Leadership Exam 2 (Evolve Questions)
The nurse manager responsible for two units has one vacancy on each unit for one shift. Unit A is a well-functioning unit, although the acuity level of half of the patients is very high. Unit B has a lesser acuity but a less experienced staff. There are two nurses in the PRN pool who are available to work. The first nurse is 6 months from graduation with a BSN; the second RN holds an ADN, is currently in an RN to MSN program, and has 10 years experience as an ER nurse. Fill in the blank with the number of the nurse that should be assigned to unit A.
1 (the first nurse) Although Unit A has a high acuity level, the unit functions very well and can provide effective support for the inexperienced registered nurse.
A hospital in a large metropolitan area hopes to obtain magnet status. The following are characteristics of the nursing service in this hospital. Select the areas that must be addressed in order to become a magnet hospital. (Select all that apply.) A) Cost reduction at the hospital has resulted in a 50% decrease in the number of staff in the Education Department. B) The hospital has a nurse vacancy rate of 20%. C) 50% of the nurse managers hold a BSN. D) The chief nursing officer holds a MSN, with a specialty in nursing administration. E) Transforming Care at the Bedside has been implemented in all units.
A) Cost reduction at the hospital has resulted in a 50% decrease in the number of staff in the Education Department. B) The hospital has a nurse vacancy rate of 20%. C) 50% of the nurse managers hold a BSN. Magnet status highlights hospitals that provide a positive work environment for nurses and other staff. A high vacancy rate suggests that nurses are leaving the hospital, in some cases, because the environment does not "hold" them to their job. Similarly, cost reduction in the area of staff development suggests a lack of support for ongoing professional development. Finally, effective January 2014, all nurse managers must hold a BSN.
Regulations in most states require that the number of patients a nurse should care for in a particular setting should be determined by a staffing plan developed by registered nurses, some of whom are direct patient caregivers. The rationale for this approach is: (Select all that apply.) A) Having nurses who provide direct care involved in developing a staffing plan will prevent cost from being the major influence on determining the number of staff required on a unit. B) Mandated staffing ratios may prevent an adequate staffing pattern in some circumstances, when unusual resources are required for a particular patient. C) Decisions by staffing committees made up of registered nurses are more likely to be accepted by the nursing staff. D) Multiple factors, such as patient acuity and nurse experience, influence the time required to adequately care for the patient. This requires nursing judgment to determine the standard.
A) Having nurses who provide direct care involved in developing a staffing plan will prevent cost from being the major influence on determining the number of staff required on a unit. B) Mandated staffing ratios may prevent an adequate staffing pattern in some circumstances, when unusual resources are required for a particular patient. C) Decisions by staffing committees made up of registered nurses are more likely to be accepted by the nursing staff. D) Multiple factors, such as patient acuity and nurse experience, influence the time required to adequately care for the patient. This requires nursing judgment to determine the standard. All of these are correct.
A patient's family asks the nurse why a clinical pathway is being used to determine her care. The best answer is "Clinical pathways: A) Help everyone caring for you to provide effective care based on research findings." B) Help us to give you care without spending too much money." C) Make sure you meet the criteria for improvement." D) Keep your doctors and nurses from giving care that is not appropriate."
A) Help everyone caring for you to provide effective care based on research findings." Clinical pathways are designed to integrate research and best practices into the care.
The chief nursing officer (CNO) of a large metropolitan hospital is preparing to defend her request for more staffing in certain units during budget development. Research has illustrated that a number of outcomes are improved when there is sufficient staffing on the unit. To make her case for more nursing staff, the CNO should gather data on which outcomes associated with staffing patterns and highlighted in the research? A) Number of errors in patient care identified over time on a unit B) Average length of stay of patients on a unit C) Unit revenue generated D) Number of physicians who regularly admit patients to a unit
A) Number of errors in patient care identified over time on a unit Inadequate staffing has been linked to an increase in the number of patient care errors.
The nurse manager in ICU develops a plan to implement the new sepsis management protocol. The plan includes education, focused sessions to discuss concerns with the staff, and sepsis warning signs in various places on the unit. This is an example of which of the following? A) Planned change B) Complexity management C) Unplanned change D) Open systems
A) Planned change Planned change is deliberate and organized and has the goal of improvement.
In order to maximize authority and accountability for all aspects of the nursing practice in the nurses responsible for the delivery of care, the most effective strategy an organization can take is to: A) Position management and administrative levels to coordinate and facilitate the work of the practicing nurses. B) Define in specific detail the daily activities of frontline nurses. C) Have nurses report directly to physicians. D) Develop multidisciplinary teams of care providers.
A) Position management and administrative levels to coordinate and facilitate the work of the practicing nurses. With a focus on shared governance, effective organizations design structures to provide nurses maximum autonomy over the decisions that impact the care they deliver.
A new graduate nurse is considering employment opportunities. He wants to make sure he works for an organization that has similar beliefs as he does about nursing. Which of these documents would NOT provide him information to help him make his decision? A) Product line B) Organizational chart C) Nursing philosophy D) Organizational mission
A) Product line An organization's culture is reflected in its mission statement. A philosophy of nursing describes the organization's beliefs about nursing, health, and patients. A review of the organizational chart typically demonstrates the level of empowerment and independence of nurses within the organization. A product or service line describes an integrated organizational structure focused on a specific service.
The most important role of the nurse case manager is to: A) Serve as a communication link between all providers of care. B) Provide supportive therapy during the grieving process. C) Provide education to patients regarding upcoming surgery. D) Perform a psycho-social assessment of the patient and his family.
A) Serve as a communication link between all providers of care. The primary role of the case manager, according to the Case Management Society of America, is to increase the involvement of individual and caregivers in the decision-making process.
In a landmark study regarding nursing staffing, Aiken, Clarke, Cheung, Sloane, and Silber found that: A) The greater the proportion of BSN-prepared nurses or higher employed by a hospital, the lower the risk-adjusted mortality. B) There is no difference in the care delivery by RNs regardless of their educational or experience level. C) The greater the proportion of RNs with 5 years' experience or more employed by a hospital, the lower the risk-adjusted mortality. D) BSN-prepared nurses provide safer care than nurses prepared at other educational levels.
A) The greater the proportion of BSN-prepared nurses or higher employed by a hospital, the lower the risk-adjusted mortality. Aiken and her colleagues found, using a Pennsylvania nurse survey and patient discharge data from 1999 and 2006, that a 10-point increase in the percentage of nurses holding a baccalaureate degree in nursing within a hospital was associated with an average reduction of 2.12 deaths for every 1000 patients—and for a subset of patients with complications, an average reduction of 7.47 deaths per 1000 patients.
The number of patient days on a 28-bed unit in September is 618. What is the average daily census (ADC)? A) 22 B) 20.6 C) 30 D) 23.5
B) 20.6 Formula for average daily census is number of patient days divided by the number of days in the time period. (618/30=20.6)
There were 525 patient days accrued in September on a 28-bed unit. There were 100 discharges during this same time period. What is the Average Length of Stay? A) 6 B) 5 C) 3 D) 7
B) 5 Formula for average length of stay is number of patient days divided by number of discharges.
To maximize the coordination of care, provide seamless transitions, and improve quality of care, organizations are increasingly turning to which organizational structure? A) Public health institutions B) Accountable care organizations C) Proprietary, investor-owned organizations D) Academic medical centers
B) Accountable care organizations Accountable care organizations (ACOs) are designed to coordinate care, provide chronic disease management, and improve the overall quality of care. Proprietary organizations are investor owned, and they operate with the specific intent of earning a profit by providing healthcare services to individuals who can afford to pay for these services. Public health institutions provide health services to individuals under the support and/or direction of the local, state, or federal government. Academic medical centers are focused on providing care while providing education for physicians and other health professionals.
How can a leader deal fairly with employees who fail to meet established standards of care? A) First, determine if the employee issue is a will or skill issue. B) Ask questions of the employee that can reflect the employee's knowledge base. C) Conduct a chart review that reflects the care issue.
B) Ask questions of the employee that can reflect the employee's knowledge base. It is appropriate to obtain more information and questions regarding the employee's knowledge base of both the standards of care and the evidence. Policies and procedures help add to this information so that the leader can make the best assessment possible. The leader could also use scenarios.
Janice wants to be a change agent. Which action listed below would be the most appropriate for Janice to take? A) Seek help from her nurse manager. B) Become an early adopter. C) Wait until a more experienced nurse vocalizes support. D) Talk to a peer on another unit about the problems with more experienced nurses.
B) Become an early adopter. Any nurse can be an early adopter by championing and promoting a change. Early adopters often help motivate other nurses to make the change.
Janice is a new graduate nurse working in the intensive care unit of a large medical center. Janice completed her nurse residency and began working full-time on the unit about 6 weeks ago. Janice is the only new graduate nurse on a unit where her colleagues range from 29 to 48 years old. Janice is a member of the American Association of Critical-Care Nurses and is aware that the protocol for sepsis management in patients recently changed. Janice wants the ICU to adopt these best practices but doesn't know how to go about implementing the change. Which of the following is the best approach Janice could take? (Select all that apply.) A) Adopt the practices herself and become a role model. B) Post an article reviewing the new sepsis management protocol on the bulletin board in the staff lounge. C) Ask other nurses on the unit why they are still using old standards of practice. D) Talk with the nurse manager about the recent protocol change.
B) Post an article reviewing the new sepsis management protocol on the bulletin board in the staff lounge. D) Talk with the nurse manager about the recent protocol change. Option A is incorrect because evidence-based practices and nursing protocols are standardized on nursing units and nurses are required to follow them. Option C is incorrect because asking other nurses this question might alienate her. Options B and D are appropriate ways a new nurse can help foster change.
Role theory provides an appreciable framework for development and evaluation of staff. What term describes when employees are unwilling or unable to meet requirements? A) Role clarity B) Role conflict C) Role ambiguity D) Role acquisition
B) Role conflict Role conflict is the term used to describe the unwillingness or inability to meet the requirements of a particular role. Role ambiguity is lack of understanding of the role. Role acquisition is the ability to clearly take on the role. Role clarity is focused on the individual having a clear concept of the role they are expected to perform.
When caring for a patient who had a hip replacement that morning, a nurse is providing what level of care? A) Tertiary B) Secondary C) Primary D) Essential
B) Secondary Secondary care involves disease-focused or restorative care. Primary care describes preventive care while tertiary care refers to specialized or consultative health care.
The California staffing law requires that a nurse should care for no more than a certain number of patients in specific units at any one time. The correct ratio of patients to unit type is: A) Three patients in the intensive care unit. B) Three patients in a labor and delivery unit. C) Six or seven patients in a medical-surgical unit. D) Ten patients in a psychiatric unit.
B) Three patients in a labor and delivery unit. Correct ratios: Two patients in an intensive care unit Five patients in a medical-surgical unit Four patients in a psychiatric unit
When the leader observes the employee has a significant increase in errors and may have some emotional problems, the most appropriate response is: A) Schedule a series of meetings with the employee to support and assist the employee in addressing the problem. B) Put the employee on the first steps of disciplinary action. C) Ask the employee some questions ending with a suggestion that Employee Assistance might be an option.
C) Ask the employee some questions ending with a suggestion that Employee Assistance might be an option. The leader is not a psychotherapist and should not attempt to address an employee's possible depression. Most organizations have Employee Assistance as a part of the benefit package. A limited number of visits are at no cost to the employee and could be of great benefit.
The nurse manager on a skilled nursing unit notices that the number of patient falls in his unit has escalated over the past year, resulting in a fall rate that is below the target projected for this unit. The best evidence-based approach to reducing the number of falls is to: A) Place patients at risk for falls close to the nursing station. B) Institute a safety restraint policy. C) Increase the number of total nursing hours on the unit. D) Purchase side rails that are easy to raise and lower.
C) Increase the number of total nursing hours on the unit. Research supports the idea that patient falls increase when there is insufficient staffing on a unit. While putting patients who are at risk for falls close to the nursing station is often appropriate, it is not the most effective strategy. Restraints are a poor nursing strategy for preventing falls, and although side rails may be helpful, they do not stop patients from falling when getting out of bed or in other situations.
The ICU soon implements the new evidence-based nursing practice for early identification and management of sepsis. Janice is concerned that the nurses with more experience will not want to adopt a new protocol or change practice patterns. This is an example of which of the following? A) External barrier B) Internal facilitator C) Internal barrier D) Change strategy
C) Internal barrier Internal barriers are restraining factors that are found within the organization or unit where the change is occurring.
What should an applicant review before attending a job interview? A) Relocation expenses B) Salary ranges for position C) Position description D) Corrective action processes
C) Position description It is vital that the applicant have a clear understanding of the job description and what is expected of them in the position. Salary ranges and relocation expenses are a discussion to be held if offered the position. Corrective action processes are not critical for the applicant to know prior to the interview.
In reviewing staffing patterns on a unit, the nurse manager finds that in the last 2-week pay period, one of the nurses has worked seven 12-hour shifts. Two of these shifts were 7 AM to 7 PM; the remainder were 7 PM to 7 AM. The nurse manager should have an individual discussion with the nurse to: A) Ask her to share her work schedule, since other staff may complain about a lack of opportunity to work overtime. B) Let her know how much her work is appreciated in a time when there is a shortage of staff. C) Review the research regarding the relationship between patient errors and fatigued nurses. D) Put her on "warning" for putting patients' safety at risk.
C) Review the research regarding the relationship between patient errors and fatigued nurses. Beginning evidence is emerging that working more than 12 hours and rotating shifts can lead to errors that compromise patient safety (Kane et al., 2007).
A cost-based system consists of: A) A method in which the cost associated with the service is attributed in advance by a third party. B) A method of reimbursement based on outcomes. C) The cost of providing a service plus a mark-up for profit.
C) The cost of providing a service plus a mark-up for profit. Response option B describes a prospective payment system defined as a method in which the third-party payer decides in advance what will be paid for a service or episode of care. Response option C describes a pay for performance system that reimburses hospitals and eventually providers based on performance and outcomes and not on the cost associated with providing the care.
Which of the following is the most appropriate assignment involving asking a nurse to "float" to another unit? A) A nurse 9 months post licensure working on an orthopedic unit is asked to float to a cardiac step-down unit. B) An experienced nurse working on a medical-surgical unit is asked to work in a medical-surgical ICU. C) An experienced psych nurse is asked to work on a palliative care unit. D) A nurse who has worked in the CCU for 2 years is asked to work on a cardiac step-down unit.
D) A nurse who has worked in the CCU for 2 years is asked to work on a cardiac step-down unit. The nurse who has worked in the CCU will have had the necessary competencies validated for this assignment.
What type of performance appraisal is based on the employee and manager jointly setting goals? A) Behaviorally anchored rating scales B) Critical incidents C) Narrative method D) Management by objective
D) Management by objective No other answer option has the employee and manager jointly setting goals.
A rural, critical access hospital has used a total patient care model to deliver nursing care to patients because of the hospital's commitment to individualized care to patients in the community. Environmental factors such as a nursing shortage in the area and limited profitability of the hospital have forced the nursing administration to consider another, less expensive model of nursing care delivery. They want to continue their commitment to individualized care to the extent possible. Which model of care would be most appropriate in this situation? A) Primary care B) Team nursing C) Functional nursing D) Patient-centered care
D) Patient-centered care The patient-centered care model of care maintains the commitment to individualized care; however, it uses less expensive unlicensed assistive personnel to extend the practice of the registered nurse.
Case management has become a very important role for all acute care organizations. Nurses must partner with case managers in reaching organizational goals. The ideal partnership includes the following contribution(s) by the nursing staff: A) Ongoing patient and family education regarding discharge planning as well as identifying barriers to discharge B) Knowledge of patient goals, expected outcomes, and anticipated discharge date C) A comprehensive assessment of the patient and family D) Appropriate and timely interventions when the patient is not progressing as expected E) All of the above
E) All of the above Case management has become a very important role for all acute care organizations. Nurses must partner with case managers in reaching organizational goals. The ideal partnership includes the following contributions by the nursing staff: Knowledge of patient goals, expected outcomes, and anticipated discharge date; comprehensive assessment of the patient and family; appropriate and timely interventions when the patient is not progressing as expected; appropriate management of pain, activity, skin integrity, bowel and bladder integrity, and cognition; ongoing patient and family education regarding discharge planning and reducing the risk of readmission; and identifying barriers to discharge (Bower, 2013).
Healthcare prices are set using the same economic equilibrium found in all major industries. True or False
False Prices in health care are not set by the same economic equilibrium found in all major industries. For the most part, healthcare pricing is highly influenced by the government and the reimbursement plans. For example, both Medicare and Medicaid impose pricing on hospitals and there is no room for negotiation.
