Leadership

In order to best ensure client safety, which of the following questions should a staff nurse ask first when determining whether to accept a client assignment that is made when several staff members have reported off sick? "Do I have the experience and knowledge to care for these patients?" "Is this a staffing crisis or a result of typical staffing patterns?" "Can I expect to be mandated to stay an additional shift?" "How long will it be before I get additional help?"

"Do I have the experience and knowledge to care for these patients?" Although all these questions can help the staff nurse think critically about accepting the assignment, initially the important question is whether the nurse possesses the experience, skills, and knowledge necessary to safely provide appropriate care for the clients she is asked to care for.

Which of the following is the best example of a situation where a nurse could demonstrate workforce advocacy? A client wishes to become an organ donor in spite of family opposition. A client feels pressured by a health care provider into agreeing to a specific medical procedure. A nurse volunteers time to participate in a fund raiser to provide toys for a hospital's pediatric unit. Staff on a particular unit feel that the nurse manager is showing favoritism when granting vacation time.

A client feels pressured by a health care provider into agreeing to a specific medical procedure. Nurses' strong concern and commitment to patient care and their role as patient advocates often place them in direct conflict with those who have more control, such as physicians and health care administrators. How a nurse reacts to such conflicts within the workplace and continues to advocate to improve patient care is a necessary focus for the profession—a focus called workforce advocacy. Volunteering time to provide funds for toys shows an interest in the client's welfare but is not as strongly related to client care. Advocacy for a client wishing to become an organ donor is an example of patient advocacy. The issue of fair management in this situation does not involve client care.

The nursing staff perceive the newly hired Chief Nurse Administrator as a leader who is committed to a vision that empowers others. The Chief Nurse Administrator is most likely employing which type of leader? a. Transformational leader c. Transactional leader b. Charismatic leader d. Autocratic leader

ANS: A A transformational leader empowers others. A charismatic leader has an appeal based on personal power. A transactional leader focuses on day-to-day operations. An autocratic leader has central power and does not empower others.

You have always dreamed of becoming a nurse and participating in collective bargaining. Some of your ideas and views are a direct result of growing up in a family of union workers. Both your mother and father were union stewards, and they promoted workplace advocacy. Your background has taught you that workplace advocacy is: a. a collective action model. c. a workplace agency shop. b. a qui tam situation. d. the initial step in whistle-blowing.

ANS: A Workplace advocacy is a collective action model that is more informal and encompasses everyday creativity and problem solving tools that occur everyday in nursing. A qui tam lawsuit is filed in whistle-blowing cases, and an agency shop is a term that refers to employees who are not required to join a union.

The union representative for the nurses at your hospital calls a meeting to discuss the possibility of a strike. Several issues are discussed. Which statement made by one of the nurses would indicate that further clarification regarding a strike is needed? a. "The decision to strike is made only if all union members agree." b. "The decision to strike occurs if the majority of union members agree." c. "If a no strike clause is in the union contract, we will not be able to strike." d. "An advance strike notice must be provided."

ANS: A A union strike is an act in which union members withhold the supply of labor for the purpose of forcing management to accept their terms. Some characteristics of these strikes are the decision to strike is made if a majority of union members agree (not all members), the union must provide a contract expiration notice and advance strike notice, mediation is mandatory for dispute settlement, and the hospital or agency has the option of establishing a board of inquiry before the work stoppage.

A nursing instructor is evaluating whether the nursing students understand the three fundamental qualities that leaders share. According to Bennis and Nanus, the fundamental qualities of effective leaders are: a. guided vision, passion, and integrity. b. knowledge of self, honesty, and maturity. c. intelligence, self-confidence, and determination. d. honesty, self-awareness, and sociability.

ANS: A Bennis and Nanus list guided vision, passion, and integrity as fundamental qualities of effective leaders. Knowledge of self, honesty and maturity; intelligence, self-confidence and determination; self-awareness and sociability are all desirable traits in leaders as well as in others.

A group of new nurse managers is undergoing a series of management training sessions. Which statement by one of the nurse managers would indicate use of McClelland's Model of Motivation? "McClelland's Model focuses on: a. achievement, power, and affiliation." b. growth needs, relatedness needs, and existence needs." c. collective decision making, quality circles, and mentoring." d. self-actualization needs, safety and security needs, and self-esteem needs."

ANS: A McClelland's Model of Motivation focuses on achievement, power, and affiliation. Growth needs, relatedness needs, and existence needs are aspects of Adler's model. Collective decision making, quality circles, and mentoring are the focus of Ouchi's model. Self-actualization needs, safety and security needs, and self-esteem needs are reflected in Maslow's model.

You are considering forming a union for nurses at the organization for which you work, and you would like to have as many nurses in your organization join as possible. According to the current laws governing unions, which nurses have the legal right to unionize? a. Staff nurses c. All nurses b. Managers d. Nurse leaders

ANS: A Nurses who are not managers or nurse leaders and are considered employees, such as staff nurses, have the legal right to unionize. Nurses who are considered managers, supervisors, or leaders are not allowed to unionize under the current labor laws.

As a new graduate, you have interviewed at several hospitals for your first nursing position. One of the hospital recruiters informs you that the nursing union has created turmoil for the hospital. The recruiter also tells you that if you choose this hospital, you will have to sign a contract stating that you will not join the nursing union. You recognize that requiring you to sign such a contract would be in direct violation of which of the following? a. 1898 Erdman Act b. 1935 National Labor Relations Act (Wagner Act) c. 1938 Fair Labor Standards Act d. 1947 Taft-Hartley Act

ANS: A The 1898 Erdman Act was the first piece of legislation to outlaw discriminatory acts by employers against unions. By refusing to allow all new employees to join the nursing union, the hospital is interfering with the union's membership and the union's ability to represent all nurses employed by the facility. The 1935 National Labor Relations Act (Wagner Act) allowed employees of private companies to organize unions to demand better wages and safer working conditions, and the 1938 Fair Labor Standards Act set minimum wage and maximum hours that can be paid before overtime is paid. The 1947 Taft-Hartley Act returned some rights to management but still equalized the balance between unions and management.

In 2007, your favorite nursing instructor, a 65-year-old African American, retired from the school of nursing. The instructor had decided to travel around the world and enjoy life; however, after the instructor's spouse became unemployed and the family lost their life savings in the stock market, the nurse educator decided to return to teaching. During the job search, the instructor was told by the deans of the different nursing programs that they were interested in hiring individuals whose formal education was much more current. However, each dean acknowledged that the instructor's record demonstrated a wealth of experience that included a number of awards, publications, and grants. The deans of the schools are most likely in violation of which of the following? a. The Age Discrimination Act c. The Taft-Hartley Act b. The Civil Rights Act d. The Erdman Act

ANS: A The dean's are most likely in violation of the Age Discrimination Act. The Age Discrimination Act promotes employment of older persons based on their ability rather than on their age. The instructor's accomplishments as noted by numerous awards, grants, and publications are proof of the abilities to meet the requirements of the position.

According to R. N. Lussier, there are content motivation theories and process motivation theories. Which of the following is considered a process motivation theory? a. Equity theory b. Hierarchy of needs theory c. Existence-relatedness-growth theory d. Hygiene maintenance and motivation factors

ANS: A The process motivation theories are equity theory and expectancy theory. The content motivation theories include Maslow's hierarchy of needs theory, Aldefer's existence-relatedness-growth (ERG) theory, and Herzberg's hygiene maintenance factors and motivation factors.

In your class on collective bargaining, you learn about unions. Which of the following is incorrect in terms of individuals who are able to unionize? a. All nurses c. Employees of nonprofit organizations b. Medical practitioners d. University professors

ANS: A While there are unions for many nurses, the statement that all nurses are now able to unionize is incorrect. For example, managers and supervisors employed in hospitals are not in unions. Other groups able to join unions includemedical practitioners (the Service Employees International Union is the largest collective bargaining agent for this group), employees of nonprofit organizations (the 1974 Taft-Hartley Amendments to the Wagner Act allowed this), and university professors. However, many chairpersons and deans of nursing programs cannot join unions because they are considered to be part of the administration.

The nurses at the hospital where you are employed are in the process of unionization. Your role during this process would include which of the following? Select all that apply. a. Act clearly within the law at all times. b. Know the rights of your manager. c. If a manager acts unlawfully, report it to the NLRB. d. Know your legal rights. e. Demand an increase in salary. f. If another nurse practices in an unsafe manner, report it to the NLRB.

ANS: A, B, C, D Your role would include acting clearly within the law at all times, knowing your legal rights, knowing the rights of your manager, and reporting unlawful acts by the manager to the NLRB. The process does not include demanding a salary increase or reporting unsafe nursing practice to the NLRB. Unsafe practices of another nurse should be reported to your immediate supervisor.

A nursing instructor determines that the nursing students understand the concept of "knowledge worker" if the students describe which of the following tasks of the knowledge worker? Select all that apply. a. Provide service b. Represent the organization c. Interact with the customer d. Focus on personal, life-long goals and achievement e. Bring expert knowledge f. Accomplish goals

ANS: A, B, C, E, F According to Peter Drucker, knowledge workers provide service, interact with the customer, represent the organization, and accomplish its goals. These workers bring specialized, expert knowledge to the organization, and they are valued for what they know. The knowledge worker focuses more on organizational goals than personal goals.

A nurse manager who structures her approach on the McClelland Model of Motivation would most likely focus on which of the following? Select all that apply. a. Power d. Achievement b. Affiliation e. Mentoring c. Quality circles f. Collective decision making

ANS: A, B, D McClelland's Model of Motivation focuses on power, achievement, and affiliation. Ouchi's model focuses on quality circles, collective decision making, long-term employment, and mentoring.

A nurse manager who follows Herzberg's Two-Factor Theory would recognize that which of the following are hygiene-maintenance factors? Select all that apply. a. Job security d. Relationships with others b. Advancement opportunities e. Status c. Working conditions f. Achievement

ANS: A, C, D, E Herzberg's hygiene-maintenance factors include status, job security, quality of supervision, safe and tolerable work conditions, and relationships with others. Advancement opportunities, achievement, recognition, the work itself, personal growth, and responsibility are all motivation factors.

You attend a meeting with other nurses employed at the hospital who are considering unionization. When you return home, you create a list of the pros and cons for unionizing. Your list of cons would most likely include which of the following? Select all that apply. a. Other union members may outvote your decisions. b. All union members and management must conform to the terms of the contract without exception c. A process can be instituted to question a manager's authority if a member feels something was done unjustly. d. Unions may be perceived by some as not being professional. e. Union dues must be paid even if individuals do not support unionization. f. Union dues are required to make the union work for you.

ANS: A, D, E Some of the cons that might be on you list include other union members may outvote your decisions, union dues must be paid even if individuals do not support unionization, and unions may be perceived by some as not being professional. In addition, the list could include the facts that there is reduced allowance for individuality, disputes are not handled with an individual and management only (there is less room for personal judgment), and some employees may not agree with the collective voice..

A nurse was recently promoted to a middle-level manager position. The nurse's title would most likely be which of the following? a. First-line manager c. Vice president of patient care services b. Director d. Chief nurse executive

ANS: B A middle-level manager is called a director. A low managerial-level job is called the first-line manager. A nurse in an executive level role is called a chief nurse executive or vice president of patient care services.

In situational theory, a telling leadership style is considered: a. high task, high relationship behavior. c. low task, high relationship behavior. b. high task, low relationship behavior. d. low task, low relationship behavior.

ANS: B A telling leadership style is high task behavior and low relationship behavior. A high task, high relationship style is called a selling leadership style. A low task and high relationship style is called a participating leadership style. A low task and low relationship style is called a delegating leadership style.

According to Vroom's Theory of Motivation, force: a. is the perceived possibility that the goal will be achieved. b. describes the amount of effort one will exert to reach one's goal. c. describes people who have free will but choose to comply with orders they are given. d. is a naturally forming social group that can become a contributor to an organization.

ANS: B According to Vroom's Theory of Motivation, Force describes the amount of effort one will exert to reach one's goal. Valence speaks to the level of attractiveness or unattractiveness of the goal. Expectancy is the perceived possibility that the goal will be achieved. Vroom's Theory of Motivation can be demonstrated in the form of an equation: Force = Valence ´ Expectancy (Vroom, 1964). The theory proposes that this equation can help to predict the motivation, or force, of an individual as described by Vroom.

The nursing supervisor has traditionally made rounds at the same time each day. When the supervisor visits each unit, the staff appear to be extremely busy even when the census is very low. Today the supervisor visited a unit two hours early and found several staff members watching television and drinking coffee in the visitor's lounge. The supervisor recognizes that the staff's previous behavior have been a result of which of the following? a. Coincidence c. Diligence of staff b. Hawthorn effect d. Time management

ANS: B Because the nursing supervisor traditionally made rounds at the same time each day, the staff members were prepared for the visit. When the supervisor arrived unexpectedly, the staff members were most likely caught off-guard. The Hawthorn effect occurs when recognition that one is being studied or observed results in a change in behavior. Coincidence, diligence of staff, and time management would not account for the dramatic change in behavior.

A nurse manager who implements the bureaucratic management style will most likely do which of the following? a. Emphasize efficiency b. Use explicit rules and regulations for governing activities c. View the individual worker as the source of control, motivation, and productivity d. Expect unity of command and direction

ANS: B Bureaucratic management focuses on the use of explicit rules and regulations for governing activities. The human relations approach views the individual worker as the source of control, motivation, and productivity. Administrative principles focus on unity of command and direction.

You and other nurses in your organization have chosen to act as a group with a single voice when dealing with some workplace problems. This is known as: a. unionization. c. collective bargaining. b. collective action. d. workplace advocacy.

ANS: B Collective action is when individuals act together as a group with a single voice, and it is one method for dealing with workplace problems. Collective bargaining is the practice of employees acting as a collective group and bargaining with management regarding wages, work practices, and other benefits. Workplace advocacy pertains to actions that nurses undertake to address problems in their everyday work setting, and it is another form of collective action.

You and other nurses in your organization have decided to use a collective bargaining method that is used in the workplace, commonly known as: a. workplace advocacy. c. collective brainstorming. b. unionization. d. collective striking.

ANS: B Collective bargaining through unionization is also a collective action model that is legally based and formal. It utilizes a written contract to guide nursing and workplace issues.

A nurse manager who uses a leadership style that is participatory and where authority is delegated to others is most likely using which of the following leadership styles? a. Autocratic c. Laissez-faire b. Democratic d. Employee-centered

ANS: B Democratic leadership is participatory, and authority is delegated to others. Autocratic leadership involves centralized decision making, with the leader making decisions and using power to command and control others. Laissez-faire leadership is passive and permissive, and the leader defers decision making. Employee-centered leadership focuses on the human needs of subordinates.

A nurse is appointed to a leadership position in the local hospital. The nurse's position would be considered which of the following? a. Informal leadership c. Leadership b. Formal leadership d. Management

ANS: B Formal leadership is based on occupying a position in an organization. Informal leadership is shown by an individual who demonstrates leadership outside the scope of a formal leadership role or as a member of a group. Leadership is a process of influence whereby the leader influences others toward goal achievement. Management is a process to achieve organizational goals.

While doing retrospective chart review, a nurse manager discovers that patients in the unit are having their Medicare double-billed for certain hospital services over a 5-year period. The nurse manager is very concerned and feels this may be a case of fraud, but she is afraid to tell anybody because the general opinion of most employees is "we have always done it this way." What step would be least effective in addressing the nurse manager's concerns? a. Filing a qui tam lawsuit in secret with the court b. Confiding in a close manager friend at work about what the nurse manager is planning c. Providing a copy of the complaint to the Department of Justice with a written disclosure of all the information concerning the fraud d. Telling no one at work about the nurse manager's discovery or planned actions

ANS: B In this situation, the nurse manager has just discovered fraudulent activities occurring in the hospital. Steps that the nurse manager should take to report this occurrence are file a qui tam lawsuit in secret with the court, provide a copy of the complaint to the Department of Justice with a written disclosure of all the information concerning the fraud, and DO NOT let anybody at the hospital know that a lawsuit is being filed (this includes another manager who is a close friend).

A non-nurse questions why nurses make such an effort to serve and protect the wishes of their patients. You, as a nurse, respond that by serving and protecting the wishes of their patients, nurses are participating in: a. unionization. c. collective bargaining. b. workplace advocacy. d. legal decision making.

ANS: B Nurses who serve and protect the wishes of their patients are participating in workplace advocacy. Patient advocacy is a form of workplace advocacy.

The nurse manager on one of the hospital units views the staff as basically lazy and only motivated by threats and coercion. Which theory of motivation would support the manager's beliefs? a. Theory W c. Theory Y b. Theory X d. Theory Z

ANS: B The Theory X view is that in bureaucratic organizations, employees prefer security, direction, and minimal responsibility. Coercion, threats, or punishment are necessary because people do not like their work to be done.

At the conclusion of a class on factors that can lead to unionization among nurses, the instructor would recognize that further clarification is needed if a student included which of the following as one of the factors? a. Job stress c. Unsafe work environment b. Whistle-blowing d. Physical demands

ANS: B The instructor would recognize that further clarification is needed if a student responded that whistle-blowing was a factor that leads to unionization among nurses. Some reasons that contribute to nurses wanting to unionize are job stress, unsafe work environment, feeling powerless, the physical demands of the job, and the need to communicate concerns and/or complaints to management without fear of losing their jobs. Whistle-blowing is the act in which an individual discloses information regarding a violation of a law, rule, regulation, or a substantial and specific danger to public health or safety.

A recent graduate is deciding on which union and professional organizations for nurses would be appropriate to join. You inform the graduate that the largest union and professional organization for registered nurses is: a. American Nurses Association. b. National Nurses United. c. National League for Nursing. d. American Association of Colleges of Nursing.

ANS: B The largest union and professional association of registered nurses is National Nurses United. In 2010, there were over 150,000 members.

According to Henri Fayol, the functions of planning, organizing, coordinating, and controlling are considered which aspect of management? a. Roles c. Functions b. Process d. Taxonomy

ANS: B The management process includes planning, organizing, coordinating, and controlling. Management roles include information processing, interpersonal relationships, and decision making. Management functions include planning, organizing, staffing, directing, coordinating, reporting, and budgeting. A taxonomy is a system that orders principles into a grouping or classification.

The theory that includes maintenance and motivation factors is: a. Maslow's hierarchy of needs. c. McGregor's theory X and theory Y. b. Herzberg's two-factor theory. d. Ouchi's theory Z.

ANS: B The two-factor theory of motivation includes motivation and maintenance factors. Maslow's hierarchy of needs includes the following needs: physiological, safety, security, belonging, and self-actualization. In theory X, employees prefer security, direction, and minimal responsibility. In theory Y, employees enjoy their work, show self-control and discipline, are able to contribute creatively, and are motivated by ties to the group, organization, and the work itself. The focus of theory Z is collective decision making and long-term employment that involves slower promotions and less direct supervision.

As a nurse manager, you have heard your staff talking about poor wages, unsafe staffing, and mandatory overtime issues. An initial effective way of dealing with this type of conversation would be to: a. report this to upper management. b. discuss these concerns with your staff using a nonpejorative tone. c. ask your supervisor what to do. d. do nothing because it will go away on its own.

ANS: B Whenever staff members gather to discuss workplace issues such as poor wages, unsafe staffing, mandatory overtime, and job security concerns, there is the potential of collective bargaining actions such as unionization or strikes. An effective nurse manager would initially discuss these matters with staff (especially with those who were overheard discussing these concerns) first to find out exactly what the concerns are and then try to determine how widespread they are among the unit.

A colleague is asking you for information regarding qui tam lawsuits. Which of the following would not be a correct statement about such lawsuits? a. Anyone can file them. b. Only an attorney can file them. c. They are used in whistle-blowing cases. d. They can be filed on behalf of the government.

ANS: B Whistle-blowing claims are brought forth in qui tam lawsuits. An interesting characteristic of these types of lawsuits is that anyone can file them on their own behalf or on behalf of the government.

With the help of the union representative, a nurse files a grievance against the hospital because of unfair practices when promoting the staff. Mediations between the union representative and management have been unsuccessful, and the situation now requires the input from a non-partial third party. This final step of the grievance procedure is known as which of the following? a. Dispute c. Fact-finding b. Arbitration d. Lockout

ANS: B Arbitration is the last step in a dispute. At this step, a non-partial third party will be involved and may make the final decision. Arbitration may be voluntary or imposed by the government.

The new nurse manager of a medical unit focuses on day-to-day operations and short-term goals, while the nurse manager of the mental health unit is committed to the vision that empowers the staff. The manager of the medical unit would most likely be considered which type of leader? a. Transformational leader c. Transactional leader b. Charismatic leader d. Autocratic leader

ANS: C A transactional leader focuses on operations and short-term goals. A transformational leader inspires and motivates others to excel and participate in a vision that goes beyond self-interests. A charismatic leader displays self-confidence and strength in convictions and communicates high expectations. An autocratic leader makes decisions and uses power to command and control others.

There is a rumor that your union and the management in the organization that you work for will be going into arbitration. Which of the following statements concerning arbitration is false? a. It is the last step in a dispute. b. It utilizes a non-partial third party. c. It must be voluntary. d. An impartial person selected will make the final decision.

ANS: C Arbitration is a method used in settling disputes. It is generally the last step in the dispute; it utilizes a non-partial third party who will make the final decision; and it can either be voluntary or imposed by the government.

You are employed in a large physician-owned private clinic. Negotiations of the new contract are at a stalemate. The administration refuses to address the issues of unfair wages for the nurses and the unsafe practices of the clinic physicians. During a union meeting, the union representative informs the nurses that the clinic's management team has threatened to close the clinic if the nurses do not accept the new contract as written You understand that management's threatened actions are considered which of the following? a. Dispute c. Lockout b. Negotiation d. Mediation

ANS: C By threatening to close the clinic, management is threatening a lockout. A lockout relates to closing a place of business by management in the course of a labor dispute to attempt to force employees to accept management terms.

A nurse working in a private physician's office noted that several of the clinic patients had been given prescriptions for cholesterol medications even though the laboratory results did not indicate the need for these medications. Concerned with the patients' health and safety, the nurse reported her suspicions to the proper authority. The nurse's actions are based on which piece of legislation which encourages individuals to come forward to report a danger to public health or safety? a. Edmunds-Tucker Act b. Taft-Hartley Amendments to the Wagner Act c.False Claims Act Modification d. Anti-fraud Act

ANS: C In 1986, the False Claims Act was modified to encourage whistle-blowers to come forward and report information regarding a violation of a law, rule, regulation, or a substantial and specific danger to public health or safety. The Edmunds-Tucker Act (1887) prohibited polygamy in the United States, and the Taft-Hartley Amendments to the Wagner Act allowed employees of nonprofit organizations to unionize. Various states such as Connecticut (2003) have state anti-fraud acts that prohibit fraudulent activities.

The leadership theory that considers follower readiness as a factor in determining leadership style is: a. contingency. c. situational. b. path goal. d. charismatic.

ANS: C Situational leadership considers the follower readiness as a factor in determining leadership style. Contingency theory views the pattern of leader behavior as dependent on the interaction of the personality of the leader and the needs of the situation. In path goal theory, the leader works to motivate followers and influence goal accomplishment. Charismatic leadership has an inspirational quality that promotes an emotional connection from followers.

A new graduate questions a colleague about organizations that have collective bargaining agents that work for nurses. Which organization would not be included on the colleagues list? a. National Nurses United c. Unites States Nurses b. Service Employees International Union d. Service Employees International Union

ANS: C Some of the largest collective bargaining agencies/unions working for nurses include the National Union of Hospital and Health Care Employees and the Service Employees International Union. Other agents that support nurses are the United American Nurses AFL-CIO, the Teamsters Union, and the American Nurses Association.

A nurse manager who uses Frederick Taylor's scientific management approach, would most likely focus on which of the following? a. General principles c. Labor productivity b. Positional authority d. Impersonal relations

ANS: C The area of focus for scientific management is labor productivity. In bureaucratic theory, efficiency is achieved through impersonal relations within a formal structure and is based on positional authority. Administrative principle theory consists of principles of management that are relevant to any organization.

A nurse manager finds two employees arguing about the assigned schedule. Which role would be appropriate for the nurse manager to implement at this time? a. dvocate role c. Decision-making role b. Interpersonal role d. Information-processing role

ANS: C The decision-making role of a nurse manager would include being an entrepreneur, handling disturbances, and allocating resources. The information-processing role involves managing the information that the people need. The interpersonal role focuses on functioning as a figurehead, leader, or liaison. In the advocate role, the nurse manager would focus on supporting employee rights.

You are caring for a 97-year-old patient whose cancer has returned. The patient tells you that he has had a good life and would like to avoid any additional surgeries. The family insists that the patient should have the surgery. You share with the physician the patient's preference not to have surgery. Your actions are an example of which of the following? a. Patient preservation c. Patient advocacy b. Family negotiation d. Patient bargaining

ANS: C When nurses preserve and protect the wishes of patients, they are practicing a type of workplace advocacy called patient advocacy. Workplace advocacy is the process or the activity that nurses undertake to address problems in their everyday work setting.

You are employed in a hospital where nurses are unionized. Which of the following situations would you report to the NLRB? Select all that apply. a. A staff nurse gave a medication to the wrong patient. b. A nurse is given a verbal warning because of consistent tardiness. c. You were not paid overtime for the extra hours you worked last week. d. A nurse was denied a promotion due to failure to provide quality care. e. Nurses are being sexually harassed by many of the physicians. f. Units are often understaffed and experiencing increased patient falls.

ANS: C, E, F The issues that you should report to the NLRB include not being paid for overtime; sexual harassment; and the units' being understaffed, resulting in increased patient falls. Salary issues and environmental safety issues are under the purview of the union.

When you were hired, you joined a group that utilized a collective bargaining agent to formally present desires to management. The group you joined is known as which of the following? a. Whistle-blowing c. ANA b. Nurse advocacy d. Union

ANS: D A union is a formal and legal group that works through a collective bargaining agent to present desires and needs to management formally through the legal context of the National Labor Relations Board (NLRB).

In contingency theory, the feelings and attitudes of followers regarding acceptance, trust, and credibility of the leader are called: a. task structure. c. low task structure. b. position power. d. leader-member relations.

ANS: D In contingency theory, leader-member relations are the feelings and attitudes of followers regarding acceptance, trust, and credibility of the leader. Task structure of contingency theory means the degree that work is defined, with specific procedures, explicit directions, and goals. Low task structure involves work that is not routine, predictable, or clearly defined. Position power in contingency theory is the degree of formal authority and influence associated with the leader.

According to R. N. Lussier, motivation: a. is unconsciously demonstrated by people. b. occurs externally to influence behavior. c. is determined by others' choices. d. occurs internally to influence behavior.

ANS: D Motivation is a process that occurs internally to influence and direct our behavior in order to satisfy needs. Motivation is not explicitly demonstrated by people, but rather it is interpreted from their behavior. Motivation is whatever influences our choices and creates direction, intensity, and persistence in our behavior.

The six traits identified by Kirkpatrick and Locke that separate leaders from non-leaders were: a. respectability, trustworthiness, flexibility, self-confidence, intelligence, sociability. b. self-confidence, progression of experiences, influence of others, personal life factors, honesty, drive. c. intelligence, self-confidence, determination, integrity, sociability, honesty. d. drive, desire to lead, honesty, self-confidence, cognitive ability, knowledge of business.

ANS: D Research by Kirkpatrick and Locke concluded that leaders possess six traits: drive, desire to lead, honesty, self-confidence, cognitive ability, and knowledge of the business. Woods identified five dominant factors that influenced leadership development: self-confidence, innate qualities, progression of experience, influence of significant others, and personal life factors. Stogdill identified the following traits of a leader: intelligence, self-confidence, determination, integrity, and sociability. Murphy and DeBack identified the following leader characteristics: caring, respectability, trustworthiness, and flexibility.

A nursing group has been very successful in achieving its goals even though the group has lacked leadership. Which of the following factors is probably most responsible for the group's success in goal achievement? a. Life experience c. Informal organizational structures b. Extrinsic satisfaction d. Cohesive groups

ANS: D Substitutes for leadership are variables that eliminate the need for leadership or nullify the effect of the leader's behavior. These include cohesive groups, work experience, intrinsic satisfaction, formal organizational structures, professionalism, indifference to rewards, routine tasks, feedback provided by the task, rigid adherence to rules, role distance, and low position power of the leader.

Which of the following is considered a decisional managerial role? a. Disseminator c. Leader b. Figurehead d. Entrepreneur

ANS: D The decisional managerial roles include entrepreneur, disturbance handler, allocator of resources, and negotiator. The information processing managerial roles include monitor, disseminator, and spokesperson. The interpersonal managerial roles include figurehead, leader, and liaison.

A nurse manager who held a commission in the Army was notified of mandatory military duty and had to go to Iraq to serve for 2 years. After discharge, the nurse returned to the hospital to resume the previous position but was informed that the position was no longer available. The hospital then offered the nurse employment as a staff nurse, which involved a major reduction in salary. The hospital was in violation of which of the following? a. 1964 Civil Rights Act b. 1974 Taft-Hartley Amendments to the Wagner Act c. 1935 National Labor Relations Act (Wagner Act) d. 1973 Vietnam Veterans Act

ANS: D The hospital's action was in violation of the 1973 Vietnam Veterans Act. This act was passed to provided reemployment rights for individuals who leave their place of employment to perform military duties. According to the act, these individuals are entitled to be restored to their former position or to "a position of like seniority, status, and pay." The 1964 Civil Rights Act provided equal employment standards, and the 1974 Taft-Hartley Amendments to the Wagner Act allowed for employees of nonprofit organizations to join unions. The original Wagner Act (1935 National Labor Relations Act) gave employees of private companies the right to organize unions.

A characteristic of the consideration dimension of leadership behavior is: a. focus on the work to be done. c. focus on production. b. focus on the task. d. focus on the employee.

ANS: D The leadership dimension of consideration involves activities that focus on the employee. Initiating structures of leadership involves an emphasis on the work to be done, and a focus on the task and production.

When a group of nurses employed at a particular hospital act together as a group to bargain with management concerning workplace issues, they are practicing: a. workplace bargaining. c. workplace advocacy. b. collective striking. d. collective bargaining.

ANS: D The practice of employees acting together as a collective group to bargain with management regarding workplace issues such as wages, work conditions, and benefits is called collective bargaining.

A nurse manager meets regularly with other nurse managers, participates on the organization's committees, and attends meetings sponsored by professional organizations in order to manage relationships. These activities are considered which function of a manager? a. Informing c. Monitoring b. Problem solving d. Networking

ANS: D The role functions to manage relationships are networking, supporting, developing and mentoring, managing conflict and team building, motivating and inspiring, recognizing, and rewarding. The role functions to manage the work are planning and organizing, problem solving, clarifying roles and objectives, informing, monitoring, consulting, and delegating.

A nursing instructor asks the student nurses about the requirements for a vocation to be recognized as a profession? Which comment by one of the students would indicate to the instructor that further teaching is needed? a. Long period of specialized education b. Service orientation c. Ability to be autonomous d. Use of evidence-based guidelines and practice standards

ANS: D Three requirements for a trade or vocation, such as nursing, to be considered a profession are a long period of specialized education, a service orientation, and the ability to be autonomous (able to be self-regulating and have control over their functions in a work situation). The use of evidence-based guidelines and standards promote effective and quality nursing care, and their incorporation into a nurse's everyday practice is called evidenced-based nursing practice.

During a presentation on workplace advocacy, the speaker asks the group to identify some of the methods nurses can become involved with in order to promote workplace advocacy. Which response by the participants would indicate to the presenter that further clarification is needed? a. Collective bargaining c. Professional practice councils b. Shared governance d. Refirmative action

ANS: D Workplace advocacy can take a variety of forms. Some forms in which nurses may be involved are collective bargaining, shared governance, and professional practice councils.

Which skill is most important for a nurse to possess when attempting to exercise or earn informal power within an organization? Ability to persuade others Expert level nursing knowledge Understanding of management goals Willingness to compromise with everyone in the team

Ability to persuade others Informal leadership is exercised by the person who has no official or appointed authority to act, but is able to persuade and influence others. The informal leader may have considerable power in the work group and can influence the group's attitude and significantly affect the efficiency and effectiveness of workflow, goal setting, and problem solving. The other options represent skills that either relates to actual nursing care (expert nursing knowledge and cooperation) or management (goals).

What interventions will a nurse manager implement when coaching a newly licensed nurse regarding the way a patient's complaint was handled? (Select all that apply.) Asks, "What will you do differently the next time this situation occurs?" Begin the discussion with a personal interpretation of the situation Focus on how to achieve the "ideal situation" Approach the conversation in a nonjudgmental fashion Use close ended questions to help focus the conversation on the situation

Asks, "What will you do differently the next time this situation occurs?" Begin the discussion with a personal interpretation of the situation Approach the conversation in a nonjudgmental fashion Effective coaching includes discussing situations in a neutral way—avoid judgmental language that will put the other person on the defensive, encouraging the other person to provide his or her perspective about the situation and to reflect on his or her performance through open-ended questions. Being realistic by focusing on what is actually achievable.

The __________________ management style encourages staff involvement in the decision-making process.

Democratic/Participative The Democratic/Participative manager encourages staff participation in decision making. Involves staff in planning and developing new ideas and programs while believing in the best in people. This manager communicates effectively, and provides regular feedback and so builds responsibility in people. Works well with competent, highly motivated

According to the definition, which word best describes leadership? Allocate Influence Evaluate Control

Influence Leadership is the ability to guide or influence others. The other words are more applicable to the supervision of resources.

________ refers to a group composed of people who work for an employer for pay.

Labor

A nurse manager will likely have which of the following types of power? Referent Informal Legitimate Connection .

Legitimate Legitimate power is based on an official position in the organization. Through legitimate power, the manager has the right to influence staff members, and staff members have an obligation to accept that influence. Although a manager may have the other types of power, they are not a result of the management position alone

Based on current trends, which nursing care environment has the greatest employment potential for new nurses? Long-term care facilities Hospital emergency departments Pre- and postsurgical departments Primary health care provider practices

Long-term care facilities Employment will not grow at the same rate in every setting—hospital employment will grow more slowly because many procedures and care are shifting to outpatient and home health settings, more sophisticated procedures can safely be done outside the hospital, and home health and long-term care facilities will see employment growth due to the aging population. The other options are more traditional environments and so are not as likely to show increased employment growth.

Which hospital-wide policy would best address the nurse's negative view of job satisfaction? Making it possible to earn additional personal leave time based on their absentee records Providing a dedicated parking area close to the hospital for nursing staff Instituting biannual staff recognition days that include a free meal in the cafeteria Providing security backup when there is a perceived sense of workplace violence

Making it possible to earn additional personal leave time based on their absentee records RNs are generally satisfied with their jobs when hospital administrators emphasize quality of patient care; recognize the importance of their personal and family lives; and provide nurses with satisfying salary and benefits, high job security, and positive relationships with other nurses and with management. The other policies may appeal to groups of nurses, but they are not directed toward any of the major job satisfaction indicators.

Which activity demonstrates the organizational Chaos Theory? Preparing the yearly unit budget Planning for unexpected staffing shortages Preparing a rubric to guide staff performance reviews Setting unit goals related to quality control of client care

Planning for unexpected staffing shortages The Chaos Theory suggests that a degree of order can be attained by viewing complicated behaviors and unpredictable situations as predictable by planning for them. The other options are not considered unpredictable.

_____________________ focuses on managing the increasingly complex requirements of documenting patient care activities.

Principles for Nursing Documentation Principles for Nursing Documentation focuses on managing the increasingly complex requirements of documenting patient care activities in both paper and electronic formats.

Which situations have been identified as positive factors in achieving job satisfaction among nurses? (Select all that apply.) Having policy and practice decisions made by administration Managers taking care not to interfere when a patient focused crisis occurs Professional development opportunities made available at the facility Attention is paid to fostering excellent nurse-physician relationships Respect is given to and expected by all members of the health care team

Professional development opportunities made available at the facility Attention is paid to fostering excellent nurse-physician relationships Respect is given to and expected by all members of the health care team Nursing job satisfaction depends on attention being paid to professional development and advancement opportunities, support for good nurse-physician cooperation and a pleasant respectful work environment. A lack of collaborative decision making and a management team uninvolved in the daily function of the nursing units serve as negative factors.

Which of the following activities engaged in by a nurse manager would be expected to have the greatest impact on patient care? Role modeling effective communication between all levels of staff Conducting a survey to identify factors affecting staff job satisfaction Providing all nursing staff with opportunities to influence unit policies Providing all staff members with written copies of organizational policies

Role modeling effective communication between all levels of staff Positive role modeling is an effective tool the nurse can use to create a positive team spirit and promote high-quality patient care. Positive role modeling simply means that the nurse performs the job in such a way that he or she demonstrates ideal performance as a professional nurse; others hopefully will follow the example. The other options are more related to the working climate and control of staff performance.

What rights were afforded to employees under the terms of the National Labor Relations Act (NLRA)? (Select all that apply.) Self-organize Form labor unions Engage in collective bargaining Engage in binding mediation Protection when employed by a nonprofit organization

Self-organize Form labor unions Engage in collective bargaining Protection when employed by a nonprofit organization Under the terms of the NLRA (1935), employees were given the right to self-organize, to form labor unions, and to bargain collectively. In 1974, rights were extended to employees working at a nonprofit organization was included. The process of binding mediation is not a component of this act.

Legally, nurses who perform charge nurse duties in a hospital that is unionized are considered: as management and not protected by the National Labor Relations Board (NLRB). on a case-by-case basis regarding the protection they receive from the National Labor Relations Board (NLRB). as ineligible for membership if employed on units that engage in direct patient care. as fulfilling long-established nursing roles and so are protected by the National Labor Relations Board (NLRB).

as fulfilling long-established nursing roles and so are protected by the National Labor Relations Board (NLRB). In 1997, the court ruled that RNs who performed charge nurse duties were not management and therefore were eligible for collective bargaining protection. The other options are not true.

When the administration and nursing staff are unable to agree upon how to manage a specific patient care problem, the compromise may be arrived at by a process called: collective bargaining. binding arbitration. sympathy striking. secret balloting.

binding arbitration Arbitration is the method used for formal talks between management and labor with the purpose of arriving at a compromise. Binding arbitration means that all parties must obey the arbitrator's recommendations. Collective bargaining requires the formation of a union to represent the workers in acquiring a share of power over decision making. Sympathy striking occurs when one union stops working to show support for another union. Secret balloting is used to provide anonymity during the voting process.

When considering the philosophy and values of a health care facility, _____________________ is the highest priority.

compassion Compassion is the highest priority when providing care and comfort to people in need with respectful and dignified treatment at all times.

In order to preserve the health care of its citizens, some states: completely ban nurses from forming unions. prohibit hospital-based unions to legally strike. allow hospitals to employ nonunion nurses during a strike. require hospitals to terminate care delivery during union strikes.

completely ban nurses from forming unions. prohibit hospital-based unions to legally strike. In some states, collective bargaining contracts may contain "no strike" clauses prohibiting the collective bargaining unit from having the power to strike. Binding arbitration is usually implemented to settle disputes. The right to form a union is ensured by federal law. Terminating care delivery and utilization of nonunion staff is seldom considered but would be a decision arrived at by hospital administrators.

Prior to 1974, a significant number of nurses were ineligible to form a union because they were: female. licensed professionals. considered service providers. employed by not-for-profit hospitals.

employed by not-for-profit hospitals. Prior to 1974 federal legislation, employees of nonprofit companies like many hospitals were not protected under the National Labor Relations Board (NLRA) and therefore were not legally protected nor allowed to form unions. The other options were not factors in that situation.

ANA's Principles for Delegation provides nurses with guidance when delegating patient care to _________.

nursing assistive personnel ANAs Principles for Delegation provides the principles and guidelines for delegation of tasks to others. Its purpose is to define relevant principles and provide RNs with practice strategies when delegating patient care to nursing assistive personnel. It also covers needed definitions and the essentials of care

Which characteristics are expected to be represented in a health care facility's mission statement? (Select all that apply.) Commitment to professional excellence Providing the most economic health care services Ethical treatment of all patients and staff Teamwork to deliver quality care Utilization of innovated service delivery methods

ommitment to professional excellence Ethical treatment of all patients and staff Teamwork to deliver quality care Utilization of innovated service delivery methods Appropriate philosophies and values include commitment to professional and individual excellence, with support for personal and professional growth, ethical and fair treatment for all through a commitment to relationships based on fairness and trust with our patients and our employees. Teamwork is consistently demonstrated as we work together to provide ever-improving quality care. Compassion is our highest priority; we will always provide care and comfort to people in need with respectful and dignified treatment at all times. Innovation in service delivery is accomplished by investing in the development of new and better ways to deliver health care.

The purpose of the required 10 notice of a nursing union's intent to strike is to: assure hospital administration of the seriousness of the nurses' concerns. be in accordance with the laws governing union strikes. provide time for hospitals to plan for effective patient care. arrange for nonunion nursing staff to fill the strikers' caregiving roles.

provide time for hospitals to plan for effective patient care. Nursing is a trusted profession. In order to safeguard nursing's image and allow for hospitals to react effectively in safeguarding patient care, a 10-day notice of intent to strike is required. The other options are not the focus of this 10-day notice.

A _________________ occurs a portion of the employees refuse to perform their usual work.

strike Strike is a work stoppage caused by the refusal of a large portion of employees to perform work; usually takes place to enforce demands relating to employment conditions or to protest unfair labor practices.

In order to best address workplace satisfaction among its nursing staff, a hospital's administration provides: a yearly salary raise. tuition reimbursement. additional vacation time. an extra 15-minute break per shift.

tuition reimbursement. Areas that have been identified as affecting nursing satisfaction include: (1) opportunities to influence decisions about workplace organization; (2) recognition of accomplishments and work well done; (3) opportunities for professional development and advancement; and (4) opportunities to influence decisions about patient care. Tuition reimbursement would meet the interest in professional development of many nurses. Although the other options are considered favorable gestures, they do not address the identified factors.

A group of workers who have come together to accomplish employment goals is called a _______.

union Union is a group of workers who band together to accomplish goals related to conditions of employment.