leadership test 3 practice questions
Clinical incompetence is one of the more serious problems facing a nurse manager. Joyce, the nurse manager, is not aware of the problems of Sarah, a novice nurse. After she investigates, it is obvious that Sarah's peers are covering for her. Which of the following might Joyce include in her meeting with the nurses? (Select all that apply.) a. "It is a nurse's professional responsibility to maintain quality control." b. "All instances of clinical incompetence are to be reported." c. "It is not considered being disloyal when one nurse reports another for poor care." d. "Patient care is the number one concern. Meeting standards is mandatory and necessary."
a, b, c, d The nurse leader must remind employees that professional responsibility is to maintain quality care, and thus they are obligated to report instances of clinical incompetence, even when it means reporting a co-worker. Ignoring safety violations or poor practice is unprofessional and jeopardizes patient care.
Nurses entering the work force today are faced with which of the following relationships that could create organizational conflict? (Select all that apply.) a. Nurse-physician relationship b. Nurse-nurse relationship c. Nurse-patient relationship d. Nurse-chief nursing officer relationship e. Nurse-auxiliary personnel relationships
a, b, c, d, e By nature, conflict is potentially present in all interpersonal situations. The nurse manager should create an environment that recognizes and values differences in staff, physicians, patients, and communities.
Which of the following activities would represent a customer-friendly approach in a healthcare setting? (Select all that apply.) a. Using a local anesthetic before inserting a needle into a child's arm b. Repeating patient history information to the admitting clerk, the admitting nurse, and the ultrasound technician c. Ensuring that birthing preferences are on file and available in a laboring mother's chart d. Providing support to families when a family member is brought into trauma
a, c, d A service orientation means delivering services in a manner that is least disruptive. When possible, services should come to the patient and should be as easy, comfortable, pleasant, and effective as possible. Meeting the emotional, psychosocial, and spiritual needs of the patient is important.
As a manager, you are interested in developing behavioral questions for an interview. Knowing that there is team conflict at times on your unit, which of the following questions would satisfy your interest in behavioral questions? a. "Tell me about a time you were involved in a conflict related to a project. What was your role in the conflict? In the resolution of the conflict?" b. "If you were to employ one strategy for managing conflict, what would it be?" c. "What is your preferred style of conflict resolution?" d. "How effective are you in working in a group? In dealing with conflict?"
a. "Tell me about a time you were involved in a conflict related to a project. What was your role in the conflict? In the resolution of the conflict?" Behavioral questions seek demonstrated examples of behavior from the candidate's past experiences; behavioral-based interviewing can be a strong predictor of a future employee.
Because of the complexity of reimbursement systems and its implications for the services available to patients, the nurse has a key role in: a. advocacy for patients with regard to services required and services utilized. b. increasing the volume of services and decreasing the number of patients served. c. accomplishing more with each visit and decreasing the volume of services used. d. decreasing the volume of services used and the number of return visits.
a. advocacy for patients with regard to services required and services utilized The specific strategies employed by organizations and nurses to contain costs and increase revenues depend on the reimbursement system(s) within which the organization operates and therefore on whether the volume of services is increased or whether the volume of services is decreased by placing greater emphasis on efficacy in each visit and reducing the number of return visits. Because of the complexity of the reimbursement environment, the nurse is placed in a position of advocacy in terms of what the patient needs and how those needs can be best met within the funding structures.
Based on data from the patient satisfaction survey, the nurse manager decides that a change should be made in communication with family members. What would be important for a nurse manager to consider when instituting a change to improve customer service? a. assess the perceptions of the nursing staff regarding the specific service problem b. include community representatives on a planning committee to address the change c. involve physicians, other healthcare professionals, and ancillary staff d. review all patient complaints with the nursing staff
a. assess the perceptions of the nursing staff regarding the specific service problem Nurses are the healthcare providers who spend the most time with the consumer and are in an opportune position to understand the issues, structures, and processes that affect patients. The nurse acts as the primary person to be alert to circumstances that may prevent a successful outcome for the patient and to intervene on the patient's behalf. As a nurse manager, it is important to support staff in their use of power to be in control and to make decisions at the consumer-staff level of interaction.
A nurse educator is giving a workshop on conflict. During the sessions, he makes various statements regarding conflict. All of the statements are true except: a. conflict can decrease creativity, thus acting as a deterrent for the development of new ideas. b. horizontal violence involves those with similar status but little power in the larger context. c. interprofessional collaboration reduces unresolved conflicts. d. all conflicts involve some level of disagreement.
a. conflict can decrease creativity, thus acting as a deterrent for the development of new ideas The opposite is true because research has shown that conflict, like change, increases creativity and allows for the development of new ideas.
To reduce reliance on overtime hours, an organization develops a strategy for floating nurses during staff shortages. To maximize patient safety and reduce costs, the healthcare organization: a. develops a centralized pool of float nurses. b. assigns nurses from less busy units to ones with increased acuity levels. c. floats nurses only between units on which the nurses have been cross-trained. d. assigns float nurses to basic care only.
a. develops a centralized pool of float nurses A centralized pool usually includes experienced nurses who maintain a broad range of competencies. Other approaches are less satisfying for nurses, are less efficient, and may be less safe.
During unit staff meetings, you observe that Marg rolls her eyes and snorts whenever Julia makes a comment. Your first response as a unit manager is to: a. discuss what you have observed with Marg b. file immediate documentation in Marg's personal file c. ask Julie to monitor Marg's behavior during meetings d. ignore the behavior, as Marg is one of your stronger nurses
a. discuss what you have observed with Marg Incivility must be addressed. The initial step in addressing it is discussion with Marg, and if the behavior continues, then written documentation should be filed in Marg's personnel file. Monitoring and follow-up are your responsibility as the unit manager.
In reviewing the job description of a nurse manager, the staff becomes aware that a nurse manager's role is complex. Which of the following duties are required of a nurse manager? (Select all that apply.) a. Ensure unit productivity reports. b. Develop policy and legislation to protect nurses' well-being. c. Plan staffing of UNPs only. d. Prepare a unit budget that reflects unit staffing needs. e. Monitor nurse-sensitive indicators such as falls and incidence of infections.
a. ensure unit productivity reports d. Prepare a unit budget that reflects unit staffing needs. e. Monitor nurse-sensitive indicators such as falls and incidence of infections. a nurse manages financial resources by developing business and staffing plans
All of the following are grounds for immediate dismissal except: a. failing to pursue further medical help for a patient; patient dies. b. selling narcotics obtained from the unit supply of narcotics. c. restraining a patient in bed for 7 hours, unsupervised, as punishment for hitting a staff member. d. grabbing the unit manager and threatening further physical harm after a poor performance appraisal.
a. failing to pursue further medical help for a patient; patient dies Situations that may warrant immediate dismissal include theft, violence in the workplace, willful abuse of the patient, harassment, and chemical abuse.
The biggest challenge in the recruitment of staff is: a. finding well-qualified candidates who can function well within your particular work culture. b. recruiting individuals with the appropriate qualifications and experience. c. screening out candidates who are unable to function well within a team. d. determining if candidates have had previous negative experiences in a work environment.
a. finding well-qualified candidates who can function well within your particular work culture Choosing the right individual is the challenge for managers and involves finding qualified candidates who will work well within your culture.
In keeping with guidelines of the organization, the nurse manager documents staff problems. Documentation of disciplinary problems should: a. include a plan to correct them and to prevent future occurrences. b. state a detailed history of past problems that are related to the current one. c. be written at the convenience of the manager. d. not be discussed until the formal performance evaluation.
a. include a plan to correct them and to prevent future occurrences In documenting staff problems, it is important to identify the incident with an objective statement of facts and record actions taken to correct/prevent future problems.
During the performance appraisal session, the manager should: (Select all that apply.) a. maintain a relaxed and professional manner. b. inquire about the employee's personal life and how it is affecting performance. c. allow the employee to express opinions orally and in writing. d. plan to give specific examples only for poor performance.
a. maintain a relaxed and professional manner c. allow the employee to express opinions orally and in writing During a performance appraisal, it is important to provide examples of both strong and problematic performance and to provide opportunities to express opinions. The supervisor needs to maintain a relaxed professional manner.
After using a mediator to resolve a conflict between the nurse manager and two staff nurses, the chief nursing officer decides to: a. observe to make sure the conflict has been resolved. b. fire both staff nurses. c. reassign both staff nurses. d. reassign the nurse manager.
a. observe to make sure the conflict has been resolved The nurse leader should follow up to determine if the conflict has been resolved because, in professional practice environments, unresolved conflict among nurses is a significant issue that results in job dissatisfaction, absenteeism, and turnover, as well as in decreased patient satisfaction and poorer quality in patient care.
An example of an initiative that may reduce total healthcare costs would be: a. offering nurse practitioner-led clinics that educate parents about non-pharmacologic strategies for managing ear infections. b. educating seniors about the comparative costs of medications that are prescribed to them. c. lowering copayments for prescription drugs for seniors. d. advocating for more readily available MRI services to ensure early diagnosis.
a. offering nurse practitioner-led clinics that educate parents about non-pharmacologic strategies for managing ear infections. Total healthcare costs are a function of prices that are established for various services and the volume or quantity of services used. Utilization of high-tech diagnostic services and lowering of copayments have been implicated in increasing total healthcare costs (thus C and D would not be correct), as well as attitudes and behaviors of consumers of health care. In general, consumers prefer to "be fixed" when something goes wrong rather than to practice prevention. Many consumers still believe that the physician knows best, so they do not seek much information related to costs and effectiveness of different healthcare options. When information is sought, it is not readily available or understandable. Also, consumers are not accustomed to using other, less costly healthcare providers, such as nurse practitioners.
A nurse manager must also consider a number of internal variables that will affect staffing patterns. An internal variable to be considered is: a. organizational staffing policies. b. state licensing standards. c. American Nurses Association. d. consumer expectations.
a. organizational staffing policies State licensing standards outline what a nurse can do. Internal policies determine what a nurse may do in a particular setting as well as the amount of flexibility that is allowed to manage times of high and low volumes, as well as changes in acuity. Organizational policies can put the nurse manager in a situation where patient safety cannot be maintained or financial obligations met.
The difference between staffing and scheduling is that staffing: a. puts the right person in the right position. b. puts the right person in the right time and place. c. refers to the number of nursing hours per patient per day. d. looks after interpretation of benefits and compensation.
a. puts the right person in the right position Nursing staffing involves planning for hiring and deploying qualified human resources to meet the needs of a group of patients. Scheduling, on the other hand, is a function of implementing the staffing plan by assigning unit personnel to work specific hours and days of the week.
The chief nursing officer is pleased with the nurse manager's strategy of improving patient satisfaction in the pediatric intensive care unit. She decides to implement these changes throughout the hospital. What would be important to consider in implementing a new program focused on improving relationships with consumers? a. recognition of the nursing staff for excellence in promoting consumer relationships b. holding the staff accountable for resolving patient complaints c. selecting a staff nurse leader to implement the program d. identifying key staff members who have already demonstrated excellence in consumer relationships
a. recognition of the nursing staff for excellence in promoting consumer relationships The nurse leader should allow professionals more influence over their practice; give staff opportunities to learn new and varied skills; give recognition and reward for success and support and consolation for lack of success; and foster motivation and belief in the importance of each individual and the value of his or her contribution.
An outpatient clinic advertised for RN positions. Before authorizing an open position, the nurse manager should: a. review the position description and performance expectations for the opening. b. place an ad in the local newspaper and on the telephone job line. c. review all current applications on file. d. look for employees within the system who might best fill the position.
a. review the position description and performance expectations for the opening. The position description provides the basis for this position within the organization and communicates expectations for the role. When applying for a position, researching the facility and position description will help an applicant gain insight into the organization; therefore, the position description should be current and communicate expectations.
To maintain patient safety, studies suggest that scheduling should avoid: a. rotating shifts. b. weekends. c. 8-hour shifts. d. mandatory overtime.
a. rotating shifts Rotating shifts and overtime past 12 hours (mandatory or not) are being shown to increase nurse error and jeopardize patient safety.
Of the following, which is the most effective strategy that a nurse manager could employ to reduce unnecessary costs in specific healthcare settings? a. Training nurses on accurate documentation of supplies used for patient care b. Reducing the number of overtime hours worked by staff c. Reducing the number of staff on a unit d. Making decisions for patients about which care is important to their health
a. training nurses on accurate documentation of supplies used for patient care Reducing overtime hours needs to be carefully assessed against the reasons for overtime (e.g., staff overload, recent illnesses, increased acuity) in terms of whether this reflects an ongoing or temporary situation and therefore whether it is a necessary variance or not. Reducing staff may or may not be effective, depending on the services being provided. Making decisions for the patient misses an important opportunity to invite the patient into discussion about patient priorities and needs and relative costs of options, which may lead to improved adherence with regimens and less waste of resources. An effective approach to cost containment is ensuring that supplies are accurately accounted for and charged in a timely manner.
A nurse manager is planning to request three new infusion pumps at a cost of approximately $1500 each. What would BEST support the capital request? a. Number of patient care hours anticipated for the year b. Cost comparisons; how much and how often infusion pumps are used; condition of existing pumps c. Outline of cost for each pump d. Estimation of total cost; no further details
b. Cost comparisons; how much and how often infusion pumps are used; condition of existing pumps Complete well-documented justifications are needed because the competition for limited resources is stiff. Justifications should be developed using the principle of any business case and should include, at minimum, projected amount of use; services duplicated or replaced; safety considerations; need for space, personnel, or building renovation; effect on operational revenues and expenses; and contribution to the strategic plan.
Sue, a nurse manager, discusses her concerns about the hospital's employee appraisal system with her work group, noting that it includes only one rating scale and that it means nothing unless the manager has effective relationship skills. Sue's concerns reflect which best practices associated with performance appraisal? a. Rating scales are too generalized to be considered valid or reliable. b. The effectiveness of appraisal is enhanced by a combination of methods and effective communication skills. c. BARS is considered superior to simple rating scales in terms of performance appraisal. d. Rating scales need to be designed by users to be well accepted.
b. The effectiveness of appraisal is enhanced by a combination of methods and effective communication skills. A combination of several methods is probably superior to any one method. The primary success of any performance appraisal lies in the skills and communication abilities of the manager.
Within a healthcare environment, where the gap between revenues and costs can mean the difference between sustainability of an organization and nonsustainability of an organization or services, it is critical for nurse managers to: a. maintain a clear vision of how to trim healthcare costs b. balance value-added services against costs and revenues c. consistently delete programs that are of high cost d. implement programs that bring in additional revenues
b. balance value-added services against cost and revenues To achieve and maintain financial viability, nurse managers must be able to think strategically financially and in terms of nursing care. Cutting costs by deleting programs and bringing in additional revenue through new programs and services are not in themselves strategic unless the decisions made lead to quality care, have positive outcomes, and are efficient in terms of cost.
Before terminating an employee, a nurse manager must: a. be an expert in all legal aspects of termination and discipline practices. b. follow the organization's specific policies for addressing disciplinary problems and termination. c. function as a counselor for problem employees. d. do everything to assist and protect the employee by adjusting standards and policies.
b. follow the organization's specific policies for addressing disciplinary problems and termination It is important to know the policies of the organization to address disciplinary issues fairly and equitably, as well as to know the model that is employed to address employee problems. Human resource departments and legal departments are important sources for consultation, advice, and support.
John is an older adult patient who comes regularly to the multigroup practice in which you are a nurse practitioner. He says that he doesn't understand what he is supposed to be doing about his medications, because every time he comes to the clinic, he sees a different provider. John's experience represents what aspect of the current consumer experience? a. nurses are well-trusted members of the healthcare team b. fragmentation of care results in lack of respect and trust c. care providers often have conflicting ideas about care d. the public does not trust care providers other than nurses
b. fragmentation of care results in lack of respect and trust When consumers visit a multigroup practice, they do not have the option of selecting a specific healthcare provider, and thus, there is less opportunity to build a trusting relationship with a provider.
The chief nursing officer plans a series of staff development workshops for the nurse managers to help them deal with conflicts. The first workshop introduces the four stages of conflict, which are: a. frustration, competition, negotiation, and action. b. frustration, conceptualization, action, and outcomes. c. frustration, cooperation, collaboration, and action outcomes. d. frustration, conceptualization, negotiation, and action outcomes.
b. frustration, conceptualization, action, and outcomes Thomas (1992) determined that conflict proceeds through these four stages in this particular order.
The nurse manager must develop a patient satisfaction survey. What is one of the critical elements in selecting a patient satisfaction instrument? a. being able to use the same instrument for all clinical units b. including items that are important from the patient's perspective c. being able to administer the instrument before a patient's discharge from the hospital d. being sure that the reading level is no higher than third grade`
b. including items that are important from the patient's perspective Because satisfaction is a measure of service and service is a measure of perception of what matters to the patient, to measure satisfaction, surveys must include items that reflect the perspective of the patient. The quality of human contacts becomes the measure by which the consumer forms perceptions and judgments about nursing and the health agency. Consumers may not be able to evaluate the quality of interventions, but they always can evaluate the quality of the relationship with the person delivering the service.
The nurse manager analyzes the data from the patient satisfaction surveys. What can a nurse manager do to strengthen service recovery and improve consumer relationships? a. post comparisions of patient satisfaction scores with those other units monthly b. involve the staff in resolving consumer issues quickly and effectively c. ensure that staff members apologize to patients when they complain about services d. ask that patients with complaints about service place them in a written format
b. involve the staff in resolving consumer issues quickly and effectively Consumers need to be treated with fairness, given explanation, and provided with information about how errors will be prevented in the future. Staff can be assisted to respond to patient concerns through scripting, support, and an atmosphere that places an emphasis on learning and solutions rather than on blaming.
The chief nursing office of a Magnet® hospital has conducted a study of ways to improve healthcare services. Healthcare services that add value for clients: a. accomplish healthcare goals b. minimize costs c. decrease the number of services used d. use high-technology treatments
b. minimize costs Models of reimbursement affect which services and approaches (e.g., decreasing the number of services used) might be financially viable and add value for clients. It is critical to determine and advertise the value of nursing care. Services that add value are of high quality, affect health outcomes positively, and minimize costs.
A nurse manager understands that the second step in handling an employee with a disciplinary problem is to document the incident. Which of the following is best for documentation of personnel problems? a. Use of the performance appraisal on an annual basis b. Notes made immediately after an incident that include a description of the incident, actions taken, plans, and follow-up c. A tally sheet of medication errors and other specific problems that will be used at annual review d. Copies of reports, placed in his or her file, of all unusual occurrences involving the employee
b. notes made immediately after an incident that include a description of the incident, actions taken, plans, and follow-up In documenting staff problems, it is important to specifically indicate what rules were broken or violated, consequences if behavior is not altered, employee's explanation of the incidents, and the plan of action to achieve and to reach new goals.
Staff members on your unit raise concern that there is rising acuity on the unit and lack of responsiveness in addressing these needs through appropriate staffing. They point to increased incidences of adverse and sentinel events on the unit. To address this concern, your hospital organization would do best to: a. implement a patient-classification system immediately. b. participate in databases that compare the outcomes and staffing levels versus those of similar institutions. c. provide increased numbers of staff to the unit. d. ignore such concerns because acuity is variable.
b. participate in databases that compare the outcomes and staffing levels versus those of similar institutions. Staff morale suffers both when acuity models indicate a gap between staffing and acuity and when there is no model but perceived acuity that is not being addressed. A truer approach is to monitor patient outcomes and participate in national databases that measure staffing levels through comparison with like institutions.
A nurse staffing plan takes into account: a. specific nurse-to-patient ratios per shift. b. participation of nurses in projecting staffing needs. c. compensation and benefits for each level of staff. d. the occupancy load of a unit.
b. participation of nurses in projecting staffing needs Nurse staffing plans employ nursing judgment and flexibility that is based on acuity, nurse experience, and unit configuration rather than set nurse-to-patient ratios. The American Nurses Association has opted to support the nurse staffing committee as the approach to ensure safe staffing. In 2013, national legislation was introduced that requires all acute care hospitals to establish a committee made up of 55% direct care RNs.
Two staff nurses are arguing about whose turn it is to work on the upcoming holiday. In trying to resolve this conflict, the nurse manager understands that interpersonal conflict arises when: a. risk taking seems to be unavoidable. b. people see events differently. c. personal and professional priorities do not match. d. the ways in which people should act do not match the ways in which they do act.
b. people see events differently By definition, conflict involves a difference in perception between two or more individuals.
A group of staff nurses is dissatisfied with the new ideas presented by the newly hired nurse manager. The staff wants to keep their old procedures, and they resist the changes. Conflict arises from: a. group decision-making options. b. perceptions of incompatibility. c. increases in group cohesiveness. d. debates, negotiations, and compromises.
b. perceptions of incompatibility Conflict involves disagreement in values or beliefs within oneself or between people that causes harm or has the potential to cause harm. Conflict may result from the interaction of interdependent people who perceive incompatibility and the potential for interference.
The education consultant for the hospital is presenting a workshop titled "Documentation: A Manager's Responsibility." Which of the following points would she not include in her PowerPoint presentation? Documentation: a. cannot be left to memory. A notation must be placed in the personnel file. b. should avoid discussion of the problem. c. should include what was done about the problem when it occurred. d. needs to include date, time, and place.
b. should avoid discussion of the problem Documentation of personnel problems is one of the most important aspects of the nursing manager's role. Through carefully detailed and timely documentation of the problem and plan, the manager decreases the burdensome problems that can ensue from improper or inadequate documentation.
In a nurse managers' meeting, the chief nursing officer encourages the managers to brainstorm ways to reduce costs. Nurse managers have the greatest impact on reducing costs by managing: a. supplies b. staffing c. fixed costs d. medication costs
b. staffing Because staffing constitutes the largest portion of any healthcare budget, managing the mix and numbers of staff required for patient care to meet identified outcomes will have the largest impact on budgets.
A nurse manager uses many sources of data when planning the unit's workload for the year. Which of the following data must be considered in the planning? a. hours of operation of the unit b. trends in acuity on the unit c. max work stretch for each employee d. weekend requirements
b. trends in acuity on the unit Acuity levels are determined through classification systems, which determine the nursing resources required.
Incivility is a disruptive behavior or communication that creates a negative environment and interferes with quality patient care and safety. The manager can implement the following steps that help to alleviate uncivil behavior on a unit. (A) Suspending the staff member from work (B) Providing written admonishment that is discussed and placed in the employee's file (C) Providing verbal admonishment (D) Terminating the staff member
c, b, a, d The steps in progressive discipline are followed from the least severe (counseling the employee) to the most severe (termination). Studies have shown that following this sequence provides a fair and effective plan for discipline and remediation.
Which of the following might best conclude an interview? a. "Thank you for your interest. Someone will be in touch with you soon." b. "Before you go, we will make sure that we have your contact information. Thank you for coming." c. "I will be in contact with all candidates by telephone by next Friday. It has been a pleasure to meet you." d. "We have several excellent candidates so I am not sure about the outcome of the interview, but I will let you know. Thank you for coming."
c. "I will be in contact with all candidates by telephone by next Friday. It has been a pleasure to meet you." An employment interview should always conclude with information as to how and when follow-up to the interview will occur.
In a job interview for a staff position, which of the following indicates your knowledge of patient safety? a. "Will I be able to get overtime hours on your unit?" b. "If there is an opportunity to work extra shifts, I would really like that." c. "Is there a strategy in place to reduce the number of overtime hours on the unit?" d. "I see no reason why I wouldn't be able to work overtime."
c. "Is there a strategy in place to reduce the number of overtime hours on the unit?" Overtime, whether voluntary or mandatory, to fill staff vacancies is seen as a risk to both patients and nurses because it is more likely to lead to compromised decision making and technical skills because of fatigue.
In determining the fit of a candidate with the culture on your unit, which of the following interview questions might be asked? a. "Could you review your résumé for us, highlighting your certifications and experience?" b. "If we were to ask your references, what would they list as your strengths? Weaknesses?" c. "We have a number of older adult patients on this unit. If you noticed another staff member addressing one of these patients impatiently, how would you respond?" d. "Tell us about your work and academic experiences and qualifications."
c. "We have a number of older adult patients on this unit. If you noticed another staff member addressing one of these patients impatiently, how would you respond?" The nurse manager wants the most qualified individual for the position who also fits the culture of the organization. Asking behavioral questions in the interview allows you to assess how a candidate may function in real-life situations and to assess if this behavior is compatible with the culture on the unit.
In planning a new wing, the nurse manager complies with the workplace safety requirements of the Occupational Safety & Health Administration (OSHA). Which of the following groups is considered to be at high risk for violence in the workplace? a. pediatric staff b. postsurgical unit staff c. ED staff d. medical oncology staff
c. ED unit staff Nurse managers have responsibility for both patient and staff safety. High-risk areas, such as the Emergency Department, require special attention.
the complexity of the healthcare environment for consumers is increased by: a. falling levels of education among the public b. increased levels of poverty c. complex compensatory systems and a variety of delivery systems d. increased numbers of uninsured or underinsured
c. complex compensatory systems and a variety of delivery systems The complexity of options in health care and the processes and policies involved in funding health services for patients, as well as fragmented relationships with a growing variety of healthcare providers, contribute to the complexity of the system for patients, especially for those who might need it most, such as the poor, uninsured or underinsured, and homeless.
Scheduling is a function of implementing the staffing plan by assigning unit personnel to work specific hours and specific days of the week. To retain nursing staff, the nurse manager must incorporate into the schedule plan: a. all weekends off. b. all holidays off. c. a variety of scheduling options. d. rotating shifts.
c. a variety of scheduling options Creating a flexible schedule with a variety of scheduling options that leads to work schedule stability for each employee is one mechanism likely to retain staff, which is within the control of nurse managers.
The most important approach that a nurse manager can take with an emotionally troubled employee is to: a. act as a therapist for the employee. b. adjust the standard of care to assist the employee. c. assist the employee in obtaining professional help. d. adjust the employee's work schedule to decrease stress.
c. assist the employee in obtaining professional help Emotional difficulties are usually beyond the scope of skills that a nurse manager would normally employ. A referral needs to be made to a professional who is specifically prepared to deal with this kind of difficulty.
Nurses generally experience difficulty in identifying behaviors and actions that could signal chemical dependency in a co-worker. Which of the following is not a behavioral change that occurs with chemical dependency? a. Personality and behavioral changes b. Job performance changes c. Changes in educational involvement and pursuit d. Absenteeism
c. changes in educational involvement and pursuit A manager needs to be alerted when suspicions of chemical dependency are raised by behavioral changes in the employee. These include mood swings, changes in hygiene and appearance, heightened interest in the pain control of patients, frequent changes in shifts, increases in absenteeism, and increases in tardiness.
A factor evaluation system: a. utilizes financial data to determine number of staff-to-patient ratios. b. utilizes DRGs to determine acuity on a unit. c. combines interventions and time required for interventions to determine levels of care required. d. combines financial resources and nursing interventions to determine patient contact hours.
c. combines interventions and time required for interventions to determine levels of care required. A factor evaluation system considers tasks, thought processes, and patient care activities and gives them a time or rating. These are then used to determine the number of patient care hours required.
A nurse manager must be familiar with the agency's policies regarding termination. Termination procedures include which of the following? a. Following specific procedures from other organizations b. Having an attorney present at the termination meeting c. Having adequate written documentation to support the action d. Having a friend present during the termination meeting
c. having adequate written documentation to support the action All steps should be followed, including full appropriate detailed documentation and following the procedures of the organization.
Kala, a unit manager, in discussing a role the CEO would like her to perform, makes the following statement, "I will sit on the hospital task force on improving morale if you send me to the hospital's leadership training classes next week, so I can further develop my skills and thus be more effective." Which of the following conflict management styles is Kala using? a. Collaborating b. Avoiding c. Negotiating d. Accommodating
c. negotiation Negotiation involves an exchange of concessions (membership on a committee in return for attendance at a workshop) or trading. This strategy supports a balance of power.
A nurse manager approves two staff nurses to attend a national conference. When reviewing the budget, the nurse manager looks at which line item? a. cash budget b. capital budget c. operating budget d. supply and expense budget
c. operating budget The operating budget includes a personnel budget, which takes into account productive and non-productive paid work hours. Education hours are covered under nonproductive paid work hours in the operating budget.
A nurse manager understands that the typical first step in handling an employee with a disciplinary problem is a: a. verbal reprimand. b. written reprimand. c. reminder of employment standards. d. day off without pay.
c. reminder of employment standards The progressive model of discipline advocates that the first step of the disciplinary process is the informal reprimand or verbal admonishment. The nonpunitive discipline model advocates reminding the employee of the employment policies and procedures of the agency.
To prepare staffing schedules, a nurse manager needs to calculate paid non-productive time. When calculating paid non-productive time, the nurse manager considers: a. work time, educational time, and holiday time. b. paid hours minus worked hours. c. vacation time, holiday time, and sick time. d. paid hours minus meeting time.
c. vacation time, holiday time, and sick time. Non-productive hours are hours of benefit time and include vacation, holiday, and personal or sick time.
The American Nurses Association has advocated for the Registered Nurse Safe Staffing Act. This legislation is based on ANA Safe Staffing Principles and takes what factors into consideration for planning staffing on a nursing unit? a. Patient acuity and complexity b. Education and training of the nurses c. Technology available and use on the unit d. All factors listed are to be considered
d. All factors listed are to be considered ANA has opted to support the nurse staffing committee as the approach to ensure safe staffing. For the last decade, the ANA has advocated for a Registered Nurse Safe Staffing Act. The legislation is based upon the ANA Safe Staffing Principles (Box 13-2) and considers the following:RN educational preparation, professional certification, and level of clinical experienceThe number and capacity of available healthcare personnel Geography of the unit Available technology Intensity, complexity, and stability of patients
Which of the following exemplifies the predominant conflict management style of nurse managers? a. Elizabeth, the head nurse on neurology, finds that Tom, the RN nurse on nights, is irritable in relation to any suggestions or new ideas, and so she comes in to work after Tom leaves the unit. b. The technology committee has recommended a clinical system for implementation on the nursing unit. Staff is anxious about the change. Tim, the head nurse, asks staff for ideas on how to meet the technology goals and to meet staff needs. c. During management meetings, George, the head nurse on nephrology, dominates meetings and decisions. Lee, the head nurse on the cardiac step-down unit, begins to miss the management meetings. d. Ann, RN, asks her head nurse if she can go on the permanent evening shift. The head nurse, Rajib, agrees, as long as Ann agrees to be involved in assisting to mentor evening staff in the use of the new clinical information system.
d. Ann, RN, asks her head nurse if she can go on the permanent evening shift. The head nurse, Rajib, agrees, as long as Ann agrees to be involved in assisting to mentor evening staff in the use of the new clinical information system. Compromise involves trading and negotiation and is the predominant conflict management style of managers.
An older adult couple with limited means and on Medicare is considering options after the hospitalization of Mrs. A. with a fractured hip. Mrs. A. is stable but requires assistance with bathing, transfer, and mobility, and this will present stress for Mr. A., who was hospitalized with a mild myocardial infarction last year. Considering their means and health concerns, which of the following might be the best option? a. hospice care b. custodial nursing home care c. home care d. hospital care
d. Home care Custodial nursing care is not covered under Medicare and therefore, the financial burden of this option may cause further stress for the couple. Medicare Part A is an insurance plan for hospital, hospice, home health, and skilled nursing care that is paid for through Social Security. Because Mrs. A. is stable and not terminal, she does not require hospice care. The assistance provided through home care is covered under Medicare and provides assistance for needs such as those of Mrs. A.
Which of the following are considered variable costs? (Select all that apply.) a. Salaries for the minimum number of staff b. Utilities and rent c. Managed care d. Supplies e. Medication and treatment supplies
d. Supplies e. Medication and treatment supplies The total fixed costs in a unit are those costs that do not change as the volume of patients changes. In other words, with either a high or a low patient census, expenses related to rent, utilities, loan payments, administrative salaries, and salaries of the minimum number of staff to keep a unit open must be paid. Variable costs are costs that vary in direct proportion to patient volume or acuity. Examples include nursing personnel, supplies, and medications. PreviousNext
The turnover rate for RNs in the ICU is high. You discuss this situation with existing staff and you find out that because of the rapid turnover, new staff are frequently required to assume full responsibilities soon into the position and before training is completed. In considering approaches that will reduce turnover rates, the staff and you decide to implement: a. an employee recognition program. b. coaching for new staff. c. a new performance appraisal system. d. a committed orientation and training program.
d. a committed orientation and training program. Retention of new nursing personnel begins on the day of their hire. This includes an effective, appropriate orientation and training program, which has a measurable impact on reducing turnover.
In the past year, you have noticed an increase in patient falls on your unit. In reading studies related to staffing and patient outcomes, you realize that you will need to plan for: a. higher patient care hours. b. safer facilities. c. institution of a patient-classification system. d. an increased number of RN positions.
d. an increased number of RN positions Lower fall rates are shown to be related to higher total nursing hours and a higher percentage of nursing hours supplied by RNs.
Factors that influence the ease with which conflict is resolved include all except which of the following? a. Level of interdependence of the parties b. Interprofessional collaboration c. Expression of one's own needs and ideas d. Avoidance of the issue or concern
d. avoidance of the issue or concern Conflict involves a level of interdependence and is a condition for conflict but not necessarily for continuance of the conflict. Expression of one's ideas and concerns is considered assertive and effective in resolving conflict if the concerns and needs of the other are also considered. Interprofessional collaboration has been shown to be effective in resolving conflict. Avoidance tends to prolong and sometimes escalate confl
The head nurse and a staff nurse are having a conflict over how to use and apply a new procedure for dressings in the medical/surgical area. The staff nurse wishes to use the new procedure based on newly released nursing research. The head nurse wishes to use a protocol that has been used in the department for a number of years. The head nurse later makes comments to other staff on her unit about the credibility of the staff nurse. This behavior is associated with: a. lateral violence b. horizontal violence c. confrontation d. bullying
d. bullying Bullying involves aggressive or destructive behavior or psychological harassment of a recipient who is in a position of power differential with the perpetrator (the head nurse). Bullying is closely related to lateral or horizontal violence and involves such behaviors as incivility or intimidation.
A nurse manager is planning to request three new infusion pumps at a cost of approximately $1500 each. This item would typically be included in which budget? a. operating b. strategic c. unit of service d. capital
d. capital Items that have a useful life of longer than a year, which is likely with the pumps, and that have a cost that usually exceeds $300 to $1000 (specific amount is set by the organization) are considered capital items. Operating budget items include what is used on a day-to-day basis, such as staffing.
You have hired a new RN to replace a well-respected and experienced nurse in your outpatient department. The new RN recently graduated and is nervous about stepping into a role that was previously filled by someone who was so competent. You recognize anxiety and set up regular, frequent meetings during which you explore how she is dealing with her anxiety, provide feedback, and discuss strategies/ideas that will enhance her performance. What development approach are you using? a. Performance appraisal b. Counseling c. Empowerment d. Coaching
d. coaching The overall evaluative process can be enhanced if the manager employs the technique of coaching. Coaching is a process that involves the development of individuals within an organization. This coaching process is a personal approach in which the manager and the employee interact on a frequent and regular basis with the ultimate outcome that the employee performs at an optimal level.
Jill is the head nurse on a unit in a large hospital. Two of the staff nurses are constantly arguing and blaming each other, and a resolution has not occurred in months. To solve the existing conflict, which is the most creative conflict resolution? a. Avoiding b. Competing c. Compromising d. Collaborating
d. collaborating Collaboration, although time consuming, is the most creative stance. The collaboration technique involves both sides in the conflict working together to develop an optimal outcome. This results in a win-win solution.
Sarah is a nurse manager in a surgical unit. She is concerned about a conflict between Lucy (a staff nurse) and one of the maintenance personnel. Sarah explains to Lucy that unsatisfactory resolution of the conflict is typically destructive and will result in: a. decreased frustration between the maintenance worker and her. b. a good relationship with the maintenance department. c. eventual resolution of the problem without further intervention. d. decreased productivity on her part.
d. decreased productivity on her part Productivity decreases with destructive conflict, whereas constructive conflict strengthens relationships.
A nurse manager must consider a number of external variables when preparing the personnel budget and projecting the unit's staffing needs. An external variable to be considered is: a. organizational staffing policies. b. staffing models. c. changes in services that will be offered d. department of Health licensing standards.
d. department of Health licensing standards Licensing regulations of the state can determine staffing models. Staffing regulations can dictate the number of professional nurses required on a unit at any given time.
A nurse makes a medication error that is not serious and does not cause harm to the patient. As the charge nurse, your best action would be to: a. call attention to it by posting the critical incidents report at the nursing station b. include the mistake on the nurse's performance appraisal c. apologize to the patient for the error and indicate that discipline has occurred d. educate the nurse on how to provide an apology to the patient
d. educate the nurse on how to provide an apology to the patient Service recovery ensures responsiveness to the patient, and as part of service recovery, it is important to address an error in the most productive way, which also includes the nurse who made the error offering an apology to the patient.
The chief nursing officer decides to establish a client advocacy position in an oncology unit. Advocacy is best represented by: a. establishing private and professional networking systems b. asking social services to handle clients' concerns c. identifying community support groups d. empowering others by promoting self-determination
d. empowering others by promoting self-determination Advocacy involves empowering and promoting self-determination in others.
As part of orientation to your unit, you decide to administer Kolb Learning Style Inventory (LSI) to new staff. The most likely reason for your decision is that the use of Kolb LSI: a. reduces the cost of orientation. b. determines if there is fit between learner and organizational values. c. develops the strengths of the new staff member. d. enables individualization of learning to the learner's needs.
d. enables individualization of learning to the learner's needs. Administration of Kolb LSI enables identification of the learning styles of new employees, which assists in focusing the implementation of orientation goals and in individualizing learning to the needs and learning style of the employee
The chief nursing officer works with her nurse managers by helping them understand how to develop and implement a budget. A nurse manager can best describe a budget as a: a. day-to-day plan for operations b. unit of service c. statement of revenues and services d. financial plan
d. financial plan The budget is an overall financial plan that reflects organizational assumptions, objectives, and standards, and various types of budget planning, including operational and capital budgets, which, in turn, reflect revenues and costs.
The chief nursing officer understands that clinical incompetence is best prevented by a(n): a. flexible protocol for evaluating competency skills. b. standardized clinical skills checklist. c. administration of personality tests and competency assessments at point of hire. d. formalized competency program with established standards for practice.
d. formalized competency programs with established standards for practice The competency program with established standards of practice outlines what the nurse must do to achieve desired competencies in her current position. Competency assessment and goal-setting should help the nurse identify how to excel and which competencies the nurse wants to achieve in the future.
The nurse manager decides to use a mediator to help resolve the staff's conflict. A basic strategy for truly addressing this conflict is to: a. identify the conflicting facts. b. be determined to resolve the conflict. c. schedule a meeting time for resolution. d. have a clear understanding of the differences between the parties in conflict.
d. have a clear understanding of the differences between the parties in conflict It is important for each person in the conflict to clarify the conflict as "I see it" and how "it makes me respond" before all the persons involved in the conflict can define the conflict, develop a shared conceptualization, and resolve their differences.
The nurse manager on a pediatric intensive care unit wants to evaluate patient satisfaction. The nurse manager understands that ultimately, positive relationships with consumers of care are evaluated by the: a. cultural sensitivity of staff b. cost-effectiveness of care delivery c. economic value of service d. outcomes for clients and their perceptions of care
d. outcomes for clients and their perceptions of care Trend-setting organizations such as Magnet® organizations need to demonstrate excellence in outcome data such as patient satisfaction. Patient satisfaction and perception of the quality of care are affected by the quality of the nurse-patient relationship. Valid measurement of patient satisfaction is an evolving science; nurses do not always accurately gauge what factors are most important to patients. Satisfaction measures are often skewed in a positive direction with scores clustered at the top of the scale.
Which of the following factors is not implicated in rising healthcare costs? a. rising expectations of consumers for cure and care b. marketing of drugs to consumers c. large administrative staffs to process medical billings d. rising Medicare costs
d. rising Medicare costs Unintentional injuries, socioeconomic conditions (e.g., poverty and violence), marketing of pharmaceuticals, and the rising expectations of consumers with regard to what should be done to manage health concerns all contribute to rising healthcare costs. The costs of Medicare are not considered in relation to rising costs of health care.
Incivility is a disruptive behavior or communication that creates a negative environment and interferes with quality patient care and safety. The manager can implement steps that help to alleviate uncivil behavior on a unit. Which of the following would not be an appropriate first step? a. suspending the staff member from work b. providing written admonishment that is discussed and placed in the employee's file c. providing verbal admonishment d. terminating the staff member
d. terminating the staff member Dismissal does not enable the present organization to attempt remediation of the behavior and is not consistent with first steps in progressive discipline.
In trying to achieve Magnet® status, the chief nursing officer establishes a shared governance model to help nurses experience job satisfaction. However, some nurses who have enjoyed working with less autonomy resist this change and begin to criticize and make rude comments about managers who embrace this model, as well as colleagues who support it. The comments are largely ignored because those who are making them are well established nurses who are often vocal about their displeasure with the organization. Organizational conflict is arising from which of the following? a. Staffing practices b. Increased participation in decision making c. Allocation of resources d. Tolerance of incivility
d. tolerance of incivility Organizational conflict arises from discord related to policies and procedures (such as staffing policies and practices and allocation of resources), personnel codes or conduct or accepted norms of behavior (such as incivility), and patterns of communication. A major source conflict in organizations stems from strategies that promote more participation and autonomy of staff nurses.
The nurse manager knows that the most serious effect that absenteeism has on the nursing unit is that: a. using replacement personnel with new ideas may be beneficial. b. salary costs are lower because personnel are fewer, and outcome is favorable. c. absence on the part of the rest of the staff is decreased. d. unacceptable patient care may result.
d. unacceptable patient care may result. Reduced staffing adversely affects patient care. Employee morale suffers, care standards may be lowered, and additional stress is placed on working staff.