leadership quiz 3

―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: a. distancing oneself from work. b. using cognitive reframing to change irrational thoughts. c. refusing a request to sit on a committee to evaluate scheduling software. d. exercising regularly.

ANS: A 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.

You have hired Chelsea as a new staff member on your unit. Although she is an experienced ICU nurse, this is her first educator role. A month into her new position, she confides that she feels really incompetent in her new position and bursts into tears. Your response is based on application of your understanding of: a. role acquisition. b. role conflict. c. role complexity. d. performance appraisal.

ANS: A Acquisition of a role is time dependent and involves application of life experiences to each role and interpretation of the role within one's own value system. As roles become more complex, an individual may take longer to assimilate the components of each role.

The validity of comments and ratings related to performance is enhanced by: a. maintenance of anecdotal notes over the entire evaluation period. b. quantity of information gathered for appraisal purposes. c. agreement of the employee with the ratings and comments. d. whether or not other individuals have contributed to the observations.

ANS: A Anecdotal notes compiled consistently over the entire rating period are a much more equitable method of providing an accurate summary of the employee's performance.

Sarah determines, in partnership with her patient, that current medications are not enabling her patient, a married account executive with fibromyalgia, to continue with her employment and family responsibilities. After searching for additional information on fibromyalgia, Sarah finds nonpharmacologic interventions that are supported through credible evidence. Sarah suggests that the patient, her physician, and she meet to discuss the medications and possible options and a plan of care for the patient's discharge. This action exemplifies which of the four historical concepts? a. Authority b. Responsibility c. Communication of conflict d. Autonomy

ANS: A Authority refers to the use of professional status and power to act in the patient's best interests. In this example, Sarah is using her professional status and power to set up a conference in which her patient, the prescribing physician, and she can discuss what is not working for the patient and potential options.

A Magnet® hospital surveys the staff about job satisfaction. This type of environment, in which nurses have authority and autonomy, is linked with: a. client satisfaction with the healthcare organization. b. organizations with a limited number of nurse managers. c. private, specialty organizations in urban areas. d. sophisticated academic health sciences universities.

ANS: A Autonomy and authority in decision making that is consistent with scope of practice are linked both to higher job satisfaction and to higher patient satisfaction with care. Job satisfaction is an important indicator of the quality of patient care.

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? a. ―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?‖ b. ―If you were to employ one strategy for managing conflict, what would it be?‖ c. ―What is your preferred style of conflict resolution?‖ d. ―How effective are you in working in a group? In dealing with conflict?‖

ANS: A 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 biggest challenge in the recruitment of staff is: a. finding well-qualified candidates who can function well within your particular work culture. b. recruiting individuals with the appropriate qualifications and experience. c. screening out candidates who are unable to function well within a team. d. determining if candidates have had previous negative experiences in a work environment.

ANS: A Choosing the right individual is the challenge for managers and involves finding qualified candidates who will work well within your culture.

The Emergency Department staff decides to use a collective bargaining model fornegotiation rather than a traditional trade union model. A traditional trade union model is characterized by: a. positional conflict. b. management support of labor's initiatives. c. a spirit of trust between management and labor. d. an ability to resolve complaints.

ANS: A Collective bargaining encompasses management support of labor's initiative, a spirit of trust between labor and management, and resolution of problems. It replaces the positional conflict that has been associated with traditional trade unions. Models such as the interest-based problem solving (IBPS) model seek to avoid positional conflicts such as those between labor and management that do not take into account the opposing party in any way.

The state of being emotionally impelled, demonstrated bya sense of passion and dedication to a project or event, describes: a. commitment. b. control. c. willingness to cooperate. d. communication.

ANS: A Commitment is described as having a sense of passion and commitment to a project without necessarily having a need to control.

A survey of staff satisfaction is conducted. The survey indicates that staff members are satisfied, are loyal to the organization, and feel that they have reasonable control intheir individual responsibilities. The findings best exemplify: a. clarity in roles and valuing of contributions. b. satisfaction but not empowerment. c. effective coaching of new staff. d. role attachment.

ANS: A Commitment, a sense of control, and satisfaction are linked to clear role expectations and a feeling that contributions are valued.

The charge nurse on a rehabilitation unit recognizes that due to the COVID-19 pandemic, her unit has been left with a shortage of nurses. She understands that delegating responsibilities to competent delegates will be necessary. She also is aware that for positive outcomes it is crucial to: a. educate delegatees on how to implement a delegated responsibility. b. allow UNP/AP's to have autonomy so the RN has less accountability. c. never delegate to a UNP/AP. d. delegate only the most critical patients.

ANS: A Educating delegatees on how to implement a delegated responsibility is crucial for positive outcomes. The Research Perspective provides an exemplar of an innovative educational approach to elevate the knowledge, skills, and attitudes of delegates.

Sources of occupational stress in nursing include all except which of the following? a. Authoritarian leadership b. Concern about moral wrongdoing by colleagues c. Multiple changes in a short time d. Rotating shifts

ANS: A Ethical distress, complexity compression, rotating shifts, high acuity levels, rotating shifts, and workload are all sources of work-related stress for nurses.

In a job interview for a nursing position, Marley can be assured that which of thefollowing will occur? a. Both eustress and distress b. Only eustress c. Only distress d. Neither eustress nor distress

ANS: A Eustress is defined as stress that is pleasant in nature, and distress is defined as stress of an unpleasant nature. One can assume that every interview has both of these stresses.

The mediator noticed that tension was still evident between the nurse manager and staff members. He informed the chief nursing officer that to begin team building, it would be important that everyone: a. work together in a respectful, civil manner. b. use avoidance techniques when confronted with a conflict. c. develop a personal friendship with each other. d. socialize frequently outside of work.

ANS: A For team building to occur, team members need to be able to listen actively and respect one another's opinions, while feeling comfortable in openly expressing their own.

Which of the following would not be a characteristic of an effective team nurse leader? a. An autocratic perspective b. Excellent communication skills c. Awareness of everyone's abilities d. A genuine interest in team members

ANS: A 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.

Sandra, an RN on the surgery unit, is assisting with a procedure in the patient examination room. The physician orders a medication to be given through IV. Sandra 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 Sandra refuses to give it. In this instance, Sandra is demonstrating: a. autonomy. b. accountability. c. authority. d. best practice.

ANS: A In this situation, Sandra is exemplifying autonomy, which is the act of making independent decisions in the best interests of the patient, based on her knowledge and experience. This is analogous to the example in the text where the workers on the manufacturing floor have the independence to say ―Stop the line‖ when something is wrong. 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.

You are hired as a new manager. When the offer of employment is made, you agree to at-will employment. Later, you become very concerned about the policies and practices of your organization and their impact on patient care. You speak with your supervisor several times about your concerns, but no action is taken. In considering your next steps, you: a. consider your increased vulnerability under the terms of your employment. b. recognize that your supervisor is more vulnerable than you are because of her more senior position. c. are more likely as a leader to take action because you are well protected from repercussions by federal and state regulations. d. contact your union to discuss your concerns and review your options.

ANS: A Managers of at-will employees have greater latitude in selecting disciplinary measures for specific infractions. State and federal laws do provide a level of protection; however, an at-will employee may be terminated at any time for any reason except discrimination. At-will employees, in essence, work at the will of the employer. Nurses in these positions need to know their rights and accountability.

As a new nurse manager who has ―inherited‖ a unit with high nurse turnover and complaints of patient dissatisfaction, your first course of action would be to: a. determine levels of nurse engagement on the unit. b. review the personnel files of nurses who have resigned. c. interview upper management about their vision for the unit. d. meet with your staff to clarify your vision for the unit.

ANS: A Multiple studies demonstrate that a healthcare organization that provides a climate in which nurses have authority and autonomy has better patient outcomes, retains nurses at a higher rate, is more cost-effective, and has evidence of greater patient satisfaction than an organization in which such a climate does not exist. Organizational assessment assists in identifying the reasons for high nurse turnover and patient complaints.

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: a. if there are no agreements, each member will make up rules about how to handledisagreements and relationships. b. people are naturally difficult and will not work well together without such agreements. c. people will naturally ask for agreements about how to be together. d. a way to eliminate nonproductive team members must be available.

ANS: A 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.

The nurse manager schedules evaluations of staff members using a newly developed performance appraisal tool. The development of a performance appraisal tool should include: a. organizational mission, philosophy, and position requirements. b. a generalized overview of the duties of a position. c. a skills checklist and accreditation requirements. d. an ordinal scale that ranks all employees.

ANS: A Performance appraisal tools and processes should reflect the organizational mission and philosophy, as well as position requirements.

From the information presented in this chapter, which of the following statements best defines an accomplished team? Effective teams: a. can create a form of synergism in which the outcome is greater than the sum of the individual performances. b. do not necessarily need goals, objectives, vision, and a clearly stated purpose. c. do not always have effective communication patterns. d. may or may not have a clear plan that is followed and revisited and has an ongoing evaluation scheme.

ANS: A Research on team building over many years has established that high-functioning teams are characterized by synergy that takes the team from a collection of individuals to an outcome that is greater than the sum of the parts.

Senior executives at Hospital A determine that the hospital will engage in a strategic planning process after changes in healthcare funding and concerns expressed in the community about care that is being delivered at the hospital. The senior executives decide on a participatory process in which staff are widely consulted regarding input about the organization and the external environment and are actively invited to be part of decisions related to the mission statement, goals, and objectives. For true shared governance to be seen as part of this approach: a. it must be evident in the outcomes of the process that staff and senior executives have partnered on the decisions. b. stakeholders must be assured of the value of their input even though final decisions rest with senior executives. c. publications must clearly outline how staff input was solicited and obtained. d. staff must be reassured that significant concern

ANS: A Shared governance demands participation in decision making. When partnership, equity, and ownership are not involved, then shared governance has not occurred, and publication and expressions of appreciation for input will not be seen as representative of shared governance.

The nurse manager of a unit has lost many staff members, and the unit is now staffed with a large number of agency and traveling nurses. She knows that the agency and traveling nurses are all contracted to stay on the unit for the next 3 months. One way to improve morale and decrease stress in the unit would be to: a. plan a social event and include the agency and traveling nurse staff members. b. plan unit-based social events for your remaining permanent staff members. c. request hospital-based ―floating‖ nurses to substitute for the temporary staff. d. implement team nursing.

ANS: A Social support, in the form of positive work relationships, can be an important way to buffer the effects of a stressful work environment. Including all staff in the social event enables those who are not normally part of the team to experience this support and provides an opportunity for the staff as a whole to develop supportive relationships.

The staff development educator presents a series of programs on stress management to the nurse managers. Research has indicated that an individual's ability to deal with stress is moderated by psychological hardiness. Psychological hardiness is a composite of: a. commitment, control, and challenge. b. commitment, powerlessness, and passivity. c. commitment, control, and passivity. d. decreased isolation, challenge, and passivity.

ANS: A Some people have the capacity to accept changes in life with good humor and resilience, which, in turn, influences behavior that prevents illness. Hardiness involves the capacity to manage time and stress, to reframe situations positively, and to commit.

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: a. both a positive stressor and a negative stressor. b. occurring only because of age. c. positive in both cases. d. harmful in both cases.

ANS: A 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).

A hospice nurse has been feeling very stressed at work because of both the physical strain and the emotional drain of working with clients with AIDS. She tries to walk 1 to 2 miles three times a week and to talk regularly with her husband about her work-related feelings. One reasonable stress-management strategy would be to: a. start taking yoga lessons. b. make an appointment to meet with a psychiatrist. c. start jogging 5 to 6 miles every day. d. plan to go out for a drink with fellow nurses after work every day.

ANS: A Stress relief techniques include 30 minutes of exercise five times a week, as well as techniques such as yoga that relieve mental stress.

Which of the following would be most in line with Hersey model and concepts? a. The team of caregivers on day shift are familiar with their roles and with the patients. The nurse manager decides to work on the unit budget in her office. b. After a year of working on the unit, Shari, an LPN, is still hesitant about many policies and procedures. The charge nurse decides to challenge Shari with more difficult patients. c. The nursing supervisor asks one of her charge nurses to lead a technology integration project. The supervisor continuously demands involvement in decisions that the charge nurse is making in the project. d. Team members complain that Alysha, an RN, is unmotivated, and that she refuses assignments that are complex or difficult. The charge nurse suggests that Alysha is relatively new and that she needs time to adjust.

ANS: A The Hersey model/framework suggests that when ability (skills, job knowledge) and willingness are strong, the involvement of the delegator is less.

Nursing labor-management partnerships: a. engage nurses at all levels in problem solving for better patient care. b. require unions and management to negotiate in good faith regarding hours of work and wages. c. have been shown to have negligible effects on nurse turnover and patient outcomes. d. have typically resulted in increased polarization of nurses and management, leading to formation of collective bargaining units.

ANS: A The development of a nursing labor-management partnership is an approach that can be used in most professional nursing environments. This process recognizes nurses as leaders on all levels and provides formal and informal mechanisms for professional nurses to work together to achieve shared goals through collaboration and shared decision making or decentralized decision making. A study of a nursing labor-management partnership suggested that nurse satisfaction was higher, turnover was lower, and more time was available for patient care.

An outpatient clinic advertised for RN positions. Before authorizing an open position, the nurse manager should: a. review the position description and performance expectations for the opening. b. place an ad in the local newspaper and on the telephone job line. c. review all current applications on file. d. look for employees within the system who might best fill the position.

ANS: A 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.

Trust is an important aspect of helping relationships, therapeutic communications, and the positive communications model. Which statement does not involve or define trust? Trust: a. involves decisions to manipulate situations to gain advantage over another. b. is the basis by which leaders facilitate the activities and progress of a team. c. is low among members and leaders in poorly performing teams. d. involves what we say and not necessarily what we do.

ANS: A Trust is high in high-performing teams and involves not consciously taking advantage of others and behaving in a way that inspires trust. It is the basis by which leaders facilitate the activities and progress of a team.

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: a. accountable. b. responsible. c. authoritative and liable. d. responsible and task-oriented.

ANS: A When a registered nurse delegates care to a UNP, responsibility is transferred; however, accountability for patient care is not transferred.

Nurses in an Emergency Department, in an inner-city neighborhood characterized by high levels of violence, are concerned with low levels of security presence in their department. Security levels have recently been decreased and the nurses question why this has occurred. An appropriate action would be to: a. provide nurses with information about rationale for recent changes in security staffing. b. refer the matter to the head of security and let her deal with it. c. provide mentors who can help nurses diffuse aggressiveness. d. accept the security levels as a consequence of funding realities.

ANS: A Workplace advocacy is an umbrella term encompassing activities within the practice setting. Workplace advocacy includes an array of activities undertaken to address the challengesfaced by nurses in their practice settings. The focus of these activities is on career development, employment opportunities, terms and conditions of employment, employment rights and protections, control of practice, labor-management relations, occupational health and safety, and employee assistance. The objective of workplace advocacy is to equip nurses to practice in a rapidly changing environment. One manifestation of workplace advocacy is ensuring that relevant information is shared about decisions that affect practice so that further data gathering and decision making (in this instance about security levels and nurse safety) is informed.

Martin, the unit manager, receives complaints from community agencies that patients who have been discharged from his unit seem to lack understanding about their disorder and immediate strategies for managing elements of their care. Martin checks the patient teaching sheets and notes that the sheets are initialed by staff. He calls the agencies and indicates that teaching has been done. Potential outcomes of Martin's actions include: (Select all that apply.) a. poor morale on the unit. b. disruption in community relationships. c. corruption of patient-staff relationships. d. patient outcomes for quality care are met.

ANS: A, B, C When management accountability for activities is not accepted, then relationships suffer, professional practice is diminished, and self-esteem suffers.

High levels of work-related stress affect all but which of the following? (Select all that apply.) a. Job satisfaction b. Absenteeism and turnover c. Nurses' health d. Client welfare

ANS: A, B, C, D Many writers and researchers have found that these work-related areas are adversely affected by stress.

An example of a nursing care activity that would not be delegated by an RN to a UNP is: (Select all that apply.) a. teaching self-catheterization to a patient with paraplegia who has limited English. b. basic care for a patient with a head injury who is rapidly deteriorating. c. one-to-one observation with a suicidal patient. d. assessment of patients being admitted through the Emergency Department. e. basic hygienic care for a patient who is post MI and stable.

ANS: A, B, D 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.

During the performance appraisal session, the manager should: (Select all that apply.) a. maintain a relaxed and professional manner. b. inquire about the employee's personal life and how it is affecting performance. c. allow the employee to express opinions orally and in writing. d. plan to give specific examples only for poor performance.

ANS: A, C 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.

Mobilizing others to accomplish extraordinary things requires what leadership behaviors? (Select all that apply.) a. Celebrating the successes of others b. Demonstrating exceptional technical skills c. Imagining possibilities d. Establishing a sense of ―being in this together‖

ANS: A, C, D Leaders who inspire teams to accomplish extraordinary things or to display synergy model the way, inspire shared vision, challenge the status quo, and encourage the heart by celebration of success.

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? a. Rating scales are too generalized to be considered valid or reliable. b. The effectiveness of appraisal is enhanced by a combination of methods and effective communication skills. c. BARS is considered superior to simple rating scales in terms of performance appraisal. d. Rating scales need to be designed by users to be well accepted.

ANS: B 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.

On your unit, despite efforts to build a strong sense of team, conflict between some of the staff is ongoing. Nonetheless, you want to proceed with developing a systematic and effective performance appraisal system. Which of the following approaches would be most appropriate for you to implement? a. Peer review b. A combination of tools c. Anecdotal notes d. Rating scale

ANS: B A combination of tools is likely superior to any one method in any situation.

Martin, the unit manager, receives complaints from community agencies that patients who have been discharged from his unit seem to lack understanding about their disorder and immediate strategies for managing elements of their care. Martin checks the patient teaching sheets and notes that the sheets are initialed by staff. He calls the agencies and indicates that teaching has been done. Martin's follow-up to complaints from the community is: a. appropriate and indicates that he has assumed accountability for the actions of his staff. b. indicative that he does not clearly understand the concept of accountability. c. indicative of strong support for his staff and their autonomy. d. important in clarifying the difference between his accountability and that of the community in patient care.

ANS: B Accountability refers to the achievement of desired outcomes. If community agencies are noticing that limited or no change in patient behavior has occurred despite teaching on the unit, then the staff has not achieved accountability, and he is not holding his unit responsible for the outcomes. Martin is also demonstrating lack of accountability.

By following a shared leadership model, the nurse manager believes that staff members will learn to function synergistically. Some teams function synergistically because members: a. do not volunteer unwanted information. b. actively listen to each other. c. listen to the person who believes he or she is an expert. d. do not speak unless they are absolutely sure they are correct in their views.

ANS: B Active listening in a group creates synergy in that team members really hear one another's ideas and share in decision making.

Anecdotal notes: a. should be completed only when there are performance concerns. b. can be used to support and justify fairness in termination discussions. c. are unnecessary if the evaluation instrument is thorough. d. need to be completed at the end of a performance period.

ANS: B Anecdotal notes should be kept consistently throughout the evaluation period and should reflect both negative and positive behaviors if they are to provide an accurate assessment of performance. Anecdotal notes provide documentation to support rating scales and narrative evaluation summaries.

You ask Evelyn, a new UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. Determination of Evelyn's educational preparation and certification is related to the concept of: a. accountability. b. authority. c. role performance. d. assignment.

ANS: B Authority refers to the right to do and may be designated by law, educational preparation, or job description.

The education consultant at St. Joseph Hospital is giving a workshop on cognitive reframing. The consultant explains that cognitive reframing reduces stress by: a. aiding individuals in identifying positive stressors. b. helping people realize that negative thinking causes emotional distress. c. eliminating negative stressors. d. replacing positive self-statements with negative irrational beliefs.

ANS: B Cognitive restructuring is a therapy that aids individuals in discovering that their irrational thoughts can be replaced with responses that are more rational. It enables individuals to gain a sense of control over the situation and can change ―I'll never ...‖ to ―I can ...‖ or ―She always ...‖ to ―Sometimes she ...‖ It is an approach that allows individuals to replace negative thoughts and statements with others that are more realistic and helpful.

During staff-development programs, staff nurses verbalize their frustration about their workloads and having to delegate so many tasks to others. One of the main reasons that delegation has emerged as an issue is because of: a. the amount of paperwork required to complete care. b. the complexity of care required by patients. c. earlier discharge practices. d. the numbers of other disciplines present on a given unit.

ANS: B Complexity of client care, a multilevel nursing model (registered nurses, mixed with LPNs/LVNs, and UNPs), and community-based care provide many challenges in determining the care required and outcomes desired and/or mandated, and in matching needs with various abilities and authority of regulated and unregulated healthcare providers. The nurse manager should ensure that staff is clinically competent and trained in their roles in patient safety.

The day shift nurse asks an LPN/LVN to complete a task for a patient. The day shift nurse is engaging in what function? a. Delegating b. Assigning c. Sharing d. Authorizing

ANS: B 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.

Government and third-party payers announce reduction of compensation for the deliveryof patient services. Hospital STV has a flat organizational structure. After the funding announcements, senior officials at the hospital meet and make decisions regarding cost containment of new revenue streams. This action is consistent with: a. the practice of leaving financial decisions with senior officials who understand the total context of funding. b. a tendency to concentrate decision making during economic downturns at the top administrative level. c. a need to make expedient decisions that are likely to be poorly received by staff. d. ensuring that decisions with regard to cost are made equitably across all departments.

ANS: B During times of economic downturn, decisions tend to become very centralized to avoid risk. History demonstrates that increasing the breadth of input during these times is more effective than narrowing it.

During a performance appraisal, Joanne, the nurse manager, indicates that Alysha has difficulty mentoring students on the unit. Alysha responds that this is not her responsibility. In responding to Alysha, Joanne needs to consider: a. Alysha's level of confidence. b. whether mentoring is included in the position description. c. whether mentoring is an essential component of the position description. d. whether mentoring can be accurately observed and measured.

ANS: B Employees must have clear role expectations, clearly understand what is expected of their performance, and understand the ramifications of not meeting those expectations. Position descriptions provide written guidelines detailing the roles and responsibilities of a specific position within the organizational context.

Which of the following strategies might be effective in empowering staff? a. Communication book in which new information on policies and processes is communicated and mistakes are highlighted. b. Monthly staff meetings during which a portion of the agenda is devoted to sharing ideas and presentations on best practices for implementation on the unit. c. Once-yearly summative evaluations based on what the manager best likes about the individual. d. Focus on discussion of errors in care with direction as to how errors are to be prevented in the future.

ANS: B Empowerment is a process that acknowledges the values and judgments of others and trusts their decisions. It allows freedom for making decisions while retaining accountability and provides an environment that is safe in which to explore.

With delegation, responsibility and accountability remain with the: a. physician. b. professional who delegates. c. individual who receives the delegation. d. individual who previously performed the task.

ANS: B 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.

As a nurse manager, the one activity you should not overlook is: a. posting the yearly rotation schedule. b. reviewing vacation requests. c. scheduling staffing for holidays 6 months in advance. d. anticipating staff sick days.

ANS: B Free time and vacation time are needed for individuals to recharge. If time for work is more than 60% of wake time, or when self-time is less than 10% of wake time, stress levels increase.

On Unit 62, the nurses and the unit manager have been involved in shared decision making related to the model of nursing care delivery that the unit will adopt. All individuals have participated and been involved in decision making and implementation of changes. When issues arise during implementation, it is expected that: a. accountability resides entirely with the unit manager. b. individual expertise will be utilized to provide solutions, but that responsibilityfor the change is shared. c. no one really has any accountability or responsibility for the changes. d. this will contribute to widespread skepticism among the staff about the probability of success.

ANS: B High-performing organizations provide for participation by all stakeholders, and each stakeholder shares responsibility and risk. This kind of environment is more satisfying for nurses and is characterized by optimism and trust.

John, a new graduate, reviews the employee evaluation for his new position. The first section requires that he list his own specific objectives to be accomplished. This is an example of: a. the traditional rating scale. b. learning goals, or management by objectives. c. a forced distribution scale. d. a behavior-anchored rating scale.

ANS: B In management by objectives, the employer and the employee jointly establish clear and measurable objectives for the next performance period.

You are charged with developing a new nursing curriculum and are committed to developing a curriculum that reflects the needs of the profession and of the workplace. To address deficits that may already be present in nursing curricula related to the workplace, you include more content and skills development related to: a. therapeutic communication with patients. b. effective communication in the workplace. c. increased emphasis on sender-receiver dyads. d. generational differences in communication.

ANS: B Nursing programs teach therapeutic communications with patients and their families. Little focus, however, is placed on effective communication in the workplace, although communication is essential to building and maintaining smoothly functioning teams.

Nurses on the dialysis unit notice that changes in labeling of fluids have meant several alarming near miss in terms of wrong administration of fluids. They take this concern to the unit manager. As an advocate of nurse autonomy, the most appropriate response in this situation would be to: a. ensure that the nurses are aware of the reasons for the change and how the decision was made about the new labels. b. discuss concerns about the labels and develop potential solutions that take into account changes that can be made at the local level and those that need system intervention. c. suggest that the staff wait until they have become more familiar with the labels before taking further action. d. tell the staff that you will notify the pharmacy about these concerns and leave it up to the pharmacy to decide what should be done.

ANS: B 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.

The chief nursing officer listens to nurse managers verbalize their feelings of personalstress. One common source of a personal ―trigger‖ seems to be: a. the death of a loved one. b. perfectionism. c. getting married. d. losing a job.

ANS: B Personal ―triggers‖ are events or situations that have a profound effect on specific individuals. A personal trigger might be a specific event, as in the death of a loved one, an automobile accident, losing a job, getting married, a new relationship, divorce, the birth of a child, or just about any major life event.

The chief nursing officer understands that a nurse manager can exhibit stress that is related to trying to keep up with the number of electronic messages that arrive, as well as trying to remain accessible to staff. What is a strategy that would assist the manager to manage the information overload effectively? a. Ignore messages unless they are labeled as important. b. Determine who is most likely to send useful or important information or requests. c. Check e-mail messages once a day. d. Encourage face-to-face meetings rather than e-mail.

ANS: B Reduction of stress related to information overload requires the development of information-receiving and information-sending skills. Information-sending skills include determining most common sources of useful data, labeling files and folders to which e-mail messages can be directed, deletion of e-mails, and focusing on the most important pieces. Information-sending skills include keeping e-mail messages short (and calling if the message needs to be long) and considering the most appropriate medium for messages (telephone, fax, face-to-face).

Joanne, a new nurse manager, writes certain assumptions regarding the organization's objectives into her budget. Her supervisor tells her that the objectives implied in her assumptions are not entirely consistent with the organization, and that she needs to clarify these objectives with her supervisor. Joanne apologizes and says she had more latitude with the budget where she previously worked. This is an example of: a. role complexity. b. role ambiguity. c. role conflict. d. time-dependent roles.

ANS: B Role ambiguity in the workplace creates an environment for misunderstanding and hinders effective communication. Without clear expectations of performance, missteps in performance can occur.

An example of role stress occurs when: a. the director of the ICU and the manager of the surgical unit wish to hire the same new employee. b. 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. c. the nurse manager for the ICU wants to advocate for more staff and finds it difficult to find data to substantiate his proposal. d. line managers believe that support staff use their technical knowledge to intrude on their authority.

ANS: B 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 chief nursing officer establishes a shared governance model to help empower the nursing staff, thus empowering the organization. Common characteristics of empowered organizations are: a. shared values, high salaries, and a human focus. b. shared values, flexibility, and a human-capital focus. c. commitment to communication, high salaries, and flexibility for evaluations. d. creation of community and of effective stress management in the midst of divergent goals.

ANS: B Shared governance involves valuing the contributions of each member of the team, releasing the need to control, and understanding that accountability rests with members of the team.

You ask Evelyn, a new UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is plenty medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. This incident is an example of: a. incompetence of the UNP. b. failure to follow-through. c. skills but no motivation. d. lack of accountability.

ANS: B The nurse should maintain open lines of communication and seek information, and the UNP should know how, when, and what to report. Communication of delegation of tasks includes specific information about what is being delegated, expected outcomes, and deviations (which includes what immediate action needs to be taken). This 2-way communication and follow-through allows patient care to be altered, if necessary, in a timely manner.

Jeff, an RN in his 30s, has lost a parent, just purchased a new home, and is laid off with 6 months' severance pay. At the same time, Jerry, an RN in his 50s, is financially secure and is asked to take early retirement with a buyout. How will the two men react to the emotional and physical influences and the sequence of stress? a. The younger man will feel more stress. b. The two men may or may not feel the same amount of stress. c. The older man will feel more stress. d. Neither man will experience any stress.

ANS: B The response to similar stressors does not always result in a similar experience of stress in individuals. Responses are mediated by the appraisal of the event as well as by factors such as gender, personality, lifestyle, and age.

The mediator suggested to the unit staff that a group agreement needed to be made so meetings could become productive. For example, the group agreement, ―We will speak supportively,‖ prevents: a. expression of opposing ideas. b. gossip and making negative comments about absent team members. c. efforts to ensure that everyone thinks alike. d. votes that oppose motions.

ANS: B This is an example of a rule that a team can implement to prevent certain negative behaviors such as gossip, backbiting, and bickering that undermine the productivity and functioning of a group.

John's performance was satisfactory during the first month, but after that time, he was found to be very inconsistent in the provision of nursing care. One month before the end of the rating period, he cared for a very wealthy and influential client, who is best friends with the clinical manager. This client donated new furniture for the staff lounge in John's name to show appreciation for his care. John's subsequent performance appraisal resulted in outstanding ratings in all areas. This is an example of: a. a performance rating based on justifiable evidence. b. a bias related to recent events. c. the impact of personality on the appraisal of performance. d. the effective use of a behaviorally anchored rating scale.

ANS: B To gain and to provide an accurate evaluation of performance over time, anecdotal notes need to be maintained throughout the evaluation period. This process assists in avoiding bias related to recent or sensational events that make a particularly strong impression.

During a fire drill, the nurse manager becomes very assertive and directive in her communications with staff. This type of situational leadership depends on: a. supportive behavior by the leader and immature followers. b. the development level of the followers and the behavior based on the situation. c. well-developed followers combined with a strong leader who acts quickly. d. the leader's ability to evaluate personnel and communicate that evaluation.

ANS: B When abilities, relationships, and/or time is limited (as in a crisis situation), the leader assumes a bigger role in guiding and in making decisions, or ―telling‖ behavior. Leaders need to behavior differently and use different leadership styles in different situations.

You ask Evelyn, a new UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. Before assigning Evelyn to Mrs. N.'s care,the most appropriate action of the care coordinator would have been to: a. determine Evelyn's educational background and preparation for this role. b. ask Evelyn if she has worked with inhalers before and to describe what she knows about them. c. advise that if Evelyn has any questions about what to do with the inhaler, she should come to the coordinator. d. advis

ANS: B When delegating tasks, in addition to specifying the task to be completed, outcomes, priorities, time lines, deviations, report time frames, monitoring, and resources, asking the delegatee to give examples of each is helpful in ensuring that communication is clear and has been understood. Preparation of UNPs lacks consistency; therefore, the safest practice is to determine the knowledge and skill level of the UNP in relation to the skill and the patient before delegating.

Which of the following indicates safe delegation? a. The nurse supervisor for a large urban acute care department asks the unit manager to accept two new acutely ill patients, which the manager does. The unit is short two staff, and the replacement is inexperienced. b. 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. c. The nurse supervisor asks the head nurse for Unit A to make do without a replacement for an ill staff member because Unit A was originally overstaffed anyway. Patient acuity levels are very high on Unit A and two staff are orientating. d. The nurse supervisor asks the charge nurse on Unit B to cover Unit F, which is two floors up, because the charge nurse for Unit F is ill. The charge nurse for Unit B is an experienced mana

ANS: B 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 car

The Emergency Department staff members are concerned that working long hours without rest puts patient safety at risk. One staff member decides that she will risk her job and become a whistleblower. Whistle-blowing is an appropriate recourse when management: a. disregards due process when disciplining a nurse. b. delays responding to repeated efforts to provide safe care. c. hires nurses who are not a part of the union during a strike. d. refuses to bargain in good faith with the elected bargaining agent.

ANS: B Whistle-blowing is often a result of organizational failure, including failure of the organization to respond to serious danger or wrongdoing created within the environment, which, in this instance, involves conditions that put the patient at risk.

The chief nursing officer utilizes the hospital's workplace advocacy to help the overwhelmed Emergency Department staff. Workplace Advocacy is designed to assist nurses by: a. creating professional practice climates in their institutions. b. equipping them to practice in a rapidly changing environment. c. negotiating employment contracts. d. representing them in labor-management disputes.

ANS: B 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 ofworkplace advocacy is to proactively equip nurses to practice within a rapidly changing environment, rather than to negotiate contracts or provide representation in employment disputes.

As a nurse manager, you notice that one of your new nurses has provided exceptional care for a patient with especially complex needs. What would be the MOST effective way of recognizing the nurse's performance? a. At the next performance review, note specifically what the nurse did to make the patient comfortable. b. To avoid embarrassing the nurse in front of others, find a way to compliment the nurse in private. c. When the nurse comes out of the room, tell the nurse specifically what you appreciated about the care that was provided. d. Encourage the patient to note the care on the patient feedback form so that the institution can recognize the nurse's efforts.

ANS: C Acknowledgement is most effective when it is specific, timely, given in public, sincere, and on an eye-to-eye basis. The more time that elapses between the event and acknowledgement, the less effective it becomes.

Which of the following might best conclude an interview? a. ―Thank you for your interest. Someone will be in touch with you soon.‖ b. ―Before you go, we will make sure that we have your contact information. Thank you for coming.‖ c. ―I will be in contact with all candidates by telephone by next Friday. It has been a pleasure to meet you.‖ d. ―We have several excellent candidates so I am not sure about the outcome of the interview, but I will let you know. Thank you for coming.‖

ANS: C An employment interview should always conclude with information as to how and when follow-up to the interview will occur.

In an inner-city area, a group of nurses meet and develop a plan to negotiate with local businesses to support a breakfast program for young elementary schoolchildren. This is an example of: a. community development. b. collective bargaining. c. collective action. d. shared governance.

ANS: C Collective action refers to activities undertaken by a group of people with common interests and, in this example, by a group of nurses who are interested in the welfare of children in their community.

The mediator asked each staff member to reflect on his or her communication style. Which of the following best describes communication? Communication: a. is a reflection of self-analysis. b. is a result of thoughtful consideration. c. consists of thoughts, ideas, opinions, emotions, and feelings. d. focuses on the sender of the message.

ANS: C Communication involves both senders and receivers and may or may not be a reflection of self-analysis and thoughtful consideration. It always, however, involves thoughts, ideas, opinions, emotions, and feelings.

The chief nursing officer decided that the nurse managers need a series of staff-development programs on team building through communication and partnerships. She understood that the nurse managers needed to build confidence in ways of handling various situations. The greatest deterrent to confidence is: a. lack of clarity in the mission. b. lack of control of the environment. c. fear that one can't handle the consequences. d. fear that the boss will not like one's work.

ANS: C Fear of not being able to manage consequences undermines confidence and a sense of competency.

The Emergency Department nurses' decision to organize for the purpose ofcollective bargaining is being driven by a desire to: a. establish the staffing pattern that will be used. b. determine the hours that one is willing to work. c. create a professional practice environment. d. protect against arbitrary discipline and termination.

ANS: C Historically, nurses were reluctant to unionize. However, concern with safety of care and quality of care, especially when tension is present in a work environment, makes unionization more desirable. US Supreme Court rulings have provided for RN-only units and protection to practice according to what the profession and licensure status require nurses to do.

An RN colleague, who is a long-standing and collaborative member of your team, is performing a complex dressing with new orders written for the first time for the assigned patient. Which of the following would be the most appropriate communication with her? a. ―How do you usually do this kind of dressing?‖ b. ―The dressing needs to be done today and tomorrow with the supplies on this cart.‖ c. ―Here is what you need for the dressing, and I will show you what needs to be done.‖ d. ―I know you know what you are doing. Let me know if you have any problems.‖

ANS: C If a situation involves a new task and the relationship is ongoing (two individuals who will usually continue to work together), the delegator explains what to do and how to do it. Hersey described the leader's behavior as explaining or persuading, which, is characterized as ―selling.‖ The RN who is assigned to the patient is an experienced nurse and team member, but is new to this specific situation. In situations where the nurse is experienced but the task is new, explain (and demonstrate) what needs to be done.

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: a. acknowledging the arrival of the second UNP on the unit. b. providing clear directions to both UNPs. c. matching tasks with qualified persons. d. receiving reports from the prior shift.

ANS: C 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.

In Hospital STV, senior administration is strongly oriented toward fiscal and social conservatism. The nursing department is deeply concerned with the provision of quality to the community, which includes a high number of poor and unemployed. To accomplish the goals of the nursing department, resources need to be allocated that administration is not able to allocate. Nursing and administration: a. are engaged in shared governance. b. are involved in an irreconcilable conflict of interests. c. represent separate subcultures in the institution. d. represent union and nonunion conflict.

ANS: C Institutions can have several subcultures, which are represented by unique features and distinct ideologies. Subcultures can be congruent and can support healthy relationships in the organization, or they may be separated and characterized by tensions that may be irreconcilable and destructive. From the information given in this scenario, it is not evident that shared governance, union presence, or irreconcilable differences are present.

Team Member A and Team Member B engage in heated disagreements on a frequent basis in team meetings. Their behavior is characterized by insistence on their points of view and refusal to back down or to negotiate alternative solutions once their ideas have been expressed. This behavior is characteristic of: a. autocratic leadership. b. constructive conflict. c. dualism. d. creativity.

ANS: C Our society tends to be dualistic in nature. Dualism means that most situations are viewed as right or wrong, black or white. Answers to questions are often reduced to ―yes‖ or ―no.‖ As a result, we sometimes forget a broad spectrum of possibilities actually exists. Exercising creativity and exploring numerous possibilities are important. This allows the team to operate at its optimal level.

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: a. 1,2,4,5,3 b. 4,1,2,5,3 c. 3,1,4,5,2 d. 3,4,2,1,5

ANS: C Planning, organizing, and keeping the group on task are critical in ensuring that meetings are productive and that time is managed well.

Which of the following exemplifies accountability? Karen, the nurse manager on 5E: a. consistently submits her budgets on time. b. gets along well with her staff and with other managers. c. outlines her rationale for reduction of RN coverage on nights to the Nursing Practice Committee after serious patient injury. d. actively solicits ideas regarding scheduling from her staff.

ANS: C Reliability, dependability, and obligation to fulfill the roles and responsibilities of the nurse manager are consistent with responsibility. Accountability refers to being answerable for actions and results.

As a nurse manager, you observe a staff nurse who over the past few weeks has become withdrawn and has had several absences due to minor ailments. Your best action would be to: a. ask the nurse if she is okay during report. b. refer the nurse to the employee assistance program. c. ask the nurse to meet with you for a few minutes before she leaves for the day. d. write a note to the nurse advising her that her work attendance must improve.

ANS: C Stress can lead to emotional symptoms such as depression and a variety of ailments. Meeting with the nurse privately may assist in identifying stress and possible solutions.

Which of the following statements would best define stress? Stress is: a. the comfortable gap between how we like our life to be and how it actually is. b. everyday life, both the highs and the lows. c. a consequence or response to an event or stimulus that can be positive or negative. d. identical to distress.

ANS: C Stress is defined as a gap between how we would like our lives to be and how they actually are and as a consequence or response to an event or stimulus. It is not inherently bad (distress), and whether highs and lows are seen as distress or eustress is dependent on each individual's interpretation of the event.

The nurse manager used a mediator to help resolve conflicts on the unit. During the mediation process, the nurse manager saw signs of potential team building. One key concept of an effective team is: a. conflict. b. task clarity. c. commitment. d. a designated leader.

ANS: C Team building involves moving toward a common vision, which requires commitment. Conflict and clarification of tasks are components in the development of this commitment.

The SBAR system of communications is one of the most used communication systems in health care because: a. it deals with all aspects of communications in patient care except communication with the physician. b. the nurse is on the same communication level as administration. c. it honors a familiar, structured transfer of information among health professionals. d. it honors an unstructured transfer of information.

ANS: C The SBAR system was developed by professionals in the California Kaiser Permanente System and involves direct, respectful communication skills among professionals with the aim of quality patient care.

While making rounds, a night supervisor finds a unit with a low census and too many staff members. The night supervisor is performing as a statutory supervisor when he or she: a. assigns nurses to care for specific clients. b. develops a protocol for unlicensed personnel. c. recommends transferring a nurse to another service. d. teaches a nurse to use a new piece of equipment.

ANS: C The night supervisor is acting in accordance with the National Labor Relations Act, which would enable the supervisor to assign nurses to care.

In determining the fit of a candidate with the culture on your unit, which of the following interview questions might be asked? a. ―Could you review your résumé for us, highlighting your certifications andexperience?‖ b. ―If we were to ask your references, what would they list as your strengths? Weaknesses?‖ c. ―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?‖ d. ―Tell us about your work and academic experiences and qualifications.‖

ANS: C 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.

The charge nurse is making patient assignments for the next shift on the unit. There is one critical patient on the unit, who is going to require more care than the other patients. Before delegating this patient in an assignment, what is the appropriate action by the charge nurse? a. Delegate the admission assessment to the LPN. b. Review the employee's performance assessment for the most recent period. c. Assess the amount of guidance and support needed for the nursing care of the patient. d. Create a task analysis of critical behaviors for the individual.

ANS: C To delegate effectively, the charge nurse must assess the abilities required in the situation and the abilities that staff have to anticipate the amount of direction, monitoring, explanation, and independence that can be assumed.

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: a. accountability. b. responsibility. c. assignment. d. delegation.

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

After staff meetings lately, Sharon, the head nurse, observes her staff in small groups, having animated discussions that end abruptly when she approaches. Sharon reflects on this observation and realizes that: a. two very outspoken members tend to dominate discussions in meetings. b. this behavior is indicative of a high level of communication among her staff. c. staff members are very committed to the team and have strong opinions. d. ongoing discussion outside of meetings is conducive to creativity.

ANS: C When team communication is dominated by a few members, leaving others uninvolved or bored, disagreement is not expressed openly. As a result, team members ―stuff‖ their feelings and wait until after meetings to voice their opinions.

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? a. Hardiness b. Depression c. Role ambiguity d. Depersonalization

ANS: D 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 nurse manager is experiencing conflicts between herself and staff members. She had tried to develop a team by using a shared leadership model to empower the staff. Staff members are functioning: a. as a team. b. independently. c. interdependently. d. as a group.

ANS: D A group is a collection of interconnected individuals working together, with a high degree of interdependence, for the same purpose. A team is a unified group that is committed to a common purpose, performance goals, and approach, for which they hold themselves mutually accountable. The conflict indicates that the staff may not be united in a common purpose.

You are a member of a team assigned to care for 15 general medical/surgical clients. You have all worked well together in the past in this same type of care. If you are assigned to coordinate this team's work, your best strategy, based on the Hersey model, would be to: a. have a list of tasks to be accomplished and tell each member of the team what he or she must do. b. encourage people to discuss their frustrations in providing this care. c. ignore them—they've done it before. d. provide minimal direction and let them come to you with questions.

ANS: D According to the Hersey model, when ability (skills, job knowledge) and willingness are strong, the role of the delegator is less (―delegating behavior‖).

The staff development educator developed strategies to help nurse managers actively listen. Guidelines for active listening include which of the following? a. Speed up your internal processes so that you can process more data. b. Realize that the first words of the sender are the most important. c. Be prepared to make an effective judgment of the communication sender. d. Cultivate a desire to learn about the other person.

ANS: D Active listening means suspending judgment about what is about to be said and listening to all that is said (and not just the first or last words). It is motivated by a genuine desire to learn about the other person.

The staff members in a local Emergency Department are experiencing stress and burnout as the result of excessive overtime. The staff decides to unionize to negotiate for better working conditions. The increase in unionization within health care may be attributed to the: a. movement from being ―blue-collar workers‖ to being ―knowledge workers.‖ b. excess profits in health care. c. level of risk that exists for health care. d. number of people who are involved in health care.

ANS: D As technology replaces unskilled workers, fewer workers are available for trade-union organizing, which has led to declines in union memberships. Nurses represent a large pool of workers who may be available for union organizing in the face of the declining pool available elsewhere.

A nurse manager in the ICU works with his staff to develop an appraisal instrument that includes quantitative data and respects standards for an RN working on that unit. This type of appraisal is a: a. rating scale. b. collaboratively based appraisal system. c. narrative instrument. d. behaviorally anchored rating scale.

ANS: D Behaviorally anchored rating scales (BARSs) describe performance quantitatively and qualitatively.

. As part of orientation to your unit, you decide to assign the new nurse to a preceptor. The most likely reason for your decision is that the use of preceptors: a. reduces the cost of orientation. b. determines if there is fit between learner and organizational values. c. develops the strengths of the new staff member. d. can impact the retention rate.

ANS: D Bodine (2020) notes that the preceptor is an important integrating force for the new employee's transition and can impact the organization's retention rate.

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? a. Championing one's own opinion b. Being compassionate c. Being flexible d. Committing to resolution

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

The nurse manager is implementing a shared governance model to help with communication and decision making. Although staff members like the concept, change is difficult. Staff nurses feel: a. more empowered. b. more communicative. c. less stressed. d. more powerless and devalued.

ANS: D Change can lead to feelings of being overwhelmed and powerless, especially if complexity compression or rapid, intense changes have been involved.

As the nurse manager on a rehab unit, you are asked to come to the tub room immediately because two nursing assistants are having a loud disagreement in front of a patient. You ask the nursing assistants to meet you outside and after ensuring that a third nursing assistant is able to care for the patient, you speak with the two nursing assistants. Which ofthe following would you ask first? a. ―How long have you two been working together?‖ b. ―Have you experienced disagreements like this before?‖ c. ―How do you think this patient's perception of her care has been changed?‖ d. ―What happened to bring on this disagreement today?‖

ANS: D Conflicts are usually based on attempts to protect a person's self-esteem or to alter perceived inequities in power. When a nurse recognizes upset and reaction, the following steps can be helpful (Sportsman, 2005): Identify the triggering event (―What happened to bring on this disagreement today?‖). Discover the historical context for each person. Assess how interdependent each person is on the other. Identify the issues, goals, and resources involved in the situation.

In delegating to a UNP in a home health setting, which of the following represents the most appropriate delegation communication? a. ―You will be taking care of Mrs. S., who needs assistance with her bath.‖ b. ―You will need to help Mrs. S. get into and out of her shower. Ensure that you check the condition of her feet, and let me know if you have any concerns when you check in.‖ c. ―I am not sure that you know how to do this, but I am giving you Mrs. S. She is quite obese and needs skin care.‖ d. ―Mrs. S. needs help to get into and out of her bathtub. Her bath will need to be completed by 10:00. When you are helping her to dry, please check between her toes and toenails, and phone me by 10:30 if you notice nail discoloration or redness.‖

ANS: D Delegation communication includes what is being delegated (and what is not), outcomes, specific deadlines (if applicable), specific reporting guidelines (what, when), and who may be consulted. Communication also includes conveying recognition of the authority to do what is expected.

In the cardiac intensive care unit, there has been simmering discontent about the new nurse manager, who avoids any discussion about her scheduling and practice decisions. The staff have begun to sort into ―different camps‖ depending on how they feel about the manager or the decisions. Which of the following statements MOST accurately describes this situation? a. The tension that has been generated will result in creative solutions. b. Staff will become a cohesive group that takes a stand against the manager. c. The conflict will result in increased dialogue about practice and scheduling options. d. Patient care may suffer because attention and energy is being diverted toward the unit relationships.

ANS: D Destructive conflict polarizes groups, saps group morale, deepens differences in values, and diverts energy from more important activities, such as patient care. Constructive conflict opens up issues of importance, results in solutions to problems, and enables authentic communication.

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. a. internal source b. familial c. burnout d. external

ANS: D 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.

Sally (RN) and Melissa (RN) have shared an ongoing conflict since the first day that Melissa worked on the unit. Sally has confided to another colleague that she doesn't even know why the conflict started or what it was about. This is an example of: a. how expectations and objectives need to be made clear in team situations. b. the need to encourage open discussion of disagreements in opinions. c. the importance of involving all staff in discussions in group settings. d. the enduring nature of first impressions.

ANS: D First impressions are lasting and, as Sally indicates to her colleagues, are often an unconscious response.

John notes that the next section is specific to the organizational philosophy and has a 4-point ordinal scale that describes performance from ―always meets expectations‖ to ―does not meet expectations.‖ This type of evaluation is most commonly known as: a. a behavior-anchored rating scale. b. management by objectives/learning goals. c. the forced distribution scale. d. a graphic rating scale.

ANS: D Graphic rating scales are commonly used in evaluation and reflect generalizations rather than specific behaviors.

The night nurse understands that certain factors need to be considered before delegating tasks to others. These factors include the: a. complexity of the task and the age of the delegatee. b. potential for benefit and the complexity of the task. c. potential for benefit and the number of staff. d. complexity of the task and the potential for harm.

ANS: D In delegating tasks to others, the nurse considers factors such as stability of the patient, safety of the situation and of the patient, time and intensity involved, and level of critical thinking required to achieve desired outcomes.

Collective action is effective in: a. ensuring that needs of nurses are placed ahead of other disciplines. b. defining nursing as a profession. c. advising patients of the needs of nurses. d. amplifying the influence of individuals.

ANS: D Individuals may have limited influence in achieving various purposes such as advancement of quality care or of the profession, whereas collective action helps to define and sustain individuals in achieving the desired purposes.

In a nurse managers' meeting, strategies for ways to help retain staff are discussed.One strategy for assisting nurses in developing collective action skills is: a. accepting the practice of ―going along to get along.‖ b. attending as many workshops as practical. c. spending as much time as possible in clinical settings. d. taking the opportunity to work with a mentor.

ANS: D Mentoring facilitates development and adoption of positive interaction and other skills that facilitate good decision making. Optimism, trust, and decision making are important in collective action and shared decision making and contribute to job satisfaction and lower turnover in staff.

The final section of a performance appraisal is a rating scale. This scale is very detailed and relates to competency standards specific to surgical clients. The scale is a summary of performance directly observed or documentation reviewed and is specific to client care situations in which the employee has been involved. This type of evaluation is most commonly known as: a. a traditional rating scale. b. management by objectives/learning goals. c. a forced distribution scale. d. a behaviorally anchored rating scale.

ANS: D Performance appraisals may include self and peer evaluations as well as managerial components.

Social stressors are considered a major factor in the stress nurses experience in the healthcare system. Which of the following is not considered to be a social stressor? a. High amounts of stress in the nursing home environment b. Changes in the current healthcare system such as nursing strategies c. Disruptive behavior coming from physicians and other healthcare workers d. Stress triggers such as self-criticism and overanalyzing

ANS: D Personal stress triggers such as self-criticism are considered intrapersonal stressors; environmental factors such as change, work environment, and interactions with others are considered social stressors.

A nurse manager has decided that she must institute some personal time-management steps to survive work and home life. Her first step should be to: a. determine what takes up so much of her time and energy. b. organize her personal and work spaces. c. purchase a handheld personal digital assistant to help remind her of important meetings. d. determine her personal and professional goals.

ANS: D Personal time management refers, in part, to ―the knowing of self.‖ Self-awareness is a critical leadership skill, and being self-aware and setting goals helps managers determine how their time is best spent.

The nurse manager was upset with the staff nurse and said, ―You did not understand what I said.‖ Which element in the communication process was she referring to? a. Feedback between receiver and sender b. A message channel c. A receiver who decodes the message d. A set of barriers that may occur between sender and receiver

ANS: D Problems can occur at any point in communication and result in miscommunication. In this instance, it can be assumed that there was a sender, a receiver, a channel, and feedback. In this scenario, barriers such as distractions, inadequate knowledge, differences in perceptions, and emotions and personality may have resulted in misunderstanding between the manager and the staff nurse.

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. an employee recognition program. b. coaching for new staff. c. a new performance appraisal system. d. a committed orientation and training program.

ANS: D 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.

Awareness and use of power have been challenging for nurses in general because of: a. incidences of punishment by authority figures. b. too little time in the workplace to collectively develop power strategies. c. lack of cohesiveness and unity among nurses. d. a tradition of obedience to authority.

ANS: D Rituals and traditions such as the Nightingale Pledge have emphasized the need for the ―good nurse‖ to be obedient to authority. This prevailing attitude has made it difficult for nurses, who typically spend considerable time in the workplace and who have opportunity through their work in teams to develop cohesiveness and unity, to develop awareness and use of power.

Which one of the following statements has been proven to be true? a. Recent research has found that women do not have a unique physiologic response to stress. b. Both men and women interpret the same stressor in the same manner without regard to past experiences. c. Stress influences the immune system in one complex manner. d. Stressors that are identical do not necessarily have similar effects on each individual.

ANS: D Stressors may be unique to certain environments, situations, and persons or groups, and individuals may respond to the same stressor in different ways.

Sally is an experienced nurse on the unit and is very experienced with ICP monitoring. She is assigned David, a patient who has been admitted with a severe head injury. In communicating with Sally, what is an appropriate action by the charge nurse? a. Provide a detailed explanation of what she needs to do with ICP monitoring. b. Tell her when she needs to provide an update about David's status. c. Ask her to tell you what she knows about ICP monitoring and share expectations about reporting. d. Advise her that you are available if she needs you.

ANS: D The charge nurse and Sally have a well-established relationship and Sally has the expertise to work effectively with David; therefore, the charge nurse would need to provide little guidance but would need to communicate that they are available if needed. Hersey refers to this leader behavior as ―delegating.‖

In looking at an organizational chart for her institution, Jennifer notes that nursing is led at the senior level by a non-nurse executive. Jennifer expresses concern that this is a reflection of how nursing is viewed within the organization. Jennifer's comments reflect: a. a concern that resource allocation will be made on a business and not a professional model. b. the dissatisfaction that occurs when lack of autonomy is given to nurses. c. concern with the nonadvancement of nursing practice in the institution. d. an awareness of how organizational culture is reflected in organizational structure.

ANS: D The organizational chart reflects the formal structure of the organization and can reflect predominant beliefs, values, and relationships in the organization. Exclusion at senior executive levels of nurse leaders may reflect institutional beliefs about how resources are allocated, the degree of autonomy given to staff, and involvement of key groups in decision making.

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 anxietyand 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? a. Performance appraisal b. Counseling c. Empowerment d. Coaching

ANS: D 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.

―I really wish that my supervisor would realize and acknowledge all the things I do well.‖ In nursing, this has been identified as a problem. Which statement is part of the solution? Focus on: a. new staff. b. care assignments with which the individual is not familiar. c. making corrections. d. the strengths of the individual rather than the weaknesses.

ANS: D The research of Rath (2007) included many recommendations, one of which was that focusing on mediocre behaviors and on a person's weaknesses will not lead to excellence. Focusing on weaknesses tends to decrease the appreciation, and thus the acknowledgements.

A key advantage that a charge nurse has in terms of delegating is that: a. clients receive less attention because too many staff make it difficult to coordinate care. b. nurses report less pressure to perform necessary tasks themselves. c. administration can predict overtime more accurately. d. team skills can be used more effectively.

ANS: D The use of multilevel healthcare providers enables healthcare organizations and nursing to provide patient-centered care, with a focus on abilities and skills that can be employed to perform ―what is needed now.‖ As tasks become more complicated, delegating skills to others enables the nurse to effectively deliver a complex level of care.

In helping nurse managers to manage their time, the chief nursing officer suggests that they: a. maintain a perfectionistic attitude. b. set up a complaint list. c. have good negotiation skills. d. have good information literacy skills.

ANS: D 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.

Nurses can use four elements to determine the abilities of the UNP/AP to perform the task or activity when delegating. These four elements are: a. ability, attitude, acuity, and authority. b. skill, diet, communication, and agility. c. accountability, time management, organizational skills, and degree. d. safety, critical thinking, stability, and time.

ANS: D To assist with the challenges of delegating, nurses can use four elements to determine the abilities of the UNP/AP to perform the task or activity. These four elements are safety, critical thinking, stability, and time.

You are working in a home health service and have three unlicensed nursing personnel (UNPs) assigned to your team. You have worked with two of them for 2 years; the third is new. The two experienced UNPs have patients with complex illnesses for whom theyprovide basic care. The third member of the team has been assigned to patients with less complex illnesses. Your best approach to supervising their care is to: a. remain in the office and ask each UNP to check in with you upon arrival at their first patient care site. b. ask another RN to supervise the two experienced assistants so you can be with the new person full time. c. meet the new staff member at the first patient care site and ask the others to call if anything is unusual. d. meet the new staff member at the first patient care site and call the others with questions to determine whether anything is unusual.

ANS: D When ability and willingness are strong, the involvement of the delegator is needed less.

Leslie, a UNP, transfers a patient while using improper technique. The patient is injured, and as a result, a suit is launched in which both Sarah (the delegator) and Leslie (the delegatee) are named. Sarah is named in the suit because she: a. retains accountability for the care of the patient. b. worked the same shift as Leslie. c. has passive accountability for delegation. d. retains accountability for the outcomes of care for the patient.

ANS: D Whenever care is provided by someone other than a registered nurse, accountability for care remains with the manager/delegator even though others provide aspects of care.

Time management is very essential for the nurse manager. Which of the following is not a good time-management technique? a. Decide what not to do. b. Learn to say ―No.‖ c. Learn to delegate. d. Break down your workload into smaller, manageable tasks.

ANS: D??? To manage time successfully, it is important to break down your workload into smaller, manageable tasks. Developing PERT and Gantt charts will aid in dealing with larger, complex projects. Both charts can be used to outline how an individual will approach a large project.

After providing hospital nursing staff with an in-service on shared governance models, what demonstrates to the chief nursing officer the education was effective? (Select all that apply.) a. Assemble a subgroup of staff to develop new unit policy. b. Search the literature together for best practice articles regarding a clinical question. c. Develop a peer recognition program. d. Ask the manager to determine policy for the unit. e. Request a team be assembled to implement a clinical ladder. f. Boast openly about the quality of their direct involvement through shared governance to their colleagues from other units.

a. Assemble a subgroup of staff to develop new unit policy. b. Search the literature together for best practice articles regarding a clinical question. c. Develop a peer recognition program. e. Request a team be assembled to implement a clinical ladder. f. Boast openly about the quality of their direct involvement through shared governance to their colleagues from other units

What type of performance appraisal is based on the employee and manager jointly setting goals? a. Management by objective b. Behaviorally anchored rating scales c. Critical incidents d. Narrative method

a. Management by objective

Emotional intelligence (EI) is a quality critical to the development of a new leader. This trait should inspire those who follow a leader whom demonstrates high levels of EI. What is the BEST example which illustrates emotional intelligence? a. Manager who conducts rounds on unit, makes eye contact with team members, and generally makes time to hear about the issues of the day. b. Manager holds meetings at the nurses station to be able to respond to emergencies and phone calls yet is rarely seen in scrubs helping at the bedside. c. Manager who holds team accountable. However, she interrupts people frequently at meetings and raises voice when disagrees with them. d. Manager writes down thoughts and puts them in an e-mail, often very late at night, for her team or colleagues to read. She expects others to respond to them by the first meeting of the day. She frequently reschedules meetings for personal reasons yet gives

a. Manager who conducts rounds on unit, makes eye contact with team members, and generally makes time to hear about the issues of the day.

A new graduate nurse is preparing to interview for a position in a clinic. The graduate nurse has limited experience or exposure to the role of a nurse in a clinic setting. What would the new nurse review prior to applying for the position? a. Position description b. Salary ranges for position c. Corrective action processes d. Relocation expenses

a. Position description

During bedside rounds, a surgeon turns to the charge nurse and says, "The poor nursing care has caused this wound to become infected. Can't nurses at this hospital do anything right?" What is the appropriate response by the charge nurse? a. "The nursing care on this unit has received awards and certainly is not the problem." b. "Let's first decide what to do for Mrs. Johnson and then step into the hall and talk further about your concerns." c. "It is inappropriate to talk to me that way. I will report this to my supervisor." d. "Would you like to change the antibiotic Mrs. Johnson is receiving?"

b. "Let's first decide what to do for Mrs. Johnson and then step into the hall and talk further about your concerns."

The staff nurse discovers that the one of the CNAs refused to help a co-worker ambulate a very obese, high-risk pregnant patient to the bathroom. What is the appropriate response by the nurse? a. Give them a lecture on working together as a team. b. Ask questions about the safety of the patient related to the behavior. c. Describe the anger and upset as inappropriate behavior. d. Assist the CNA to ambulate the patient and ignore the CNS issues.

b. Ask questions about the safety of the patient related to the behavior.

The charge nurse observes a specific employee has a significant increase in errors and may have some emotional problems from personal issues at home. What is the appropriate response by the charge nurse? a. Schedule a series of meetings with the employee to support and assist the employee in addressing the problem. b. Ask the employee some questions ending with a suggestion that Employee Assistance might be an option. c. Put the employee on the first steps of disciplinary action. d. Send the employee to the mental health center and ask for documentation before returning to work.

b. Ask the employee some questions ending with a suggestion that Employee Assistance might be an option.

The charge nurse is question in if the staffing ratios demand the use of high-level delegation strategies. What "delegation right" is she assessing in this thought process? a. Task b. Circumstances c. Person d. Communication or direction

b. Circumstances

Delegation, a multifaceted decision-making process, what is NOT a reason to implement delegation? a. Improve the work performance of staff. b. Decrease the registered nurse's accountability. c. Achieve nursing goals. d. Improve patient care outcomes.

b. Decrease the registered nurse's accountability.

Role theory provides one framework for development and evaluation of staff. What term describes when employees are unwilling or unable to meet requirements? a. Role ambiguity b. Role conflict c. Role acquisition d. Role clarity

b. Role conflict

What is the BEST way that nurse leaders can reduce stress on the job? a. Delegate to others who are unlicensed, whenever possible. b. Support a professional practice model and learn to "let go." c. Be available 24/7 so the staff feel supported. d. Post the Employee Assistance Hotline in the staff lounge.

b. Support a professional practice model and learn to "let go."

The main purpose(s) of collective action in nursing is/are what? (Select all that apply.) a. To facilitate formation of a recognized bargaining unit (union) b. To promote the practice of professional nursing c. To establish and maintain standards of care d. To facilitate the orientation and competency of newly licensed registered nurses e. To allocate resources effectively and efficiently f. To create satisfaction and support in the practice environment

b. To promote the practice of professional nursing c. To establish and maintain standards of care e. To allocate resources effectively and efficiently f. To create satisfaction and support in the practice environment

What statement by a newly promoted nurse manager indicates the need for follow-up on leadership style and development for the manger? a. "As a new leader, I should identify and work with a mentor." b. . "I intend to promote shared decision making in my unit." c. "I don't need to worry about engaging my workforce because all nurses are naturally engaged."Correct Answer d. "I will purposefully cultivate a broad follower base in my unit."

c. "I don't need to worry about engaging my workforce because all nurses are naturally

How can a leader deal fairly with employees who fail to meet established standards of care? a. . Determine if the employee issue is a will or skill issue. b. Conduct a chart review that reflects the care issue. c. . Ask questions of the employee that can reflect the employee's knowledge base. d. Ask other staff to document concerns to use for discharging.

c. . Ask questions of the employee that can reflect the employee's knowledge base.

Two of the CNAs on the unit have a history of problems with each other and typically do not work the same shift. Working together today is a rare occurrence. What is the appropriate response by the nurse? a. Separate the two and send each to a different area on the unit. b. Ask them not to talk to each other for the remainder of the shift. c. Ask questions about what triggered the upset. d. Make certain they are not schedule together again.

c. Ask questions about what triggered the upset.

A very close relationship exists between stress management and time management. What is the best way to define time management? a. "Going with the flow" so that unexpected events don't have a negative impact on the plans for the day b. Using tools and principles to engage others in low-priority needs and objectives in order that the leader may occupy self with high-priority needs c. Using tools, techniques, and principles to achieve personal and professional goals d. Doing things that matter to others, such as supervisors, subordinates, and peers

c. Using tools, techniques, and principles to achieve personal and professional goals

A new staff nurse discovers two of the certified nursing assistants (CNAs) in the utility room speaking loudly and pointing at each other. What is the MOST appropriate action by the nurse? a. Continue walking down the hall, believing they will work it out. b. Walk into the utility room and tell them to stop or they will be reported to HR. c. Make an observation about their behavior and ask them what's going on. d. Get the nurse manager and take her to the utility room.

d. Get the nurse manager and take her to the utility room.

What is the appropriate term for the ability to transfer selected nursing activities in a given situation to a competent individual? a. Supervision b. Accountability c. Responsibility d. Legal authority

d. Legal authority

Two employees disagree about who should work on Christmas Day. The bottom line is that one employee will have to work, and the schedule must be posted tomorrow. What is the best method for the nurse manager to assist in the conflict between the nurses? a. Use your position of power to resolve the conflict. You decide who will work Christmas Day. b. Rely on centralized staffing to resolve the issue. c. Try to arrange a compromise. Have one employee work the first half of the shift and have the other work the second half. d. Meet with both employees at the same time. Engage them in the problem-solving process.

d. Meet with both employees at the same time. Engage them in the problem-solving process.