Chapter 10: Leading, managing, and delegating.

Nursing students enrolled in a leadership and management course discuss the roles of the nurse manager during post conference. What roles should the students include in the discussion? Select all that apply. A. Developing and overseeing a unit budget for staff and patient care B. Hiring, evaluating, and promoting staff growth C. Performing patient care D. Developing treatment plans to improve care and patient outcomes E. Handling escalating situations between caregivers and patients

a, b, e. Responsibilities of the nurse manager include overseeing day-to-day operations, designing and managing a budget, supervising and providing training to team members, hiring and evaluating nursing staff, handling escalating situations between patients and health care providers, and collaborating to attain optimal patient outcomes. Nurse managers' roles do not typically include performing patient care or developing treatment plans.

A chief nursing officer with a transformational leadership style is developing a plan for success to obtain Magnet status. What are the most appropriate strategies for the leader to use? Select all that apply. A. Sharing their vision of excellence in patient care and high-level education B. Encouraging nurses to incorporate evidence-based practice through hospital committees and to join nursing organizations C. Promoting compliance by reminding subordinates that they have a good salary and working conditions D. Ensuring employees are kept abreast of new developments in their department and the larger organization E. Writing the Magnet application and supporting documentation with limited input from the nursing staff F. Encouraging nurse managers and nurses to self-schedule as long as proper coverage is maintained

a, b. Transformational leaders inspire, motivate, create intellectually stimulating practice environments, and challenge themselves and others to grow personally and professionally. They demonstrate caring and vulnerability, communicating honestly and openly. They are risk takers and pay attention to process as well as outcomes. Instituting a reward program and reminding workers that they have a good salary and working conditions are examples of transactional leadership, which is based on a task-and-reward orientation. Ensuring that employees keep abreast of new developments in nursing care is a characteristic of quantum leadership. The group and leader work together to accomplish mutually set goals and outcomes with the democratic leadership style, and the laissez-faire style encourages independent activity by group members, such as setting their own schedules and work activities.

A nurse who is considered a servant leader is working in an economically depressed community setting up a free mobile health clinic. Which actions best exemplify a servant leader? Select all that apply. A. Motivating coworkers to solicit funding to set up the clinic B. Setting only realistic goals that are present oriented and easily achieved C. Forming an autocratic governing body to keep the project on track D. Spending time with supporters to help them grow in their roles E. Ensuring that other's lowest priority needs are served F. Prizing leadership because of the need to serve others

a, d, f. To serve as servant leaders, nurses need to invest in those who support the organization's values, show passion, can play to their strengths, and demonstrate a positive attitude. They should develop their vision to see the future related to a current anticipated need and motivate others to follow and engage. They also need to provide ongoing opportunities for collaborations, sharing, reflection, encouragement, and celebration as well as hard work. The servant leader allows others to have a voice, to exercise control, and to practice leading themselves. The servant first makes sure that other people's highest priority needs are being served. The best test, and most difficult to administer, is: Do those served grow as people? Do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servants?

A nurse manager is planning to update a health care provider's office from paper to electronic health records (EHR) by using the eight-step process for planned change. Place the following actions in the order in which they should be initiated: A. The nurse devises a plan to switch to EHR. B. The nurse records the time spent on written records versus EHR. C. The nurse attains approval from management for new computers. D. The nurse analyzes all options for converting to EHR. E. The nurse installs new computers and provides an in-service for the staff. F. The nurse explores possible barriers to changing to EHR. G. The nurse follows up with the staff to check compliance with the new system. H. The nurse evaluates the effects of changing to EHR.

b, f, d, c, a, e, h, g. Planned change involves the following steps: (1) recognize symptoms that indicate a change is needed and collect data, (2) identify a problem to be solved through change, (3) determine and analyze alternative solutions, (4) select a course of action from possible solutions, (5) plan for making the change, (6) implement the change, (7) evaluate the change, and (8) stabilize the change.

A nurse erroneously administered two tablets of acetaminophen totaling 650 mg to their patient. When reporting this to the nurse manager, the nurse states, "there are two tablets in a package labeled '325 mg. acetaminophen.' The prescription reads 'administer 325 mg of acetaminophen;' therefore, I administered what was in the package." Based on a philosophy of just culture, what should happen next? A. The nurse should be found at fault for not clarifying the order. B. The package labeling should be reviewed with the pharmacy. C. The nurse should be disciplined. D. No follow-up is needed as the medication is over the counter.

b. A just culture is committed to accountability and safety. Nurses are encouraged to disclose clinical errors and potential error situations without the fear of punitive actions, allowing others to learn from this experience. Health care workers within the organization discuss concerns and challenges related to patient care, turning them into opportunities for improvement.

A nurse manager who is working to institute the SBAR communication process for all health care providers is meeting resistance to the change. How does the manager best approach the resistance? A. Containing the anxiety in a small group and moving forward with the initiative B. Explaining the change and listing the advantages to the person and the organization C. Reprimanding those who oppose the new initiative and praising those who willingly accept the change D. Quickly introducing the change and involving staff in implementation of the change

b. Change is ubiquitous, as is resistance to change. The manager should explain the proposed change to all affected, list the advantages of the proposed change for all parties, introduce the change gradually, and involve everyone affected by the change in the design and implementation of the process. The manager should not use the reward/punishment style to overcome resistance to change.

A nursing student is actively working toward strengthening their leadership skills. What action will best assist the student to meet this goal? A. Being self-reliant in solving problems B. Being self-directed and asking for assistance when needed C. Using written communication instead of face-to-face communication D. Reporting nurses who do not follow policies to the nurse manager

b. Leader behavior includes being self-directed and knowing your limitations; demonstrating a commitment to excellence; having a clear vision and strategic focus that allow movement forward toward a creative solution; showing commitment to and passion for your work; and displaying problem-solving skills, trustworthiness and integrity, respectfulness, accessibility, empathy and caring, desire to be of service, and responsibility to enhance the personal growth of all staff.

The nurses at an acute care hospital participate in a committee focused on achieving Magnet status. Which action do the nurses suggest to help achieve this goal? A. Centralizing the decision-making and scheduling process B. Promoting self-governance at the unit level C. Deterring professional autonomy to promote teamwork D. Promoting evidence-based practice over innovative nursing practice

b. Magnet hospitals use a decentralized decision-making process, self-governance at the unit level, and respect for and acknowledgment of professional autonomy. In Magnet hospitals, 14 characteristics, the Forces of Magnetism, have been recognized that identify quality patient care, excellent nursing care, and innovations in professional nursing practice.

An RN on a telemetry unit is falling behind while performing assessments and administering medications. Which task can the nurse safely delegate to the AP? A. Assessing a patient who has just arrived on the unit B. Teaching a patient with newly diagnosed diabetes about foot care C. Documenting a patient's I & O in the electronic health record D. Helping a postoperative patient out of bed for the first time

c. Documenting a patient's I & O on a flow chart does not require professional judgment and can be delegated to AP. Professional nurses are responsible for the initial patient assessment, discharge planning, health education, care planning, triage, interpretation of patient data, care of invasive lines, administering parenteral medications. What they can delegate are assistance with basic care activities (bathing, grooming, ambulation, feeding) and things like taking vital signs, measuring intake and output, weighing, simple dressing changes, transfers, and postmortem care.

A charge nurse on the step-down unit will likely use which leadership style during resuscitation efforts for a cardiac arrest? A. Democratic B. Laissez-faire C. Servant D. Autocratic

d. Autocratic leadership assumes control over the decisions and activities of the group, such as taking charge of emergencies, dictating schedules and work responsibilities, and scheduling mandatory in-service training. Polling other nurses is an example of democratic leadership, which is characterized by a sense of equality among the leader and other participants, with decisions and activities being shared. In laissez-faire leadership, the leader relinquishes power to the group and encourages independent activity by group members. Examples of laissez-faire leadership style are allowing the nurses to divide up the tasks and encouraging them to work independently.

A nurse is asked to act as a mentor to a new nurse. What action will the mentor expect to perform? A. Accepting payment to introduce the new nurse to their responsibilities B. Hiring the new nurse and assigning duties related to the position C. Enabling the new nurse to participate in professional organizations D.Advising and assisting the new nurse to adjust to the work environment of a busy emergency department

d. Mentorship is a relationship in which an experienced person (the mentor) advises and assists a less experienced person (protégé). This is an effective way of easing a new nurse into leadership responsibilities. An experienced nurse who is paid to introduce an employee to new responsibilities through teaching and guidance describes a preceptor, not a mentor. The nurse mentor does not hire or schedule new nurses. Nurses do not need mentors to join professional organizations.

After observing conflicts between nurses about scheduling, a nurse manager compliments the nurses for achieving the monthly goal of no patient falls. What strategy for conflict resolution did the manager display? A. Collaborating B. Competing C. Compromising D. Smoothing

d. The manager who avoids conflict by complimenting the parties and avoids disagreements is using smoothing to reduce the emotion of the conflict. The original conflict is rarely resolved with this technique. Collaborating is a joint effort to resolve the conflict with a win-win solution. All parties set aside previously determined goals, determine a priority common goal, and accept mutual responsibility for achieving this goal. Competing results is a win for one party at the expense of the other group. Compromising occurs when both parties relinquish something of equal value.

Nursing students enrolled in a leadership and management course attend clinical on a surgical unit. As they are planning their day, they note one student has a complex patient with multiple medications and the need for frequent turning, pressure injury wound care, and tube feedings. Which action by the group best reflects effective teamwork and coordination? A. Asking patients to prioritize what they want to accomplish each day B. Including a "nice to do" for every "need to do" task on the list C. "Front loading" their schedules with "must do" priorities D. Scheduling times to assist the student with the complex patient

d. The students use teamwork and collaboration to appropriately coordinate patient care; this is the best response. By asking the patient to prioritize what they want to accomplish each day, the nurse is demonstrating an effective time management technique. To manage time, the nurse should establish goals and priorities for each day, differentiating "need to do" from "nice to do" tasks; the nurse should include the patient in this process. The nurse should also establish a time line, allocating priorities to hours in the workday in to keep track of falling behind and correct the problem before the day is lost.