Leadership Exam 2

A new nursing graduate has just started working in a hospital unit that has had difficulty in staff retention. Which type of resistance may be a result of changes that will occur despite the beliefs of the workforce? A. Cultural B. Technical C. Political D. Personal

A. Cultural Rationale: Cultural resistance may be a result of changes that will occur in spite of the norm, or beliefs, of the workforce. Technical, political, and personal resistance are not associated with norms or belief systems within the workforce.

Choose other factors that may evoke resistance to change. (Select all that apply.) A. Feelings of losing control B. Anxiety C. Weak proposal D. Clear guidelines E. Trust F. Timing

A. Feelings of losing control B. Anxiety C. Weak proposal F. Timing Rationale: Resistance to change is related to many factors. These include, but not limited to that may evoke, the timing, unclear guidelines, weak proposal, anxiety, feelings of losing control, and lack of trust.

Environmental factors that influence health care can be restraining forces, driving forces, or both. From the factors given here, identify those that can be termed as restraining forces. (Select all that apply). A. Poverty B. Government regulation C. Rising health care costs. D. Population demographics E. Stress F. Workplace shortages

A. Government C. Rising healthcare costs E. Stress F. Workplace shortages

What area do consumers value the most when seeking health care? A. High quality, low cost, and ability to meet patient outcomes B. Ability to meet patient outcomes, advanced technology, and staffing levels C. Low cost, ability to meet patient outcomes, and advanced technology D. Advanced technology, staffing levels, and low cost

A. High quality, low cost, and ability to meet patient outcomes Rationale: Health care consumers value high quality, services that positively affect patient outcomes, and are of low cost. It is imperative that nurse leaders understand the importance of the financial aspect of the organization to plan budgeting for staff and unit that best addresses values and concerns of the health care consumer.

After attending a health care research seminar, a registered nurse who works in the transplant unit became very interested in the ability of 3D printing to help save lives. The nurse would really like to raise awareness and see the hospital invest in a 3D printer. What are the different technical reasons for resistance that the nurse may encounter? (Select all that apply.) A. Lack of resources B. Unqualified personnel C. Budget issues D. Power E. Public education

A. Lack of resources B. Underqualified personnel C. Budget Issues Rationale: Technical resistance deals with budget issues, a lack of recourses, and unqualified personnel. Power would not be an underlying issue. Public reaction is associated with community education, and this would take place much later in the process.

Which of the following best describes the key point(s) of the Complex Adaptive Systems Theory? A. Nonlinear process B. Rational, normative, power C. Human nature and surprising effects. D. Patterns, moving target, and unpredictable. E. Precontemplation, contemplation, preparation, action, maintenance.

A. Nonlinear process

The nurse leader is a change agent and needs to identify factors that lead to resistance of change. Identify the factors of resistance. (Select all that apply.) A. Personal energy needed B. Lack of trust C. Poor timing D. Comfort with the current way of completing goals or tasks E. Understanding of need for change

A. Personal energy needed B. Lack of trust C. Poor timing. D. Comfort with the current way of completing goals or tasks. Rationale: A variety of resistance to change may be seen, which include behavioral, emotional, or cognitive. The nurse leader should recognize factors that result in resistance to change in order to reduce the amount of resistance that may occur. These include, but are not limited to, poor timing of the change, weak proposal for the change, lack of adequate data or planning, improper timeframe of implementation, comfort with current situation, fear of loss of control, lack of confidence in leader, anxiety over success or effects of change, lack of trust, and personal energy required for the change to occur.

In the change process, what stage occurs after the design stage? A. Plan - use a roadmap and ask questions B. Integrate - see if the change is working C. Design - get feedback from your team D. Implement - Investigate complexities and stress

A. Plan Rationale: in the plan stage you prepare the implementation plan and ask questions such as possible resistance, etc.

A nurse leader is working in the ER when a patient presents with a deep head laceration requiring immediate suturing. The nurse leader went to the medical supply area for antibacterial ointments, gloves, and bandages. However, the nurse noticed that the medical supply cabinet was extremely disorganized, so it took much longer than it should have to find the necessary supplies. The next morning, the nurse leader began to ask team members if they had any input regarding the organization of the medical supplies, and then began to brainstorm a few different ideas, such as rearranging the supplies and relabeling items. What is the next stage of change the nurse leader should address? A. Plan B. Design C. Implement D. Integrate

A. Plan Rationale: The nurse leader has already designed the change by brainstorming solutions using personal skills and by reaching out to all those affected. The next phase should be planning—deciding on a strategy and asking questions regarding the change.

A nurse manager is attempting to restructure the unit to prevent understaffing of the nurses. The nurses agree this is a needed change. What type of change strategy would be most effective? A. Rational-empirical strategies B. Normative-reeducative strategies C. Power-coercive strategies. D. None of the above.

A. Rational-empirical Strategies Rationale: Rational-empirical strategies work especially well when there is not a lot of resistance to change in the first place, and especially when the change is perceived to be reasonable.

The charge nurse of a step-down unit is implementing a new procedure for charting, which will impact all of the nursing staff. According to Lewin's Model of Change, the "Movement stage" can be more successful if certain things are considered by the change agent. (Select all that apply.) A. Set target dates B. Include all stakeholders C. Ignore resistance to change D. Implement the change E. Have flexible target dates

A. Set target dates B. Include all stakeholders D. Implement change Rationale: During the Movement stage, a lack of planning by the change agent can fuel uncertainty and heightened anxiety. To facilitate more success during the Movement stage, Lewin recommends that the change agent include everyone who will be affected by the change during its planning, set target dates, and implement the change while being available to offer support and encouragement throughout the process. Ignoring resistance to change and having flexible target dates will only increase the levels of uncertainty and anxiety during the Movement stage.

A nurse manager is preparing a presentation to be delivered to a group of nurses in a nursing unit about the current U.S. health care system. Which statement about resource utilization is most accurate? A. The health care resources that are available in the United States are not used cost-effectively. B. Currently, there is a scarcity of resources available in the U.S. health care system. C. Limiting spending for health care resources will improve the quality of U.S. health. D. Additional funding for health care resources would improve the status of U.S. health.

A. The health care resources that are available in the United States are not used cost-effectively. Rationale: The United States is the leader in expenditures for health care and there are adequate resources. However, the resources that are available are not used cost-effectively.

Which of these changes is likely to encounter the least resistance? A. Establishing interdisciplinary teams for fall prevention B. Introducing a new type of IV pump C. Transferring certain staff members to a different unit D. Implementing a new process for end-of-shift handoffs

B. Introducing a new type of IV pump Rationale: Of the changes listed, introducing a new type of equipment, such as an IV pump, represents the change least likely to encounter resistance. Changes that impact employee security, such as job transfers, are likely to be unpopular. Changes to the daily routine of patient care may also be met with resistance, particularly when the new way of doing things may be perceived as time consuming; employees may not want to implement changes to end-of-shift handoffs, especially since this happens at the end of the day when they are already tired. When changes span different departments, it can be difficult to take all perspectives into consideration, making the change more likely to be met with resistance.

Health care is not only financed by private insurance, government funding, and private donations but also by individual out-of-pocket expenses. A. FALSE B. TRUE

B. TRUE Rationale: Health care facilities and organizations are financed through private insurance, government funding, individual (out-of-pocket expenses), and other means such as private donations and charitable foundations.

A nurse manager is considering how to gain more staff involvement in meeting budgetary goals. Which activity is most likely to result in staff understanding and participating in budgetary goals? A. Forecasting or estimating needs using current data B. Comparing actual expenses with budgeted expenses C. Communicating budgetary planning goals to staff D. Being held accountable for the unit's financial results

C. Communicating budgetary planning goals to staff Rationale: The unit manager has a responsibility to communicate budgetary planning goals to staff. The more that staff understand the budgetary goals and the plans to achieve the goals, the more likely that the goals will be attained. It is the responsibility of unit managers to compare actual expenses with the budgeted expenses as well as being held accountable for the unit's financial results, but this does not directly influence staff understanding of and participation in achieving budgetary goals. It is not appropriate to use current data to forecast or estimate needs; historical data is needed to do this.

The nurse manager for a medical-surgical unit is implementing a change in unit procedures as it relates to patient discharge. During the fourth phase of change known as "action," the manager should incorporate the major component known as: A. evaluation. B. intervention. C. communication. D. assessment.

C. Communication Rationale: The action phase of change involves making the actual changes. The change agent must be available to answer any questions or concerns that come up during the process. The goals and objectives must be carefully communicated so everyone will be a willing participant. While resistance must be overcome for change to occur, mobilizing supportive forces and minimizing obstacles should be planned for in previous stages. While collecting data to understand the change needed and overcoming resistance are critical for change to occur, collecting data, mobilizing supportive forces, minimizing obstacles, and planning are found in previous stages.

A few months ago, a new nurse leader at a hospital discovered via evidence-based practice that tablet computers improved accuracy of documentation and decreased patient wait time. The leader noted that these outcomes are beneficial to the facility, staff, and patients, as tablets provide portable access to patient electronic medical records. The nurse leader is currently in the planning stage. Which activities are part of planning stage? (Select all that apply.) A. Evaluating how the plan unfolds in real-time. B. Brainstorming the impact, pros and cons, and potential challenges to implementation with impacted teammates. C. Determining the scope of the change project, a schedule for its implementation, and a budget to submit to administration for approval. D. Keeping track of the pace and stress of change. E. Anticipating resistance to the change by less tech-savvy staff.

C. Determining the scope of the change project, a schedule for its implementation, and a budget to submit to administration for approval. E. Anticipating resistance to the change by less tech-savvy staff Rationale: The nurse leader had already designed the change by brainstorming solutions using personal skills and by reaching out to the team. The nurse leader is currently in the planning stage, asking questions regarding the change, such as "will there be resistance," "is this justified," and "what can be done to overcome barriers." The nurse leader will need to get approval of the budget before continuing on to the next step: implementation. Evaluation occurs after implementation has occurred.

You are the nurse manager of a medical-surgical unit that is in need of a change in staffing rotation patterns, which will lead to major changes in how the unit is staffed. According to Lewin's Change Theory, what forces are in play to enact these changes? A. Refreezing forces B. Freezing forces C. Driving forces D. Restraining forces

C. Driving forces Rationale: Lewin's Change Theory gives us tools to discover what forces are helping or holding us back. Imagine the different factors that drive you closer to your goal. The first step in assessing environmental forces is to identify forces that are helpful. Lewin calls these forces "driving forces" because they drive you closer to your overall goals. Freezing forces, restraining forces, and refreezing forces are not associated with assessing environmental forces.

Which of the following best describes the key point(s) of Olson & Eoyang's self-organization theory? A. Nonlinear process B. Rational, normative, power C. Human nature and surprising effects. D. Patterns, moving target, and unpredictable. E. Precontemplation, contemplation, preparation, action, maintenance.

C. Human nature and surprising effects

Last month, two nursing units were merged to save on staffing costs. The nursing manager is now inquiring among the staff about how the change is working and if any barriers remain. What stage of change is this? A. Implement B. Plan C. Integrate D. Design

C. Integrate Rationale: The integration phase is when to evaluate how well an implemented change is working, and to ensure that it is merging solidly with the existing infrastructure. Designing, planning, and implementing are the three previous stages in the change process.

A nurse manager is assigned to a new unit due to issues of administrative mismanagement, which had resulted in staff becoming disillusioned as to the mission of the unit. As the unit manager, you are expected to develop new policies for the staff to follow. What is one of the greatest factors that may contribute to resistance of change on this unit? A. Anger B. Passivity C. Lack of trust D. Resistance

C. Lack of trust Rationale: Any type of change, especially the change in unit leaders, creates mistrust among subordinates. Immediate acceptance, trusting partnerships, and reassurance are not associated with initial change.

As the nursing manager of a unit, which key steps should be performed before implementing a change effort? (Select all that apply.) A. Delay gathering input from team members. B. Keep track of the pace and stress of the change. C. Use a roadmap as a guide to complete the change. D. Investigate the magnitude and complexity of the intended change. E. Encourage input from team members who would be impacted by the change.

C. Use a roadmap as a guide to complete the change D. Investigate the magnitude and complexity of the intended change. E. Encourage input from team members who would be impacted by the change. Rationale: Getting input from impacted teammates will ensure they buy into the process from the start. Getting a handle on how complex and broad the needed change is will ensure you plan enough budget, resources, and time to complete the project. Once you know the scope, schedule, and budget, creating a roadmap showing the intended steps along the way will help keep you on track and can also be used to keep others informed about progress.

Which are an organization's responsibilities for career management? a) Posting job opening externally b) Offering support and encouragement c) Dismissing education and training d) Determining the course of an employee's career

b) Offering support and encouragement Rationale: An organization has many responsibilities in career development, but each employee's needs, skills, and personal choices should also largely influence the course of his or her career.

1) As a nursing leadership student, you have had the opportunity to develop a palliative care manual that will be utilized by the palliative care network (PCN) in your region for teaching healthcare professionals. The PCN has requested that you provide a prioritized plan of action for marketing the manual on a regional and state basis. What is the first priority? a) Motivate the target market. b) Research the target market. c) Communicate benefits to the group. d) Package the product.

b) Research the target market

1) A rational-empirical change strategy would be most appropriate for which of the following change projects? a) Changing work hours. b) Adding additional work responsibilities c) Introducing time-saving technology d) Implementing a cross-training program.

c) Introducing time-saving technology

A staff nurse develops an innovative documentation system for post-op patients. The nurse manager grants the nurse paid leave to develop one for the medical patients. What type of power is the nurse manager using? a) Reward power. b) Expert power. c) Legitimate power. d) Informational power.

c) Legitimate power.

· What is the best example of a pediatric unit's organizational culture? a) All client rooms are private. b) Nurse-to-client ratio is 4 to 1. c) Nurses wear colorful scrubs. d) Primary nursing model is used for care.

c) Nurses wear colorful scrubs. i) Rationale: Organizational culture is based on norms and traditions such as nurses wearing colorful attire. Organizational climate is based on physical attributers and policy and procedures.

Which of the following is the correct definition of "chain of command"? a) Relationship without authority. b) The tendency for people to perform as expected. c) The hierarchy of authority and responsibility. d) Activity directed through linear authority

c) The hierarchy of authority and responsibility.

Which statement represents a powerful image of a team leader? a) "I'm in charge here, and so all requests need to come to me." b) "I'm too tired to deal with Dr. Jones today. When he gets here, tell him I've gone to lunch." c) "Is it oaky with the rest of you if I do all the charting and you do the direct patient care?" d) "We have a great deal to accomplish today, but I am confident that, by working together, we can do it and do it well."

d) "We have a great deal to accomplish today, but I am confident that, by working together, we can do it and do it well."

An organization can be defined as: a) Individuals with specific responsibilities. b) A group of people acting together to improve quality. c) A group of people striving to achieve a balanced budget. d) A group of people with a common purpose.

d) A group of people with a common purpose.

A female manager has worked hard in her career to reach a high position in the organization. What action by the manager will directly prevent her from developing the queen bee syndrome? a) Increasing accountability to subordinates. b) Aiming for an equal number of male and female subordinates. c) Emphasizing formal demonstrations of power rather than informal demonstrations. d) Working with other women to help them achieve similar success.

d) Working with other women to help them achieve similar success.

It is not necessary for the nurse leader to develop a budget cycle; the emphasis should be on assessing departmental needs. A. FALSE B. TRUE

A. FALSE Rationale: Although the nurse leader needs to assess departmental needs, he or she must identify the goals of the department and develop a budget cycle that provides the opportunity for the budget to be reviewed and revised as necessary to address changing needs.

Which of the following reasons for resistance to change can be classified as technical. Select all that apply. A. Unqualified personnel B. Values C. Control D. Budget Issues E. Organizational hierarchy F. Lack of resources

A. Unqualified personnel D. Budget issues F. Lack or resources

How employees perceive an organization is the: a) Organizational climate. b) Organizational culture. c) Organizational chart. d) Organizational structure.

a) Organizational climate.

Culture can be characterized by which of the following statements. a) Culture is under management's control. b) Culture is based on beliefs about group survival. c) Groups exert cultural control by reward and sanctions. d) Culture is based on perceptions that individuals have no control on the environment in the organization.

c) Groups exert cultural control by reward and sanctions.

The gap that exists between a position of authority and subordinate is often referred to as the ______. A. Expert-power gap B. Authority-power gap C. Referent-power gap D. Legitimate-power gap

B. Authority-power gap Rationale: The authority-power gap refers to the gap that sometimes exists between a position of authority and subordinate response

Which of the following is not included in the contemporary change process? A. Contemplation B. Evaluation C. Preparation D. Action

B. Evaluation Rationale: Evaluation is part of the nursing process, but the structured approach includes include precontemplation (no intention of change), contemplation (person considers change), preparation (intent to change), action (modification of behavior by individual), and maintenance (change is maintained).

Nurse leaders can use the nursing process to develop a budget for their unit or department. A. TRUE B. FALSE

B. FALSE Rationale: The budgeting process includes several steps such as the data-gathering process, which is a pivotal step when the nurse leader is attempting to develop a unit and departmental budget. The mission, goals, objectives, program priorities, financial objectives, and possible assumptions related to economics all must be considered.

What is the final stage in the change process? A. Plan - use a roadmap and ask questions B. Integrate - see if the change is working C. Design - get feedback from your team D. Implement - Investigate complexities and stress

B. Integrate Rationale: you check to see if the change is working. Integration occurs after the implementation stage, when the change is executed and you have the change to investigate the complexities and stress involved as the change is implemented.

Which of the following reasons for resistance to change can be classified as political? Select all that apply. A. Values B. Power C. Control D. Unqualified personnel E. Organizational hierarchy F. Lack or resources

B. Power C. Control E. Organizational hierarchy

What is the role of the change agent? A. Allows resistance to change to occur B. Seeks to lead or create change C. Delegates the change process D. Allows others to identify necessity of change

B. Seeks to lead or create change Rationale: The change agent is the individual who seeks and leads the change along with creating the change plan. The person usually does not delegate the change process, but the change agent leads the change process. The change agent communicates the necessity of the change to all stakeholders and attempts to prevent the amount of resistance that is to be expected.

Health care reimbursement affects both the operational budget and the departmental budget. A. FALSE B. TRUE

B. TRUE Rationale: Health care reimbursement directly affects the operational budget and the departmental budget. A variety of payment methods are available and guide patient reimbursement, which will directly affect health care organizational financial planning.

1) The best example of an internal force change is: a) Dissemination of research findings. b) Implementation of a federal or state law. c) A purchasing decision by management. d) Changing demands from insurance companies.

C. A purchasing decision by management.

Expenses that directly affect patient are: a) Direct costs b) Fixed costs c) Mixed costs d) Variable costs

a) Direct costs

The nurse manager is aware that there will be critical changes made to staffing due to low census in an acute care facility, and staff is already lacking trust in administration. What would be the best way for the nurse manager to handle the situation? A. Be truthful regarding the situation about staffing and census. B. Tell the staff that these things happen and administration will work it out. C. Be sure to inform staff not to spread rumors to perpetuate fear. D. Inform the staff that everything will work out for the best.

A. Be truthful regarding the situation about staffing and census. Rationale: When trust is low in a facility, staff will turn to the manager for answers. If the manager does not know the answers, tell the staff that and inform them they will be informed as soon as the manager knows. The manager should keep the lines of communication open and share as much information as is allowed. The manager should not use condescending responses such as "everything will be all right" or "it will work out for the best." Staff will spread rumors when they are uninformed about what is occurring, and informing them that they must stop will not stop the rumors.

Gender differences do not lead to power struggles in nursing. A. FALSE B. TRUE

A. FALSE Rationale: Power struggles can be a direct result of gender differences. Although they are fading in today's working environment, the socialization of men and women in their perspective female/male roles continues to impact the influence of gender on power.

A nurse manager is performing a daily assessment of staffing needs. Which types of nursing units can successfully use a predetermined standard of nursing staffing for the patient census? (Select all that apply.) A. General medical-surgical units B. Operating room C. Specialty care units D. Emergency department E. Home care

A. General medical-surgical units B. Operating room C. Specialty care units E. Home care Rationale: Predetermined standards of nursing care time and patient number can be used for inpatient hospital units, home care agencies, and operating rooms. Because the census is very highly variable in the emergency department, a predetermined staffing standard cannot be easily used.

A nurse manager is considering the reasons for the current problems with the health care system. Which are negative consequences of higher spending in health care? (Select all that apply.) A. Higher spending may result in overutilization of services. B. Higher spending guarantees a higher quality of care. C. Higher spending may result in overuse of technology. D. Higher spending may result in higher quality of care. E. Higher spending may result in duplication of services.

A. Higher spending may result in overutilization of services. C. Higher spending may result in overuse of technology. E. Higher spending may result in duplication of services. Rationale: Sometimes higher expenditures in health care result in duplication of services, overutilization of services, and overuse of technology. These are all negative outcomes of higher spending. Higher spending may result in a higher quality of care, and this would be a positive outcome of higher spending. Higher spending does not guarantee a higher quality of care.

Which of the following are factors that affect the ability to forecast the budget? A. Mission and philosophy of the organization B. Legislative climate C. Political culture D. Economics E. Social climate

A. Mission and philosophy of the organization B. Legislative climate C. Political culture E. Social climate Rationale: Factors such as the mission and philosophy of the organization, current political and economic culture, social and legislative climates may affect the ability of persons to forecast the budget.

Select the classic change strategies that nurse leaders use to apply the change process. (Select all that apply.) A. Normative-reeducative B. Contemplation C. Power-coercive strategy D. Rational-empirical E. Action

A. Normative-reeducative C. Power-coercive strategy D. Rational-empirical Rationale: Nurse leaders should approach change using a structured approach. Lewin (1951) and Burrows and Needs (2009) validated the existence of classic change strategies that are classified into the following categories: rational-empirical, normative-reeducative, and the power-coercive strategy; action and contemplation are part of the change process but not strategies in themselves.

What is the term for the notion that the person with the most direct control or influence on financial elements such as revenues, expenses, assets, and liabilities, should be held accountable for them? A. Responsibility accounting. B. Cost containment. C. Cost effectiveness D. Affordability accounting.

A. Responsibility accounting.

The budget uses numerical data to predict short- and long-term needs of an organization. A. TRUE B. FALSE

A. TRUE Rationale: The budgeting plan uses numerical data (quantitative data) to predict the short- and long-term needs of an organization; this process provides mechanisms for planning and control within the organization.

A nurse manager is performing a daily assessment of staffing needs. Which statements about calculating the NCH/PPP are most accurate? (Select all that apply.) A. The calculation should include all members of the nursing staff on duty. B. The calculation of the NCH/PPP absolutely determines staffing needs. C. The total staff for 24 hours is divided by the patient census at 12 a.m. D. The calculation includes the total staff for any 12-hour shift that day. E. The first step is to calculate the number of staff for the 24-hour period.

A. The calculation should include all members of the nursing staff on duty. C. The total staff for 24 hours is divided by the patient census at 12 a.m. E. The first step is to calculate the number of staff for the 24-hour period. Rationale: The first step is to calculate the total number of all nursing staff for 24 hours (including all three 8-hour shifts for nursing staff including the ward clerk) and then divide that by the patient census at 12 a.m. on day two. The standard is flexible to be adjusted for the staff mix and patient acuity.

A nursing manager is considering the budget for a nursing unit as compared with the overall institutional budget. Which is the most negative outcome of multiple nursing units "padding" or inflating their department budgets to cushion against administrative cuts? A. The entire institution's budget may be ineffective. B. Some units may not have access to adequate resources. C. All units will inflate their department budgets as a result. D. It will come out okay at the end of the budget period.

A. The entire institution's budget may be ineffective. Rationale: If some units inflate their department budgets, it may cause the entire institution's budget to be ineffective. Some units will stay on track with their budgets but some units will lack adequate resources. Budgets based on inaccurate predictions will also be inaccurate.

What is the primary purpose of law and legislation governing nursing practice? A. To protect the patient and the nurse B. To protect the nurse C. To protect the patient D. To protect the health care facility

A. To protect the patient and the nurse Rationale: The primary purpose of law and legislation governing nursing practice is to protect the patient and the nurse. These laws define the scope of nursing practice and also protect individual rights.

Diana is assisting an organization that is in a serious financial crisis. Programs, products, and services are all on the chopping block if she cannot prove their value to the organization. No value = no funding. What budgeting method will help Diana fix this fiscal crisis? A. Zero-based B. Incremental C. Performance D. Flexible

A. Zero-based

Diana is working for a facility which is innovating. She wants to help make sure they aren't going too far down a path of financial commitment without a demonstration of value. What budgeting method will help Diana provide checks and balances for a rapidly changing environment? A. Zero-based B. Incremental C. Performance D. Flexible

A. Zero-based

Which of the following reasons for resistance to change can be classified as cultural? Select all that apply. A. Values B. Organizational hierarchy C. Principles D. Control E. Lack of resources F. Beliefs

A. values C. Principles F. Beliefs

Diana is helping an organization that has gone through multiple periods of innovating, and is now in a place of processing change. She will be designing a budget where the only upcoming changes have to do with salaries and service rates. What budgeting method will help Diana manage these specific changes? A. Zero-based B. Incremental C. Performance D. Flexible

B. Incremental

A new nurse manager is learning about fiscal planning. Which are barriers for nurse managers' participation in fiscal planning? (Select all that apply.) A. Nurses are directly involved in fiscal planning. B. Nursing education lacks preparation in fiscal planning. C. Many nurses perceive that fiscal planning is difficult. D. Nurses lack the intuition necessary for fiscal planning. E. Nursing input in fiscal planning is undervalued.

B. Nursing education lacks preparation in fiscal planning. C. Many nurses perceive that fiscal planning is difficult. Rationale: Many nurses perceive that fiscal planning is difficult and most nursing education lacks preparation in fiscal planning. These are barriers to nursing involvement in fiscal planning. Nurse managers are expected to be expert financial managers. In the past, nursing input in fiscal planning was undervalued. Fiscal planning does not require intuition; it requires knowledge, experience, and forecasting.

Operational budgets are financial plans for the entire organization day-to-day operations. This type of budget includes which of the following? A. Supplies, expenses, and equipment purchases B. Payroll, supplies, and expenses C. Payroll, monthly expenses, and large purchase items D. Expenses, equipment purchase, and payroll

B. Payroll, supplies, and expenses Rationale: Operational budgets are the financial plans for the entire organization's daily activities. Day-to-day operations include payroll, supplies, and expenses. The capital expenditure budget's purpose is for purchasing large capital items such as equipment. The cash budget is the operating financial plan for the month, that is, monthly accounts bills and employee salaries.

A nurse manager is reviewing the budget for the nursing unit. Which budget covers the expenditures for the unit's workforce? A. Capital B. Personnel C. Operating D. Volume

B. Personnel Rationale: The personnel budget pertains to the workforce. A manager must monitor the personnel budget closely to prevent understaffing or overstaffing. The operating budget reflects expenses that change in response to the volume of service, such as the cost of electricity, repairs and maintenance, and supplies. The capital budget plans for the purchase of buildings and major equipment that has a long life, is not used in daily operations, and is more expensive than operating supplies. Volume is not an expenditure category.

Which of the following are steps included in the flexible budgeting process? (Select all that apply.) A. Determine the time period for the budget B. Separate the costs into fixed, variable, or mixed categories C. Forecast the cost for each of these categories of activities D. Analyze the cost patterns over that period of time E. List all current and proposed objectives and activities in the department

B. Separate the costs into fixed, variable, or mixed categories C. Forecast the cost for each of these categories of activities D. Analyze the cost patterns over that period of time Rationale: In the flexible budgeting process, you first must determine the time period for the budget. Next, you analyze the cost patterns over that period of time. Then, you separate the costs into fixed, variable, or mixed categories. Finally, you forecast the cost for each of the categories of activities. Listing all of the current and proposed objectives and activities in the department is a step in the zero-based budgeting process.

The nurse leader does not need to be concerned with the budgeting process steps. A. FALSE B. TRUE

B. TRUE Rationale: Steps in the budgetary process include assessing what needs to be included in the budget diagnose/identity a plan, implement the plan, and evaluate the plan.

A nurse manager is performing a daily assessment of staffing needs. When determining if staffing adjustments are needed, which data should the current NCH/PPP calculation be compared to? A. An average of the unit's NCH/PPP B. The budgeted NCH/PPP for the unit C. The unit's minimum NCH/PPP D. The unit's maximum NCH/PPP

B. The budgeted NCH/PPP for the unit Rationale: To determine if staffing adjustments are needed, the current NCH/PPP should be compared to the budgeted NCH/PPP for the unit. If the current NCH/PPP is greater than budgeted, staffing must be reduced. If the current NCH/PPP is less than budgeted, staffing must be increased.

A nurse manager is performing a daily assessment of staffing needs. If the current NCH/PPP is greater than the budgeted NCH/PPP for the unit, which action should be implemented to keep staffing on track? A. The nursing staff should remain the same for the current shift. B. The nursing staff should be reduced for the current shift. C. The nursing staff should be reduced for the coming shift. D. The nursing staff should be increased for the coming shift.

B. The nursing staff should be reduced for the current shift. Rationale: If the current NCH/PPP is greater than budgeted, staffing must be reduced. If the current NCH/PPP is less than budgeted, staffing must be increased.

A nurse manager is evaluating the current fiscal year budget. Which statement regarding the evaluation stage of the budgetary process is most accurate? A. The CEO is accountable for individual unit budgetary outcome. B. Budgets are usually created at the beginning and unchanged. C. Large variations from the projected budget must be examined. D. Most units will have no variation from the projected budget.

C. Large variations from the projected budget must be examined. Rationale: Usually, each unit will experience some variation from the projected budget. This must be monitored and the budget periodically adjusted. Large variations from the projected budget must be examined and corrective action taken. Individual unit managers are accountable for their unit's budgetary outcome.

A nurse has just been promoted to a managerial position in the ICU of a busy hospital and is worried that members of the nursing staff will not treat the nurse's requests with the same respect and seriousness as they did the requests of the previous manager, who was well-regarded. What behaviors would reinforce the new manager's authority and power in the eyes of the staff? (Select all that apply.) A. Withholding important information that might upset the staff B. Frequently delegating critical decisions C. Reminding staff how their efforts contribute to the unit's goals D. Demonstrating influence with the hospital's senior leadership team E. Practicing making outright commands of the staff

C. Reminding staff how their efforts contribute to the unit's goals D. Demonstrating influence with the hospital's senior leadership team Rationale: By demonstrating influence with the senior leadership team, the manager bolsters the perception among staff members that the manager's power is legitimate. In addition, by reminding the staff how their efforts and the manager's efforts are contributing to the unit's overall goals, the manager reinforces the belief among the staff that the manager is doing a good job and that the organization has their best interest in mind. If the manager frequently delegates critical decisions, the staff's level of trust in the manager will diminish. Also, because overusing commands can stifle cooperation, outright commands should be used only infrequently. Finally, the manager should be forthright with staff members and not withhold important information in order to maintain the staff's trust and respect.

A nurse-educator has a very narrow power-authority gap when interacting with students in the clinical setting. What negative student outcome may occur because of this narrow gap? A. The students will work independently without requiring educator input. B. The students will question everything the nurse-educator says. C. The students will question their ability to make independent decisions. D. The students will not be productive in their clinical day

C. The students will question their ability to make independent decisions. Rationale: The traditional nurse-educator has been portrayed as an authoritarian who demands unconditional obedience. Educators who maintain a very narrow power-authority gap reinforce dependency and obedience by emphasizing the ultimate calamity—the death of the patient. The nursing students may be socialized to be overly cautious and to hesitate when making independent nursing judgments. Questioning everything the nurse-educator says, decreased productivity, and working independently without educator input are examples of a wide power-authority gap.

A nurse manager is using a budgeting approach that requires justification for each budgetary need. What approach is being used? A. Flexible B. Incremental C. Zero-based D. Performance

C. Zero-based Rationale: The zero-based budgeting approach requires justification for each budgetary need. This method does not automatically assume that because a program has been funded in the past, it should continue to be funded. A flexible budget automatically calculates what the expenses should be, given the volume that is occurring. Performance budgets emphasize outcomes and results, instead of activities or outputs. Thus, the manager would budget as needed to achieve specific outcomes and would evaluate budgetary success accordingly

A nurse manager is preparing the annual budget for the coming fiscal year, and is considering what the goal is of using the allocated funds. What stage of the budgetary process is this? A. Evaluation B. Planning C. Assessment D. Diagnosis

D. Diagnosis Rationale: The diagnosis phase of the budgetary process considers what goal will be accomplished by using a cost-effective budget that maximizes available resources. The assessment phase determines what needs to be covered in the budget. The planning phase maps out the time frame in which the budget will be implemented. The evaluation phase is the final step in the budgetary process, in which the budget is reviewed periodically and modified as needed throughout the fiscal year.

Diana is facing a budgeting task where costs depend on how many units of service or product are used. What budgeting method will help Diana cope with unknown variables? A. Zero-based B. Incremental C. Performance D. Flexible

D. Flexible

A new nurse manager with limited budgeting expertise is considering what approach to use to determine the budget of the nursing unit for the upcoming fiscal year. Which approach would be the easiest to implement? A. Performance B. Flexible C. Zero-based D. Incremental

D. Incremental Rationale: The incremental budgetary approach is a simple multiplication of the current-year expenses times the inflation rate or consumer price index. It is easy and quick to implement and requires little budgeting expertise on the part of the manager. However, it is generally an inefficient approach fiscally because there is no motivation to contain costs and no need to prioritize programs and services.

A nurse manager wants to improve the efficiency and effectiveness of budgetary expenditures. Which budgeting approach would be the best to use in this situation? A. Flexible B. Zero-based C. Incremental D. Performance

D. Performance Rationale: Performance budgeting aims to improve the efficiency and effectiveness of budget expenditures by linking funding to results. The aim of zero-based budgeting is to provide justification for each budgetary need. Flexible budgets aim to accommodate changing population and manpower needs that are difficult to predict. The incremental approach projects a budget for the upcoming fiscal year by multiplying current expenses by the inflation rate or consumer price index

Identify a management function of time management. a) Determines the quality of work needed to be completed. b) Breaks down large tasks into smaller ones to be more manageable. c) Functions as a role model and resource persons to others when setting priorities for goal attainment. d) Filters or prevents interruptions to effective time management.

b) Breaks down large tasks into smaller ones to be more manageable.

Which of the following is NOT a rule for keeping power? a) Practice benign neglect b) Do your homework. c) Be competitive. d) Form alliances.

c) Be competitive. Rationale: you are already in a source of power. Showing competitiveness shows a sign of powerlessness.

The oncology unit has recently experienced a higher-than-normal patient census, which is requiring that nurses to pick up an additional patient. The hospital CFO has indicated that there are no additional funds available to hire additional full-time nurses. As such, the unit manager anticipates some behavioral responses by the stakeholders of change (the nursing staff) within the unfreezing phase. What are some possible behavioral responses? (Select all that apply.) A. Withdrawal B. Discontentment C. Passivity D. Anger E. Acceptance

A. Withdrawal B. Discontent D. Anger Rationale: During the unfreezing stage, people become discontented and even angry at the status quo. Ironically, they may also become angry and withdrawn because resistance is a normal and expected part of the change process. Open acceptance and passivity are not associated with the unfreezing phase of change.

Which of the following best describes the key point(s) of Burrowes and Needs' Stages Change Model? A. Nonlinear process B. Rational, normative, power C. Human nature and surprising effects. D. Patterns, moving target, and unpredictable. E. Precontemplation, contemplation, preparation, action, maintenance.

E. Precontemplation, Contemplation, Preparation, Action, Maintenance

A novice nurse-manager is frequently late for appointments. This manager's colleagues are likely to have what perception of the manager? I have no idea she never answered it.... a) The manager is overworked with too many responsibilities. b) The manager needs additional management training. c) The manager does not value other people's time. d) The manager lacks the skill necessary for the job.

There was no answer provided but I think it is C.

It is important for nurse leaders to establish a trusting relationship with those involved in the change process. FALSE TRUE

True Rationale: If the nurse leader establishes a trusting relationship through effective and open communication and requires participation in the change process, the nurse leader will decrease the amount of resistance. Planning a response to concerns is a crucial step to maintaining the relationship.

_______________ developed a theory which included the stages unfreezing, movement, and refreezing.

Kurt Lewin Rationale: Kurt Lewin developed change theory that provides nurse leaders with tools to become effective change agents. The stages of the change theory he proposed included unfreezing, movement, and refreezing.

The nurse leader should identify _____________ forces prior to attempting to implement change.

Restraining Rationale: Lewin described driving (facilitator) and restraining (barriers) forces. It is imperative that the nurse identify these facilitating factors prior to attempting implementation because barriers could prevent the implementation stage.

Resistance to change should be expected. TRUE FALSE

True Rationale: Resistance to change is to be expected. Resistance is found in the following categories: technical, political, or cultural. Fiscal restraints, lack of recourses, unqualified personnel, organizational resistance, and diversity often are causes of resistance.

The nurse leader should not only understand the change process but also understand how to adapt to various methods in order to become an effective change agent in their organizations. TRUE FALSE

True Rationale: To be an effective change agent, the nurse leader must understand and accept the change process as outlined by evidence-based practice. This understanding propels the nurse leader to apply the various stages along with providing tools for maintenance of the change.

1) Which statements if made by the nurse manager would demonstrate effective change management? Select all that apply. a) "We cannot lose sight of the mission and values of our institution as we begin to integrate these changes." b) "Although this task is going to be difficult, we have the full support of our hospital administration." c) "In order for this plan to work, everyone must agree to be a participant." d) "Let's wait until our administration as completed their reorganization before we implement change."

a) "We cannot lose sight of the mission and values of our institution as we begin to integrate these changes." b) "Although this task is going to be difficult, we have the full support of our hospital administration."

Which of the following nurses would be considered to have expert power? a) A nurse with extensive experience and specialized training in pre-operative nursing. b) A nurse-manager who dispenses favors to nurses who are willing to work overtime. c) A nurse whose dynamic and engaging personality makes it easy to create alliances. d) A nurse who is positioned high on the hospitals organizational chart.

a) A nurse with extensive experience and specialized training in pre-operative nursing.

1) The chief nursing officer has to write a strategic plan. The most difficult stage in the strategic planning process is: a) Assessment of the external and internal environment. b) Review of mission statement, goals, and objectives. c) Identification of strategies. d) Implementation of strategies.

a) Assessment of the external and internal environment.

1) Which change strategy is most appropriate when administration needs cooperation from all parties involved in the change? a) Empirical-rational. b) Power-coercive. c) Empirical-re-educative. d) Normative-re-educative

d) Normative-re-educative

Which one of the following best describes the key point(s) of Chaos theory? A. Nonlinear process B. Rational, normative, power C. Human nature and surprising effects. D. Patterns, moving target, and unpredictable. E. Precontemplation, contemplation, preparation, action, maintenance.

D. Patterns, moving target, and unpredictable

A nurse manager is considering revising the budget cycle for the nursing unit. Which budget cycle has the greatest probability for error? A. Short-sighted planning B. Calendar year budget C. Fiscal year budget D. Planning for the distant future

D. Planning for the distant future Rationale: Error is more likely if the budget is forecasted too far in advance. Short-sighted planning is more likely to result in lack of planning for major capital expenses and difficulty compensating for unexpected expenses. Most budgets are based on fiscal or calendar years

In Decentralized decision making: a) Many problems can be solved at the level they occur. b) Decisions. Are made by a few individuals at the top of the organization hierarchy. c) Communication is limited at different levels of the hierarchy. d) Decision making and responsibility are assigned to the highest practical managerial level in the organization.

a) Many problems can be solved at the level they occur.

1) An organization's budget is generally of little concern or importance to staff nurses? a) True b) False

b) False

Which budgeting approach can foster overspending? A. Incremental B. Zero-based C. Flexible D. Performance

A. Incremental Rationale: The incremental method multiplies current-year expenses by a certain figure, usually the inflation rate or consumer price index, and projects the budget for the coming year. Although simple, this method is often fiscally inefficient because there is no motivation to contain costs and no need to prioritize programs and services

How can a nurse leader bridge the authority-power gap? A. Prevent organizational chaos B. Use effective communication as needed C. Make a genuine effort to know and care for each individual D. Make an effort to legitimatize the authority of the position

C. Make a genuine effort to know and care for each individual Rationale: Subordinates better tolerate authority if they feel that the leader appreciates their individuality. Although effective communication is needed, it does not bridge the gap. The other choices do not assist in bridging the gap but are part of the nurse leader's role.

Diana is assigned to a unit that offers specialized services to their patients. She will be designing a budget to manager few variables, with clear measures of performance. What budgeting method would be appropriate for Diana to manage these limited variables? A. Zero-based B. Incremental C. Performance D. Flexible

C. Performance

1) A cost center is the smallest functional unit that generates expenses and revenues. a) True b) False

a) True

1) Resistance is recognized as a natural and expected response to change. a) True b) False

a) True

1) What is the expected outcome when acting as a change agent? a) Demonstrating management skills. b) Encouraging nurses to stick together. c) Improving client care. d) Guiding nursing practice.

C) Improving client care.

Choose the method of reimbursement that includes the cost of providing the service plus a markup for profit. A. Flat-rate B. Rate based on services rendered C. Cost-based D. Charge

D. Charge Rationale: Four major methods for reimbursement include charges, cost-based, reimbursement, flat-rate reimbursement, and rate based on services rendered. The charge method of reimbursement includes the cost of providing the service plus a markup for profit. In cost-based reimbursement, costs are calculated and used as the designated payable charges. Cost reimbursement includes those provided by government agencies and insurance companies. Flat-rate reimbursement is where a third party may decide in advance with the service payment will be. This payment is usually prospective in nature.

What behaviors should a nurse manager exhibit to narrow the power-authority gap that exists between the manager and the staff? (Select all that apply.) A. Being accountable B. Asking personal questions of your staff C. Withholding information about organizational and unit goals D. Holding others accountable E. Treating everyone the same

A. Being accountable B. Asking personal questions of your staff D. Holding others accountable Rationale: "Walking your talk" by being accountable and holding others accountable for their actions narrows the power-authority gap, as does asking personal questions to acknowledge people's uniqueness. While it sounds nice or fair in theory, treating everyone the same can widen the power-authority gap because it is not acknowledging the individual strengths and assets that each person brings to the situation. Finally, the manager needs to provide enough information about organizational and unit goals to subordinates so that they understand how their efforts and those of their manager are contributing to goal attainment.

A nurse manager informs the staff that if they do not increase productivity by 15%, there will be people losing their jobs. What form of power is the nurse manager displaying with the staff members? A. Coercive power B. Legitimate power C. Expert power D. Reward power

A. Coercive power Rationale: Coercive power is based on fear of punishment if the manager's expectations are not met. The manager may obtain compliance through threats (often implied) of transfer, layoff, demotion, or dismissal. Expert power is gained through knowledge, expertise, or experience. This type of power is limited to a specialized area. Legitimate power is position power. Authority is also called legitimate power. Reward power is obtained by the ability to grant favors or reward others with whatever they value.

A nurse manager is performing a daily assessment of staffing needs. Which data would be needed to calculate the NCH/PPP? (Select all that apply.) A. Patient census as of midnight on day two B. Staff on duty for 24 hours from 12 a.m. C. Census for the entire calendar year D. Staff on duty for 24 hours from 11 p.m. E. Work hours for each staff member on duty

A. Patient census as of midnight on day two D. Staff on duty for 24 hours from 11 p.m. E. Work hours for each staff member on duty Rationale: The data needed to calculate the NCH/PPP include the staff on duty for 24 hours from 11 p.m. on day one to 11 p.m. on day two; patient census as of midnight on day two; and the number of hours worked by each staff member on duty. A census for the entire calendar year is not necessary.

The nurse is a member of the nursing staff at a hospital that is undergoing significant organizational change. Which factor is the greatest contributor to the resistance encountered with organizational change? A. Employee mistrust of management B. Ineffective organizational management C. Poor organizational leadership D. Insufficient staff involvement in the process

A. employee mistrust of management Rationale: The greatest factor contributing to the resistance encountered with change is a lack of trust between the employee and the manager or between the employee and the organization. While other options may increase resistance, employee distrust is the primary barrier to change.

What are the two major expenses nurses control in the budgets of health care organizations? a) Supplies and home health care referrals. b) Supplies and personnel. c) Personnel and treatments. d) Personnel and length of stay

b) Supplies and personnel.

Which of the following refers to the system in which facilities join a payment system, whereby they receive a specified a fixed payment for each Medicare patient's admission, regardless of the actual cost? A. Both PPS and DRGs B. Diagnosis-related groups (DRGs) C. Neither of these D. Prospective payment system (PPS)

D. Prospective payment system (PPS) Rationale: The diagnosis-related groups (DRGs) are predetermined payment schedules; however, health care organizations with DRGs join the prospective payment system (PPS) to receive predetermined payment for each Medicare patient admission, regardless of actual cost.

Select some alternatives that could enable your nurses to move to a new comfort zone. Select all that apply. A. As the nurse leader, you could offer the opportunity for nurses to exchange shifts. B. The nurses could work together to figure this out on their own, saving you more time for real work. C. You could ask the nurses to consult with their families to prioritize which holidays are most important for them to celebrate together. D. You could tell the families to celebrate on a different day and stop being so demanding.

A. As the nurse leader, you could offer the opportunity for nurses to exchange shifts. C. You could ask the nurses to consult with their families to prioritize which holidays are most important for them to celebrate together.

Which of these factors are relevant to Lewin's Change Theory? Rules of implementation: (Select all that apply). A. Change should only be implemented for good reason. B. Change should never be gradual. C. All change should be unplanned, sporadic, and sudden. D. All individuals who may be affected by the change should be involved in planning for change

A. Change should only be implemented for good reason. D. All individuals who may be affected by the change should be involved in planning for change.

Environmental factors that influence health care can be restraining forces, driving forces, or both. From the factors given here, identify those that can be termed as driving forces. (Select all that apply). A. Education B. Generosity C. Economy D. Medical advantages E. Technology explosion F. New health care policies

A. Education B. Generosity D. Medical advances E. Technology explosion

A nurse manager is considering the use of critical pathways for a nursing unit. Which statement regarding critical pathways is most accurate? A. They can be used to monitor quality of care. B. They reduce the need for utilization review. C. They reduce the need for documentation. D. They accurately predict patient progress.

A. They can be used to monitor quality of care. Rationale: Critical pathways were originally developed to reduce the length of stay but also can be used to monitor the quality of care. Two disadvantages of critical pathways are that they require additional documentation and utilization review. Critical pathways are standardized and variances may occur in some patients. If a variance does occur, the variance should be analyzed.

Which of these factors are relevant to Lewin's Change Theory? Qualities of Change Agents (Select all that apply). A. Visionary B. Risk taker C. Flexible D. Creative E. Sensitive F. Current

A. Visionary B. Risk taker C. Flexible D. Creative F. Current

A nurse-manager makes lists of tasks for each day. What should the manager do in order to ensure that lists accurately reflect changes in priorities? a) Reevaluate the lists on a regular basis and adjust them as needed. b) Ensure that each day's list is significantly different from the previous days list. c) Make lists as detailed as possible in term of the time allocated and the specifics of each task. d) Have the lists reviewed by a trusted colleague on a regular basis.

a) Reevaluate the lists on a regular basis and adjust them as needed.

Regular data gathering from employees is an example of long-term coaching. a) True b) False

a) True Rationale: Long-term and short-term coaching includes data gathering in order to assess possibilities

Which of the following is not a capital expenditure? a) Three new infusion pumps costing $1,500 each for the medical unit. b) New furniture for the waiting room costing $15,000 c) Coffee and pop for the waiting room at a cost of $2,000 for the month of June. d) Two new stretchers for the ER costing $10,000 for each one

c) Coffee and pop for the waiting room at a cost of $2,000 for the month of June.

Advisory or staff relationships on the organization chart: a) Are depicted as unbroken lines. b) Denote the official line of command. c) Denote a relationship of information and assistance but not organization authority. d) Generally outnumber line relationships.

c) Denote a relationship of information and assistance but not organization authority.

What determines the size of the authority-power gap between a manager and an employee? a) The organizational philosophy. b) The degree of rigidity in the corporate chart. c) How credible the manager is perceived to be. d) How much informal power the manager possesses.

c) How credible the manager is perceived to be.

The nurse manager reviews salaries for the orthopedic technicians who are responsible for setting up traction for the orthopedic clients. The nurse manager explains to her technicians their position does not contribute to the charges the client incurs. This is referred to as: a) Fixed cost. b) Variable cost. c) Indirect cost d) Direct cost

c) Indirect cost Rationale: Efficiency variance is a reflection of the difference between budgeting and actual nursing care hours provided

Why can unity of command be difficult to maintain? a) It can be difficult to keep track of who one reports to. b) The organizational chart can be confusing. c) The multidisciplinary nature of healthcare makes it difficult to maintain.

c) The multidisciplinary nature of healthcare makes it difficult to maintain. Rationale: Unity of command is a simple system, but sometimes overly simplified in a complex field such as healthcare.

A nursing staff member who is on a unit committee to bring about a planned change is currently in the integrating phase of change. What activities are associated with the integrating phase? (Select all that apply.) A. Assessing how well the change is working against an established measurement for success B. Assessing how well the new process is accepted and becoming the norm C. Brainstorming solutions by using your own skills and the skills of those who will be affected by the change. D. Investigating the magnitude and complexity of the intended change as it is implemented E. Asking a lot of questions, such as "what can be done to overcome barriers?

A. Assessing how well the change is working against an established measurement for success. B. Assessing how well the new process is accepted and becoming the norm. Rationale: During the integrating phase, the goal is to see how well the change is working and the degree to which the new process is accepted and becoming the norm. Asking questions is part of the planning stage, and investigation during implementation actually is a part of the evaluation process. Brainstorming is part of the design stage.

Change should be immediately implemented if the need for change has been identified. A. FALSE B. TRUE

A. False Rationale: Lewin noted that change should be implemented for an established reason; however, it should be gradual to prevent resistance and provide the nurse leader with the opportunity to develop a plan for the change using the change process.

The charge nurse for a post-op treatment center believes that change needs to take place to make the nursing process smoother and the treatment center safer. The nurse's rationale for making change would include which reasons? (Select all that apply.) A. To improve staff productivity B. To establish leadership power C. To reduce unnecessary workload D. To fill work quotas E. To solve an existing problem

A. To improve staff productivity C. To reduce unnecessary workload. E. To solve an existing problem Rationale: Change should be implemented only for good reasons, such as the solution of an existing problem, increasing staff efficiency, eliminating unnecessary workload, or improving productivity. Filling work quotas or establishing leadership power is not a reason to implement change.

A nursing staff member in the ED has noted where improvement of a procedure would bring about more efficiency. The staff member wants to share their idea with their supervisor. What would be the best option to facilitate the possibility of change? A. Communicate within a vacuum. B. Schedule a meeting with your supervisor and submit a concise plan related to your idea for consideration. C. Minimize the use of grassroots support from other staff. D. Take initiative and implement the change without approval.

B. Schedule a meeting with your supervisor and submit a concise plan related to your idea for consideration. Rationale: Open communication is one of the best methods to facilitate change. Communicating within a vacuum, minimizing grassroots support, or avoiding following the chain of command are not methods that facilitate positive change

A nurse leader recently transferred to a different hospital that is much older than the hospital at which the nurse was previously employed. After working in the new hospital for a month, the nurse leader believes it would be a great idea to brighten the rooms with a lighter paint job, obtain newer hospital beds and curtains, and hang some fun artwork. However, the nurse leader doesn't want to be perceived as a threat to the team. How could these ideas be presented to minimize resistance? (Select all that apply.) A. Send a letter to the supervisor's boss and report failures of the unit. B. Engage other nurses in a discussion about the benefits of exam room aesthetics, then solicit their ideas to improve aesthetics. C. Tell the supervisor and demand the change. D. Make over one of the exam rooms and use it as a test case to collect data on patient satisfaction, then present the data along with the idea to the team if the experiment was successful. E. Engage other nurses in a discussion about the benefits of exam room aesthetics, then present the idea.

B, D, E Rationale: Getting other nurses involved in a discussion appeals to the rational-logical mindset. The nurses may then be interested to hear your ideas about improving aesthetics or be engaged enough to offer some of their own ideas. Getting your supervisor involved may feel like pressuring. Sometimes demos or prototypes provide "quick wins" that demonstrate the benefit of a change and can also identify unforeseen obstacles without having to address the change full scale. You should avoid jumping chain of command by going over the head of your supervisor as this can potentially set up division.

Which one of the following best describes key point(s) of classical social strategies for change? A. Nonlinear process B. Rational, normative, power C. Human nature and surprising effects. D. Patterns, moving target, and unpredictable. E. Precontemplation, contemplation, preparation, action, maintenance.

B. Rational, normative, power

A nurse leader is thinking about approaching their manager with a new idea. To be properly prepared, the nurse leader should recognize this as a natural and expected response to change: A. Acceptance B. Resistance C. Passivity D. Blockage

B. Resistance Rationale: Resistance is recognized as a natural and expected response to change, and when this point is understood, nurse leaders can plan for it and develop the skills and tools to manage it. Acceptance is not recognized as an expected response to change. Passivity and blockage are not recognized as natural responses to change.

What is the first stage in the change process? A. Plan - use a roadmap and ask questions B. Integrate - see if the change is working C. Design - get feedback from your team D. Implement - Investigate complexities and stress

C. Design Rationale: Design is the first stage in the change process. In this stage you collect feedback from your team.

A single parent raising two children and relying on public transportation, is determined to become a registered nurse. What are the restraining forces in this situation? (Select all that apply.) A. An advancement in medicine B. Student success center established within the nursing department C. Relying on public transportation D. Being a single mother E. Stress of being away from children

C. Relying on public transportation D. Being a single mother E. Stress of being away from children Rationale: Restraining forces are factors that may hold a person back from obtaining their goals. In this case, the stress of being away from their children, being a single parent, and relying on public transportation are factors of restraint. However, both driving and restraining forces that can influence a person's obtaining a goal. Advancement in medicine and the presence of a student success center are not restraining forces.

A nurse manager notices that supply carts are unorganized and could use some attention. What strategy can the manager use to help implement change in this area? A. Allow each individual to decide how he or she will make the change. B. Proceed slowly in making the change. C. Ensure that each subordinate knows there are no exceptions. D. Encourage input from subordinates for potential options.

D. Encourage input from subordinates for potential options Rationale: The nurse manager can encourage input from the team in order to promote change. Managers should immerse themselves in identifying and implementing strategies to minimize or manage resistance to change. One such method is to encourage subordinates to speak openly so that options can be identified to overcome objections. Change initiatives should be implemented uniformly; allowing each individual to decide how to make the change could lead the group in many directions. While all change efforts should be intentional, not all need to be made slowly. Finally, while the ideal is for implementation to be uniform, there are always exceptions.

The unit manager of a medical-surgical unit is transitioning the unit to electronic charting. According to Lewin's model, which of the following roles describes you as the change agent? A. The refreezer B. The mover C. The role player D. The unfreezer

D. The unfreezer Rationale: Even new or inexperienced nursing team members can be good at identifying areas that need change. This role is the unfreezer. The next step is the role of movement, where strategies are implemented to make change happen. The last step is the role of the refreezer, who brings stability and solidity to the new workflow. The role player is not associated with the transition stage as it relates to the change agent.

The nurse manager's goal is to adequately staff the unit and use minimal supplementary staff. The manager has added this to her operating budget. A colleague informs the manger it should be added to the: a) Personnel budget b) Operating budget c) Revenue budget d) Expense budget

a) Personnel budget Rationale: The personnel budget projects the salary costs that will be paid and charged to the cost center in the budget period.

1) Which indicates an integral part of implementing a change? a) Providing information and giving support for those undergoing the change. b) Ensuring there are no remaining pockets of disagreement when the change occurs. c) Pulling individuals who are not persuaded into a talk about the benefits of the change. d) Continually rewarding those working toward the change and ignoring those who are not.

a) Providing information and giving support for those undergoing the change.

A nurse-manager admits to feeling frustrated and confused by the fact that each day "just slips away," leaving many important tasks undone. How should the manager begin develop better time management skills? a) Identify a mentor who can plan the manager's schedule. b) Complete a time inventory to identify how time is used. c) Experiment with adjusting to the daily schedule. d) Request a temporary reduction in workload.

b) Complete a time inventory to identify how time is used.

Career development occurs in the early phases of one's work life, during the period of education, training, and job search. a) True b) False

b) False Rationale: Career development should be viewed as a lifelong process that can be accomplished through various means, including education, self-assessment, and experience.

Management development can be initiated in any level of an organization, independent of the administration. a) True b) False

b) False Rationale: Management development must be supported by top-level administration

The zero-base budgeting approach is best described as: a) Primarily adding to the costs and revenues generated the previous year. b) Justifying every proposed expenditure c) Allowing absolutely no variance from the approved budget d) A historical approach based on analysis of current income expenses

b) Justifying every proposed expenditure

Nursing Managers have the greatest impact on reducing costs by managing: a) Supplies b) Staffing c) Medication costs d) Fixed costs

b) Staffing

What is the goal of a budget? a) To predict an organization's activities b) To maximize the use of resources c) To help with planning and control. d) All of the above

d) All of the above

Which strategy is most effective in empowering staff? a) Serving as a role model of an empowered nurse. b) Following a rigid but consistent rule enforcement policy. c) Providing all employees with an annual cost-of-living raise. d) Encouraging staff to establish a strong unit culture with turf boundaries.

d) Encouraging staff to establish a strong unit culture with turf boundaries.

During the budgeting process nurse managers are typically responsible for all of the following except? a) Calculating workload b) Developing unit operating objectives c) Justifying capital equipment requests d) Predicting cashflow

d) Predicting cashflow

Organizational culture can be defined as: a) How employee's "perceive" an organization. b) The use of power by the organization to direct the work of others. c) The predictable stages of group development. d) The system of symbols, beliefs, values, history, and communication patterns unique to each organization.

d) The system of symbols, beliefs, values, history, and communication patterns unique to each organization.