Leadership Exam 1
Which statement made by the nurse manager is an example of the first step of delegation?
"I am going to delegate the responsibility of creating the vacation schedule."
Which manager statement reflects concern about the most important requirement for today's nurse manager?
"I am taking a day off tomorrow for my annual physical." The most important work of the manager is to stay physically and mentally healthy.
Which example represents a qualifier that may interfere with the message to be communicated?
"I hate to bother you with this, but we have a problem." Rationale: Qualifiers are often used as "entry statements" into important discussions, but they can interfere with the message being communicated.
The nurse has attended a "how to" refresher course on successful delegation. Which statement indicates successful learning has taken place?
"I knew that effective delegation made my job easier, but I never thought about how it could benefit the hospital."
An employee is sabotaging the work of a newly oriented charge nurse, and the charge nurse has not been successful in addressing the problem. When the nurse manager addresses the issue, which is the most appropriate statement?
"I know it must be frustrating working with a new charge nurse, but how can we make this situation better?"
Which statement indicates understanding of how a nurse could improve personal decision-making skills?
"I should practice making decisions by developing potential solutions and then choosing one." Rationale 2: Practicing making decisions will increase the nurse's experience, comfort, and overall skill.
An inexperienced speaker is practicing the delivery of a speech. Which statement indicates a lack of understanding about how easily communication is distorted?
"The topic is not complicated, so I don't have to worry about misunderstanding."
The health care institution has organized a committee to review and revise the strategic plan. As part of this work, committee members have been asked to submit a philosophy statement for consideration. Which statement meets the requirements of a philosophy?
"We believe clients are most important." The philosophy is a written statement that reflects the organization's values, vision, and mission. It is broader than a value statement.
The nurse is working on a committee tasked with making a major organizational change. Which comments by the nurse would help to advance the work of this committee?
1. "Have we looked at all available data in order to make an informed decision?" 2. "What are the obstacles to implementing this change within the organization?" 3. "Are we including the opinions of all stakeholders in this decision?"
Which directions given by the nurse to the assistant are most likely to be understood and completed correctly?
1. "Here are your directions for this morning. Please give the clients in rooms 2156, 2158, and 2159 total bed baths." 2. "Go to the diet kitchen and get a cup of apple juice for the client in room 2112."
The nurse is always intimidated when asking a physician to clarify orders. Which statements should the nurse use to help counteract this feeling?
1. "How often did you want the furosemide given?" 2. "Doctor, what rate did you want for the I.V.?"
The continuous quality improvement (CQI) coordinator is establishing quality measures for a unit. These measures would be written according to which criteria?
1. CQI coordinator researches studies that show processes improves client outcomes. 2. CQI coordinator has evidence for particular practices effective in decreasing length of stay. 3. Processes measured produces desirable outcome. 4. Few unexpected bad effects from the process.
As the RN team leader, identify potential disadvantages of using team nursing to deliver care to assigned clients.
1. Continuity of care may suffer. 2. Client/staff communication may be an issue. 3. Delegation is necessary.
Which situations are examples of ineffective delegation?
1. Delegating committee attendance to a staff nurse, the nurse manager also attends the meetings. 2. Unit clerk asks the nurse manager to "listen for the phones". 4. Staff nurse asks the UAP to discharge a client. 5. The staff nurse often bathes clients because "I like to give bed baths."
The health care facility has elected to make a significant change in organization strategy. The change has been thoroughly researched and all levels of leadership have been included in the decision. Which roles are commonly undertaken by the nurse manager when such a change is necessary?
1. Disciplinarian 2. Fact manager 3. Liaison 4. Support person 5. Discussion leader
A major change has occurred in the governance of the hospital. How can the nurse manager help staff cope with this change?
1. Disperse information about the change as quickly as possible. 2. Remind staff that change is part of the health care environment. 3. Talk about the change in positive terms.
A large metropolitan hospital uses differentiated practice as part of the structure of nursing services. Following this plan, nursing responsibilities are assigned based on which criteria?
1. Educational level 2. Experience 3. Nurse preference
A nurse practitioner and a physician are considering establishing a medical home. For this venture to be successful, these health care providers should ensure which resources are available?
1. Electronic medical records (EMR) technology 2. An understanding of the complexity of multiple-need clients 3. A plan for compensation for the primary care provided
A health care organization has provided intensive education to staff regarding benefits and correct methods of delegation. Why has the organization spent the time and money to sponsor these sessions?
1. Good delegation helps to reduce overtime. 2. Absences decrease when delegation is used correctly. 4. Patient satisfaction scores increase when care is efficient and effective. 5. Good delegation increases productivity.
What should the nurse executive consider when planning the nursing care delivery system of a new hospital?
1. How to optimize use of nursing knowledge 2. How to ensure that clients receive optimal care 3. Skill sets likely to be present in the nurses who will be employed at the hospital 4. What groups of nurses are available for employment
Staff nurses have been asked to comment on the work of a nurse manager as part of the manager's performance review. Which comments by the staff nurses would indicate to the supervisor that the manager is also a leader? Select all that apply.
1. I hope to be as good a manager as he is someday. 2. His example has encouraged me to get to know people in other departments in the hospital.
In which ways can nurse managers reduce risks for the organization?
1. Investigating a complaint about nursing care from a client's spouse 3. Talking to physicians about ways to improve client care 4. Keeping staff members on task throughout the workday 5. Making sure staff members work minimal overtime
Why does conflict help generate change?
1. It brings more attention to an issue in need of change. 2. People get involved because conflict breeds curiosity.
A nursing supervisor has introduced a needed change in policy to the nurse managers. The managers have met maximum resistance when attempting to gain support for the change. Which options reflect valid strategies for the nurse managers?
1. Meet with the supervisor and discuss modification of the proposed change. 2. Slow down the change process. 4. Work together to identify strategies to overcome resistance. 5. Proceed with the change.
A nurse who works for an accrediting agency is reviewing the structure of a health care organization. Which situations would the nurse interpret as indicating the agency is based on classical theory?
1. Much of the care provided is based on standard operating procedure. 2. There is a well-defined chain of command in the organization. 3. The facility's organizational chart reveals departmentalization.
A nurse manager is orienting newly hired staff nurses to the organization's total quality management program. As part of orientation, the manager has assigned the nurses to interview the organization's internal customers. Which group would the nurses interview?
1. Newly hired radiology technicians 2. Nurses who have worked at the facility over 5 years
A health care organization has just achieved Magnet status. During the award ceremony the organization's chief executive officer should give primary praise for this achievement to which employees? Select all that apply.
1. Nurse executive 2. Staff nurses While much of the work will have been delegated to others, the nurse executive is a primary force in achieving Magnet status. Magnet status focuses on nursing excellence. Staff nurses are the primary drivers of this excellence.
The community hospital is considering a redesign initiative. As part of a SWOT analysis, nurses on the strategic planning committee have been asked to distribute surveys to stakeholders. The nurses will contact which groups?
1. Other nurses who work at the hospital 2. Physicians 3. Hospital administrators 4. Representatives from local insurance offices
A health care organization is using the quality concepts of lean thinking and decentralization as part of their redesign efforts. Which initiatives would this organization undertake?
1. Outcome data will be analyzed to identify successful interventions. 2. Previous quality improvement efforts may or may not be discarded.
The administrators of a small hospital are revising its disaster plan. What should be the primary focus of this plan?
1. Preparing for a surge of casualties in case of a disaster 2. How to reduce disaster impact on clients and staff
Which topic would likely appear on the agenda for a staff meeting chaired by a nurse manager who follows transactional leadership?
1. Progress on request to increase personal day benefits. 2. Review of policy and procedures for unit evacuation 3. Standardized first of shift assessments.
A nurse manager's supervisor reports that many staff members have complained about the manager's rigidity. What situations reflect this rigidity?
1. The manager has historically used trial and error as a decision-making strategy. 2. The manager uses old ways of thinking to solve the day-to-day issues of the unit.
Which situations would cause concern about liability with regard to delegation?
1. The nurse asks the LPN to change a central line dressing. 2. The nursing supervisor asks the nurse for details about a client's history. 4. The supervisor asks the charge nurse to give a nurse a difficult assignment.
The leader of a continuous quality improvement (CQI) team has asked that an information packet be distributed to members of the resource group. The secretary would prepare packets for which people?
1. The resource group is made up of senior management and establishes overall policy, vision, and values associated with CQI. 2. The resource group is made up of senior management such as the CEO and vice presidents.
A health care system is considering applying to the Magnet Recognition Program. The leaders of this health system should prepare to address ________ qualities or "Forces of Magnetism."
14 Rationale : There are 14 qualities or "Forces of Magnetism" that must be demonstrated to achieve Magnet status.
Which situations are examples of the nurse directing rather than delegating?
2. A staff nurse asks the assistant to sit with the roommate of a client who has just died. 3. During a code blue situation, a nurse tells another nurse to start an I.V. 4. A nurse tells an assistant to move a client into the hallway during severe weather.
A nurse manager is delegating a new, complex task to the unit secretary. Which strategies should the manager use?
2. Make eye contact with the secretary when explaining the task. 3. Talk to the secretary in person rather than by telephone or in e-mail. 5. Discuss the importance of the task to the organization.
The staff is transitioning to a major change in the provision of nursing care in a large hospital. Which behaviors should the nurse manager watch for that would indicate possible problems?
2. Nurses are doing both the old work and the new work. 3. A nurse says, "I guess everything we've done for years is wrong." 5. Nurses are doing parts of the old procedure and parts of the new procedure.
A problem has arisen on a unit whose nursing staff is composed primarily of members of Generation X. Which strategies should the nurse manager employ to get staff input into solving this problem?
2. Post a notice on the bulletin board explaining the issue. 3. Ask nurses individually for input.
The nursing supervisor is assessing a unit that has received several written complaints. The nurse manager seems overwhelmed and stressed trying to address many client situations. The charge nurse is trying to help everyone at once. Based on this assessment, what might this supervisor conclude?
2. The unit culture may foster distrust and poor communication among staff. 3. Client complaints are usually an indicator of a larger unit problem. 4. Nurses on the unit are in need of additional training and skills.
The nursing supervisor is planning an education session on collaborative communication between nurses and physicians. Which topics should be on this agenda?
2. Understanding the role of the physician 3. Understanding the role of the nurse 4. Communication across disciplines 5. Active listening skills
The nurse has made several "near errors" in client care in the last 2 months. The nurse manager says, "These are simple errors. You just aren't listening." How could the nurse improve listening skills in this situation?
3. When listening to instructions, the nurse should ask anyone who interrupts to wait a moment. 4. The nurse should get sufficient time away from work to rest. 5. The nurse should be careful not to prejudge what the speaker is going to say.
To meet the Institute of Medicine (IOM) recommendation, nursing should strive to have ____ % of nurses prepared at the baccalaureate or higher level by 2020.
80 Rationale : The IOM recommends increasing the level of education of all nurses. The goal is 80% at baccalaureate level or higher by 2020.
Which factor best represents a driving force in the process of change?
A budget in the red necessitates change and pushes participants in the desired direction.
The hospital has an annual campaign in which the staff is divided into two teams to raise money for hospital special events. The team raising the most money gets possession of a "trophy" designed by the administrative staff. This is an example of which type of conflict?
A competitive conflict that is positive to the work environment
A nurse practitioner and a physician have opened an office together. The nurse regularly collaborates with the physician in client care and is a general partner in the business of the office. This is an example of which diversification method?
A joint venture is a partnership in which each partner contributes different areas of expertise or resources to create a product or service.
Which is the most effective method of creating a blame-free environment?
A just culture provides an environment in which employees can question policies and practices, express concerns, and admit mistakes without fear of retribution.
A newly licensed nurse received specific knowledge of management skills while in nursing school. What does the nurse need now?
A manager who can help with skills transfer from school to work The manager is an essential component in helping the new nurse transfer this learning into the "real" world of bedside care.
A client has been told that chemotherapy must be postponed until he is hydrated. The client refuses the intravenous hydration and demands to go home. How would the nurse best categorize this situation?
A medical-legal incident occurs when a client or family refuses treatment as ordered.
The health care organization's monthly newsletter has a headline reading "Nurse Promoted to Leader of Specialty Care Units." What is the error inherent in this headline?
A person cannot be promoted to the role of leader. Organizations cannot promote someone to a position of leader. Interpersonal skills influence others to accomplish a specific goal. The organization can promote a person who may become a leader.
The nursing task force is developing measurable goals for each client on the orthopedic unit. The statement "Each client will have a written assessment and plan of care document within eight hours of admission" is an example of which component of quality management?
A process standard is a written statement that defines actual delivery of nursing care to a specific population
Which action will have the greatest impact on the successful implementation of a planned change?
A supportive work environment for those experiencing the change is the strategy most likely to result in an easier transition.
A nurse is working in a unit with several less-experienced nurses. Which attribute displayed by the senior nurse would make her leadership of the less-experienced nurses most effective?
Ability to inspire the others to commit to the team's goals. A nursing leader must be a visionary in order to empower others to make needed changes for the good of the group.
The nursing supervisor identifies ineffective communication as a problem among the managers. According to Lippitt's phases of change, which action by the supervisor reflects the final stage of improving this issue?
According to Lippitt's phases of change, the final stage is terminating the helping relationship.
The nursing faculty would like to incorporate problem-based learning into the curriculum. Which action is essential?
Add more information to existing care plans as the study unfolds. Rationale 3: Problem-based learning exists when students are exposed to "what comes next" in a case study. Additional information is revealed as the case study progresses.
What is the most important reason that excellent communication skills are essential for nurses?
All nursing activities occur in relationships. Rationale: Nursing activities occurring in relationships make communication skills essential.
The nursing committee is planning a change in the unit's organization. Which statement reflects the priority expected outcome of these change agents' work?
All nursing responsibilities and changes have the expected outcome of improving client care.
A nurse believes that milk is part of the healthy adult's diet. The nurse frequently offers milk to adults as a between-meal beverage. This action is based on which concept?
An underlying assumption Rationale 2: The nurse's assumption is that milk is good for adults.
The nursing supervisor would like to delegate an information-gathering task. All the people listed have the ability to perform the task. In general, whom should the supervisor ask to do this work?
An unlicensed nursing assistant Rationale: The rule of thumb is to ask the lowest person in the hierarchy who has the requisite capabilities.
The nurse manager asks a staff nurse why a procedure is done in a certain manner. The nurse replies, "I don't know why I started doing it this way. I've never read any research on it, but this technique always works for me." The manager would place this technique into which category of evidence?
Anecdotal Anecdotal evidence is derived from experience
Following a barium swallow, a client noticed hives and shortness of breath. no known allergies prior to this incident. diagnosis- allergic reaction to preservatives in the barium. Which is the correct risk category for this incident?
Any incident occurring before, after, or during a procedure is categorized as a diagnostic procedure complication.
The nurse is using critical thinking skills to decide which of several options is the best. Which question is most important for the nurse to take into consideration?
Are there different situational effects or contexts to be considered? Critical thinking involves choosing the best alternative from several, depending on the situation in which the problem occurred. This is the context of the problem.
A nurse working in a rehabilitation center notices clients frequently asking for something to drink. Which response indicates the use of creativity in finding a solution to this problem?
Asking all employees to write down their ideas about a solution Rationale 2: Asking others to think about different options opens up the possibilities beyond one individual's ideas. This is part of the preparation stage of creativity.
The nurse administrator has been asked to work with other administrators to make a change in a long-standing hospital policy. What should be the nurse's first action?
Assessment is always the first action for a nurse in any situation.
The nurse manager feels that changing the unit's method of assigning break times would benefit the flow of client care. What should be the manager's first action associated with this idea?
Assessment is the first step of the change process, just as it is the first step of the nursing process.
The staff nurse would like to improve personal communication with peers, patients, and the medical staff. Which strategy would be most effective for this nurse?
Attend the hospital-based communication training. Rationale: Attending training on communication would be the best plan for this nurse. The strategies described in the other options would likely be included in this training.
The nurse manager has instituted a policy of sending information to the staff via email. Many misunderstandings have occurred since this policy was implemented. What technique should the manager use to reduce this miscommunication?
Being certain that emails go only to the intended recipients
As part of the process of promoting quality improvement, the nursing manager is comparing data between two hospitals on average length of stay for a total hip replacement. This comparison is an example of which process or step?
Benchmarking is the comparison of data with other reliable sources internally and externally with the goal of quality improvement.
A staff nurse has experienced disagreements with one of the medical residents about several issues. The resident reacts to this conflict by belittling the nurse in front of colleagues. This behavior is most characteristic of which type of conflict?
Both parties are engaged in activities to reduce, defeat, or eliminate the opponent, which result in irrational, unproductive behavior. This is disruptive conflict.
According to the behavioral view of leadership, how are leaders formed?
By being educated With training Through life experiences. Behaviorists believe leaders are made, not born.
The nurse's friend says, "I've been thinking about going to that health care clinic in the grocery store so someone can look at my daughter's rash. What do you think?" Which response by the nurse is appropriate?
Care in these clinics is provided by nurse practitioners with physician backup. If the nurse practitioner believes additional studies or assessment should be done, referrals are made.
The hospital's management team wishes to institute case management to improve the quality of nursing care. As a beginning step, the team is choosing specific medical diagnoses on which to focus. What criteria should the team use when choosing these diagnoses?
Case management is used with high-risk diagnoses.
In order to organize services needed to achieve specific client outcomes, hospital administrators should consider what type of client care delivery system?
Case management organizes client care by major diagnoses and focuses on attaining predetermined outcomes within a specific time frame.
A nurse manager encourages nursing staff members to assist in developing a new creative staffing pattern that can respond quickly when staff resign or go back to school. This is an example of the use of which organizational theory?
Chaos theory posits that an organization is dependent on its adaptability and response to change in its environment. Nurse managers must create an environment that accepts change, tolerates conflict, and promotes creative solutions
The nurse manager is working on a committee whose task is to review and revise job descriptions for nursing employees. In which job description would the committee most likely include the phrase "Management responsibilities include shift-by-shift coordination and promotion of quality client care"?
Charge nurse Rationale: The charge nurse is unique to the health care setting and assists with the shift coordination and promotion of quality client care as well as efficient use of resources.
A nurse manager states, "I cannot stand all these conflicts in my department. Nothing good can come out of it." Which indicates the best reason the manager's statement is untrue?
Conflict can stimulate more people to become involved in a situation, thus creating more innovative solutions to the issue
A conflict has arisen between two staff nurses who work on the same unit. Which strategy is most important for the nurse manager to consider?
Conflict management begins with a decision regarding if and when to intervene. Failure to intervene can allow the conflict to escalate.
Nurse manager assesses two staff nurses engaged in a conflict; having negative impact on client care. Manager meets with the nurses involved, identifies the conflict. Attempt is made to resolve the conflict through knowledge and reason. What strategy is this manager using?
Confrontation- most effective means of resolving conflict. Conflict is brought out in the open and deliberate attempts made to resolve it through knowledge and reason.
The nurse manager presents an issue to the nursing staff for a decision. The group assesses the problem, and a decision is made meeting the needs of both the nurse manager and the nursing staff. This is an example of which conflict management strategy?
Consensus occurs when the problem is fully explored, the needs and goals of both parties are addressed, and a mutual decision is made.
The director of quality improvement reports that the hospital will soon be using "dashboards" as part of the quality management process. How should the staff interpret this information?
Dashboards are electronic tools that provide ease of access to real-time or retrospective data.
The nurse prepares the medication ordered for the client. The nurse asks the nurse assistant to give the medication when the client receives breakfast and to report on the task at its completion. The nurse assistant agrees. Which component of the steps of delegation was violated by this request?
Deciding on the delegate Rationale: The violation occurred at the step of deciding on a delegate. Nurse assistants cannot administer medications.
A nurse asks an unlicensed assistant to help with discharging clients since so many are going home at one time. The nurse states, "Can you help get these clients ready to go home by helping them pack?" Which option best describes the statement with regard to effective delegation?
Delegation would have been more effective had the nurse been more specific about which clients and when it should be completed.
Which strategy is most likely to increase participation in the use of evidence-based practice in nursing?
Ensure adequate training, recognition, and easy access to the Internet. There must be training, easy access, and recognition for using evidence-based practice in nursing.
The nurse has been concentrating on improving personal communication skills. Which option represents the final step in this nurse's work to improve communication?
Ensure the communication is understood. Rationale: Ensuring all parties understand the communication is the last step as it involves evaluation.
Regardless of which delivery system or combination of delivery systems is appropriate, which skill is required for effective use?
Flexibility is a skill imperative when choosing a delivery system(s) for nursing care. The system must meet client and staff needs and organizational and unit-specific goals, as well as remain within cost constraints
A staff nurse tells a manager, I don't want to be promoted. I am a much better follower than I am a leader." How should the manager interpret this remark?
Followership is a valuable skill in nurses. Rationale: In any situation where people must work together, followership is a valuable skill.
The nurse manager tells a newly hired nurse that the unit practices functional nursing. What should the new nurse expect?
Functional nursing breaks down client care into tasks assigned to the appropriate professional or skilled caregivers. This may result in one nurse (the "med nurse") administering all the medications on the unit.
Which is the most important reason that practicing and mastering effective delegation skills is essential for nurses?
Higher client satisfaction Rationale: When effective delegation takes place in an organization, everyone benefits. This leads to higher client satisfaction, which is the ultimate goal of nursing care and nursing management.
Which statements exemplify the attributes of critical thinking essential to nurses?
I am always curious about why we do things the way we do." Can you help me understand your perspective a little better?" "I don't think I can make that decision until I have more information."
The nurse has been asked to assume a first-level management role on the nursing unit. Which statement indicates that this nurse will need further mentoring in the new role?
I won't be able to increase my team's motivation. That has to come from within them. Rationale: Manager can affect motivation by developing strategies and possible incentives.
Which situation is an example of organizational culture?
ICU nurses know to take turns covering each other's clients to facilitate eating breakfast and lunch on the day shift.The nurses have created this system of coverage informally as part of their daily work.
The hospital is opening its first intensive care unit. The nurse executive should plan to staff this unit according to which model of care?
In total patient care, one nurse cares for a client and, being totally accountable for the client, can give continuous, holistic, and expert care.
The staff nurse is unsure of the correct protocol for calling in sick to work. The nursing supervisor told the nurse to call the nursing office; however, the nurse manager told the nurse to call the unit. This issue is likely the result of which distorted communication?
Intersender conflict Rationale: Intersender conflict occurs when a person receives two conflicting messages from different sources.
The nurse manager asks the staff nurse to work a double shift because the census is high. Although the nurse realizes the staffing for the night shift is low, the nurse has already made a family commitment for the same night. This is an example of which concept?
Intrapersonal conflict occurs when the consequence of real or perceived differences in mutually exclusive goals, values, attitudes, beliefs, feelings, or actions occurs within one individual.
Although the postoperative assessment of a client reveals no abnormalities, the nurse believes the client's condition is deteriorating and orders frequent vital signs. This intervention was made on the basis of which type of problem solving?
Intuition Past experience
Which data would be of most interest to an organization using Lean Six Sigma as a means of quality improvement?
Lean Six Sigma focuses on eliminating waste, such as an increase in expensive overtime wages, and would focus on processes that may be allowing this to occur.
Which organization would the hospital management team contact to pursue certification as a Magnet hospital?
Magnet Recognition Program The Magnet Recognition Program, developed by the American Nurses Credentialing Center, designates health care organizations that provide nursing excellence.
During an evaluation conference, the nurse manager observes nonverbal messages, including nodding in agreement and smiling. These behaviors are examples of which aspect of communication?
Metacommunication Rationale: Metacommunications are nonverbal messages conveyed by body language and environmental factors.
The nurse manager orienting newly hired nurses has explained the organization's blame-free environment. Which remark by one of the nurses indicates understanding of the policy?
Mistakes should be reported and reflected upon so that the same mistakes will not be made again.
Nurse asks nurse manager if he can go home early.The request is denied, says, "I don't understand why I can't leave early.This statement is an example of which technique of influencing the supervisor?
Negative inquiry Rationale: Negative inquiry is a statement of "I don't understand." Negative inquiry is an effective technique, provided the person to whom it is directed does not become defensive or distraught.
Nurses and nursing administration have experienced conflict about scheduling, their intent is to arrive at an agreeable solution between both parties. Which option does this process best exemplify?
Negotiation involves a reciprocal "give and take" on issues among the parties. The desired outcome is to achieve agreement even though consensus will never be reached.
A proposed change in a health care organization is controversial and will require cooperation from all parties involved. Which change strategy should the change agent use?
Normative-reeducative strategy uses collaboration as its primary decision-making technique. It is most likely to result in the greatest number of people being happy with the decisions made.
Procedural changes are being planned on the unit as a direct result of client satisfaction surveys. Which person is most strategically placed to handle how these changes are initiated?
Nurse manager The nurse manager is situated on the front lines but is also responsible to upper management. The manager can be supportive of the staff's feelings while at the same time adequately and appropriately representing the needs and wants of the administration
The CEO of the hospital approaches the chief nurse with a request that the nurse act as the primary change agent in the implementation of a new hospital-wide policy. Why would the nurse be a good choice for this assignment?
Nurses are client advocates who routinely interact with multiple disciplines in the provision of quality care.
Which part of Six Sigma is vastly different from other quality management programs?
One of the Six Sigma themes is aiming for perfection but tolerating failure.
A nurse executive is considering initiating a blog to enhance communication among staff nurses, managers, and supervisors throughout the organization's different campuses. What serious considerations should the nurse make prior to starting a blog?
Open access to the blog may damage recruiting efforts. Users of the blog must be very careful not to divulge any information that would violate client confidentiality. The organization's reputation may be altered by a blog.
What is the best example of a pediatric unit's organizational culture?
Organizational culture is based on norms and traditions such as nurses wearing colorful attire.
The nurse manager gave the unit secretary complete responsibility for the unit's staffing, including finding replacements for call-ins and disciplining nurses with excessive call-ins. This is an example of which type of delegation?
Overdelegation Rationale: Overdelegation delegator loses control by providing the delegate with too much authority or responsibility. Discipline of an employee is a responsibility of the manager and cannot be delegated due to confidentiality and controversy associated with it.
A newly licensed RN is beginning a job search. This nurse would be best served by working in an organization that provides which nursing care delivery system?
Practice partnerships allow for two personnel to work together in giving client care. Ideally, a senior RN can be paired with a novice RN.
The nurse has determined that in order to provide the highest quality care it is important to become more creative. What is the most effective way for the nurse to increase creativity?
Practice the steps of the process as often as possible. Rationale 4: The most effective of these methods would be practicing the steps. Creativity is a skill that can be learned and improved through practice, just like technical skills.
The nurse works in a school clinic that is part of an integrated health care network. How would this nurse explain to parents and teachers the focus of care provided in the clinic?
Primary care is the focus of integrated health care networks.
Which statement reflects a characteristic common to all methods of quality management?
Quality management is not designed for the purpose of placing blame on an individual.
The nurse manager consistently refocuses the staff on achieving outcomes and directly involves the staff in decision making to achieve those outcomes. How would this style of leadership be described?
Quantum Quantum leadership is based on the concepts of chaos theory, with the focus on outcomes.
The nurse manager generally uses a stepwise method to arrive at decisions that are logical and that serve to maximize the achievement of the desired objective. Which decision-making model does this manager use?
Rational decision-making model Rationale 3: The rational decision-making model is a series of steps that managers take to make logical, rational choices that maximize the achievement of successful outcomes.
In a leadership training class, which statement by a student indicates learning has been successful?
Relationship building is essential to successful leadership. Rationale:Authentic caring in relationship is an important method of improving respect and competence as a leader.
The RN leader of a team overhears one of the UAPs on the team say, "I'll sure be glad when I get my RN license. All they do is sit around doing paperwork." How does the RN interpret this comment?
Resentment against the team leader for not doing "real nursing" is a common drawback of team nursing.
The nurse has set a goal becoming a clinical leader (CNL). What actions should this nurse plan to reach this goal?
Return to school to obtain a master's degree. Rationale: CNLs are educated at the master's level.
The nurse plans to seek employment in an acute-care setting after graduation. Which form of communication would be most effective in applying for a position?
Send a written letter and résumé in the mail.
What is occurring as the traditional parallel structure found in hospitals is being replaced by service-line structure?
Service-line structure is appropriate when environmental uncertainty is high and the organization requires frequent adaptation and innovation.
Which structure is reflected by the statement "Nursing practice is best determined by nurses"?
Shared governance is a form of participative decision making. Nurses gain control over practice, are more accountable, and feel empowered.
The novice nurse manager is acting in the role of change agent for the unit. Which statement indicates that this manager needs further training in regard to change?
Staying available the whole time is not realistic and will make it difficult for the change agent to maintain the energy it will take to make the change more successful.
The nurse manager is calculating the cost of offering two bonus incentives to nursing staff for covering call-ins for sickness. Which option best describes the basis of this decision?
Subjective probability Rationale 4: Even though option A is more cost-effective, the manager believes option B to be in the best interest of the unit. Subjective probability is the likelihood that an event will or will not occur based on personal judgment and beliefs.
Hospital administration is working with a university school of nursing to establish a nursing residency program. Why is this a desired action?
The Institute of Medicine has proposed residency programs for nurses. The IOM has made this proposal.
Which statement represents a situation is which delegation is ineffective or inappropriate?
The RN asks the LPN to assist with admissions by assessing the clients as they get to their rooms.
RN receives morning reports. Delegates to LPN and NA. Busy, with physician visits and new orders, and RN communicates orders to LPN and NA. RN meets with case manager to discuss nursing home placement. What type of nursing care delivery system is in place in this hospital?
The RN in this case is leading a team. A variety of skilled caregivers cares for a group of clients.
A nurse has been invited to discuss health care costs at a senior citizens' club. What information should the nurse plan to include in this discussion?
The United States spends more money on health care than any other country.
Computerized charting will be initiated on select units of the hospital. Orientation to this new system will be provided to each nurse by a team of nurses educated in nursing informatics. This is an example of which type of change strategy?
The assumption of the empirical-rational model is that people are rational and will follow their rational self-interest if that self-interest is made clear to them.
Which nursing care delivery situation best reflects the concept of a clinical microsystem?
The burn unit likely has a core team of caregivers, a defined population to receive care, informational systems in place, support staff, equipment, and an environment that facilitates provision of care.
The RN working on an orthopedic unit is caring for a postoperative client with a hip replacement who is not transferring well from bed to chair. The client is behind on the mobility training program. What action is the nurse's priority?
The case manager tracks all variances, reports to the collaborative team, and may revise the critical pathway.
The nurse is working on a unit with a blame-free environment and makes an error that puts a client at risk. What should the nurse do first?
The client's safety is always the priority.
What is the primary belief behind the evolution of the clinical microsystem as a nursing care delivery system?
The clinical microsystem method allows those who are involved in the smallest unit of care to make the decisions for that unit.
New triage area in emergency department causes conflict between nurse manager and nurses. The design is not "user friendly." Repeated complaints, manager asks maintenance to change arrangement of the room. What is the most important reason this change occurred?
The complaints motivated the nurse manager to make the change to increase unit effectiveness.
After shift change the nurse discovers that a client's IV heparin has been turned off at the IV controller. The amount of fluid left in the IV bag indicates that the client received half of the dose ordered. Which statement should be documented in the client's medical record?
The documentation in the chart should be a statement of the facts as well as the client's physical status after the incident.
The following documentation was entered in the client's medical record: "The client was found lying on the floor. Dr. X was notified. Apparently the restraints were improperly applied." Which statement best describes this documentation?
The documentation is not appropriately written because it implies that someone was to blame for the incident.
When faced with the prospect of change, the nurse states, "We have always done it this way and never had any problems." A few weeks later, the same nurse remarks, "This new way seems to work better than the old way did." This statement is characteristic of which type of change response?
The early majority prefers the status quo but eventually accepts change.
In which situation should the nurse be most concerned that communication was distorted?
The emergency nurse receives a client who was transferred via ambulance for confusion.
Which situation is an example of reverse delegation?
The licensed practical nurse asks the nurse manager to administer insulin to her client.
The nurse manager knows that maximum power will be needed to achieve a desired change and has identified a key person on the organizational chart who will be affected by the change. What is important for the nurse manager to do?
The people just above and just below this person will be important to the way this key player reacts to the change.
For the nurse to effectively and legally delegate, which document must be consulted and followed to reduce the likelihood of liability?
The regulations of the state nurse practice acts
The nurse has a concern regarding the quality of care being provided in the hospital. What should the nurse consider first before communicating this concern?
The relationship between the nurse and the receiver of the message
Which relationship is an example of staff authority in classical theory?
The staff nurse's mentor calls to see how the nurse's first day on a new unit progressed. The staff nurse/mentor relationship is one in which the mentor offers advice and recommendations to the staff nurse but is not responsible for the care the nurse provides.
The nurse is trying to understand why it has taken so long for electronic health records (EHRs) to be used in health care. Which statement is a reason for this delay?
There have been concerns about privacy and confidentiality The most overwhelming issue in using these records has been the profession's and public's concerns regarding privacy and confidentiality.
Which situation represents an obstacle to delegation?
There is a budget shortfall for the current fiscal year Rationale: Resources such as qualified nurses, finances, and educational resources may be limited, which are obstacles to delegation.
Which statement regarding the use of electronic medical records (EMR) is accurate as associated with quality improvement?
There is not enough research on using EMR and the quality of care provided to determine the impact.
A newly licensed nurse working on a unit committee challenges every detail of a proposal the committee is developing. How should other committee members interpret this behavior?
This nurse is learning to be creative. Rationale 2: Challenging details is a part of the preparation portion of learning to be creative.
The nurse executive is reviewing client satisfaction surveys. Which trend would the nurse evaluate as indicating the nursing care delivery system in use is not effective?
This response may indicate that the RN is not able to provide the skilled care needed. There may be a lack of RN presence in patient care.
A group of nurses has been convened to solve a problem. As the first step in this process, the group leader asks for a definition of the problem to be solved. Which statement reflects the best problem statement?
Unit clerks have made 10 transcription errors in the last 6 months. Rationale 4: A good problem statement reflects the facts without judgment as to cause.
The quality management director of a large health care conglomerate wishes to initiate benchmarking strategies to assess care. Which directive should this manager publish?
We will compare outcome indicators with other health care conglomerates of similar size and organization. Benchmarking uses an organization's outcome data and compares it with that of a similar organization to address strengths and challenges
Which statement reveals the most dangerous result of using measured standards as part of the CQI process?
When innovation is sacrificed because of the work involved in CQI or because variance is discouraged, stagnation occurs. This is the biggest danger of using standardization.
Which is the most important consideration in choosing a structure for nursing care?
While all four options are important, client need takes precedence over the others because nursing provides a service to the client.
A client who is being discharged from the hospital will need follow-up for wound care. The client's spouse is not capable of providing bed baths for the client. The nurse case manager who is planning care for this client should contact which agency?
With shorter hospital stays, home health agencies are frequently used to provide clients with intermittent or temporary follow-up care such as wound care and bathing.
The job description of the staff nurse states the nurse is responsible for attending hospital committee meetings as assigned. The nurse manager asking the staff member to attend a risk management meeting is an example of which concept?
Work assignment Rationale: This assignment reflects duties listed in the nurse's job description so asking the nurse to attend a meeting is work assignment.
A successful nurse manager is mentoring a newly promoted nurse manager. Which comment by the mentor reflects the most important consideration of all nurse managers?
Your most important role is to ensure client care accountability. Rationale: Managers most important role is assuring quality client care, managers are accountable for quality care.
A nurse says, "I am always worried that I will be liable if someone I delegate a task to does something that hurts the client." What is the manager's best response to this concern?
"As long as you follow the five rights of delegation, your liability is minimal."
The nurse manager is counseling a male nurse about several recent incidents in which female nurses complained that he was abrupt and condescending. What advice should the manager give this nurse?
"Don't feel as if you are responsible for fixing every problem." Rationale: There are many gender differences in communication. Male tend to take responsibility and feel the need to "fix" things.
A nurse has a longstanding conflict with another nurse working the same shift. Over the last few days the first nurse has made an effort to smooth over the conflict. Which statement would the nurse manager evaluate as an example of a "smoothing" comment?
"Even though we don't agree on much, I do think you are correct about enforcing the length of lunch breaks."
The nurse manager meets with the staff nurses to discuss ways to improve communication among the shifts. Which statement by the nurse manager best exemplifies the final stage of conflict management?
"I will evaluate the outcomes of our strategies on a monthly basis." In any situation, the nurse manager should use the nursing process to intervene
A community-owned hospital has been purchased by a health care conglomerate. The staff is aware that the organizational theory governing the hospital is likely to change. Which statement indicates a lack of understanding of organizational theory on the part of a staff nurse?
"If this new company is based on systems theory, there will be a lot of focus on how much work we can produce."
After several near-incidents during procedures, the nurse manager is increasingly concerned about how nursing staff communicates with physician staff. Which advice from the manager would be most beneficial to the nursing staff?
"Let's review the steps of the procedures that we know are the biggest problems."
A nursing curriculum includes integrated content on critical thinking. Which statement reflects movement toward designing the curriculum to meet Carnegie Foundation recommendations?
"Our emphasis must change to improving students' clinical reasoning skills." This is a Carnegie recommendation.
A 70-year-old client develops a catheter-induced urinary tract infection. Which statement by the nurse would indicate to the nurse manager a need for additional understanding of this situation?
"Thankfully we can treat this with an antibiotic." The nurse who focuses on taking care of the results of a potential medical mistake is not accepting the seriousness of the situation.
The nurse manager overhears staff discussing the shortage of nurses. Which statement by a staff member would the manager evaluate as misinformation?
"The demand for nurses is declining because of fewer hospital admissions." Job numbers for nurses are expected to continue to grow.
The nurse manager has decided to use evidence-based practice (EBP) to solve an issue and has called staff nurses together for input. Which question, as posed by the manager, reflects the first step of the EBP process?
"What is the exact clinical issue with which we are dealing?" Identifying the clinical question is the first step in the EBP process
Manager approaches nursing supervisors requesting approval for 12-hour shifts into scheduling. Supervisor denies the request, due to previously with poor outcomes. Which responses by the nurse manager may positively influence the supervisor?
1. "I agree it was not effective years ago, but other units have now had success with it." 2. "What were your specific concerns about the 12-hour shifts?"
The manager's performance evaluation the supervisor says, "You are very good at adaptive decisions, but you need to be more precise in routine decisions. When the situation calls for really innovative decisions, you do not seem sure of yourself." How should the manager interpret this information?
1. "I am not following the policies and rules well." 2. "I should review the procedure manual." 3. "I'm good at using my previous experiences to guide my decisions."
A nurse manager is faced with the task of introducing an unpopular change to a staff that includes several nurses who have acted as rejecters to previous changes. The manager expects resistance but hopes to identify these rejecters early in the process. The manager should be particularly alert to which statements?
1. "I don't care what they say; I'm not giving care that way." 2. "I bet I can make it very difficult for this change to occur."
Efforts to increase nurses' use of evidence-based practice (EBP) to improve client care in the hospital have failed. Which answers are nurses likely to give when asked why this is occurring?
1. "I don't have time to finish everything I already have to do each shift." 2. "I don't want to practice nursing just like everyone else." 3. "The library at our hospital doesn't have many journals." 4. "If administration wanted us to use EBP, they would get us some more nurses to share the work."
The nurse manager has asked that another staff nurse position be funded for the unit. The supervisor denies the request. Which statements by the manager are examples of negative assertion?
1. "I know I haven't been too careful in keeping personnel costs low, but we are really going to need another position." "I realize that my staff is not always positive about organizational changes, but having this extra staff member might reduce some of their stress."
A nursing administrator overhears nurses conversing during a break in a seminar on change. The administrator would interpret which statement as meaning that the nurse who made it is ready to become a change agent?
1. "I know that suggesting this change may backfire on me." 3. "I see an opportunity to make a difference in the way this facility provides nursing care." 5. "This change is certainly going to be a challenge, but that's okay."
Which statements would be important for the charge nurse to make when delegating a responsibility?
1. "I think it would be important to our organization if you represent the unit on the policy and procedure committee." 3. "I think your attendance at the task force meeting will be a good reflection on our unit."
Which statement by the formal leader of a nursing unit reflects the personality required to energize the staff and promote creativity?
1. "I would like to thank everyone for your hard work and dedication while we have been short staffed." 2. "I am certain that our new assignment system is going to make the workload more equitable." 3. "I know this week has been rough. I feel a little like sandpaper myself."
A hospital is considering implementing the use of critical pathways and case management. Which statements by a nurse would indicate to the nurse manager that more education should be provided?
1. "If we use critical pathways, we won't have physical therapy to help us ambulate clients." 2. "The critical pathway lists discharge outcomes but won't help us with day-to-day guidance of care." 3. "Once the client is on a critical pathway, we must follow it until discharge."
As a part of the strategic planning process, nursing units have been asked to develop strategies to meet designated objectives. Which statements represent strategies?
1. "Initiate intravenous therapy within 30 minutes of the order being taken." 2. "Use scanning mechanisms to record the numbers of supplies used."
Which statement by a newly licensed nurse indicates an understanding of why it is necessary to structure nursing care?
1. "It helps to coordinate care to a group of clients." 2. "It organizes care responsibilities." 3. "It provides skilled care by skilled staff."
The nurse manager has four different generations represented in the nursing staff on the unit. What statements indicate the manager is wise about how to deal with this generational mix?
1. "Our Generation Y nurses help keep us all up on new technology." 2. "The most loyal of all my nurses are the traditionalists." 3. "I expect that our next manager will come from my group of baby boomers."
Currently clients on a unit are bathed in the morning between 8:00 am and 11:00 am. The nursing staff is changing bathing clients in the evening between 7:00 pm and 9:00 pm. Which statement reflects an underlying assumption that might affect the staff's ability to think critically about this change?
1. "The day shift just wants to shift work onto the evening shift." 2. "Everyone likes to bathe right before bed." 3. "The physician staff will be upset if we change our morning routine." 4. "If we let them change this, they will want to make lots of other changes, too."
A nurse manager is directing a team of staff nurses working to solve a clinical problem using evidence-based practice (EBP). Which manager statements would direct these nurses to the forms of strongest clinical evidence? Select all that apply.
1. "The studies we want are built around the scientific approach to solving problems." 2. "Our focus should be on studies that use both experimental and control groups to determine intervention effectiveness."
Which statements by the nurse manager would demonstrate effective change management?
1. "We cannot lose sight of the mission and values of our institution as we begin to integrate these changes." 2. "Although this task is going to be difficult, we have the full support of our hospital administration."
Which statements by a hospital executive reflect power-coercive strategies to implement change?
1. "We must follow the federal guidelines in the way we bill for our services." 2. "If we don't reduce our nosocomial infection rate, Medicare won't reimburse us." 3. "Administration has to make this change or our accreditation status will be at risk."
Which statements by a nurse in the emergency department are examples of group thinking?
1. "We've already talked about this enough. We need to present a united front on this issue." 2. "The medical unit nurses won't like this decision because it is too much work." 3. "Let's all vote yes on this so we can get back to work."
A nursing supervisor would like the nurse manager to serve as change agent for a needed revision to unit policy. Which statements would alert the supervisor that this manager is not the best choice for this assignment?
1. "Well, we don't want to rock the boat too much." 2. "Do you think we can get enough support from the nurses to make this change?" 3. "We tried making a change like this before and it didn't work out well."
Which situation would be included in reporting for Joint Commission mandatory national patient safety goals?
1. A client is left in the hallway transport did not contact the client's nurse. 2. nurse gives medication by wrong route. 3. client developed sepsis after urinary catheter. 4. Surgery is done on a client's right eye instead of the left eye.
The nurse is assigned to the Risk Management Team. Which events would be addressed by this team?
1. A client's hand is injured during an arterial blood gas draw. 2. A client leaves the hospital against medical advice (AMA).
Which statement describes the primary difference between group and individual decision making, besides the number of individuals involved?
1. A decision made by a group is often better than a decision made by one person. 2. Groups can provide more input into the process. 3. A decision made by a group can create a greater obligation to achieve results. 4. Routine decisions are more often made by individuals.
The nurse applying for a position is told, "This hospital has a very traditional organizational structure." The nurse would expect the organization to use which structure?
1. A functional structure is a traditional organizational structure. 2. A parallel structure is a traditional structure, even though it is more modern than a functional structure. 3. Matrix is a traditional structure.
Which situation represents an exception to the blame-free environment?
1. A nurse routinely changes nursing notes after a client is discharged. 2. A nurse does not complete an incident report after a medication error
The procedures for managing client pain are being investigated as part of the hospital's total quality management program. Whom should the manager plan to invite to this meeting?
1. A representative from pharmacy 2. A representative from the medical staff 3. A staff nurse who works with clients in pain
In order to delegate, which must be present?
1. Accountability for the assignment on the part of the delegate 2. Accountability for the assignment on the part of the delegator 3. Authority by the delegator to assign the task to the delegate 5. Authority of the delegate to accomplish the task as assigned
A disagreement has arisen between two staff nurses. Both have discussed the situation with the manager. The manager feels that that problem is likely self-solving. How should the manager approach this situation?
1. Allow some time to pass to see if the situation resolves. 2. Support both nurses as they work through this issue. 3. Provide any resources the nurses may need to help solve the problem. 4. Intervene if the problem begins to impact client care.
The nurse executive of a for-profit hospital continually works to provide an environment that is better for the nursing staff. Why is this effort so important?
1. An environment that is better for nurses is associated with lower mortality rates. 2. Nurses are more satisfied working in an environment that is better for nursing.
Which health care situations reflect the philosophy of quality management as designed by Deming? Select all that apply.
1. At 2:00 p.m. the nurse orders a lunch tray for a client who has just been removed from NPO status. 2. A nurse tells the manager that a housekeeper's work is not up to standards. 3. A nurse volunteers to take a Spanish language class to be able to communicate with clients.
A nurse manager is looking for evidence-based information regarding wound care. Which criteria should be used to evaluate the usefulness of an intervention?
1. Can the manager find two or more research studies that support the use of the intervention? 2. Is the research study that recommends the intervention rigorous in design and execution?
The nurse manager is facilitating the work of a collaborative team whose mission is to negotiate employment contracts with physicians. The nurse manager does not want to compromise the nurses' concerns in favor of the doctors' concerns. Which strategies would facilitate this outcome?
1. Collaborating focuses on solving the problem and satisfying both parties' concerns. 2. Competing is a victory for one side and a loss for the other.
The hospital has a very formal organizational structure and culture. Which conditions or events would indicate that a counterculture is developing within this hospital?
1. Collaboration and work sharing are becoming more common among nurses in specialty care units. 2. An informal group of nurses, radiology technicians, and physical therapists have been discussing how to better care for clients with hip replacements. 3. Nurses have begun questioning the wisdom of standardizing some nursing procedures.
The nurse manager is listening to new nurses discussing nurses as managers and overhears one state, "I don't care how long I am a nurse; I will never be a manager." In which ways do nurses manage regardless of their official role?
1. Deciding on priorities. 2. Being a liaison 3. Coordination of client care 4. Delegation responsibilities.
To be effective in today's health care system, the nurse manager must be aware of which trends?
1. Decreasing resources 2. Increasing numbers of retirees 3. Complicated technology
During the first staff meeting, a newly promoted nurse manager says, "I would like a commitment from all the nurses to review and improve the way delegation is done on the unit." Why would the manager be interested in delegation?
1. Effective delegation allows the manager to focus more time on management tasks. 2. Efficiency increases with effective delegation. 3. Focus on managerial duties, provides better advancement. 5. The manager maximuming entire staffs potential.
The administration of a health care system advertises that it promotes "a healthy work environment." Which events would cause a nurse working in this system to question this statement?
1. Nurse collaborates with physical therapy establishing mutually treatment schedules lobbies physicians to support nursing's position in any disagreements. 2. When staff nurses ask for the nurse manager's opinion on client care issues, the response is frequently, "I'll leave that decision up to you." 3. Administration has developed a plan in which each week two nurses from each unit are recognized as "best nurse of the week." 4. The nurse executive communicates with managers mostly by email.
Which nurse has legitimate leadership authority in the organization?
1. Nurse managers 2.Case managers Rationale: The have legitimate authority conferred by the organization and described in job descriptions.
A registered nurse will be the case manager of a group of ten clients. What will the nurse expect as part of this assignment?
1. Nurse meet with other disciplines to agree on choices of critical pathways for each client. 2. Nurse work to build consensus with physicians caring for clients teams. 3. Nurse defines expected nursing outcomes for the clients on the team. 4. The nurse will collect and analyze data regarding the clients on the team.
The nurse manager is conducting a nurse's annual performance review. Which events from the previous year would be evidence that this nurse is a successful follower?
1. Nurse participate in testing a new charting system before placed in unit. 2. Critiquing the manager's decision to change the unit's method of client assignments privately. 3. An in-service on a new intravenous access catheter, the nurse used one of the devices the on the next I.V. ordered.
Which nursing interventions would be in line with the chronic care model?
1. Nurse provides client with URL for website dedicated to self-management chronic respiratory disease. 2. Nurse advocates for client who decided to forego further dialysis. 3. Client information is entered into E.H.R. 4. Operating hours of community recreation center, provided to client with CAD.
A nurse manager is committed to establishing an environment that supports critical thinking and creativity. What strategies would help in this effort?
1. Provide opportunities for staff to interact with nurses from outside the facility. 2. Give the nurses freedom to design their work environment. 3. Be receptive to ideas even if they seem strange at the beginning.
A nursing team consists of an RN, two LPNs, and two UAPs. Which work would be completed by the RN?
1. Reviewing the client's plan of care with the UAPs 2. Discussing the client's increasing shortness of breath with the LPN 3. Updating the care plan of a client who will undergo surgery tomorrow 4. Calling the physician to discuss the client's response to a new treatment
The nurse manager has been assigned the task of developing and implementing a new staff system for the emergency department. The nurse has reached the "directing" phase of this project. On which activities would the nurse focus at this point?
1. Selling the new system to the current emergency department staff. 2. Coach the staff through the implementation of a new schedule. Convincing or "selling" the new idea and coaching and counseling are major roles in the directing phase.
The nurse executive wishes to hire nurse managers who embody the service leadership mission of the organization. Which specific attributes should this nurse look for in applicants?
1. The ability to be empathetic to clients and staff. 2. Awareness of the needs of clients and the organization. 3 Use of persuasion as a leadership technique.
A nurse manager who is retiring is helping the new manager learn about the position. As part of this education, the current manager has the new manager make all decisions that can be made under certainty. What conditions will these decisions have in common?
1. The alternatives are known. 2. The conditions of each alternative are clear.
Which quality improvement initiatives would help the health care organization meet Institute of Healthcare Improvement (IHI) goals?
1. The amount of material opened and wasted for surgical procedures will drop by 25 percent this fiscal year. 2. Wait times in the emergency department will decrease by 15 percent this year. 3. Fewer than 5 percent of clients will report inadequate pain control while hospitalized.
A client who was discharged yesterday is very upset about the quality of care received during hospitalization for gastric surgery. What options for reporting concerns does this client have?
1. The client can indicate dissatisfaction on the survey often sent to clients after discharge. 2. The client can call the hospital administration. 3. The client can make a public report through the Agency for Healthcare Research and Quality.
The hospital administration is considering adopting primary nursing as its model of nursing care delivery. Disadvantages of this method are that
1. The client may have multiple primary nurses if transfers within the facility are necessary. 2. Staff nurses cannot be held legally liable for care provided outside their work hours. 3. All persons caring for the client must have excellent communication skills.
A nurse manager is aware that there is a strong "grapevine" communication system on the unit. The manager elects to use this grapevine to distribute information about an upcoming change in unit policy. In making this decision, the manager should consider which possibilities?
1. The information may be rapidly disseminated. 2. The information may be altered as it moves across the grapevine.
Which leadership activities exemplify a quantum leadership style?
1. The leader is accepting of change. 2. The leader encourages staff nurses to help clients access internet sites about their disease process. Rationale: Change is excepted by the quantum leader. Informational power is shared by the quantum leader.
A nursing unit has just completed a 6-month trial of using team nursing to provide care. The overwhelming opinion of the staff is that the experiment was a disaster. What are the most common reasons team nursing is not successful?
1. There are problems with delegation. 2. Communication on the team or with the nurse manager is flawed.
A hospital increased its RN-to-client ratio 1 year ago. What effects is the hospital likely to see as a result of that choice?
1. There has been a decrease in client deaths. 2. The overall quality of care has increased. 3. The nosocomial infection rate has dropped.
A risk manager generally uses root cause analysis to investigate incidents. What are the likely outcomes of this action?
1. There is disagreement over the cause of the incident. 2. There are insufficient resources to make needed changes to prevent similar incidents.
The vice president for nursing services is aware that many of the problems in the nursing staff result from poor management at the unit level. What are some reasons that nurse managers are sometimes ineffective in their role?
1. There is little training available for nurse management positions. 2. Entry-level educational programs for nurses do not contain sufficient managerial content. 3. Management techniques are often learned "on the job." 4. Nurses often experience poor supervision in their own careers.
A nurse has accepted the position of vice president in charge of nursing in an organization that has a functional structure. What issues should the nurse be alert for?
1. There may be lack of coordination of services across the different departments in the organization. 2. Senior nursing managers may be overwhelmed with work and decisions 3. Managers have limited knowledge of general management techniques
Which situation is an example of a major weakness of service-integrated structure?
1. Two different units have purchased a demonstration model that could be used by both units. Duplication of resources is a major weakness of service-integrated structures.
A nursing committee has been organized to help plan a new intensive care service at the hospital. Which questions are essential for this committee to consider?
1. Where will the service be housed? 2. When will the service begin? 3. Who will provide the services? Planning and implementation are critical.
The nurse manager has determined that changes are necessary in the way holiday shifts are assigned. When assessing the political climate surrounding this potential change, the nurse manager would ask which questions?
1. Who is in control of the way holiday shifts are being assigned? 2. Who will lose when holiday shift assignments are changed? 3. Who is benefiting the most from the way holiday shifts are currently assigned?
The nurse supervisor would like to delegate accreditation preparation activities to the nurse manager. The manager is unsure of what is expected and has no experience with accreditation. How should the manager respond?
1."I will need some education on the accreditation process before I can accept this task." 2. "Please tell me more about what this assignment entails."
The nurse manager should be most careful not to hold preconceived beliefs when listening to which person?
A staff nurse the manager has worked with for 25 years Rationale 2: When there is a long-term relationship, the listener sometimes thinks they know what the other person is going to say. Careful listening is necessary in these situations.
"We want to be the hospital of choice in the Midwest" is which type of statement?
A vision statement describes the goal to which the organization aspires—in this case, to be the hospital of choice in the Midwest.
In the morning care conference, the nurse instructs the assistant to feed breakfast to the clients in beds 2234, 2230, and 2241. The assistant indicates understanding of the assignment and repeats the bed numbers back to the nurse. What is the nurse's next step?
Check with the assistant to see how the assignment is going during the time breakfast is served.
The nurse manager is planning to initiate new policies in the department and is reviewing several change theories. Which step of Havelock's model will the nurse find most closely resembles Lewin's moving stage?
Choosing a solution and gaining acceptance are most like Lewin's moving stage. Previous to this stage in both models, the work is to convince participants that change is necessary and to secure resources for the change. After solutions are identified and implemented, the final stage begins.
What action is necessary by a delegate accepting delegation?
Clarify the timeline and expectations. Rationale: It is important for the delegate to make sure the timeline and expectations are clearly defined, and he or she may opt to outline the specifications in writing
Medical residents do not answer pages very quickly, do or at all. The nursing staff complains to nursing supervisor. Several weeks, conflict spiraled into heated disagreement. Which is the most important reason to make the necessary changes to settle this conflict?
Client care and satisfaction will suffer should it be allowed to continue
The nurse manager is facing resistance to change from many staff nurses. Why should the manager work hard to address this resistance?
Client care is always the most important reason that nurses do what they do. If the change does not improve client care in some respect, is it worth the effort?
A nurse became nurse manager of a high-acuity unit 3 months after being licensed-struggles with the responsibilities of the position and is often unable to make decisions. Which component management competencies does this nurse probably lack?
Clinical practice knowledge. Rationale: To effectively manage a high-acuity unit, the nurse must have sufficient experience to develop clinical practice knowledge. three months is not long enough for that to occur.
Difference in opinion regarding methods to care for clients on mechanical ventilators. Nurse manager ask nurses to review evidence-based practice related to the situation. Each nurse volunteers to gather data prior to the next meeting. This is an example of which type of problem solving?
Collaboration occurs when all parties use their expertise to problem solve. The group focuses on problem solving as opposed to competition.
What is the most common skill shared by effective nurse leaders in leadership theories or models?
Communication Rationale: Regardless of the type of leader or the type of unit a nurse manages, communication skills are the key to effective leadership.
The novice nurse manager is hesitant to delegate tasks to competent, experienced staff nurses. Fear of which factor is most likely to explain this hesitancy?
Competition and criticism Rationale: The novice nurse manager may be insecure and fear that another staff member could perform the task more effectively. There is a fear that a successful delegate could threaten the nurse manager's credibility as a leader.
To address the problem of increasing costs of staffing agencies, a hospital has developed a plan for an internal float pool of nurses to be used when scheduled staff nurses call in sick. What type of planning has the administrative staff done?
Contingency Rationale: Contingency planning is a proactive response to problems that may interfere with getting work done.
A nurse manager is participating in the health care organization's strategic planning committee. Which factor is the primary driving force and controlling factor in new initiatives this committee might recommend?
Cost of care Today's health care environment, the cost of providing care is still the primary issue. Cost of care controls access, availability, and even quality.
The nurse manager is challenged to find an innovative way to adequately staff the unit and provide quality nursing care. Which ability would be most useful to the nurse in this situation?
Creativity Rationale 1: Creativity is a part of the critical-thinking process that fosters the development and implementation of new approaches to different situations.
A nursing task force has been created to determine whether a new model of differentiated practice would be more effective than the current model. The task force analyzes data as a basis to examine alternatives. Which activity does this represent?
Critical thinking Rationale 2: Critical thinking is a higher-level cognitive process that involves the examination of assumptions, interpretation and analysis of arguments, and the development of a conclusion that can be justified.
The nurse manager's expected outcome is to increase evidence-based practice on the nursing unit. To meet this outcome, the manager encourages nurses to base their practice on which technique?
Current research Current research is a good source of evidence-based practice strategies.
A newly promoted nurse manager would like staff to solve problems without relying on preconceived ideas. How should the manager role-model this ability?
Demonstrate a genuine desire to find our why there is dissention. Rationale 3: Good managers start out with a commitment to find out why others disagree.
During a discussion of how to proceed on a project, a team member says, "I don't care how we do it. Just tell me what to do and I will get it done." What kind of followership is this nurse exhibiting?
Dependent Rationale: This dependent "you make the decision and I'll do it," statement is characteristics of an ineffective follower.
A serious disagreement has arisen between two staff nurses. The unit manager elects not to make a decision regarding the disagreement until more evidence is collected. Which part of the nursing process does this manager's critical thinking reflect?
Diagnosis Rationale 2: Suspending judgment is equivalent to the diagnosis step.
The hospital chief operating officer holds monthly focus groups with the purpose of gaining ideas and insights from nursing administration and staff nurses. Which type of communication does this indicate?
Diagonal communication Rationale 3: Diagonal communication involves dialogue among individuals at different hierarchical levels (e.g., staff nurses to chief executive officer of nursing).
The nurse manager is concerned about a family member's complaint regarding the professional behavior of a nurse on the unit. Which is the most effective method to address this issue?
Discuss the complaint with the individual nurse face-to-face.
Using the classical organizational theory model, what would be the most appropriate method for the nurse to voice concern over unfair client workload assignments?
Discuss the problem with the nurse's team leader and then the charge nurse if the problem remains unsolved.
The day shift nurses and night shift nurses are in clear opposition regarding the responsibilities that each shift should be assigned. This opposition has created a "we-they" distinction on the unit. This is an example of which phenomenon?
Distancing mechanisms or differentiation serve to divide group members into small, distinct groups, which increases the risk for conflict.
At the beginning of a brainstorming session, the manager lists the rules to be followed. Which rule should be included and enforced?
Do not critique any ideas presented. Rationale 3: Brainstorming is for idea generation only. Idea critique will follow in another session.
A newly licensed nurse is concerned about the legal aspects of delegation. What is the most important question for the nurse to consider prior to delegating a task?
Does this task involve nursing judgment? Rationale: The nurse should not delegate tasks that involve nursing assessment or judgment.
When the nurse manager orders supplies for the unit, which communication mode is best?
E-mail Rationale: To avoid misunderstanding of supplies needed, a written request is the most appropriate choice. It avoids misunderstanding, as the needs can be checked off a list.
The nursing group has been charged with the task of solving a patient care problem on the units. Which step should this group take first in this process?
Gather information to define the problem. Rationale 3: Problem solving begins with collecting the facts, which provides clues to the scope and solution of the problem.
A graduating nurse student is deciding which nursing specialty would be a good place to begin a nursing career and ensure long-term stability. Which specialty is most likely to have the greatest growth in need?
Geriatric nursing As baby boomers age, geriatric nursing will be needed more than any other specialty. Not only are the baby boomers a large segment of the population, but better health practices are resulting in people living longer.
The nurse manager is facilitating change to a new documentation system in the unit. If the manager wants to use the most common method to overcome resistance to the change, which strategy would be chosen?
Giving information is the most common method of changing individuals' perceptions, attitudes, and values.
The nurse manager needs to delegate specific tasks to the charge nurse of the unit. Which action is an appropriate use of delegation?
Having the charge nurse lead a nursing quality assurance task force
The nurse manager has established a program that recognizes a different staff member each month for contributions to client care. As a result, overall staff productivity and the number of client compliments have increased. This is an example of which concept of organizational theory?
Hawthorne effect The Hawthorne effect is the tendency of people to perform as expected because of special attention.
The person who has just been promoted to nurse manager is male. If this nurse communicates in a way that is considered typical for men, what can the staff expect?
He will prefer to ask questions rather than make statements Rationale 4: Women are more apt to ask questions to seek input.
The mother of a staff nurse is critically ill and the nurse must miss several shift of work. If the leadership style of the nursing manager is transactional, which approach to covering these shifts is most likely?
If you work overtime tonight I will authorize double your hourly pay rate. Rationale: Transactional leadership is based on the principles of social exchange theory. The primary premise is that individuals act in their own best interest.
Hospital administrators are considering changing from the traditional method of creating work schedules to a system in which the nurses will choose their own workdays. Choices will be made according to seniority. Which change strategy would likely be best for this endeavor?
In most cases, the normative-reeducative approach to change is effective in reducing resistance and stimulating personal and organizational creativity.
The nurse manager has scheduled a series of meetings with employees to solve a unit problem. The manager purposefully created a 2-week gap in the meetings to allow which portion of the creative process to occur?
Incubation Rationale 4: The period of lapsed time before a decision is made is the "incubation" time.
One of the nurse competencies of the synergy care delivery model is "moral agency." Which action is an example of that trait?
Moral agency is "doing the right thing." Reporting a medication error is the right thing to do.
The nurse manager assesses that there is conflict between two of the charge nurses. The decision is made to postpone an intervention and allow the conflict to escalate. Why might the nurse manager make this decision?
Motivate the participants to seek resolution.
The organization that awards Magnet status would look for environments where which practices are the norm? Select all that apply.
Nurses are involved in decision making. Magnet status designates organizations that foster independence, autonomy, and creativity among the nursing staff. Nurses are involved in decision making in these institutions.
An accreditation visitor observes the following situation in a healthcare organization. Which situation would this visitor interpret and document as evidence of the shared governance type of shared leadership?
Nurses formally organized to make decisions regarding practice standards. Rationale: Shared governance is a formal process. Decision making is done by designated nurse representatives.
The new chairperson of the nursing department has determined that the faculty's teaching is stagnant and outmoded. The chairperson would like to encourage the faculty to adopt more innovative teaching strategies. According to Lewin, what is the first step in initiating this plan?
The first step is to unfreeze the existing equilibrium by asking staff to become part of the process of change, particularly in the first phase.
A new IV pump has just been purchased by the facility. Which statement by the nurse manager reflects Rogers' first step in making the change to this new equipment?
The first step of the diffusion of innovation occurs when the decision-making unit is introduced to the innovation and knowledge is gained.
Hospital concerned about low customer satisfaction ratings and poor evaluation on quality indicators. Nurse managers implement nursing delivery system that is cost-effective and improves both customer satisfaction and quality of care. Which nursing delivery system should the managers implement?
The focus of patient-centered nursing is the promotion of efficiency, quality, and cost control.
Which situation is an example of the overall goal of quality management in today's health care activities?
The focus of quality management is on ways to prevent problems and improve quality of care. This nurse may have prevented a fall.
A client needs a high-risk surgical procedure. According to the Leapfrog Group, the client should choose which hospital for care during this procedure?
The hospital with the highest performance ratings for this procedure The Leapfrog Group focuses on quality indicators including the use of higher-performing hospitals for high-risk procedures.
The nurse executive is reviewing statistics about the nursing staff. Which statistic shows that the staff reflects national trends?
The number of nurses under age 30 has increased in the last two years The number of nurses under age 30 is increasing.
Which situation reflects the primary service provided by home health care?
The nurse changes the client's abdominal dressing daily. Nursing care is the primary service provided by home health agencies
A hospitalized client is complaining of abdominal pain that has developed since admission. The nurse says, "I am going to call the hospitalist." How should the client interpret this statement?
The nurse is going to call a physician who cares for inpatients. A hospitalist provides care only to hospital inpatients
Which action by the nurse manager is a demonstration of satisficing?
The nurse manager agrees with a proposed budget that does not provide badly needed new client beds.
Which situation requires an adaptive decision?
The nurse manager discovers that two clients require the use of a new piece of equipment and that the one the hospital has is the only one in the state.
A staff nurse asks the nurse manager, "What assignment are you delegating to me today? I would like to begin to organize my day before shift report begins." What is the error inherent in this statement?
The nurse manager is not delegating but rather making daily assignments.
During a performance evaluation the nurse manager states, "My span of control is just too large." How should the unit supervisor interpret this statement?
The nurse manager may have too many staff members to manage. Span of control addresses the number of employees a manager can effectively supervise.
At a strategic planning meeting the nurse executive recommends instituting patient-centered care as a model of care delivery in the hospital. Which statement by the hospital CEO indicates understanding of this concept?
The nurse manager's role in patient-centered care requires considerable time. The nurse manager must be a strong leader.
Hospital administration is considering the purchase of a robotic pharmacy system. What would be the advantage of this system to the nurses who work in the hospital?
The nurse should get medications more quickly because the robot can work more consistently without breaks. Robots should be able to get medications to the floor more quickly
During a nurse's interview for a new job, the health benefits are described as being provided by a health maintenance organization (HMO). What should the nurse expect from this coverage?
The nurse will have to choose a provider from within the HMO. An HMO is a geographically organized system that provides an agreed-upon package of health maintenance and treatment services. Providers must be chosen from those in the HMO.
A long-term care facility's organization reflects a functional structure. Which facility practice reflects a basic weakness in this organizational strategy?
The nursing department is responsible for writing the client's comprehensive care plan. In functional structure, individual departments are grouped and responsible for specific tasks.
A change in nursing care delivery system is being considered by hospital administrators. Which information should the nurse executive add to this discussion?
The nursing process reflects nursing care and consists of assessment, planning, implementation, and evaluation.
The nursing supervisor states, "I really don't have the time to delegate this task to a nurse manager. I can do it faster!" What is the most likely basis for this statement?
The nursing supervisor is concerned that staff is ill-prepared to assume additional responsibilities.
Which situation indicates the nurse needs additional training on effective delegation?
The office nurse calls in orders for admission on a client following a surgical complication.
A group of nurses is developing a poster presentation titled "Nursing Care Delivery Through the Ages" for the hospital's annual Nurses' Day celebration. What form of nursing care delivery should they depict as occurring prior to 1930?
The original model of nursing care delivery was total patient care or the case method. During the 1920s, total patient care was the typical delivery system, with much RN care being provided in the home.
The nurse manager has determined the need to hire two staff nurses. Which factor is most critical as the nurse manager prepares to submit the request to administration?
Timing of the request Rationale: The nurse manager should plan to meet with administration when there is sufficient time and the supervisor seems receptive.
Which statement explains why nurses must be leaders to be successful in client care?
To direct client care activities and get the outcomes you desire, you need good leadership skills. Rationale: Nurses must direct client care in order to successfully achieve client outcomes in a timely fashion.
A long-term-care facility is considering implementing total patient care. Prior to implementing this system, what must be available?
Total patient care means that all the care for the clients or residents is provided by the RN.
The hospital organization has developed a philosophy based on the client, organizational involvement, quantitative measurement of outcomes, and processes for improvement. In which quality management process are these characteristics typically seen?
Total quality management (TQM). TQM is a management philosophy emphasizing a commitment to excellence throughout the organization. It is founded on four core concepts: client, organizational involvement, quantitative measurement of outcomes, and processes for improvement.
A community hospital has been purchased by a large health care conglomerate. Nursing administration has the task of changing the nursing practice model followed for 50 years. To best achieve this change, which leadership theory will the executive nurse follow?
Transformational leadership This is concerned not with the status quo but with effecting revolutionary change in organizations and human service.
The nurse manager makes an error that results in the unit being $20,000 short on operating budget for the fiscal year. When asked about the error, the nurse takes full responsibility. This statement reflects which component of emotional intelligence?
Transparency Rationale: Transparency is displaying honesty and integrity.
Newly promoted nurse manager fears that previous coworkers will undermine her in the position. She does not share info with these coworkers on needed changes that are going to occur in the organization. Which emotional intelligence self-management competency is this nurse most clearly violating?
Transparency Rationale: Transparency is displaying honesty, integrity, and trustworthiness. this nurse is not displaying these traits.