Management Final & NECLEX Questions, S1 Fall 2019
Budget: What is an audit?
A systematic & official examination of a record, process, structure, environment, or account to evaluate performance
Theoretical approaches to problem solving and decision making: Nursing Process (ADPIE)
A: Assess D: Diagnose P: Plan I: Implement E: Evaluation
Prioritization
ABC: Airway; Breathing; Circulation LOC; Pain
Disciplinary Conference: Reason for Disciplinary Action
Begin by clearly specifying why the employee is being disciplined Focus on measurable behaviors & keep your concerns free of non-work related matters
A client tells the nurse that he gets dizzy and lightheaded with each use of the incentive spirometer. The nurse asks the client to demonstrate the use of the device. Which action should the nurse expect to be a contributing factor in this client's symptoms? A. Inhaling too slowly B. Exhaling too slowly C. Not resting adequately between breaths D. Not forming a tight seal around the mouthpiece
C. Not resting adequately between breaths Rationale: Hyperventilation is the most common cause of respiratory alkalosis, which is characterized by lightheadedness and dizziness. If the client does not breathe normally between incentive spirometer breaths, hyperventilation and fatigue can result. The nurse should instruct the client to assume a sitting or upright position when using the incentive spirometer and the client should be taught about how to take adequate breaks in between breaths.
Power Type: Expert or Knowledge
Charge nurse, specialty
Leadership Style: Autocratic/Authoritarian
Controlling, "my way or the highway, makes the decisions alone, micromanager
Which finding would prompt the RN to call the neonatologist back to evaluate the infant further? A. Cyanosis of the hands and feet B. Heart rate of 160 beats/min C. Respiratory rate of 55 breaths/min D. Central cyanosis
D. Central cyanosis Rationale: The heart rate and respiratory rate, and findings of peripheral cyanosis are normal in the first hour of life. Central cyanosis, however, may suggest a cardiac or respiratory abnormality and must be evaluated.
Disciplinary Conference: Agreement & Acceptance of Action Plan
Get agreement & acceptance of plan Give support & let the employee know that you are interested in him/her as a person
Power Type: Informational
Holder of information
Transformational Leadership
Identify common values with the people around them, inspiring, thinking long term, looking at effects, transform the environment in a positive way
Disciplinary Conference: The Environment for Discipline
Manager should implement discipline privately, never in front of patients or peers
Conflict management strategy: Accommodating
People neglect their own needs, goals, and concerns while trying to satisfy those of others This approach has an element of being self-sacrificing and simply obeying orders or serving other people
Disciplinary Conference: Closure
Provide employee with a copy of the disciplinary action & place a copy of the documentation in the personnel file Inform employee about company policy concerning disciplinary action & length of time disciplinary action forms remain in employee's file before removed
Servant Leadership
Putting serving others as #1 priority, includes patients, employees, community, promote collaboration, teamwork & sense of belonging
Effective performance appraisals tool: Job Dimension Scales
Requires a rating scale constructed for each job clarification
5 Rights of Delegation
Right Task: can you delegate this task? low-risk or no higher education to do Right Circumstance: what is going on with the patient, stable or unstable? work load of person you are delegating a task to Right Person: do they have the experience to do this task & within their scope Right Direction/Communication: explaining clearly how to perform the task, what to expect, and what to report to you Right Supervision: RN-followed up, how it was done-still accountable for task getting done & done right
Maslow's Hierarchy of Needs
Self-actualization Esteem Love Safety Physiological
Lewin (Three Phases of Planned Change): Refreezing
Support others to keep the change as the new status quo
The AIDET communication strategy: Explanation
Tell them what you are doing, why & how
Helpful tips in conflict resolution: Soothing One Party
Temporary solution used in a crisis when there is no time to handle the conflict effectively or when the parties are so enraged that immediate conflict resolution is unlikely Must address the underlying problem later or this is not effective
Conflict management strategy: Collaborating
The most time-consuming approach, is the most creative Involves analyzing situations and defining the conflict at a higher level where shared goals are identified and commitment to working together is generated
Leadership Style: Laissez faire/Permissive
The people make the decision (self scheduling)
Marginal employees — how to work with them effectively : Used by high-level managers
Transfer the employee to another department, section, or unit Dismiss or attempt to talk them into early retirement or resignation Coaching (most time-intensive option): attempts to improve performance through active coaching/counseling
Conflict management strategy: Appropriate Uses of Compromise
When two powerful sides are committed strongly to perceived mutually exclusive goals When temporary solutions to complex issues need to be implemented When conflicting goals are "moderately important" and not worth a major confrontation When time pressures people to expedite a workable solution When collaborating and competing fail
A client with a known history of panic disorder comes to the emergency department and states to the nurse, "Please help me I think I'm having a heart attack." What is the priority nursing action? A. Assess the client's vital signs. B. Encourage the client to use relaxation techniques. C. Identify the manifestations related to the panic disorder. D. Determine what the client's activity involved when the pain started.
A. Assess the client's vital signs. Rationale: Clients with a panic disorder can experience acute physical symptoms, such as chest pain and palpitations. The priority is to assess the client's physical condition to rule out a physiological disorder for these signs and symptoms. Although option 2, 3, and 4 may be appropriate at some point in the care of the client, they are not the priority.
You are caring for a patient with esophageal cancer. Which task could be delegated to a UAP? A. Assisting the patient with oral hygiene B. Observing the patient's response to feedings C. Facilitating expression of grief or anxiety D. Initiating daily weighings
A. Assisting the patient with oral hygiene Rationale: Oral hygiene is within the scope of duties of the UAP. It is the responsibility of the nurse to observe response to treatments and to help the patient deal with loss or anxiety. The UAP can be directed to weigh the patient but should not be expected to know when to initiate that measurement.
Henry is a Unit Manager on the Medical Unit. He is not satisfied with the way things are going in his unit. Patient satisfaction rate is 60% for two consecutive months and staff morale is at its lowest. He decides to plan and initiate changes that will push for a turnaround in the condition of the unit. Which of the following actions is a priority for Henry? A. Call for a staff meeting and take this up in the agenda. B. Seek help from her manager. C. Develop a strategic action on how to deal with these concerns. D. Ignore the issues since these will be resolved naturally
A. Call for a staff meeting and take this up in the agenda. Rationale: Calling for a staff meeting will allow for the participation of every staff in the unit. If they contribute to the solutions of the problem, they will own the solutions; hence the chance for compliance would be greater. The unit manager should not seek help from higher ups until he has attempted to correct the issue. Creating a strategy is important, but the manager should attempt to involve the staff in the change as much as possible. Ignoring the issue will not address the problem.
A nurse is caring for a group of clients on a medical surgical unit. Which of the following tasks should the nurse delegate to the unlicensed assistive personnel (UAP)? Select all that apply. A. Collecting a stool specimen B. Providing instructions about using an incentive spirometer C. Measuring oral intake D. Providing postmortem care E. Changing a dressing
A. Collecting a stool specimen C. Measuring oral intake D. Providing postmortem care Rationale: Collecting a stool specimen, measuring oral intake, and providing postmortem care do not require assessment, analysis, or teaching. Providing instructions about using a spirometer requires client teaching which is the nurse's responsibility. Changing a dressing requires assessment which is not within the UAP's practice.
Katherine is a young Unit Manager of the Pediatric Ward. Most of her staff nurses are senior to her, very articulate, confident and sometimes aggressive. Katherine feels uncomfortable believing that she is the scapegoat of everything that goes wrong in her department. Which of the following is the best action that she must take? A. Identify the source of the conflict and understand the points of friction B. Disregard what she feels and continue to work independently C. Seek help from the Director of Nursing D. Quit her job and look for another employment
A. Identify the source of the conflict and understand the points of friction Rationale: Identifying the source of the conflict and understanding the points of friction is appropriate as she is the unit manager. This involves a problem-solving approach, which addressed the root cause of the problem. Seeking help from the Director of Nursing would be the next appropriate step if she was unable to find the source of conflict. Disregarding the situation at hand poses a risk of build up of emotions in which the nurse may become burnt out. Quitting her job and finding a new job may not be practical and would not solve the problem at hand.
A nurse working at a rehabilitation center attends an interdisciplinary team meeting for a client who had a left hemispheric stroke. Which of the following members of the interdisciplinary team should the nurse expect to contribute to the plan of care? (Select all that apply) A. Nurse B. Respiratory Therapist C. Speech Therapist D. Physical Therapist E. Occupational Therapist
A. Nurse C. Speech Therapist D. Physical Therapist E. Occupational Therapist Rationale: The nurse typically spends the most time with the client and can provide the most insight to the current and potential needs of the client. The speech therapist will be needed because the client may have difficulties with speech and swallowing due to the stroke; the speech therapist will assess the patient and provide ongoing treatment. The physical therapist will be needed to evaluate the physical impairments related to mobility, such as walking, usually with an assistive device such as a cane or walker. The occupational therapist will be needed to assess the client's ability to perform ADL's and enhance independence; the respiratory therapist will not need to attend the interdisciplinary team meeting because clients who have had cerebrovascular accidents typically do not have respiratory challenges.
A client arrives at the emergency department with upper gastrointestinal (GI) bleeding and is in moderate distress. The priority nursing action is to: A. Obtain vital signs B. Ask the client about the precipitating events C. Complete an abdominal physical assessment D. Insert a nasogastric (NG) tube and hematest the emesis
A. Obtain vital signs Rationale: The priority action is to obtain vital signs to determine whether the client is in shock from blood loss and to obtain a baseline by which to monitor the progress of treatment. The client may not be able to provide subjective data until the immediate physical needs are met. Insertion of an NG tube may be prescribed but is not the priority action. A complete abdominal physical assessment needs to be performed but it is not the priority.
The nurse is preparing for the admission of an infant with a diagnosis of bronchiolitis caused by respiratory syncytial virus (RSV). Which interventions should the nurse include in the plan of care? Select all that apply. A. Place the infant in a private room. B. Ensure that the infant's head is in a flexed position. C. Wear a mask, gown, and gloves when in contact with the infant. D. Ensure that nurses caring for the infant with RSV do not care for other high-risk children. E. Position the infant on the side, with the head lower than the chest.
A. Place the infant in a private room. C. Wear a mask, gown, and gloves when in contact with the infant. D. Ensure that nurses caring for the infant with RSV do not care for other high-risk children. Rationale: RSV is a highly communicable disorder and is transmitted via droplets or contact with respiratory secretions. Use of contact, droplet, and standard precautions during care (wearing gloves, mask, and a gown) reduces nosocomial transmission of RSV. In addition, it is important to ensure that nurses caring for a child with RSV do not care for other high-risk children to prevent the transmission of the infection. An infant with RSV should be placed in a private room and should be positioned with the head and chest at a 30-40 degree angle and the neck slightly extended to maintain an open airway and decrease pressure on the diaphragm.
A patient with a pulmonary embolus is receiving anticoagulation with IV heparin. What instructions would you give the nursing assistant who will help the patient with activities of daily living? Select all that apply. A. Use a lift sheet when moving and positioning the patient in bed B. Use an electric razor when shaving the patient C. Use a soft-bristled toothbrush or tooth sponge for oral care D. Use a rectal temperature to obtain a more accurate body temperature E. Be sure the patient's footwear has a firm sole when the patient ambulates
A. Use a lift sheet when moving and positioning the patient in bed B. Use an electric razor when shaving the patient C. Use a soft-bristled toothbrush or tooth sponge for oral care E. Be sure the patient's footwear has a firm sole when the patient ambulates Rationale: While the patient is receiving anticoagulation therapy, it is important to avoid trauma to the rectal tissue, which could cause bleeding (e.g., avoid rectal thermometers and enemas). All of the other instructions are appropriate to the care of a patient receiving anticoagulants
A new charge nurse on a busy surgical unit notes high degree of tension among the nursing staff. Which of the following should be the initial method used for resolving this issue? A. Work with the nurses to identify stressors B. Hire additional staff to decrease the workload C. Make relaxation tapes available to staff to help decrease stress D. Reassess the situation after the nurses have become accustomed to the new charge nurse
A. Work with the nurses to identify stressors Rationale: Assessing the situation further is the first step in determining a solution. Although hiring additional staff may eventually be necessary this would only be done after the need for additional staff was determined to be the best of all possible solutions. Making relaxation tapes available to staff may help them individually, but it would not address the discovery and correction of the factors causing the staff's stress. If the nurse manager is newly placed in this position it is likely that the factors contributing to the staff's stress have existed prior to the change in unit management. Waiting for an adjustment would be the same as doing nothing to address the current problem.
Power Type: Reward
Ability to reward
Emotional Intelligence (EI)
Ability to use emotions effectively & understanding, perceiving, and controlling own emotions & others
Verbal communication skills: Passive-aggressive
An aggressive message presented in a passive way. Generally involves limited verbal exchange by a person who does feel strongly about the situation; Typically conducted in an effort to manipulate the situation ex: Throwing Down patient assignment clipboard and walking away
Modes of organizing patient care: Team and Modular nursing
Ancillary personnel collaborate in providing care to a group of patients under the direction of a professional nurse (delegation) Requires extensive team communication and regular team panning conferences Modular: A variation of Team nursing Uses a smaller team Pairs professional nurse with ancillary staff to deliver care to groups of patients Used frequently during the 1980s and 1990s Advantages: Extra Help Delegation Democracy High autonomy Nurse satisfaction (feeling of belonging) Disadvantages: Lots of Hands in the pot Need for excellent communication Need strong leadership Redundancies Settings: Medical Surgical Units Inpatient facilities Blended with Case management
Effective performance appraisals
Appraisal should be based on a standard The appraisal tool must adequately & accurately assess job performance Employee should have input into development into development of the standard Employee must know the standard in advance Employee must know the sources of data gathered for the appraisal Appraiser should be someone who has observed the employee's work Appraiser should be someone who the employee trusts & respects Employer support & clarity of expectations are critical to the employee perceiving the appraisal as fair
Modes of organizing patient care: Primary nursing
As originally designed, it requires an all- RN nursing staff RN primary nurse assumes 24-hour responsibility for planning the care of one or more patients from admission to discharge During work hours, the primary nurse provides direct care fro those patients Advantages: With patient from start to finish Satisfying for nurses Continuity of Care Autonomy Trust Disadvantages: On call work Fatigue/burnout Costly Need more skilled RNs Settings: In patient psych facility Home health
The AIDET communication strategy: Thank you
Attitude of gratitude
Power Type: Legitimate or position
Authority, have title that gives them power
When prioritizing care, which of the following clients should the nurse see first? A. A 17-year-old client 24-hours post appendectomy B. A 33-year-old client with a recent diagnosis of Guillain-Barre syndrome C. A 50-year-old client 3 days post myocardial infarction D. A 50-year-old client with diverticulitis
B. A 33-year-old client with a recent diagnosis of Guillain-Barre syndrome Rationale: Option B: Guillain-Barre syndrome is characterized by ascending paralysis and potential respiratory failure. The order of client assessment should follow client priorities, with disorder of airways, breathing, and then circulation. There's no information to suggest the post-myocardial infarction client has an arrhythmia or other complication. There's no evidence to suggest hemorrhage or perforation for the remaining clients as a priority of care.
The Nurse is caring for four clients and is preparing to do his initial rounds. Which client should the nurse assess first? A. The client with diabetes being discharged today B. A 35-year-old male with a tracheostomy & copious secretions. C. A teenage scheduled for physical therapy this morning D. A 78-year-old female client with a pressure ulcer in need of a dressing change.
B. A 35-year-old male with a tracheostomy & copious secretions Rationale: The patient with problem of the airway should be given highest priority. Remember Airway, Breathing, and Circulation (ABC) is a priority than LOC.
A patient with chronic obstructive pulmonary disease (COPD) is in the hospital. Which intervention for airway management should you delegate to a nursing assistant (PCT)? A. Teaching the patient to use incentive spirometry B. Assisting the patient to sit up on the edge of the bed C. Instructing the patient to cough effectively. D. Auscultation of breath sounds every 4 hours
B. Assisting the patient to sit up on the edge of the bed Rational: Anything that has to do with teaching, instructing or assessing a patient needs to be done by a nurse. Assisting the patient with positioning and activities of daily living is within the scope of practice for the PCT.
The nursing manager decides to form a committee to address the issue of violence against ED personnel. Which combination of employees would be best suited to fulfill this assignment? A. RNs, LPNs, and nursing assistants B. At least one representative from each group of ED personnel. C. Experienced RNs and experienced paramedics. D. Physicians and charge nurses.
B. At least one representative from each group of ED personnel. Rationale: At least one representative from each group of ED personnel should be included because all employees are potential targets for workplace violence in the emergency department
A patient in a long-term care (LTC) facility who has chronic lymphocytic leukemia has a nursing diagnosis of Activity Intolerance related to weakness and anemia. Which nursing activity will you delegate to the UAP? A. Evaluating the patient's response to normal activities of daily living B. Checking the patient's blood pressure and pulse rate after ambulation. C. Determining which self-care activities the patient can do independently. D. Assisting the patient in choosing a diet that will improve strength.
B. Checking the patient's blood pressure and pulse rate after ambulation. Rationale: UAP education covers routine nursing skills such as assessment of vital signs. Evaluation, baseline assessment of patient abilities, and nutrition planning are activities appropriate to RN practice.
A client admitted to the hospital with a diagnosis of cirrhosis has fluid build up in the abdomen and difficulty breathing. The nurse performs which intervention as a priority measure to assist the client with breathing? A. Repositions side to side every 2 hours B. Elevates the head of the bed 60 degrees C. Auscultates the lung field every 4 hours D. Encourages deep breathing exercises every 2 hours
B. Elevates the head of the bed 60 degrees Rationale: The client is having difficulty breathing because of upward pressure on the diaphragm from the fluid. Elevating the head of the bed enlists the aid of gravity in relieving pressure on the diaphragm. The other options are general measures to promote lung expansion in the client, but the priority measure is the one that relieves diaphragmatic pressure.
When a nurse is suffering from laryngitis, which of the following nonverbal cues could be the most effective in communicating with a patient? A. A soft voice and physical appearance B. Gestures and eye contact C. Write a note and tell the patient you are sick D. Posture and hand movements
B. Gestures and eye contact Rationale: A soft voice poses risk of the patient not hearing or understanding you. Writing the patient a note to explain your illness is not professional. Finally, while posture and hand movements are important in nonverbal communication, gestures and eye contact offer more understanding and communication in a one on one and intimate interview with the patient.
One Minute Manager Principles: One minute praising
Be observant, do no expect perfection #1 motivator: feedback on how they are doing Be immediate, do not wait to praise Describe what they did right and why it helps Share your personal feelings Encourage to do more of the same
One Minute Manager Principles: One minute goal setting:
Best strategies for learners, students, and new hires (#1 reason: they don't know what is expected of them) Agree on the goals Decide what "good behavior" looks like Write goals in 250 words or less Later, look at performance and see how it matched the goal Give feedback
The nurse provides instructions regarding home care to a parent of a 3-year-old child who has been hospitalized with hemophilia. Which statement by the parent indicates the need for further teaching? A. "I should not leave my child unattended" B. "I need to pad table corners in my home" C. "My child should not have any immunizations" D. "I need to remove household items that can tip over"
C. "My child should not have any immunizations" Rationale: The nurse needs to stress the importance of immunizations, dental hygiene, and routine well-child care. Options A, B, and D are appropriate statements. The parents should also provide instructions regarding measures to take in the event of blunt trauma (especially trauma that involves the joints), and they should be instructed to apply prolonged pressure to superficial wounds until the bleeding has stopped. Teaching the parent's about safety measures is important when a child has hemophilia.
You are monitoring the cardiac rhythms of clients in the coronary care unit. Which client will need immediate intervention? A. Client admitted with heart failure who has atrial fibrillation with rate of 88 beats/min while at rest. B. Client with a newly implanted demand ventricular pacemaker who has occasional periods of sinus rhythm at 90 to 100 beats/min. C. Client who has just arrived on the unit with an acute MI and has sinus rhythm at a rate of 76 beats/min. D. Client who recently started taking atenolol (Tenormin) and has a first-degree heart block, with a rate of 58 beats/min.
C. Client who has just arrived on the unit with an acute MI and has sinus rhythm at a rate of 76 beats/min. Rationale: Premature ventricular contractions occurring in the setting of acute myocardial injury or infarction can lead to ventricular tachycardia and/or ventricular fibrillation (cardiac arrest), so rapid treatment is necessary. The other clients also have dysrhythmias that will require further assessment, but these are not as immediately life threatening as the premature ventricular contractions in the setting of MI.
An hour after admission to the nursery, the nurse observes a newborn baby having spontaneous jerky movements of the limbs. The infant's mother had gestational diabetes mellitus (GDM) during pregnancy. Which of the following actions should the nurse take FIRST? A. Give dextrose Water B. Call the Physician Immediately C. Determine the blood glucose level D. Observe closely for other symptoms
C. Determine the blood glucose level Rationale: You probably recognized the baby's jerky movements as an indication of hypoglycemia. Don't forget that an important part of the assessment process is validating what you observe. You must complete an assessment before you analyze, plan, and implement nursing care.
The charge nurse is delegating tasks to her subordinates in the medical unit. Which infection control activity should she assign to an experienced nursing assistant? A. Asking clients about the use of immunosuppressant medications B. Demonstrating correct hand washing to client visitors C. Disinfecting blood pressure cuffs after clients are discharged D. Screening clients for upper respiratory tract symptoms
C. Disinfecting blood pressure cuffs after clients are discharged Rationale: Nursing assistants can support agency policy to disinfect items that come in contact with intact skin such as blood pressure cuffs by cleaning with chemicals like alcohol. Options A, B, and D: The use of immunosuppressants, teaching, and assessment for upper respiratory tract symptoms require further education and a broader scope of practice. These tasks should be performed by licensed nurses.
A nurse has prepared an IM injection for a client who is preoperative, when another client suddenly calls for assistance. The nurse asks an LPN to give the injection since an assistive personnel is waiting to take the client to surgery. Which of the following is the appropriate action by the LPN? A. Prepare a new syringe for the client who is preoperative. B. Give the prepared medication to the client who is preoperative. C. Help the client requesting assistance so the nurse can give the prepared injection. D. Report this request to the charge nurse.
C. Help the client requesting assistance so the nurse can give the prepared injection. Rationale: It is not necessary to waste the medication that is already prepared. The LPN should never give a medication that another nurse has prepared because the LPN would be unable to confirm what the syringe contains. The charge nurse should only be involved if there is no apparent and acceptable solution to the dilemma; the nurse should help the other client so the first nurse can give the injection. The nurse who has prepared the injection is the only one who can safely identify what is in the syringe and be responsible for the correct administration.
The nurse just received the client's morning labs. Which of the Following is the most concerning? A. Sodium 133 B. Potassium 5.2 C. Magnesium 0.8 D. Calcium 10.6
C. Magnesium 0.8 Rationale: With a magnesium level this low a patient could experience changes in ECG and life threatening ventricular dysrhythmias. While the other three lab values are abnormal they are not as concerning due to them not being as far from the norm as magnesium.
A 16-year old patient with cystic fibrosis is admitted with increased shortness of breath and possible pneumonia. Which nurse activity is most important to include in the patient's care? A. Allow the patient to decide whether she needs aerosolized medications B. Plan activities to allow at least 8 hours of uninterrupted sleep C. Perform postural drainage and chest physiotherapy every 4 hours D. Place the patient in a private room to decrease the risk of further infection
C. Perform postural drainage and chest physiotherapy every 4 hours Rational: Allowing for independent decision making and providing uninterrupted sleep is important. However, the physiological need to improve respiratory function takes priority in this case. Airway clearance techniques are critical in a patient with cystic fibrosis.
A patient with sleep apnea has a nursing diagnosis of Sleep Deprivation related to disrupted sleep cycle. Which action should you delegate to the nursing assistant (PCT)? A. Discuss weight loss strategies such as diet and exercise with the patient B. Teach the patient how to set up the BiPap machine before sleeping C. Remind the patient to sleep on his side instead of his back D. Administer modafinil (provigil) to promote daytime wakefulness
C. Remind the patient to sleep on his side instead of his back Rationale: The nursing assistant can remind patients about actions that have already been taught by the nurse and are part of the patient's plan of care. Discussing and teaching require additional education and training. These actions are within the scope of practice of the RN. The RN can delegate administration of medication to an LPN/LVN.
Follower-Ship
Challenge where indicated Know when you accept responsibility and carry it out Use freedom responsibly Risk following Are trustworthy and respectful Are loyal to leaders Know oneself Follow when appropriate, use the organizational structure Good listener, believer
Modes of organizing patient care: Case management
Collaborative process that emphasizes the steps of the nursing process (ADPIE) to meet an individual's health needs through communication and available resources to promote quality, cost-effective outcomes Coordinates care throughout an episode of illness Focus is on individual clients, not populations of clients Here at OSF= Care Transition Coordinator role AKA Nurse Navigator Some experts feel that the role of the Case manager should be reserved for the APN or RN with considerable work experience Advantages: Increased patient centered care Reduced admissions Greater continuity of Care Autonomy Disadvantages: Stressful Heavy patient Load Need for excellent communication Settings: Everywhere Lots of blending of this method with other types of greater continuity of care
Helpful tips in conflict resolution: Responsibility Charting
Coming together to establish the function and responsibility of roles Clearly defining responsibility of each party on joint roles
Effective performance appraisals tool: Checklist: Simple checklist
Comprises numerous words/phases describing various employee behaviors or traits
A client is admitted to the emergency room with a diagnosis of acute myocardial infarction. The client tells the nurse, "I'm scared. I think I'm going to die." Which of the following responses by the nurse would be MOST appropriate? A. "Everything is going to be fine. We'll take good care of you" B. "I know what you mean. I thought I was having a heart attack once." C. "I'll call your doctor so you can discuss it with him." D. "It's normal to feel frightened. We're doing everything we can for you."
D. "It's normal to feel frightened. We're doing everything we can for you." Rationale: (A) This is a "don't worry" response. There is no acknowledgment of the client's fears. (B) The focus of this response is on the nurse, not the client. (C) It is within the scope of nursing practice for the nurse to respond to the client's feelings. Don't pass the responsibility to the physician. (D) This answer choice responds to feelings and provides information. Keep it in consideration. The nurse is empathetic, acknowledging that the client feels frightened, and provides information
After change of shift, you are assigned to care for the following patients. Which patient should you assess first? A. A 60 year old patient on a ventilator for whom a sterile sputum specimen must be sent to the lab B. A 55 year old with COPD and a pulse oximetry reading from the previous shift of 90% saturation C. A 70 year old with pneumonia who needs to be started on intravenous (IV) antibiotics D. A 50 year old with asthma who complains of shortness of breath after using a bronchodilator
D. A 50 year old with asthma who complains of shortness of breath after using a bronchodilator Rationale: The patient with asthma did not achieve relief from shortness of breath after using the bronchodilator and is at risk for respiratory complications. This patient's are urgent. The other patients need to be assessed as soon as possible, but none of their situations are urgent. In COPD patients, pulse oximetry oxygen saturations of more than 90% are acceptable.
A nurse on a medical surgical unit is planning the care of assigned clients. Which of the following clients should the nurse assess first? A. A client who is newly admitted and is to have an indwelling urinary catheter inserted B. A client who has kidney stones and reports flank pain of 6 out of 10 C. A client diagnosed with early stage chronic kidney disease with a serum creatinine level of 2 mg/dL D. A client who has a cast newly applied on his forearm and reports tingling of his fingers
D. A client who has a cast newly applied on his forearm and reports tingling of his fingers Rationale: Tingling, numbness, pallor, paresthesia and pain are clinical findings associated with compartment syndrome which is serious and can cause ischemia, dysfunction, and eventual necrosis. It is part of the ABCs regarding to circulation; the client who needs a urinary catheter inserted is stable and does not need an immediate assessment. While the client who has kidney stones is in pain, he/she is not the priority concern because he/she is stable. Having a serum creatinine level of 2 gm/dL is an expected value for patients with early stage chronic kidney disease and therefore does not need immediate attention.
A client presents to the emergency room with dyspnea, chest pain, and syncope. The nurse assesses the client and notes that the following assessment cues: pale, diaphoretic, blood pressure of 90/60, respirations of 33. The client is also anxious and fearing death. Which action should the nurse take first? A. Administer pain medications B. Administer IV fluids C. Administer dopamine D. Administer oxygen via nasal cannula
D. Administer oxygen via nasal cannula Rationale: Promotion of adequate oxygenation is the most vital to life and therefore should be given highest priority by the nurse
A nursing graduate is attending an agency orientation regarding the nursing model of practice implemented in the health care facility. The nurse is told that the nursing model is team approach. The nurse determines that which scenario is characteristic of the team-based model of nursing practice? A. Each staff member is assigned a specific task for a group of clients B. A staff member is assigned to determine the client's needs at home and begin discharge planning C. A single registered nurse is responsible for providing care to a group of 6 clients with the aid of an assistive personnel. D. An RN leads two LPN's and three PCT's in providing care to a group of 12 clients
D. An RN leads two LPN's and three PCT's in providing care to a group of 12 clients Rationale: In team nursing, nursing personnel are led by a registered nurse leader in providing care to a group of clients. Option A 's functional nursing. Option B identifies a component of case management. Option C identifies primary nursing.
Which Intervention for a patient with a pulmonary embolus could be delegated to the LPN on your patient Care team A. Evaluating the patient's complaint of chest pain B. Monitoring laboratory values for changes in oxygenation C. Assessing for symptoms of respiratory failure D. Auscultating the lungs for crackles
D. Auscultating the lungs for crackles Rationale: An LPN who has been trained to auscultate lung sounds can gather data by the routine assessment and observation under the supervision of an RN. Independently evaluating patients, assessing for symptoms of respiratory failure, and monitoring and interpreting laboratory values require additional education and skill appropriate to the scope of practice of the RN.
A nurse manager finds an increased incidence of healthcare-associated infections (HAIs) on a long-term care unit. Which of the following is the priority action the nurse manager should take to address the problem? A. Monitor the staff's hand hygiene techniques. B. Hold a mandatory in-service about hand hygiene and infection rates. C. Require nurses to take an online course on HAIs. D. Conduct a chart review to gather data about clients who developed HAIs.
D. Conduct a chart review to gather data about clients who developed HAIs. Rationale: Monitoring hand hygiene techniques of the nurses will help identify inadequate cleansing practices and provide an opportunity for the nurse manager to teach proper hand hygiene. A mandatory in-service about hand hygiene and HAIs provides a forum to educate nurses. Lastly, requiring nurses to take an online course on HAIs will enhance their knowledge of hand hygiene and infection control. However, all three of these things should be done after the manager better understands the scope of the problem; by conducting a chart review or audit to gather data about the clients who developed infections, the nurse can gain insight into potential indicators or factors that resulted in the increased incidence of HAIs. This is the priority action to take. The other steps will come after.
The nurse manager has implemented a change in the method of the nursing delivery system from functional to team nursing. A PCT is resistant to the change and is not taking an active part in facilitating the process of change. Which is the best approach in dealing with the PCT? A. Ignore the resistance B. Exert coercion on the PCT C. Provide a positive reward system for the PCT D. Confront the PCT to encourage verbalization of feelings regarding the change
D. Confront the PCT to encourage verbalization of feelings regarding the change Rationale: confrontation is an important strategy to meet resistance head-on. Face-to-face meetings to confront the issue at hand will allow verbalization of feelings, identification of problems and issues, and development of strategies to solve the problem. Option A will not address the problem. Option B may produce additional resistance. Option C may provide a temporary solution to the resistance but will not address the concern specifically
A registered nurse is a preceptor for a new nurse and is observing the new nurse organize the client assignments and prioritize daily tasks. The registered nurse should intervene if the new nurse implements which action? A. Provides times for staff meals B. Gathers the supplies needed for a task C. Combines all tasks for clients in one list D. Documents task completions at the end of the day
D. Documents task completions at the end of the day Rationale: The nurse should document task completion continuously throughout the day. Options 1, 2, and 3 identify accurate components of time management.
The nurse is giving a report to an unlicensed assistive personnel (UAP) who will be caring for a client who has hand restraints (safety devices). The nurse instructs the UAP to check the skin integrity of the restrained hands how frequently? A. Every 2 hours B. Every 3 hours C. Every 4 hours D. Every 30 minutes
D. Every 30 minutes Rationale: The nurse should instruct the UAP to check safety devices and skin every 30 minutes. The neurovascular and circulatory status of the extremity should also be check every 30 minutes. In addition, the safety device should be removed at least every 2 hours to permit muscle exercise and to promote circulation. Agency guidelines regarding the use of safety devices should always be followed.
The patient with COPD tells the nursing assistant that he did not get his annual flu shot this year and has not had a pneumonia vaccination. You would be sure to instruct the nursing assistant to report which of these? A. Blood Pressure of 154/88 B. Respiratory Rate of 27 C. Heart Rate of 96 beats/min D. Temperature of 101.2
D. Temperature of 101.2 Rationale: Due to this patient having COPD it is especially important that they receive their pneumonia vaccination or flu shot yearly. Without it they are at an increased risk of developing a lung infection. A elevated temperature would indicate the patient might have a possible infection and should be reported right away. While the other vital signs are slightly elevated the temperature is the most important one.
Steps and Application of the Management Process: Planning
Determining philosophy, goals, objectives, policies procedures, and rules. carrying out long and short range projections, determining fiscal course of action, and managing planned change
Lewin (Three Phases of Planned Change): Movement
Develops a plan, set goals and objectives, identify areas of support & resistance, include all those affected by the change, set target dates Develop appropriate strategies, implement the changes, be available, evaluate the change and modify as needed
Verbal communication skills: Assertive
Direct, honest, and appropriate communication that does not infringe on another person's rights ex: I would like the opportunity to be charge nurse on the night shift
Ethical Terms (Principles): Beneficence
Doing Good Actions are taken in an effort to promote good Non-maleficence (associated w/beneficence): if one cannot do good, then one should at least do no harm Nursing Management: If a manager uses this ethical principle in planning performance appraisals, he/she is much more likely to view the performance appraisal as a means of promoting employee growth
Effective performance appraisals tool: Self-Appraisals
Employees submit written summaries of their work-related accomplishments & productivity
Helpful tips in conflict resolution: Confrontation
Encouraging individuals involved in conflict to handle their own problems with face-to-face communication
Steps and Application of the Management Process: Organizing
Establishing structure to carry out plans, determining to most appropriate type of patient care delivery, and grouping activities to meet unit goals, working with the structure of the organization, understanding and using authority appropriately, having necessary equipment, chain of command
Modes of organizing patient care: Functional nursing
Evolved as a result of World War II Uses relatively unskilled workers who have been trained to complete certain tasks Work/care divided by technical aspects/skills Advantages: Can serve many people Efficient Clear roles Care can be provided with a minimal # of RNs Disadvantages: Fragmented care Nurse Dissatisfaction Decreased quality Decreased continuity of care Settings: OR ED Nursing Homes (LT Care settings)
Disciplinary Conference: Rationale for Disciplinary Action
Explain the disciplinary action that you are going to take & why you are going to take it
Verbal communication skills: Aggressive
Expressing oneself in a direct and often hostile manner that it fringes on another person's rights; "winning at all costs" behavior ex: I would be a much better charge nurse for the night shift than mike
Helpful tips in conflict resolution: Behavior Change
For serious cases of dysfunctional conflict Using educational modes, training development, or sensitivity training
Effective performance appraisals tool: Essays
Free-form review: appraiser describes in narrative form an employee's strengths & areas where improvement or growth is needed
Lewin (Three Phases of Planned Change): Unfreezing
Gathers data, accurately diagnoses the problem, decide if a change is needed, make others aware of the need for a change. Distrust the status quo, a need for the change must be perceived by others. Change agent convinces members of group to change
Power Type: Charismatic or personal
Genuine nature, comes across as approachable/like-able
Disciplinary Conference: Employee's Response to Disciplinary Action
Give the employee the opportunity to explain why the rule was not followed
Power Type: Referent
Good reputation (Don't need to have met them, heard about it, reputation)
The AIDET communication strategy: Acknowledge
Greet people with a smile, use their name, attitude is everything, creating lasting impression
Group process: Norming
Group Process: Consensus evolves as group cohesion develops; conflict and resistance are overcome Task Process: Cooperation develops as differences are expressed and resolved
Group process: Performing
Group Process: Interpersonal structure focuses on task and its completion; roles become flexible and functional; energies are directed to task performance Task Process: Problems are solved as the task performance improves; constructive efforts are undertaken to complete task; more of group energies are available for the task
Group process: Storming
Group Process: Resistance to group influence is evident as members polarize into subgroups; conflict ensues and members rebel against demands imposed by the leader Task Process: Resistance to task requirements and the differences surface regarding demands imposed by the task
Group process: Forming
Group Process: Testing occurs to identify boundaries of interpersonal behaviors, establish dependency relationships with leaders and other embers, and determine what is acceptable behavior Task Process: Testing occurs to identify the tasks, appropriate rules, and methods suited to the task's performance
Power Type: Coercive or punishment
Have ability to terminate (punish) or give incentive (reward)
Steps and Application of the Management Process: Directing
Humans Resources: managing responsibilities such as motivating, managing conflict, delegating, communicating, and facilitating collaboration
Strategies for Successful Delegation
Identify necessary skill & education levels to complete the delegated task Plan ahead Select and empower capable personnel Communicate goals clearly Empower the delegate
3 Good reasons to Delegate
If someone is better prepared or has more experience or knowledge about how to solve a problem Provide learning or "stretching" opportunities for subordinates Delegate routine tasks so they are free to handle problems that are more complex or require higher level of expertise
Marginal employees — how to work with them effectively : Used by low-level managers
Ignore the problem and attempt to "work around" the employee
Authentic Leadership
In order to lead must be true to themselves, what they know, what they believe, their values, and act accordingly no matter the situation, willingness to stick to values: AKA transparent integrity
Leadership Style: Democratic/Participative
Including everyone you are working with in the decisions, person in charge ends up making ultimate decision based on feedback
Motivation: Intrinsic
Internal drive to do or be something
The AIDET communication strategy: Introduce
Introduce yourself, members of your team, tell them who you are & how you are going to help them, escort people when they need to go instead of pointing them
Conflict management strategy: Compromising
Involves both assertiveness and cooperation on the part of everyone and requires maturity and confidence Negotiating is a learned skill that is developed over time A Give-and-take relationship results in conflict resolution, with the result that each person can meet his or her most important priorities as much of the time as possible
Ethical Terms (Principles): Fidelity
Keeping Promises Refers to the moral obligation that individuals should be faithful to their commitments & promises Breaking a promise, is wrong regardless of the consequences Nurse's primary commitment is to the patient
The AIDET communication strategy: Duration
Let them know how long you will be there, keep in touch, what to expect, how long it would take
Ethical Terms (Principles): Paternalism
Limits freedom of choice; justified only to prevent a person from coming to harm Related to beneficence: One person assumes the authority to make a decision for another Clinical Nursing: Care providers may become paternalistic when patients lack some capacity with regard to decision marking & in some cases, even when they do not Nursing Management: Managers use this in subordinates' career planning Managers assume that they have greater knowledge of what an employee's short- and long-term goals should be than the employee does
Helpful tips in conflict resolution: Third-party Consultation
Manager may assist in being a neutral party to help others resolve conflict constructively If it involves multiple parties and highly charged emotions, may consult outside experts to facilitate communication
Employee discipline process
Manager's first step should be to obtain the employee's personnel file materials & review the file documents (determine whether employee has demonstrated similar behavior in the past, who addressed the previous issue & how they were resolved) Then the manager must thoroughly investigate the situation that has prompted the employee discipline Managers must isolate the source of the true problem before responding to employees who are unproductive or inefficient & determine if the problem is related to training & development Managers should consult with either a superior or the HR before dismissing an employee
Effective performance appraisals tool: Checklist: Weighted scale
Most frequently used; composed of many behavioral statements that represent desirable job behaviors
Motivation: Extrinsic
Motivation enhanced by the job environment or external rewards Managers focus on extrinsic (hope to cause intrinsic)
Contingency Leadership
No one leadership style is ideal for every situation, how you lead should depend on the situation
Conflict management strategy: Smoothing
Occurs when one party in a conflict attempts to pacify the other party or to focus on agreements rather than differences
Modes of organizing patient care: Total patient care
Oldest mode for organizing patient Care Nurses assume total responsibility for meeting the needs of all assigned patients during their time on duty Advantages: Continuity of Care Trust from patient Greater Autonomy & responsibility for RN Disadvantages: Costly No delegation Fatigue/Burnout Settings: Home Health PACU ICU
Conflict management strategy: Competing
People pursue their own needs and goals at the expense of others Sometimes people use whatever power, creativeness, or strategies that are available to "win." Competing may also take the form of standing up for your rights or defending important principles
Steps and Application of the Management Process: Controlling
Performance appraisals, fiscal accountability, quality control, legal and ethical control, professional and collegial control, CPR, qualified for job
Disciplinary Conference: Clarification of Expectations for Change
Present a performance improvement plan to be sure employee expectations for remediation are clear
Ethical Terms (Principles): Autonomy (Self-Determination)
Promotes self-determination & freedom of choice or accepting the responsibility of one's choice Nursing Management: Use of progressive discipline recognizes the autonomy of the employee, employee has the choice to meet organizational expectations or to be disciplined further; If employee's continued behavior warrants termination, principle of autonomy says that the employee has made the choice to be terminated by virtue of his/her action, not by that of the manager
Effective performance appraisals tool: Trait Rating Scales
Rating a person against a set standard
Steps and Application of the Management Process: Staffing
Recruiting, interviewing, bringing, and orienting staff. scheduling, staff development, employee socialization, and team building, terminating employment
Effective performance appraisals tool: Behaviorally Anchored Rating Scales
Requires that a separate rating form be developed for each job classification
Effective performance appraisals tool: Checklist: Forced checklist
Requires the supervisor to select an undesirable & a desirable behavior for each employee
Ethical Terms (Principles): Confidentiality
Respecting Privileged Information The obligation to observe the privacy of another & to hold certain information in strict confidence There are times when the presumption against disclosing information must be overridden Nursing Management: Health-Care managers are required by law to report certain cases: drug abuse in employees, elder abuse, child abuse
Disciplinary Conference: Timing & Conference Length
Scheduled in advance at a time agreeable to both the employee & manager Both will want time to reflect on situation that has occurred
Emotional Intelligence (EI): Five components
Self-awareness, self-regulation, motivation, empathy, social skills
Delegation: Not to be Delegated: TAPE
T = teaching (Educate, Discuss, Explain, Confer) A = assessment (new admissions, analyze, administer) P = planning (Develop) E = Evaluating (review, synthesize, coordinate)
Benchmarking
The process of measuring products, practices, and services against best performing organizations—a tool or identifying desired standards of organizational performance Organizations can determine how & why their practice differs from exemplar organizations & use the exemplar organizations as role models for standard development & performance improvement
One Minute Manager Principles: One minute reprimand
Tough on performance not on the person Be immediate and specific Describe the poor performance Tell them how you honestly feel Encourage them and remind them how much you value them Let them know it's over Be assertive, open, honest, caring Do not reprimand a learner (use goal setting) The one thing you want to address and move on Don't "gunnysack" hold it in and blow up on everything later
Helpful tips in conflict resolution: Structure Change
Transferring or discharging people from unit Changing managers, adding a public advocate, or putting a grievance procedure in place
Ethical Terms (Principles): Justice
Treating People Fairly Equals should be treated equally & that unequals should be treated according to their differences Used when there are scarcities or competition for resources or benefits Nursing Management: Manager will work to see that pay raises reflect consistency in terms of performance & time in service
Ethical Terms (Principles): Veracity
Truth Telling Used to explain how people feel about the need for truth telling or the acceptability of deception Nursing Management: Manager who believes that deception is morally acceptable if it is done with the objective of beneficence may tell all rejected applicants that they were highly considered whether they had been or not
3 Common Delegation Errors
Under-delegating: false assumption that delegation may be interpreted as lack of ability on his/her part to do job correctly & completely Over-delegating: burdened subordinates, poor time management, poor organization Improper delegating: delegating at wrong time, to wrong person, or wrong reason
Six Sigma
Used when creating a culture of safety management at institutional levels Sigma: Statistical measurement that reflects how well a product or process is performing Higher sigma values: Indicate better performance Health-Care industry comfortable striving for three sigma processes Organizations should aim for the Six Sigma as the target and can be achieved by applying the Six Sigma methodology to every aspect of QI (patient satisfaction will be increased & errors reduced by process improvement strategies)
Conflict management strategy: Avoiding or withdrawing
Very unassertive and uncooperative, because people who avoid neither pursue their own needs, goals, or concerns immediately nor assist others to pursue theirs In the avoidance approach, the parties involved are aware of a conflict but choose not to acknowledge or attempt to resolve it
Ethical Terms (Principles): Utility
What is best for the common good outweighs what is best for the individual Justified paternalism as a means of restricting individual freedom Nursing Management: If used, be careful not to become so focused on desired group outcomes that they become less humanistic
Verbal communication skills: Passive
When a person suffers in silence although he or she may feel strongly about the issue ex: crying in the nursing break room because you were not asked to be a preceptor
Conflict management strategy: Appropriate Uses of cooperating/Accommodating
When other people's ideas and solutions appear to be better, or when you have made a mistake When the issue is far more important to the other person or people than it is to you When you see that accommodating now "builds up some important credits" for later issues
Conflict management strategy: Appropriate Uses of Collaborating
When seeking creative, integrative solutions in which both sides' goals and needs are important, thus developing group commitment and a consensual decision When learning and growing through cooperative problem solving, resulting in greater understanding and empathy When being honest about and working through difficult emotional issues that interfere with morale, productivity, and growth