

puts the right person in the right position. Nursing staffing involves planning for hiring and deploying qualified human resources to meet the needs of a group of patients. Scheduling, on the other hand, is a function of implementing the staffing plan by assigning unit personnel to work specific hours and days of the week.

A nurse manager wants to decrease the number of medication errors that occur in her department. The manager arranges a meeting with the staff to discuss the issue. The manager conveys a total quality management philosophy by:

recommending that a multidisciplinary team should assess the root cause of errors in medication. Quality management stresses improving the system, and the detection of staff errors is not stressed. If errors occur, reeducation of staff is emphasized rather than imposition of punitive measures such as disciplinary action or blaming.Leadership must identify safety shortcomings and must locate resources at patient care levels to identify and reduce risks. One method of doing this is to invite all staff into a discussion related to solutions to an identified concern. This approach encourages teamwork.

A nurse manager understands that the typical first step in handling an employee with a disciplinary problem is a:

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

An outpatient clinic advertised for RN positions. Before authorizing an open position, the nurse manager should:

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

Which of the following has been identified as important to staff retention?

role mentoring Mentoring has been identified as important to staff retention.Role preview, discrepancy, and acceptance are all specific Role Transition phases. Mentoring can occur at any time or throughout these phases.

The new head nurse on telemetry has been in the position for 3 months. The head nurse and the administrator disagree on how much time the head nurse should allot to various aspects of the role. Staff members on the unit complain that the head nurse is unavailable for clinical concerns because of being off the unit while attending meetings. To facilitate the process of role transition, the head nurse should:

schedule a series of meetings with staff and the administrator to clarify expectations. During role transition, it is important for the manager to negotiate the role by writing down the manager's expectations of the role and determining the expectations of others (staff, supervisors) in order to clarify expectations and reduce or ameliorate role ambiguity and role strain. It can take up to a year to understand the role, system, and boundaries in a new job-role-position.

An example of one strategy used to improve participation in the change process by staff fitting the behavioral description of innovators and early adopters is to:

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

In a nurse managers' meeting, the chief nursing officer encourages the managers to brainstorm ways to reduce costs. Nurse managers have the greatest impact on reducing costs by managing:

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

To effectively achieve a change goal/outcome in a change situation, the wound care specialist will:

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

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. Legally, the nurse manager is accountable to nursing practice standards, standards for nurse administrators, and hospital policies and procedures.

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

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

An example of a nursing care activity that would not be delegated by an RN to a UNP is: (Select all that apply.)

teaching self-catheterization to a patient with paraplegia who has limited English. basic care for a patient with a head injury who is rapidly deteriorating. assessment of patients being admitted through the Emergency Department. Functions such as assessment, diagnosis, planning, and evaluation cannot be delegated. In addition, stability, critical thinking, time, and safety are factors that are considered in assessing whether or not to delegate care to a UNP. Teaching self-catheterization to a patient with limited English requires critical thinking; basic care for a patient who is rapidly deteriorating exemplifies concern with stability; and assessment of patients through Emergency is related to the factor of time. An exception to safety and stability in which patients may be delegated to UNPs is when patients are placed on suicide precautions.

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

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

Resistance is most likely when change:

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

An example of role stress occurs when:

two part-time staff members are hired to work in a unit, but the job expectations for them are not clear, and the head nurse expresses disappointment in their performance. Role stress is an additional stressor for nurses. Viewed as the incongruence between perceived role expectations and achievement, role stress is particularly acute for new graduates. Failure to comply with expectations can lead to role conflict. Role conflict and role ambiguity are major sources of conflict for nurses.

The nurse manager knows that the most serious effect that absenteeism has on the nursing unit is that:

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

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. Decision-making tools such as decision grids and SWOT analyses are most appropriate when information is available and options are known.

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