Chapter 9 & 10 Leadership

2. An organization focuses on improving interdisciplinary collaboration. Which of the following most likely is the focus of the organization? A. Culture of safety B. Care environment C. Excellence D. Meaningfulness

A. This is correct. A culture of safety involves a commitment to consistent and safe operations, including an emphasis on interdisciplinary collaboration.

10. A nurse manager is planning for implementation of a change in practice based on current evidence. When planning for implementation, which of the following is the priority consideration? A. Is this the only change taking place? B. Will the change work on this unit? C. Is the change necessary? D. Where have past changes failed?

A. This is correct. Considering whether other changes are also occurring can assist the manager in gauging stress, a factor to consider when implementing change.

4. In a health-care organization, all employees are ranked according to their level of authority. Which characteristic of a bureaucracy does this best describe? A. Division of labor B. Hierarchy C. Rules and regulations D. Technical competence

B. This is correct. Hierarchy is the ranking of each employee according to his or her level of authority.

7. A new RN asks a peer how the peer always seems to get timely responses from the laboratory department. The experienced RN explains the process she uses. This is most likely an example of which of the following? A. Formal processes B. Informal processes C. Authority D. Reward

B. This is correct. Informal processes are not written processes and may not even be discussed, but are often much simpler and easier to navigate than the formal processes.

8. The first step in change is to plan carefully. Which of the following questions should be asked during the design stage of change? A. Does everyone agree on the change? B. Is the change really needed? C. How difficult is the change to make? D. How quickly should the change be made?

B. This is correct. It is important to ascertain if there is a better way of doing things and if the change is really necessary

12. Which of the following best describes a reason why radical changes are often easier to maintain than relatively smaller changes? A. Information is more abundant with radical changes. B. Support groups for radical changes deal with emotional aspects of change. C. It takes much longer to feel a difference. D. Fear is often the motivation for making radical changes.

B. This is correct. Knowledge alone is often not enough. Support groups, meditation, yoga, relaxation, and aerobic exercise can deal with the emotional aspects of change.

8. The ability of an RN to conduct research, collect data, interpret it, and utilize it best describes which source of power? A. Authority B. Reward C. Control of information D. Coercion

C. This is correct. Control of information is power that stems from the special knowledge an individual is believed to possess.

7. Which of the following is true about behavior changes? A. Crisis is a powerful motivation for change. B. Change is motivated by fear. C. Individuals who are active and engaged can learn to make a change. D. Small changes are easier to make and sustain.

C. This is correct. People can continue learning and implementing changes throughout their lives, as long as they remain active and engaged.

15. Which of the following best describes power? A. Power increases with each step up in hierarchy. B. Power is directly related to the amount of authority one has in an organization. C. Those at the bottom of the hierarchy have no sources of power. D. Sources of power exist at all levels of the hierarchy

D. This is correct. Sources of power exist at all levels of the hierarchy.

4. A new nurse manager plans to implement a new scheduling process. This was met with resistance from the staff who were very happy with the current scheduling process. How can the nurse manager lower their resistance to this change? 1. Tell the staff that their concerns about the new schedule are unfounded and plan to post the new schedule. 2. Share information about the new schedule and discuss its impact on the unit. 3. Post the schedule and deal with staff on an individual basis. 4. Ask the staff to come up with an alternative for the nurse manager ' s consideration.

2. Sharing information about the new scheduling process and how it can benefi t the staff off ers them time to learn about the new process and possibly have input into the proposed change.

2. Which of the following best describes what is most likely to be within a nurse's comfort zone? 1. A new assignment 2. Tasks she's done many times 3. Change to a diff erent shift 4. Addition of several new tasks

2. Th e nurse is accustomed to the daily routine, knows what to expect, and understands what is expected. Th is puts the nurse in his or her comfort zone.

5. Which of the following is a characteristic of a bureaucratic organization? 1. Organic structure 2. Flexible teams 3. Rigid unit structures 4. Self-correction and self-control

3. Rigid unit structures are characteristic of a bureaucratic organization. Th ey are very organized and formal. Organizational charts depict each department, and decision making is a very formal, organized process.

3. Organizational culture is best defined as: 1. The stated vision and mission of an organization 2. Policies and procedures 3. The type of décor that was chosen for the facility 4. An enduring set of shared values and beliefs

4. Shared values and beliefs are the foundation of organizational culture

6. What is the best explanation of authority? 1. It is position dependent. 2. It is based upon the ability to lead others. 3. It is expertise-driven. 4. It resides primarily in the clients served.

1. Authority is position dependent. It is assigned based on the organization's hierarchy. For example, a nurse manager has authority over the staff nurses on that unit. Unless a job description or the person hiring requires expertise, leadership, or collaboration with this manager's staff , authority is entirely dependent on where the position falls on the organizational chart. Th e higher the position, the more authority.

1. Which of the following is a macro-level change? 1. Shift in Medicare payment policies 2. Change in shift diff erentials 3. Opening a new unit 4. Changing visiting hours

1. Macro-level changes happen on a large scale. Changes to national Medicare payment policies are large and far reaching because Medicare encompasses the U.S. health-care system.

7. Th ere are numerous sources of power in an organization. Several are available to nurses. Which one is not? 1. Authority 2. Reward 3. Control of information 4. Coercion

1. Nurses do have the authority to control clinical resources and make patient care decisions by virtue of their position and licensure.

7. When is it most appropriate to dictate (order) change? 1. When the change is very complicated 2. In an emergency 3. When resistance is very high 4. If the change is unimportant

2. In an emergency, there is little time for discussion or debate around taking action. In this situation, it is appropriate for someone in authority to take charge and dictate how the department will proceed. Th is is most common during lifethreatening events such as a Code Blue, a fi re, or a natural disaster

1. If you are employed at a hospital owned by a corporation listed on the stock market, in which category does your facility belong? 1. Publicly (government) supported 2. Voluntary, not-for-profit 3. For-profit 4. All of the above

3. For-profi t hospitals are corporately owned and listed on the stock market. Decisions are driven by the shareholders.

1. Which of the following is an example of a macro-level change? A. Policy changes B. Adjustments to shift change report C. Implementing a new evidence-based practice (EBP) D. Quality improvement changes

A. This is correct. Policy changes occur at the state or federal level and impact every health-care facility.

15. Which of the following will provide psychological safety when making a major change? A. Provide opportunities for individuals to ask questions. B. Allow individuals to agree to the change without consequences when they do not implement the change right away. C. Provide details about why the change is necessary. D. Recognize resistance and work to eliminate it.

A. This is correct. Providing an opportunity for individuals to ask questions and express themselves will increase psychological safety.

5. An organization works hard to be the best in the market and drive out competition. This describes which of the following organizational goals? A. Growth B. Profit C. Status D. Dominance

D. This is correct. An organization's goal for dominance goes beyond growth to the point of attempting to drive competition out of the market.

11. A nurse manager reflects on current practice and notes that a recent change has become a part of daily practice. Which stage of change does this scenario best describe? A. Implementation B. Design C. Planning D. Integration

D. This is correct. Integration is the refreezing phase, when a change has become a part of practice.

10. Several of your colleagues are going to join the American Nurses Association (ANA). You know the annual dues are a little more than you can aff ord right now, but you want to learn more. Your friends think that joining the ANA will help empower them. How do professional organizations empower nurses? 1. They represent nurses in the political arena. 2. They equalize power between employees and staff . 3. They provide opportunities for promotion. 4. They provide health insurance.

1. Professional organizations create a collective voice for nurses that can be stronger and more likely to be heard, especially at the national, state, and local levels. Your membership and participation let your voice be heard.

8. In which of the following situations would a personal change probably be the hardest to make? 1. When the need is immediate 2. If the benefi ts will be realized years from now 3. When the reward is immediate 4. If it is change that keeps you in your comfort zone

2. If the benefi ts will not be realized for several years (e.g., going back to school so that you can advance your career), it makes it harder to make the change because there may be more at risk (e.g., your dream job may not be available).

2. Creating a culture of safety requires organizational commitment to preventing harm. Which of the following is not a key feature of a culture of safety? 1. Provision of adequate resources to provide care and service 2. Use of interprofessional collaboration to solve problems and assess risk 3. Adherence to staffing ratios 4. Encourages the reporting of errors and near misses

3. Although staffi ng ratios may improve patient safety, they are not required to ensure a culture.

9. You have been asked to serve on your unit practice council. Th is is an important role and one that you are excited to perform. What should you know about professional governance so that you are prepared for this work? Professional governance in nursing involves: 1. Working longer hours 2. Attending a lot of meetings 3. Nurses setting nursing standards for daily practice 4. Changing the organization's culture

3. Nurses set nursing standards of practice for their organization. Because you are closest to the bedside, you see and experience the realities of clinical practice. Your input ensures that clinical practice standards are relevant and that nursing care is delivered in a safe, highquality manner.

5. Th ere has been a sudden increase in catheter-associated urinary tract infections that must be addressed on Jane ' s unit. What is the best way for Jane to persuade the staff to implement a new Foley catheter care protocol? 1. Tell them the change has been ordered by the administration. 2. Present statistics proving the need to change. 3. Tell a compelling story about why change is needed. 4. Explain the importance of the change in simple terms.

3. Telling a story about a patient gives the nurse manager an opportunity to appeal to the staff members' emotions, which compels staff to act, can increase receptivity to change, and may even create a sense of urgency for change.

9. When designing a technical change, which of the following should be considered? 1. Will it work better than the old way? 2. Is this change needed? 3. Is there a simple way to do this? 4. All of the above

4. All of the above

3. How can you increase your staff ' s receptivity to an important change in procedures? 1. Assign the new procedure to the newest staff member. 2. Apologize for making their work more complicated. 3. Provide them with a booklet on preparing for change. 4. Give them time to learn the new procedure.

4. Allowing time to learn or practice the new procedure lets staff gain confi dence and reduces the threat of failure. Th is can make the staff more receptive to the proposed change.

6. An RN is considering returning to school for a bachelor of science in nursing (BSN) degree. The RN realizes the knowledge gained will improve his practice and could impact patient outcomes. However, the RN is not sure about when to start the process. The RN's manager shares her own story with the RN, explaining why the manager decided to return to school and how this has impacted her professional life and personal life. Which of the following stages of change is the RN most likely in? A. Contemplation B. Preparation C. Precontemplation D. Action

A. This is correct. During the contemplation stage, the individual intends to make a change. It is during this stage that a compelling leader can use emotional persuasion to encourage a change.

6. In which of the following types of networks is the main focus of supervisors on planning and providing resources? A. Organic B. Bureaucratic C. Traditional D. Innovative

A. This is correct. Organic networks shift decision making to the individuals who implement the decisions, rather than the supervisors. This leaves the supervisors free to focus on planning and providing resources.

10. Which of the following is true regarding nursing practice councils? A. Practice councils are a form of shared governance, giving nurses the ability to participate in levels of decision making for the unit. B. Practice councils give nurses the authority to control all aspects of their practice. C. Genuine sharing of decision making occurs when managers retain control. D. A nursing practice council works best for an organization when it is the only practice council in place.

A. This is correct. Shared governance is a nursing practice structure that gives nurses the authority to participate in decision making for the unit through practice councils.

1. A new registered nurse (RN) with an organization is learning the layout of patient rooms. Which of the following organizational levels does this best describe? A. Artifact level B. Espoused beliefs C. Underlying assumptions D. Organizational culture

A. This is correct. The artifact level of organizational culture includes visible characteristics, such as the layout of patient rooms.

4. A nursing unit updated their barcode scanners because the batteries of the old ones were not replaceable and stopped holding charge. The proposed new scanners are wired so that batteries are not required. However, the registered nurses (RNs) resist this change because the placement of the scanners could make it difficult to reach the patients if they were not in bed. Which of the following most likely describes the source of the resistance? A. Design flaws B. Practical reasons C. Personal needs D. Position and power

B. This is correct. Practical reasons for resistance result from a question of whether the change can realistically be implemented without needing to have workarounds created.

3. Which of the following is a way to appeal to feelings in order to increase receptivity for a change? A. Present statistics on the number of patients with catheter-associated urinary tract infections during the next staff meeting. B. Share a patient's story of how a catheter-associated urinary tract impacted him personally. C. Provide staff with a report of infection control measures and their effectiveness. D. Inform staff about the cost of individual supplies.

B. This is correct. Sharing a patient story or visual presentation impacts feelings.

14. For nurses to participate in decision making, they need to have the authority to make decisions without asking permission. Which source of power does this best describe? A. Resources B. Support C. Information D. Opportunity

B. This is correct. Support is the authority to take action without asking permission.

14. To increase the number of baccalaureate-prepared RNs on the unit, the manager has proposed starting a cohort of RNs in a BSN program at one time. The manager has scheduled an information session for all who are interested. During the session, six RNs sign up for assistance with the application process. Which stage of change are these RNs most likely in? A. Precontemplation B. Preparation C. Contemplation D. Action

B. This is correct. The RNs are planning to make a change and have set a goal time for starting the change.

2. Management on a nursing unit has decided to upgrade to new beds in an effort to decrease occurrences of skin breakdown on the unit. The manager begins the staff in-service on the new beds by reviewing the recent incidence of skin breakdown and comparing it with statistics from similar units. Which stage of the change process is the manager addressing? A. Change B. Refreezing C. Unfreezing D. None of the above

C. This is correct. During the unfreezing stage, the reason for the change is discussed and it includes other actions that create a readiness for change.

13. Which of the following is true about personal change? A. The most effective leaders focus on improving the team, rather than themselves. B. Radical changes are more important for leaders than small changes. C. The process of personal change may follow the same steps as organizational change. D. Small personal changes do not require much effort.

C. This is correct. Personal changes follow a similar process as organizational changes.

3. Which of the following components of the care environment involves understanding and valuing the work individuals do? A. Excellence B. Meaningfulness C. Regard D. Learning and growth

C. This is correct. Regard requires understanding and valuing the work of individuals.

12. Which of the following best describes the main purpose of collective bargaining? A. To provide protection to employers B. To promote cooperation C. To equalize power between employees and employers D. To promote a clinical ladder for staff

C. This is correct. The purpose of collective bargaining is for an equalization of power between employees and employers. This equalization leads to improved working conditions, increased job security, and pay raises.

9. Which of the following is a good recommendation when planning change? A. Appoint a champion even for small changes. B. Not all effective leadership skills are needed for effecting change. C. Small changes do not require involving people who may be affected. D. Motivating people may be required even for small changes.

D. This is correct. Even small changes require effective leadership skills, such as motivating people.

9. An RN has joined the practice council at the hospital network. The RN is able to have some say regarding nursing practice in the network and now feels as if network administration is listening to the RN's recommendations. Which of the following components of empowerment does this scenario best describe? A. Meaning and decision making B. Self-determination and autonomy C. Impact and autonomy D. Impact and decision making

D. This is correct. Impact occurs when an RN feels he or she can make a difference because others listen to his or her ideas. Decision making is control regarding nursing practice within an organization. Joining a practice council empowers the RN through impact and decision making

5. Nurses on a unit have prepared a presentation for their administrators on a proposal for a change in practice based on current evidence. They begin the presentation with a description of the current practice and evidence of why it is inefficient. This is an example of lowering resistance through which method? A. Sharing information B. Providing psychological safety C. Dictating change D. Disconfirming currently held beliefs

D. This is correct. The scenario describes disconfirming currently held beliefs that the current practice is efficient. This sets the stage for the reason why a change is needed and will decrease resistance.

11. A new RN in the critical care unit joined the professional organization for critical care nurses. The new RN took advantage of webinars and journal articles that offered continuing education credits. The new RN attended the national conference and began studying for the certification examination. Which benefit of professional organizations does this scenario best describe? A. Collegiality B. Commitment to improved patient outcomes C. Recognition of achievement D. Enhancement of nursing competence

D. This is correct. Through publications, conferences, and continuing education, professional organizations enhance an individual nurse's competence.

13. Which of the following is the best way a nurse manager can work with leaders of collective bargaining units? A. Focus on staffing goals B. Focus on a clinical ladder to support staff expertise C. Focus on patient outcomes D. Focus on shared goals

D. This is correct. Through respect for differences and finding common ground, shared goals can be established that will be mutually beneficial.

10. Which of the following is the best indication that a change has been integrated? 1. When no one talks about it anymore 2. If adoption occurred rapidly 3. When resistance turns from active to passive 4. When a full year has passed since the change was introduced

1. When a change has truly been incorporated into the daily routine, it has been integrated. Usually staff will no longer refer to the practice as new or a change because they have integrated it into their work. Results of the change will be present, too.

8. Nurses who feel empowered can make significant contributions to a health-care organization. Feeling empowered includes feeling as if you make a diff erence, that colleagues value your opinion, and that your voice is important. What is essential to nurse empowerment? 1. Belonging to a professional organization 2. Participating on a unit practice council 3. Reasonable work assignments 4. A rewards and recognition program

2. Direct control over work and the ability to infl uence clinical and organizational decisions are essential to feeling empowered. Participating on a unit practice council is an opportunity to contribute to the nursing unit and even the organization, make a diff erence in clinical practice, and know that her opinion and ideas are valued and important.

4. Communities and regulatory agencies continually challenge hospitals, skilled nursing facilities, and home health companies to enhance, improve, or change care delivery and the care environment to ensure safe, high-quality care. Which factors are important in improving a hospital's care environment? 1. Adequate staffing 2. Collegial relationships among staff 3. Emphasis on staff development 4. All of the above

4. All of the above

6. What type of resistance to a change is the hardest to overcome? 1. The resistance that comes from inertia: "We always do it this way." 2. Active resistance to changing a preferred procedure 3. Passive resistance to an unpopular change 4. Resistance based upon fear of losing one ' s job

4. Resistance based on the fear of losing one's job is the most diffi cult type of resistance to overcome because the person perceives that there is a threat to his or her way of life, which the person will guard at all costs. Th e individual does not feel that he or she can speak freely without jeopardizing his or her job, so although the individual disagrees with the change, he or she keeps silent to stay employed.