Ch 5: Managing time and stress

10. Nurse managers are in a position of impacting the stress levels of employees through improving work environments and creating a culture of enhanced staff satisfaction. Having structures and processes in place to prevent work-related stress from happening in the first place requires: a. genuine intention and corresponding action. b. additional evidence about the human and financial costs of work-related stress. c. more stability in the health care industry. d. decreased demands from payers, consumers, and regulators.

ANS: A It has always been challenging to secure the necessary resources for prevention, even for patient care. However, failure to do so puts employees at risk, which in turn can jeopardize the lives of patients. It is no longer possible to wait for more evidence about the human and financial costs of work-related stress. Waiting for more stability in the industry, which may never come, wastes precious time. Once that is embraced and there is genuine intention, then design and creation can begin in earnest.

12. Nurses on the midnight shift are experiencing difficulty with receiving materials from the central supply department. Last night a patient was admitted to the unit from the emergency department with a heart dysrhythmia. The nurse requested that a temporary pacemaker kit be placed in the unit as a standby in case the patient required its use. The central supply unit did not comply until the patient required its emergent use. The nurse was stressed. This is an example of which type of stress? a. Job stress b. Overload of role c. Moral distress d. Role conflict

ANS: A Job stress is a tension that arises related to the person-in-environment demands of a person's role or job. Job stress, or "disquieting influences," can accumulate into levels that are too high, reach the point of burnout, and manifest as emotional and/or physical exhaustion and lowered job productivity

13. When a nurse leader is able to fully embrace the American Association of Critical-Care Nurses' (AACN's) Healthy Work Environment and engage others in its achievement, what is the leader demonstrating? a. Authentic leadership b. Meaningful recognition c. True collaboration d. Skilled communication

ANS: A The nurse leader is demonstrating authentic leadership when he or she is able to embrace and model the AACN's Healthy Work Environment.

4. Nurses who must manage unplanned and regular responsibilities simultaneously may experience: a. complexity compression. b. resilience. c. moral distress. d. empowerment.

ANS: A When unexpected conditions are added to regular responsibilities, nurses may experience what experts call complexity compression, which has been linked to burnout, turnover, and other types of work-related stress (Krichbaum et al., 2007). Nurses experience this when they must manage unplanned (complexity) and regular responsibilities simultaneously (compression).

7. Conflict and stress in the workplace can be managed through building relationships. Organizations can foster the building of relationships through: (Select all that apply.) a. social media. b. informal social gatherings. c. mentoring. d. confidential meetings.

ANS: A, B, C Building relationships can be fostered in organizations by formal and informal social gatherings, mentoring, social media, and deliberate culture creation (Moreland & Apker, 2016). Perceived supportive work environments are characterized by perceptions that supervisors are supportive, there is fairness, and there is open communication. Stress is reduced when nurses feel that win-win solutions occur in the work environment

10. Max is a nurse on the 7 PM to 7 AM shift on the orthopedic floor. He is the most experienced nurse on the unit during this shift, with 6 years of nursing experience. Max usually acts as charge nurse during his shift while caring for a group of patients. Recently there has been an influx of new graduates working on his shift. Some nights, he is expected to orient a new nurse, act as the charge nurse, and mentor other new nurses working on the floor. He is concerned that with all the new nurses, there are not enough mentors for all of them, resulting in less-than-optimal care delivery. Which factors have been shown to decrease stress for nurse leaders? (Select all that apply.) a. Support from others b. Autonomy c. Predictability d. Transparency

ANS: A, B, C High stress is experienced by nurse leaders and stems from the challenges of a multifaceted job with myriad sources of stress. Having support from others (e.g., supervisors, comanagers, and coworkers) is a factor that decreases stress (Kath et al., 2012; Shirey et al., 2010). The amount of autonomy and predictability in the job mitigates the negative effects of stress as well (Kath et al., 2012).

6. Managers have a key role in mitigating stress in the workplace. Which strategies will assist the manager in creating a more healthy work environment? (Select all that apply.) a. Recognize nurses for the value they bring to the organization. b. Partner with the nursing staff to make policies and lead organizational operations. c. Keep information confidential regarding safety concerns or initiatives. d. Ensure staffing is an effective match between patient needs and nurse competencies. e. Ensure that the manager maintains responsibility for all aspects of unit functioning.

ANS: A, B, D A healthy work environment (HWE) is one that is safe, empowering, and satisfying. Nurse managers can foster an HWE by recognizing nurses for the value they bring to the organization, partnering with the nursing staff to make policies and lead organizational operations, and ensuring that staffing is an effective match between patient needs and nurse competencies.

9. A staff RN is writing an article for a prestigious nursing journal. The deadline is in 1 week, and she is feeling overwhelmed about completing her work. She is unable to keep up with home management, and she is beginning to procrastinate on the project. She also has other responsibilities, such as taking her elderly mother grocery shopping and to health care appointments. She is married to a busy executive and has three children, all of whom are active in high school sports. Which of the following stress management strategies would be helpful? (Select all that apply.) a. Schedule "think time" appointments at least once a week for a block of time; get out of the office for these times. b. Bring a water bottle to work and refill as needed to keep hydrated. c. Cut extra activities out of her schedule, such as her morning walk. d. Create a "getaway" place at work where she can spend a few minutes in silence and thought.

ANS: A, B, D Scheduling "think time" appointments and spending a few minutes in silence can help her clear her mind and regroup. Keeping hydrated will help keep energy levels up. Exercise is important to help the nurse deal with stress and would not be wise to delete from her schedule, if possible

1. Definitions of stress are: (Select all that apply.) a. a negative emotional experience that is associated with biological changes that trigger the body to make adaptations. b. the accomplishment of specified activities during an available time period. c. a physical, mental, psychological, or spiritual response to an experience. d. a response that is evaluated by the individual as a threat to one's sense of well-being.

ANS: A, C, D Stress is a negative emotional experience associated with biological changes that trigger the body to make adaptations. It can be a physical, mental, psychological, or spiritual response to an experience that is evaluated by the individual as a threat to one's sense of well-being.

2. Which of the following responses may occur related to stress? (Select all that apply.) a. Increased heart rate b. Decreased blood glucose levels c. Emotional exhaustion d. Burnout e. Chronic health conditions

ANS: A, C, D, E Stress has a variety of induced changes, including increases in heart rate and blood glucose levels, emotional changes, and burnout, and it can lead to acute and chronic health problems.

4. What are some methods that nursing staff can use to manage personal stress levels? (Select all that apply.) a. Take personal time each day. b. Take on extra shifts to keep the mind occupied. c. Get enough sleep. d. Pay attention to diet and exercise. e. Have a strong support network of friends and family.

ANS: A, C, D, E While stress management is unique to each person, some of the tools that may be effective include taking personal downtime each day, getting enough sleep, eating right, exercising, and having a strong network of friends and family for support.

16. A nurse manager has several complaints from her staff that she is inaccessible during the day. What is the best strategy the nurse manager takes to improve her staff satisfaction? a. Notify staff when she will be out of the office. b. Block time for daily rounds with staff. c. Set realistic follow-up deadlines for staff issues, questions, and concerns. d. Ask the staff to communicate with her through their supervisors.

ANS: B Blocking time to round with staff is the best way the nurse manager can be on the unit and visible to her staff. Notifying staff when she is out of the office, setting realistic deadlines for following up with issues, and delegating certain activities to the supervisors are good time management strategies, however they don't address the staff's issue of not seeing her

15. In setting boundaries it is important to do which of the following? a. Set rigid boundaries. b. Set boundaries based on individual needs. c. Consider where one is in the lifespan when setting boundaries. d. Set boundaries even if it produces more stress than not having boundaries at all.

ANS: B Boundaries need not be exceedingly rigid and may change over time. Boundaries should be set based on individual needs, not gender, stereotypes, or even where someone is on the lifespan. The most important thing is that setting them should not induce more stress on the individual than not having them at all

11. There is evidence of a link between _____ employees with higher productivity and more satisfied customers. a. stressed b. empowered c. financially focused d. creative

ANS: B Employees who are empowered in their jobs are also more engaged and satisfied. Research indicates that structural empowerment leads to higher productivity and satisfaction for the employee, which translates to more satisfied customers.

7. An internal obstacle that may contribute to moral distress is: a. lack of resources. b. lack of confidence. c. lack of structure. d. lack of processes.

ANS: B Moral distress occurs when an individual knows what ethical action should occur but is prevented from doing so by either internal or external barriers (Rushton, 2006). Internal obstacles include personal characteristics such as fear or lack of confidence. External obstacles include a lack of resources, structures, or processes that prevent taking the desired and right action (McCarthy & Deady, 2008).

5. What are some potential reasons that nurses experience higher levels of stress? (Select all that apply.) a. Nurses are skilled at setting boundaries. b. Nurses often put others' needs ahead of their own. c. Staff nurses are under pressure to do more with less. d. There are support staff cuts. e. There are fluctuations in staffing levels.

ANS: B, C, D, E Staff nurses are under constant pressure to do more with less, and this can cause professional and personal stress for staff as well as managers. Support staff have been cut, jobs are fewer, and staffing levels fluctuate. Nurses may have a difficult time dealing with stress, because they often put others' needs ahead of their own and need to be able to create healthy boundaries

3. Which of the following statements are true regarding job stress? (Select all that apply.) a. Job stress is related more to external demands that are brought into the workplace. b. Job stress can lead to burnout. c. Job stress is manifested as emotional and/or physical exhaustion. d. Job stress increases productivity. e. Levels of job stress that are too low or too high decrease individual productivity.

ANS: B, C, E Job stress is a tension that arises related to the environmental demands of a person's role or job. Job stress can accumulate to levels that are too high, reach the point of burnout, and manifest as emotional and/or physical exhaustion. Levels of job stress that are too low or too high decrease individual productivity.

6. A staff nurse has a concern about a co-worker who may be diverting medications. The staff nurse would like to report the concern to a supervisor, but she is fearful of retaliation from her colleagues. The staff nurse knows that the ethical thing to do is report the concern for the sake of patient safety. This nurse is experiencing: a. stress. b. procrastination. c. moral distress. d. burnout.

ANS: C Moral distress occurs when clinicians know what is the ethical action to take, yet are prevented by either external or internal obstacles. Moral distress will contribute to stress and eventual burnout if the staff nurse does not take action.

14. A new nursing manager is falling behind on the staffing schedule, the monthly budget, and employee evaluations. She says to her director, "I'm working 60 hours per week and I still don't have enough time to do it all." The nursing director suggests which of the following to her? a. Setting priorities b. Obtaining additional preceptoring. c. Scheduling blocks of time for each activity to be accomplished. d. Giving up management and returning as a regular staff nurse.

ANS: C Time management involves a deliberative process of identifying, focusing, and completing activities needed to accomplish specific tasks and achieve goals. Blocking time to get tasks done is a strategy that can be used to for time management at work.

1. _____ is defined as the accomplishment of specified activities during the time available. a. Stress b. Mismanagement of resources c. Time management d. Self-management ANS: C

ANS: C Time management is defined as the accomplishment of specified activities during the time available. It is the process of managing the things an individual does with his or her available time. At its core, time management is self-management.

8. A new nurse manager is provided with a smartphone in order to efficiently manage her time. What is the most effective method of managing stress related to e-mail? a. Create an auditory cue that alerts the manager to incoming messages so they can be processed immediately. b. Set aside time during meetings to read and respond to messages. c. Schedule blocks of time to tackle e-mail. d. Delete e-mails that require a lengthier response.

ANS: C Time management will not be effective if the manager is expected to respond to messages as soon as they arrive. Managers can set a rule to check e-mails two to three times per day rather than constantly and should use a sorting a flagging methodology to effectively manage the need for follow-up. Managers should not utilize meetings in order to read and respond to messages.

8. Job stress can accumulate into: (Select all that apply.) a. better time management skills. b. feelings of elation. c. burnout. d. physical exhaustion.

ANS: C, D Chronic stress can lead to acute and chronic health problems. Job stress is a tension that arises related to the person-in-environment demands of a person's role or job. Job stress, or "disquieting influences," can accumulate into levels that are too high, reach the point of burnout, and manifest as emotional and/or physical exhaustion and lowered job productivity. Levels of job stress that are too low or too high decrease individual productivity.

5. Creating a safe, empowering, and satisfying work environment can be accomplished through implementation of: a. Institute of Medicine Coalitions. b. health care reform. c. the Troubled Asset Relief Program. d. Healthy Work Environment (HWE) standards.

ANS: D A Healthy Work Environment (HWE) is one that is safe, empowering, and satisfying. The American Association of Critical-Care Nurses (AACN) has established six standards that support Healthy Work Environments (AACN, 2005). Although developed for nurses, they are applicable for all types of employees

3. Jay, a nurse in the intensive care unit, has been caring for a patient with end-stage renal disease, congestive heart failure, and a stroke. The client has had four cardiac arrests in 4 days. Despite the grave prognosis, the client's family continues to want resuscitation at all cost. Jay knows that further medical care is futile. Jay is at risk for: a. confrontational conflict. b. resilience. c. burnout. d. moral distress.

ANS: D Moral distress is linked to issues related to patient care, including ethical dilemmas that can put professionals in difficulty and give rise to feelings of unease. It occurs when an individual knows what ethical action should occur but is prevented from doing so by either internal or external barriers (Rushton, 2006).

2. Nurses who are successful at time management: a. display an ability to set measurable goals and objectives. b. frequently volunteer for new and creative projects. c. hesitate to delegate because of perfectionist characteristics. d. tend to accomplish specific activities within a time frame.

ANS: D Time management is accomplishing specific activities during the time available. It is a process of managing

9. The first critical step in creating an environment to prevent and address work-related stress is: a. delegation. b. motivation. c. innovation. d. intention.

ANS: D To prevent and address work-related stress, creation and innovation are needed. A creation is something new that did not previously exist in that form and occurs in a multitude of fields, not just the arts (Creation, n.d.). Experts who study creativity may differ on the requisite attributes of creative individuals and exact steps in the creative process. However, most agree that intention is the critical first step (Ditkoff, 2010). Without intention, no action is ever taken.