Mgmt Exam 2

A nurse-manager has established a new committee and will be chairing the committee. The committee consists of six representatives from various departments, at various levels within the organization. What goal should the committee members set? a. Creating a new organizational chart b. Adding four to six new members c. Emphasizing formal communication d. Implementing shared decision making

A nurse-manager has established a new committee and will be chairing the committee. The committee consists of six representatives from various departments, at various levels within the organization. What goal should the committee members set? a. Creating a new organizational chart b. Adding four to six new members c. Emphasizing formal communication d. Implementing shared decision making

After starting a new job, a nurse-manager has been surprised at the amount of grapevine communication that happens. The manager should recognize what characteristic of this type of communication? a. It is difficult to control or stop. b. It always involves verbal, face-to-face communication. c. It consists of negative and subversive messages. d. Strong organizations have policies that prohibit it.

ANS: A Feedback: "Grapevine" communication is informal and is difficult to control or stop. Consequently, policies that aim to ban it are unrealistic. This type of communication can involve all types of content, not just negative messages. The spread of easy, instant electronic communication means that it is not always verbal.

The Omnibus Budget Reconciliation Act of 1987 established regulations for the education and training of which category of health-care worker? a. Certified nurse aide (CNA) b. Registered nurse (RN) c. Licensed practical nurse (LPN) d. Ward clerk

ANS: A Feedback: Although the Omnibus Budget Reconciliation Act of 1987 established regulations for the education and certification of "nurse's aides" (minimum of 75 hours of theory and practice and successful completion of an examination in both areas), no federal or community standards have been established for training the more broadly defined NAP. LPNs and ward clerks are not addressed by this act.

How can the Internet be best used as a means of improving one's personal nursing practice? a. Accessing the latest research and best practice information b. Communicating with other health-care team members c. Minimizing the need for paper documentation d. Securing client information for confidentially

ANS: A Feedback: As an information source, the Internet allows nurses to access the latest research and best practice information so that their care can be evidence-based. It is not a secure form of communication in many cases. Electronic health records (not the Internet) replace paper records. It is not secure, so the Internet is not used as a confidential repository of client information.

A nurse-manager is orienting a new graduate nurse to the unit and has found this individual's charting regarding assessment to be inadequate. What is the most appropriate statement to initiate a discussion with the new RN? a. "I'm concerned that your assessment charting seems to be unclear. Can I help you with this?" b. "Unfortunately, your charting is inadequate in every way." c. "Do you think a refresher course in charting would help you?" d. "Are you having difficulty assessing your client?"

ANS: A Feedback: Assertive communication is not rude or insensitive, nor is it passive-aggressive. Backing up the communication to focus on the RN's intention is respectful and solution-oriented. The manager should not presume that the nurse is having difficulty with assessment unless there is evidence of this. The manager should avoid accusatory descriptors such as "inadequate in every way." Suggesting remediation would likely be premature before trying to work collaboratively with the nurse.

A nurse-manager has recently established a "best practice committee" at the clinic. Which behavior by the committee members suggests that it is in the "storming" stage? a. Members attempt to impress each other with their credentials. b. The short- and long-term goals for the group are agreed upon. c. Group members achieve their stated goals. d. The members receive their instructions and mandate from the manager.

ANS: A Feedback: Competition and posturing characterize the storming stage. Agreeing on goals occurs during norming, and these are accomplished during the performing stage. Initial instructions are given during the forming stage.

A health-care organization utilizes decentralized decision making. What will most likely happen when there is need for decisions to be made in the organization? a. A decision can be made at the lowest practical managerial level. b. The decision will be made by top-level managers. c. There is a potential that the decision will be made too quickly. d. It will be unclear who is ultimately accountable for the decision.

ANS: A Feedback: Decentralized organizational structure allows decision making to be made at the level at which problems occur. Decision making by top managers is more likely when decision making is centralized. Decentralized decision making does not necessarily lead to rash decisions or unclear accountability.

A new nurse-manager has been warned by colleagues about the prevalence of "the grapevine in the organization's communication." What is the manager's best initial response to this phenomenon? a. Seek to understand the patterns and contributors of this pattern of communication. b. Inform subordinates about the harmful effects of grapevine communication and that it will not be tolerated. c. Instruct subordinates to use formal patterns of communication rather than informal patterns. d. Use grapevine communication to disseminate messages that are accurate and respectful.

ANS: A Feedback: Given the frequency of grapevine communication in all organizations, all managers must attempt to better understand how the grapevine works in their own organization as well as who is contributing to it. It cannot normally be dictated into nonexistence, and the manager should avoid using this form of informal communication because messages can be easily distorted.

A nurse delegated some tasks to a nurse several hours ago. The manager has now learned that the nurse did not complete any of the delegated tasks. What is the manager's best initial action? a. Determine exactly why the nurse did not complete the delegated tasks. b. Assertively state the expectation that delegated tasks will be completed on time. c. Document the nurse's insubordination and arrange a private meeting. d. Take action to reestablish the authority power gap.

ANS: A Feedback: If an employee does not complete delegated tasks, the manager should assess the reasons for this before taking action. Addressing the problem before knowing the circumstances or the cause would be premature.

A nurse is in a conflict with a colleague, but both nurses are committed to collaboration. To promote collaboration, the nurses should: a. identify a common goal that is important to both of them. b. possess the ability to negotiate without having emotion get involved. c. have a relationship that existed before the conflict. d. ask a neutral third party to mediate in the conflict.

ANS: A Feedback: In collaboration, all parties set aside their original goals and work together to establish a supraordinate or priority common goal. This does not necessarily require the preexistence of a relationship or mediation. Collaboration is still possible even if the conflict has an emotional element.

A negotiating session has just concluded with a compromise agreement. What is the manager's best action? a. Clearly restate the terms of the compromise to all involved before dispersing. b. Give feedback to the members of the other negotiating team on their behavior and performance. c. Evaluate the fairness of the compromise to all involved parties. d. Restate each party's original bottom line.

ANS: A Feedback: Once a compromise has been reached, restate it so that everyone is clear about what has been agreed on. Giving feedback to others after negotiation is not a usual practice. The fairness of the compromise would be considered as it was negotiated, not after the fact. There is no benefit to stating the original bottom lines.

A nurse-manager has accepted a new position on a hospital unit. An experienced nurse on the unit tells the manager, "We all work really well with each other. There's never any conflict." How should the manager interpret this statement? a. The unit may be lacking in growth and new ideas. b. There is a need for the manager to introduce conflict. c. The manager needs to ensure that this characteristic continues. d. There is likely conflict that the nurse is not recognizing or acknowledging.

ANS: A Feedback: Some level of conflict in an organization appears to be desirable because it appears to prevent organizational stagnation. Despite this, it would normally be inappropriate for the manager to deliberately introduce conflict for the purpose of promoting growth. There is no reason to believe that the nurse's statement is untrue.

Feedback from a nurse-manager's peers suggests that the manager's face-to-face communication is often ineffective. The manager should consider what potential cause of this problem? a. Incongruence between the manager's verbal and nonverbal messages b. Ineffective listening skills on the part of subordinates and colleagues c. Inadequate formal training on communication skills d. Career stagnation by the nurse-manager

ANS: A Feedback: The incongruence between verbal and nonverbal messages is the most significant barrier to effective interpersonal communication. Ineffective listening skills on the part of the receivers may contribute to a perception of poor communication by the manager, but this would be unlikely to be the case among many different individuals. Many people never receive formal training on communication, but this does not necessarily inhibit them from becoming reasonably skilled communicators. Career stagnation would be a problem, but it would be less likely to affect overall communication skills.

Which action on the part of a unit's nurse-manager demonstrates the mark of a great leader? a. Acknowledging the accomplishments of staff members at the unit meeting b. Providing onsite in-services on new equipment for the staff c. Including funds in the unit's budget of staff development d. Stressing the importance of patient safety to all new employees

ANS: A Feedback: The mark of a great leader is when he or she can recognize the excellent performance of someone else and allow others to shine for their accomplishments. Although the other options are appropriate, they are not identified as being the mark of a great leader but rather an efficient manager.

Which assessment should the RN prioritize when assigning tasks to nursing assistive personnel (NAP)? a. Determining the NAP's skills and knowledge level b. Assessing which tasks the NAP is motivated to perform c. Evaluating the NAP's ability to follow instructions d. Asking colleagues to appraise the NAP's strengths and weaknesses

ANS: A Feedback: The nurse or manager must be knowledgeable about the skills and knowledge of all members of the health-care team. These variables are more important than the NAP's motivation, ability to following instructions, or personal attributes because they are more closely associated with client safety and the avoidance of liability.

A nurse-manager is new to the unit and is worried about being perceived as incompetent or underqualified by subordinates. The manager should recognize that this creates a risk for what problem? a. Underdelegating b. Overdelegating c. Improper delegating d. Inappropriate delegating

ANS: A Feedback: Underdelegating occurs when a manager has a false assumption that delegation may be interpreted as a lack of ability on his or her part to do the job correctly or completely. This insecurity may make the manager highly reluctant to delegate.

What strategy best increases the likelihood that a nurse-manager's communication will be accurately interpreted? a. Using more than one mode of communication b. Using face-to-face communication c. Producing clear, simple, written communication d. Repeating the message as often as possible

ANS: A Feedback: Using various communication methods in combination increases the likelihood that everyone in the organization who needs to hear the message actually will hear it. The other options are single methods. Repeating a message is often not as effective as communicating it in a different way using a different mode.

The nurse-manager has learned that two employees are in conflict. The manager's fact gathering reveals that the conflict exists because each employee misunderstands the job description and role of the other employee. What conflict management strategy should the manager implement first? a. Responsibility charting b. Confrontation c. Behavior change d. Third party consultation

ANS: A Feedback: When a supervisor delineates job duties to persons in conflict, it is called responsibility charting. This attempt at clearing up the misunderstanding should be attempted before resorting to other strategies.

An employee has come to the manager with a long list of complaints about a coworker, all of which are attributable to personality factors rather than unsafe practice. What is the manager's best initial action? a. Encourage the employee to speak directly with the coworker. b. Ask the employee to e-mail or text message the complaints to the coworker. c. Arrange for third-party mediation. d. Acknowledge and document the employee's complaints.

ANS: A Feedback: When team members inappropriately expect the manager to solve their interpersonal conflicts, managers can urge subordinates to attempt to handle their own problems by using face-to-face communication to resolve conflicts. This basic approach should be attempted before mediation. E-mails and text messages are too impersonal for interpersonal conflicts that can have significant conflict aftermath. Acknowledging and documenting the complaints offers no course of action to the employee.

An RN is leading a care team on a busy hospital unit. What tasks is the RN justified in delegating to NAP? Select all that apply. a. Feeding a client who has unilateral weakness b. Repositioning an immobile client every 2 hours c. Assessing a client's surgical wound d. Weighing a client who has chronic heart failure e. Transporting a client to a diagnostic test

ANS: A, B, D, E Feedback: Assessment is beyond the scope of NAP. However, NAP can appropriately feed, reposition, transport, and weigh clients.

The nurse-manager is overseeing a culturally diverse group of staff. The manager should consider what variables when planning delegation? Select all that apply. a. Communication style b. Concepts of time c. Intelligence d. Biological variations e. Social organization

ANS: A, B, D, E Feedback: There are six cultural phenomena that must be considered when working with staff from a culturally diverse background: communication, space, social organization, time, environmental control, and biological variations. Intelligence is not a cultural phenomenon.

Which of the following behaviors should the nurse-manager identify as workplace violence, incivility, or bullying? Select all that apply. a. A group of nurses consistently refuse to help a nurse when that nurse has a heavy workload, despite having time to do so. b. Staff members assign an unwanted nickname to a colleague. c. A nurse's specific vacation request is denied by the manager for 2 years in a row. d. A nurse asks a colleague to assess a known verbally abusive client without warning to see how the colleague will respond. e. A nurse tells a nursing student to rush to room 311, knowing that the unit has no room 311.

ANS: A, B, D, E Feedback: Workplace incivility can take many forms, including name-calling, refusing help, setting up a colleague for failure, or playing pranks. Vacation denials can happen for many reasons and would not necessarily constitute an uncivil act.

Max Weber, as part of the scientific management era, contributed immensely to the development of organizational theory. Which statements are representative of his beliefs? Select all that apply. a. Bureaucracy could provide a rational basis for administrative decisions. b. Worker satisfaction was integral to productivity. c. Organization charts could depict the hierarchy of authority. d. Impersonality of relationships should exist in organizations. e. Advancement and placement should be based on relationships.

ANS: A, C, D Feedback: Weber emphasized the impersonality of work relationships, the ability of bureaucracy to provide rational decisions, and the role of organizational charts. Max Weber's theories did not address worker satisfaction. Weber advocated promotions based on competence, not relationships.

A manager's subordinate is having difficulty carrying out a delegated task. What is the manager's best initial action? a. Release the subordinate from the task so he or she will not become demoralized. b. Be available to the employee as a role model and resource for the task. c. Assign another more experienced employee to help with the task. d. Reassign the employee a different, less complex task.

ANS: B Feedback: A manager should be available to the employee to help identify solutions to problems encountered with a delegated task and should encourage the employee to persevere. Taking back a task that was originally delegated is an absolute last resort. Reassigning and coassigning the task are options that are not initially considered, but which may be necessary later.

Two groups in the health-care organization have been unable to reach an agreement after prolonged negotiation. The groups have agreed to arbitration. What will happen during this process? a. A neutral party will facilitate new negotiations, starting from the beginning. b. A neutral party will listen to both groups and then present a binding recommendation. c. A neutral third party will act as a "go between" in the negotiations. d. Negotiations will continue in a court setting, and a lawyer will mediate between the groups.

ANS: B Feedback: Arbitration is a binding conflict resolution process in which the facts of the case are heard by an individual who makes a final decision for the parties in conflict. It does not involve repeating the negotiations and does not take place in a court setting.

Which principle should guide the nurse-manager's use of nonverbal communication? a. It is generally consistent across cultures, unlike verbal communication. b. It supersedes verbal communication when the two are incongruent. c. Nonverbal communication should be minimized because it confuses the receiver regarding the true intent of the message. d. Nonverbal communication is a significant part of the communication exchange only when it is not congruent with the verbal exchange.

ANS: B Feedback: Because nonverbal communication indicates the emotional component of the message, it is generally considered more reliable than verbal communication. It varies widely between cultures, and the manager does not normally have to make a conscious effort to minimize it. It is always significant regardless of how it aligns with the verbal message.

A nurse-manager is attempting to help a group of staff members reach a consensus on a sensitive issue. What is a consequence of using a consensus-based approach? a. One group will be perceived as the "winner" and one group as the "loser." b. It is likely that neither group will achieve their desired "ideal" outcome. c. A solution that is ideal to both groups will be selected. d. There is an increased risk for similar conflict in the future.

ANS: B Feedback: Consensus means that negotiating parties reach an agreement that all parties can support, even if it does not represent everyone's first priorities. Consensus decision making does not provide complete satisfaction for everyone involved, and the solution is unlikely to be described as "ideal" by anyone involved. Reaching a consensus does not involve an increased risk for future conflict.

A registered nurse has been leading teams of NAP for several years and will soon be leading licensed practical nurses for the first time. In preparation for delegating to these nurses, the RN should: a. delegate the same tasks to the LPNs that the RN normally delegated to NAPs. b. review the practical nurse scope of practice in the jurisdiction where they are working. c. ask each LPN what tasks he or she is comfortable performing. d. consult a decision tree for delegation to unlicensed assistive personnel.

ANS: B Feedback: Delegation to a LPN is different from delegation to a NAP. The parameters vary from state to state, and the RN should review the scope of practice. The LPN's comfort level is secondary to his or her knowledge, skills, and scope practice. A decision tree for delegation to unlicensed assistive personnel would guide delegation to NAPs, not LPNs.

The nurse-manager is chairing a committee, most of whose members are subordinates. When communicating with the members during meetings, the manager should: a. ensure their contributions are recorded for performance appraisal purposes. b. avoid overt demonstrations of power or authority. c. reserve the right to impose decisions on the committee. d. avoid informality in speech or writing.

ANS: B Feedback: During committee work, encouraging interaction that is free of status and power is important. Recording for performance appraisal purposes is likely to be intimidating for committee members. There is no reason for all communication to be formal in a committee setting.

A subordinate is reluctant to accept a task that the nurse-manager wants to delegate. The manager suspects that the subordinate's reluctance is due to a lack of self-confidence. What is the manager's best initial action? a. Teach the subordinate about the value of self-confidence. b. Try to empower the subordinate. c. Offer a reward to the subordinate in order to motivate. d. Restate the importance of the task to the subordinate.

ANS: B Feedback: Empowering the subordinate who lacks self-confidence is an appropriate initial action. If this is not possible, then reassigning the task may be necessary. Teaching about the need for self-confidence rarely instills self-confidence in those who lack it. Restating the importance of the task does not address the nurse's confidence level.

The nurse-manager has consulted the hospital information system to address a clinical issue. What characteristic is the hospital information system most likely to have? a. It is likely based on a social media platform. b. It is probably not freely available from the Internet. c. There is a high likelihood that it is out of date. d. It is probably accessible only from desktop computers, not wireless devices.

ANS: B Feedback: For security and confidentiality purposes, hospital information systems are typically not available to all on the Internet. However, they have the advantage of being easy to update and are more likely to be up to date than paper-based equivalents. These systems would not be hosted on a social media platform due to security risks. They can often be accessed wirelessly, provided the user has access to the secure network.

A charge nurse has assisted two employees to resolve their conflict, with the outcome being that the two opposing goals were discarded and new goals were adopted. What is this an example of? a. Smoothing of conflict by the leader b. Facilitating collaboration c. A majority rule approach d. A good lesson in compromising

ANS: B Feedback: In collaboration, all parties set aside their original goals and work together to establish a common goal. In promoting collaboration, the charge nurse has not simply smoothed over the conflict. The formation of new goals differentiates between collaboration and compromise. There is no evidence that a majority rule approach has been taken because there are two parties involved.

A health-care organization has laid off several RNs and hired numerous NAPs in their place. What effect is this change most likely to have on the remaining RNs? a. There will be a risk of the RNs underdelegating. b. The RNs' level of liability will increase. c. Cultural variables will become a larger consideration. d. The RNs' scope of practice will become expanded.

ANS: B Feedback: In general, increasing delegation to NAPs increases the scope of liability for the RN. There is no reason why this change in staffing would create a risk for underdelegating or make culture a more salient concern. The RNs' scope of practice is enacted in the jurisdiction's nurse practice act and is not affected by this change.

A manager needs to delegate some tasks. What consideration should the manager prioritize when identifying the appropriate person to whom to delegate a specific task? a. Whose turn it is to delegate a task b. The qualifications of the person regarding the task c. The fiscal cost of delegating the task d. Whether the person has experience with similar tasks

ANS: B Feedback: Managers should ask the individuals to whom they are delegating if they are capable of completing the delegated task. If the person lacks the appropriate qualifications, the fact that he or she has experience is irrelevant. The manager should not base delegation decisions primarily on whose turn it is or on cost.

Which personal characteristics will best help meet the psychological needs of conflict negotiation? a. Perseverance and assertiveness b. Calmness and self-assuredness c. Compassion and reflectiveness d. Organization and self-reflection

ANS: B Feedback: Negotiation is psychological and verbal. The effective negotiator always appears calm and self-assured. The other options are not as impactful when considering the psychological aspects of the negotiation process.

A hospital is downsizing, but the RNs have been assured that everyone on the unit will keep their jobs and that downsizing will occur through normal attrition. Today, the evening charge nurse reported to the manager that the staff was discussing rumors about mass layoffs. What is the best approach to take? a. Tell an informal leader the truth and let the leader spread the news informally. b. Hold a meeting for all staff members and tell them that the rumor is not true. c. Ignore the rumor because it will soon pass. d. Find out who started the rumor and correct the information.

ANS: B Feedback: Nurse-leaders should intervene appropriately when communication problems (in this case, rumors) arise. It is not particularly important who started the rumor if all staff members are now privy to it. Direct action is preferred to indirect action, such as introducing a competing message. Inaction would likely fuel the rumors.

A nurse-manager is engaged in a negotiation with staff representatives when the discussion becomes controlled by a particularly aggressive member. Which action will the nurse-manager take to assure that the process is successful? a. Ask that the aggressive individual recognize the rights of all the other members. b. State, "I need to have time to think over all that we have discussed." c. Halt any discussion until new representatives can be appointed. d. Share with the members that aggressiveness negatively impacts the negotiations.

ANS: B Feedback: Some people win in negotiation simply by rapidly and aggressively taking over and controlling the negotiation before other members realize what is happening. If managers believe that this may be happening, they should call a halt to the negotiations before decisions are made. Saying simply, "I need to have time to think this over" is a good method of stopping an aggressive takeover. The other options are much less effective and may even lead to increased aggressiveness among team members.

The nurse is caring for a postoperative client whose pain is not being relieved by the current analgesia regimen. When using the SBAR model for communicating with the client's health-care provider, how should the nurse best address the "A" component of the model? a. "The client is postoperative day 2 following total hip arthroplasty." b. "The client's pain control might be inadequate because she's been rating it at 9 out of 10 for the past hour." c. "The client also has type 2 diabetes and atrial fibrillation." d. "An increase in her hydromorphone dose is probably a good idea."

ANS: B Feedback: The "A" in the SBAR or ISBAR model denotes "assessment," in which the nurse summarizes the client's condition and states what the problem likely is.

The nurse is caring for a client with a diagnosis of chronic obstructive pulmonary disease and who is experiencing a new onset of dyspnea. When contacting the client's care provider, the nurse should state the client's admitting diagnosis in what stage of the SBAR tool? a. S b. B c. A d. R

ANS: B Feedback: The "B" in the SBAR tool denotes "background." This is the stage of the tool where the nurse communicates the clinical context, including the client's diagnosis.

Which nursing action demonstrates compliance with the American Nurses Association (ANA) principles for social networking by nurses? a. Strictly avoiding the use of social networking in a professional setting b. Participating in the development of institutional policies governing online conduct c. Ignoring any information that appears to have the potential to harm a patient's welfare d. Realizing that social networking is not related to a nurse's professional boundaries

ANS: B Feedback: The ANA has developed principles for social networking that include participation in policy development, nurse-patient boundaries, separating personal and professional online information, and reporting to authorities when patient welfare has been potentially harmed. There is not an absolute prohibition against the use of social media in a professional setting, but it must adhere to strict guidelines.

A nurse-manager was involved in conflict where the other individual adopted a competing approach. This approach is evident in what circumstances? A. When fair play is important to all involved parties b. When one party wins at the expense of the others c. When managers need to control a volatile situation d. When an appropriate political strategy is necessary

ANS: B Feedback: The competing approach is used when one party pursues what it wants at the expense of the others. Because only one party typically wins, the competing party seeks to win regardless of the cost to others. Neither manager control nor political strategy is necessarily associated with the competing approach to resolving conflict.

What statement about conflict most closely reflects the interactionist theories of organizational conflict? a. "The most important response to conflict is to deal with it immediately." b. "Conflict can actually be a good thing and can help us to grow." c. "The presence of conflict in our workplace shows that there is bad management." d. "The best organizations are places where there is no conflict."

ANS: B Feedback: The interactionist movement encouraged organizations to promote conflict as a means of producing growth. Interactionist did not see conflict as evidence of bad management or dysfunction. Interactionists did not particularly emphasize the need to deal with conflict immediately.

The manager has learned that some of the more experienced nurses on the unit have been playing pranks on a newly hired nurse and delegating their most challenging tasks to the nurse. What is the manager's best response after confirming that these events took place? a. Offer support and encouragement to the newly hired nurse. b. Confront the more experienced nurses directly about their behavior. c. Implement a structure change so the experienced nurses no longer work at the same time as the new nurse. d. Arrange for third-party consultation involving the more experienced nurses, the manager and the new nurse.

ANS: B Feedback: The manager must address bullying directly and promptly. The nurse should also offer support to the bullied nurse, but the priority is addressing the behaviors. Separating the group from the individual or having mediation may eventually be necessary, but the manager would first confront the behavior.

A nurse-manager is participating in negotiations around the allocation of resources in the organization. During the negotiations, the manager should: a. try to speak the same amount or slightly more than the other party. b. use open-ended questions rather than yes or no questions. c. declare his or her bottom line at the start of negotiations. d. ensure that the negotiations proceed at a rapid pace.

ANS: B Feedback: The manager should encourage the other negotiator to talk by asking lots of open-ended questions that cannot be answered with a simple "yes" or "no." It is not beneficial to openly declare the bottom line before negotiations have even begun. The manager should listen 70% of the time and talk only 30% of the time. Speed is not a goal during negotiation and can lead to hasty decisions.

A member of a work group that the nurse-manager leads is aloof and dismissive of the group's role. The member has occasionally made jokes during serious discussions and seems skeptical that the group will meet its goals. What role is this member playing? a. Blocker b. Playboy c. Dominator d. Recognition seeker

ANS: B Feedback: The playboy remains uninvolved and demonstrates cynicism, nonchalance, or horseplay. The blocker persists in expressing negative points of view and resurrecting dead issues. The dominator attempts to control and manipulate the group, whereas the recognition seeker works to focus positive attention on himself or herself.

A large health-care organization has struggled to meet mandated electronic health record (EHR) standards. What actions address the likely challenge that this organization is facing? Select all that apply. a. Improving communication between managers at the organization's various sites b. Increasing the organization's budget for technology c. Investing more in employee training d. Engaging clients and families with the process e. Increasing the use of evidence-based practice

ANS: B, C Feedback: Many of the challenges faced during the adoption of EHRs involve inadequate technology and training. Communication between managers has not been identified as a major hurdle. Evidence-based practice enhances client care but does not directly address challenges around EHRs. Similarly, engaging clients and families greatly benefits the care that nurses provide but not the adoption of EHRs.

The nurse-manager has been approached by an angry employee whose vacation request was denied. What should the manager do when communicating with this employee? Select all that apply. a. Tell the employee that anger will not be tolerated and then leave the situation. b. State, "I understand that you are angry that your vacation request wasn't approved." c. Allow the employee sufficient opportunity to express what she wants from the manager. d. Tell the employee how her mode of communication is hindering the message. e. Ask the employee, "Are you accusing me of bullying you by turning down your request?"

ANS: B, C Feedback: When dealing with an emotional employee, the manager should allow the employee time to express what he or she wants and to make statements that reflect back the employee's message. The manager should not terminate the interaction unless there is a plausible safety risk. Telling the employee how her tone is hindering communication and asking whether the employee is accusing the manager are likely to escalate the situation, further harming communication.

A nurse-manager has begun a new role in a community health center and will need to delegate tasks often to subordinates. What actions should the manager perform when delegating tasks? Select all that apply. a. Choose the most time-consuming tasks to delegate to subordinates. b. Evaluate the skills and education of subordinates before delegating. c. Ensure that subordinates know the goal of any delegated task. d. Avoid monitoring the subordinate unless there is evidence of a problem. e. Evaluate subordinates' performance after they have completed a task.

ANS: B, C, E Feedback: Safe and effective delegation involves evaluating the skills and education of staff, identifying goals clearly, and evaluating performance after completion. Tasks should not be selected for delegation on the sole basis of being time-consuming for the manager. Monitoring is appropriate and necessary and is not reserved just for problems or emergencies.

A nurse-manager has delegated some administrative tasks to an experienced RN. How does this act of delegation differ from the usual practice of assigning work to subordinates? Select all that apply. a. The nurse's task will be beyond his or her scope of practice. b. The manager transfers the authority for the task to the nurse. c. The nurse is practicing on the manager's license. d. The manager is released of the need to oversee the nurse. e. The manager remains accountable for the task.

ANS: B, E Feedback: In delegation, the individual transfers the authority to perform a specific activity from their own practice, to an individual qualified to perform that task, but retains accountability for the delegated task. Delegation does not involve going beyond the nurse's scope of practice, and there is still a need for oversight. The nurse does not perform on someone else's license when completing delegated tasks.

A performance appraisal states that the manager often underdelegates. What is potential cause of this delegation error? a. A high degree of trust in subordinates b. A democratic leadership style c. A need for perfectionism d. Sufficient time to accomplish unit goals alone

ANS: C Feedback: A manager with a need for perfectionism and control may believe that another person will not complete a task. Trust in subordinates and a democratic leadership style would support effective delegation. Delegating should not be based on the issue of time exclusively.

A nurse-manager has a reputation as being an assertive communicator. How does this manager most likely communicate? a. Through confrontation and intimidation b. In an unfeminine way that is clear and direct c. Directly and honestly, while respecting the rights of others d. In a clear, but occasionally offensive, manner

ANS: C Feedback: Assertive communication allows people to express themselves in direct, honest, and appropriate ways that do not infringe on another's rights. It is a myth that assertiveness is "unfeminine," offensive, or confrontational.

The RN overhears the nurses' aide speaking in a harsh tone to a client with early Alzheimer's memory loss. Which statement should the RN make to begin addressing this issue? a. "You must remember to watch your tone of voice with clients. Someone might overhear." b. "Do you think it would be a good idea to have an in-service on dealing with Alzheimer's patients?" c. "I am concerned about your conversation with the client. It sounded short and impatient." d. "I have decided to reassign that client to another aide."

ANS: C Feedback: Assertive communication effectively identifies and addresses an issue without being rude, insensitive, or passive-aggressive. None of the remaining options actually identifies the specific communication problem.

A middle-manager who oversees the operations of several nursing units has a high degree of organizational centrality. What is most likely true about this manager? a. The manager is isolated from top-level managers. b. The manager interacts with a comparatively small number of coworkers. c. The manager receives much communication from varied directions. d. There are more middle-level managers than first-level managers in the organization.

ANS: C Feedback: Centrality is a position on an organizational chart where it is possible to have many different types of communication (upward, downward, lateral, and diagonal). This does not suggest that there are more middle-level managers than lower level managers or that this manager is isolated from his or her superiors.

Which statement best defines conflict? a. It involves an internal struggle resulting from value-related discord. b. Its basis is the violation of personal rights or values. c. It centers on either internal discord or external discord between individuals. d. It is the outcome of a visible struggle between individuals.

ANS: C Feedback: Conflict is generally defined as the internal or external discord that results from differences in ideas, values, or feelings between two or more people. The remaining options describe only limited aspects of conflict.

Which is a true statement about destructive negotiation tactics? a. Ridicule often takes the form of ambiguous or inappropriate questioning and is a diversionary tactic. b. Most managers successfully resist the helplessness tactic because of their nursing preparation. c. Negotiation tactics can sometimes be manipulative; thus, managers must be cognizant of the other party's motives. d. Nurses are known to be particularly vulnerable to the tactic of flattery.

ANS: C Feedback: Destructive negotiation tactics are never a part of a successful collaborative conflict resolution. An astute nurse-manager must stay cognizant of the other party's motives and behaviors in order to identify manipulative tactics. Ridicule is a separate tactic from ambiguous and inappropriate questioning. Nurses can be particularly vulnerable to the helplessness tactic because nurses are educated and inclined to help others. Nurses are not noted to be exceptionally vulnerable to flattery, however.

Electronic health records (EHRs) have recently been introduced in a health-care organization, and the steering committee is ensuring that the system meets the criteria for meaningful use. This characteristic of the EHR ensures that the system: a. is readily accessible in any care setting, nationwide. b. uses language that is accessible to and understandable by clients. c. contains data that has the potential to improve client outcomes. d. means the same thing to every user.

ANS: C Feedback: EHRs must meet meaningful use requirements, which involve capturing the right data that can improve client outcomes. This characteristic of EHRs does not specify their accessibility or require that they mean the same thing to all users.

Which action is considered a leadership role associated with delegation? a. Creating job descriptions for all personnel b. Providing formal recognition or reward for completion of delegated tasks c. Demonstrating sensitivity to how cultural phenomena affect transcultural delegation d. Reprimanding employees who demonstrate overt resistance to the tasks they are delegated

ANS: C Feedback: Factors such as communication, space, social organization, timing, environmental control, and biological variations affect delegation to a culturally diverse staff and should be modeled as a leadership role. The other choices are all management functions.

What principle should guide the nurse-manager's understanding of gender differences in communication? a. Research has disproven any gender-based differences in communication that were thought to exist. b. Gender is the variable that has the greatest effect on an individual's communication style. c. Men and women communicate and use language differently. d. In contrast with stereotypes, women have been shown to be more competitive communicators.

ANS: C Feedback: Gender is a significant factor in organizational communication, as men and women communicate and use language differently. Women are generally perceived as being more relationship-oriented than men, but this is not always the case. Gender is significant but is not seen as the most significant variable in communication.

A nurse-manager delegates many tasks in the course of a day. Which practice should the manager reconsider or discontinue? a. The manager grants temporary authority to support completion of a delegated task. b. The manager confirms that the person to whom a task is delegated is adequately qualified. c. The manager provides employees with exact instructions for each step of completing the task. d. The manager asks for regular updates from the employee when tasks take a long time.

ANS: C Feedback: If an employee has the skills necessary to complete a task, that employee should be able to carry out the task with autonomy and be provided with the authority and resources necessary. There should be no need for the manager to give excessively detailed instructions. Depending on the complexity of the project, the manager should meet with the employee for updates. The manager must always confirm employees' qualifications.

The nurse-manager has asked an NAP for an update on delegated tasks, and the NAP has said, "I'm swamped right now." What is the manager's best response? a. "Don't be afraid to let me know if you feel the project is overwhelming you." b. "Time management is key to keeping on schedule with your tasks." c. "I can give you a few solutions to help manage this heavy workload." d. "Do you want more time to complete your work?"

ANS: C Feedback: If the worker is having difficulty carrying out the delegated task, the leader-manager should be available as a role model and resource in identifying alternative solutions. Leaders should encourage employees, however, to attempt to solve problems themselves first, although they should always be willing to answer questions about the task or to clarify desired outcomes as necessary. Suggesting solutions or removing the person from the task prematurely does not demonstrate an understanding of effective guidance. The NAP has already expressed feeling overwhelmed, so there is no need to give permission to do so.

A nurse has successfully completed a difficult and complex task that the manager delegated. What is the manager's best action? a. Document the fact that the nurse completed the task. b. Assign a slightly more difficult task the next time. c. Acknowledge the nurse's significant accomplishment. d. Ask the nurse to act as a role model for other staff members.

ANS: C Feedback: It is important to reward employees for accomplishment. This must precede "stretching" the nurse with even more difficult assignments or asking the nurse to act as a role model.

Which task would the director of a home health agency not delegate another staff RN? a. Assigning home health aides to specific client care b. Serving on a diabetic study committee of community resources c. Meeting with the agency's administration regarding budget cuts d. Reviewing the care assignment for the following shift

ANS: C Feedback: Management responsibilities associated with budgeting would not normally be delegated to another RN on the staff because this is a role that is not the responsibility of an RN. The other options could be appropriately delegated to another RN in most circumstances.

What must managers delegate to another RN in order to assure completion of a task? a. Time and space b. Leadership and creativity c. Authority and responsibility d. Personnel and knowledge

ANS: C Feedback: Managers must delegate the authority and the responsibility necessary to complete the task. Qualities like leadership, knowledge, and creativity are not transferable. The remaining option choices are resources that are provided rather than delegated.

What principle should guide the nurse's delegation of tasks to unlicensed nursing assistive personnel (NAP)? a. It is safe to assume that the NAP has at least a high school diploma as a minimum hiring criterion. b. Like all members of the care team, NAP stands to lose their licensure in case of negligent practice. c. No federal or community standards have been established for training the broad classification of NAP. d. The nurse is protected from liability when allowing the NAP to perform only those tasks the employer includes in their job description.

ANS: C Feedback: No federal or community standards have been established for the training of the NAP. The hiring policies of institutions vary regarding the employment qualifications of the NAP, and many institutions do not have distinct job descriptions for NAP that define their scope of practice. NAPs do not have a license that they can lose.

A nurse-manager is having a difficult conversation with a subordinate whose performance has long been inadequate. The emotional component of the manager's message will be most clearly conveyed by: a. the formality or informality of the words the manager chooses. b. the pace and pitch of the manager's speech. c. facial expressions, body movements, and gestures. d. the amount of time that the manager lets the employee speaks before interrupting.

ANS: C Feedback: Nonverbal communication is considered more reliable because it conveys the emotional part of the message. The other variables are not as significant communicators of emotion.

An employee who is involved in a dispute has sought the assistance of the organization's ombudsperson. What role will the ombudsperson play in resolving the employee's conflict? a. Providing expert testimony in conflict cases b. Providing psychosocial support to employees in distress c. Investigating the employee's grievance against the other party d. Monitoring the implementation of the terms of a conflict's compromise

ANS: C Feedback: Ombudspersons investigate grievances filed by one party against another and ensure that individuals involved in conflicts understand their rights as well as the process that should be used to report and resolve the conflict. They do not normally provide expert testimony, psychosocial support, or monitor implementation of a solution.

Which statement is true regarding the general delegation liability of the registered nurse (RN)? a. It is minimal because subordinates alone are held accountable for practicing within the accepted scope of practice for their job classification. b. It is high because the RN is automatically held liable for the tasks delegated to all recognized subordinates. c. It is reduced when the RN delegates appropriately and supervises the completion of the tasks. d. It is avoided entirely as long as the nurse delegates only other licensed personnel.

ANS: C Feedback: Proper delegation practices that include assessment and evaluation help protect the RN from liability. In general, accountability is shared and does not lie solely with the subordinate. Delegation to licensed personnel does not completely release a nurse from liability.

What is an inappropriate reason for delegation? a. To empower subordinates by "stretching" them in their work assignment b. To free the manager to address more complex unit needs c. The manager does not find the task intellectually challenging. d. Someone else is better qualified to do the task.

ANS: C Feedback: That the manager is not challenged by a task is not a valid reason for delegating that task to another. The other options are all appropriate reasons to delegate tasks to qualified staff.

The nurse-manager is negotiating for the funds necessary to purchase several new isolettes for the facility's newborn nursery. The chief financial officer (CFO) states, "I've always been curious about that piece of equipment; how does it actually work?" What negotiation action has the CFO engaged in? a. Collaborating b. Smoothing c. A diversionary tactic d. Appropriate fact finding

ANS: C Feedback: The CFO was consciously or unconsciously using a diversionary tactic that deflects from the issue at hand. There is no evidence of collaboration with this question, and it is unnecessary information. Smoothing is an approach to conflict, not negotiation.

The nurse-manager is using the GRRRR model of listening when interacting with a colleague who exhibits challenging behaviors. What is the final action that the manager should implement when using this model? a. Confirm an action plan. b. Request any necessary information from the colleague. c. Thank the colleague for the collaborative conversation. d. Reflect privately on the quality of the interaction.

ANS: C Feedback: The final phase of the GRRRR model of listening involves reward, when both parties reward each other by recognizing and thanking each other for a collaborative exchange. The model does not explicitly prescribe a time of reflection. Confirming an action plan and requesting information take place in earlier phases of the model.

Which of the following workplace situations would be categorized as latent conflict? a. A nurse expresses frustration to a colleague who did not perform some tasks that were clearly delegated. b. A nurse expresses anger to the manager, accusing the manager of preferential treatment toward other nurses. c. The most experienced nurses on a unit are allowed to self-schedule, but less experienced nurse are not. d. Two nurses were in conflict about inequities in their work assignment but were able to resolve the conflict.

ANS: C Feedback: The first stage in the conflict process, latent conflict, implies the existence of antecedent conditions such as inequities in staffing. In this stage, conditions are ripe for conflict, although no conflict has actually yet occurred. In each of the other examples, the conflict has progressed beyond this antecedent stage.

The nurse-manager is sitting on a practice committee and has adopted the role of gatekeeper. What action should the manager perform in this role? a. Acknowledge and praise each member's contributions. b. Mediate, harmonize, and resolve conflict when it arises. c. Facilitate and promote participation by all group members. d. Record the group's process and provide feedback to the group.

ANS: C Feedback: The gatekeeper makes sure all voices in the group are heard in order to facilitate and promote open communication. Acknowledging and praising each member's contributions is the role of the encourager. The recorder records the group's process and provides feedback to the group. The harmonizer mediates, harmonizes, and resolves conflict.

A recent graduate has begun working at a health center and finds the behaviors of colleagues stressful and intimidating. The nurse's colleagues whisper when she is around, roll their eyes at her, and laugh when she asks for assistance or clarification. What is this recent graduate's best action? a. Organize a meeting to confront the colleagues about their behavior. b. Avoid the offending colleagues whenever possible. c. Report these behaviors to the nurse-manager. d. Seek assistance from the organization's ombudsperson.

ANS: C Feedback: The nurse-manager should be made aware of this behavior so that action can be taken. It is unrealistic to expect a new graduate to organize a staff meeting to confront a group of more experienced colleagues about their behavior. Ombudspersons generally deal with disputes and grievances, not the immediate management of workplace violence. The nurse may be tempted to simply avoid these colleagues, but this is not sustainable and does not address this unacceptable behavior.

A nurse-manager is communicating with a subordinate. What component of this communication would be considered as part of the external climate? a. The clarity of the message b. The subordinate's personality c. The culture of the organization d. The manager's stress level

ANS: C Feedback: The organizational climate and culture would be considered part of the external climate of this communication. The sender's and receiver's personality and stress levels are components of the internal climate. The clarity of a message is not a component of the external climate.

An RN is a team leader for a small module of clients. While listening to a recorded report on a client, one of the team members remarks, "My mother lives near him, and she says his home life is in chaos." How should the RN best respond? a. Politely ask the team member to be quiet. b. Include the information in report for the next shift. c. Ask the team member how this information relates to the client's care. d. Ignore the team member's comment.

ANS: C Feedback: The role of the leader is to encourage communication that is appropriate and discourage communication that is inappropriate among staff. The RN's question about the purpose of this communication helps to determine whether it was appropriate or not. This should be clarified before deciding how to proceed.

A nurse sits at the foot of a patient's bed during an admission interview. This positioning supports the proxemics concept of which psychological comfort zone? a. Intimate relationships b. Personal interactions c. Social exchange d. Public distance

ANS: C Feedback: The study of how space and territory affect communication is called proxemics. In the United States, between 6 and 18 inches of space is typically considered appropriate only for intimate relationships, between 18 inches and 4 feet is appropriate for personal interactions, between 4 and 12 feet is common for social exchanges, and more than 12 feet is a public distance. Most Americans claim a territorial personal space of about 4 feet.

A hospital unit is in a major transition from a nursing model that was exclusively RNs to one that involves a mix of RNs, LPNs, and NAPs. The transition has resulted in several conflicts between staff. What conflict resolution strategy will the manager most likely need to use? a. Third-party consultation b. Behavior change c. Responsibility charting d. Structure change

ANS: C Feedback: The transition from a homogenous workforce to a highly diverse one with a complex skills mix is likely to cause conflict around roles and jurisdictions. This type of conflict can be addressed by reviewing and reinforcing the responsibilities of each team member. Each of the other listed strategies may be necessary for some conflicts on the unit, but the most likely strategy is the one that directly addresses roles and responsibilities.

Periodically during the day, the RN checks with the team members to determine whether they are having difficulty completing their assigned tasks. This describes which manager role? a. Skills evaluation b. Client safety c. Effective delegation d. Micromanagement

ANS: C Feedback: This manager provided the team with the autonomy to complete the work and was available should any need arise. This describes effective delegation. This action does not constitute micromanagement, provided it is not excessive. This promotes client safety but is not synonymous with it. This practice is not a form of skills evaluation.

Several RNs on the unit want to address the possibility of initiating flextime on the unit because they state that the current scheduling system is unfair. What is the manager's best initial response? a. Assuring the RNs that every effort is being made to streamline the current scheduling system b. Asking the RNs to circulate a partition to be signed by employees who support the change c. Arranging for the RNs to air their views at the next staff meeting d. Sharing with the RNs that they need to address the issue with upper management

ANS: C Feedback: This manager should plan to let employees air their views at the next staff meeting. Nursing managers can no longer afford to respond to conflict traditionally (to avoid, deflect, or suppress conflict) because this is nonproductive. Putting off the nurses be providing false reassurance or referring them elsewhere is not a direct and respectful response to conflict.

There is one vertical, solid line connecting a middle manager and a top-level manager on a clinic's organizational chart. What should a nurse conclude from this aspect of the organizational chart? a. The middle- and top-level manager share equal authority. b. The middle manager is in a permanent position. c. The middle manager has only one boss. d. The top-level manager was originally promoted from being a middle-manager.

ANS: C Feedback: Unity of command means one immediate boss per employee and is denoted by a single vertical line. This does not suggest equal authority among the two managers or that the top-level manager was promoted from the position below him or her. This portion of the chart does not indicate that the middle manager's position is permanent.

Which vocal delivery suggests to a listener that a person is asking a question rather than making a statement? a. Loudness b. Frequent pauses c. Tentativeness d. Rapid delivery

ANS: C Feedback: Vocal clues such as tone, volume, and inflection add to the message being transmitted. Tentative statements sound more like questions than statements, leading listeners to think that you are unsure of yourself, and speaking quickly may be interpreted as being nervous. Loud and frequent pauses can be barriers to communication but do not suggest questioning.

An experienced RN has seen a significant increase in the need for delegation skills over the past several years. This change is most likely attributable to: a. increased numbers of uninsured clients. b. increased lengths of stay. c. increases in the use of NAP. d. decreases in nurse-client ratios.

ANS: C Feedback: With the increased use of NAP in patient care, the need for nurses to have highly developed delegation skills has never been greater. The impact of insurance, nurse-client ratios, and hospitalization stays does not have as great an impact on delegation as does the correct option. Hospital stays are shorter, not longer, than in the past.

A manager is careful to address nonverbal aspects of communication when communicating with employees. What practices should the manager adopt? Select all that apply. a. Have communications in public places as much as possible to reduce intimidation. b. Stand between 12 and 18 inches from an employee when having an important conversation. c. Be thoughtful about aspects of appearance that can be controlled by the manager. d. Avoid crossing arms across the chest. e. Limit eye contact with employees to avoid being perceived as aggressive.

ANS: C, D Feedback: The manager should take care on aspects of appearance and should avoid crossed arms, which communicate defensiveness or aggression. There are many communications that are inappropriate to have in a public place and space of 12 to 18 inches is considered unusually close. Even though some individuals and cultures perceive eye contract as provocative or aggressive, it is still valued in most circumstances.

What action should the nurse-manager perform when supporting the delegation of a task to a subordinate? a. Holding the subordinate's professional development as the highest priority b. Frequently reassuring the employee that if they are incapable of completing a delegated task, it will be reassigned c. Drafting a preliminary plan of how the task will be redone if the outcome does not meet stated expectations d. Occasionally providing learning or "stretching" opportunities for employees

ANS: D Feedback: "Stretching" provides growth opportunities for employees, builds employee self-esteem, and helps prevent boredom and demotivation. Client safety is prioritized over professional development. The manager should avoid excessive reassurance and threats of reassignment. The nurse should not presume that the task will need to be redone before the subordinate has attempted it.

What statement about the maintenance of confidentiality is true? a. It is the right of every client and must never be breached. b. It is made easier with electronic technology. c. It is primarily the duty of the medical records staff. d. It can be violated when there is a legitimate professional need.

ANS: D Feedback: Confidentiality is a right that must be upheld, unless there is a legitimate professional need to know, such as when a provider must share information about a client with another provider so that the other provider can assume care. New technologies pose new threats to confidentiality, and every health-care provider shares responsibility for it.

A nurse-manager will be participating in negotiations around the skills mix in the organization. Before these negotiations begin, the manager should perform what action first? a. Identify the ideal skills mix for the organization. b. Choose an appropriate negotiation strategy. c. Interact with the other party to identify any hidden agendas. d. Learn as much as possible about the issue.

ANS: D Feedback: For managers to be successful, they must systematically prepare for the negotiation. As the negotiator, the manager begins by gathering as much information as possible regarding the issue to be negotiated. This data-gathering phase should precede the other listed actions.

What is the best example of downward communication by a nurse-manager? a. The manager reports a nurse's serious error to the chief nursing officer. b. The manager seeks advice from a colleague about how to deal with an employee who is chronically late. c. The manager contacts a client's physician to confirm the client's scheduled transfer. d. The manager reviews the results of a nurse's performance appraisal with the nurse.

ANS: D Feedback: In downward communication, the manager relays information to subordinates. Reporting to the chief nursing officer would be upward communication; communication with a fellow manager would be horizontal. Communication with a physician would be diagonal.

Which nurse is experiencing intrapersonal conflict? a. A manager who has received a negative performance appraisal and who wishes to dispute the findings b. A manager who has to confront a nurse who made a medication error but did not follow up with documentation c. A manager who is in conflict with a long-standing employee who often ignores the manager's directives d. A manager who perceives a dilemma between loyalty to staff and loyalty to the organization in a particular situation

ANS: D Feedback: Intrapersonal conflict occurs within the person. Each of the other examples constitutes interpersonal conflict.

A registered nurse reports to the nurse-manager that the team's nursing assistant regularly fails to complete assigned tasks. The nurse-manager responds that it is the nurse's initial responsibility to talk with the nursing assistant about this problem. The manager is engaged in what aspect of conflict? a. Conflict avoidance b. Conflict smoothing c. Encouraging competitive conflict resolution d. Facilitating conflict resolution

ANS: D Feedback: Managers should not intervene in every conflict but should urge subordinates to handle their own problems. This is an example of supporting conflict resolution. In most circumstances, this approach should be implemented before the manager becomes directly involved. The manager's deference does not indicate conflict avoidance or conflict smoothing.

Which employee of a health-care organization would likely be considered a middle-level manager? a. An experienced primary care nurse who mentors other nurses b. The team leader of the hospital's wound care specialists c. The charge nurse who oversees day shifts on a medical unit d. The hospital's nursing supervisor

ANS: D Feedback: Nursing supervisors are middle-level managers. All the other listed nurses are first-level managers.

A nurse-manager is drafting a memo that will be distributed within the organization. When using this form of communication, the manager should: a. send it to everyone in the organization to ensure equal access to information. b. begin with at least one page of background information to ensure clarity. c. avoid using headings so the reader is not confused. d. include only essential information.

ANS: D Feedback: Only essential information is included in a memo because extraneous information will detract from the message. Headers should be used to make the memo easier to read, and it should only be sent to a small to moderate number of people. Brevity is valued, so one page of background information would be excessive.

A nurse has begun working in a new health-care facility and is beginning to understand the organizational culture. When seeking to understand the organizational culture, the nurse should: a. carefully examine the demographic characteristics of the workforce. b. ask the middle- and upper level managers about the potential for advancement. c. ask coworkers at various levels to interpret the organizational chart. d. try to perceive the dominant values, traditions, and beliefs in the organization.

ANS: D Feedback: Organizational culture is the symbols and beliefs, values, history, and communication patterns of the organization. It differs from organizational climate, which is how the employees perceive the organization. Employees may not be able to articulate the organizational culture due to their proximity to it. Culture does not determine the potential for advancement and is not solely a reflection of demographics.

An RN needs to confirm the specific delegation parameters for RNs. The RN should refer to guidelines from what organization? a. The Joint Commission b. U.S. Department of Health and Human Services c. National League for Nursing (NLN) d. The state board of nursing

ANS: D Feedback: State boards of nursing are responsible for clarifying the delegation parameters for RNs. None of the other options are involved in this process.

A clinical nurse specialist (CNS) is included on a hospital department's organizational chart. However, there are no solid lines leading to or from the nurse's position on the chart. What does this imply? a. The CNS lacks productive relationships with colleagues. b. Any member of staff may exercise authority over the CNS. c. The CNS is not accountable for his or her practice. d. The CNS does not have formal authority over other staff members.

ANS: D Feedback: The absence of a "line position" denotes an absence of formal decision-making authority. This is often the case for an advisory (staff) position such as CNS. However, this does not suggest that every other staff member holds authority over the CNS or that the CNS is not accountable for his or her safe practice and adherence to standards. Line positions do not represent personal relationships.

Two nurses in a small community are in conflict because the first nurse's son committed a violent assault on the second nurse's son. In recent weeks, workplace interactions between the two have become increasingly tense. What is the nurse-manager's best strategy for resolving this conflict? a. Confrontation b. Soothing c. Responsibility charting d. Structure change

ANS: D Feedback: The manager does not have the ability to mitigate the realities of these nurses' relationship, and it may be unrealistic to expect them to set aside this significant event. As a result, it may be necessary for one of the nurses to change work locations. This issue has nothing to do with roles or responsibilities, so responsibility charting is irrelevant. Soothing is always a temporary solution. Confrontation has the potential to exacerbate this particular conflict because there is no solution that changes the facts of their circumstances.

A member of the team has been delegated some tasks and reports, "I've been given too much to do and I'm not going to be able to complete the work on time." What is the RN's best initial action? a. Assign the work to another team member. b. Take on the responsibility of the tasks. c. Have the team member perform only the most necessary tasks. d. Examine the workload and assist the individual in reprioritizing.

ANS: D Feedback: The manager should help the overwhelmed employee reprioritize the workload with the goal of making it manageable for that employee. This strategy should be tried before assigning work to another team member or having the employee abandon some of the tasks. In most cases, it is ineffective if the RN takes on the tasks that the employee was supposed to complete.

The nurse-manager is mediating a conflict between two nurses on the unit. What goal should the manager prioritize when addressing this conflict? a. A solution is chosen that minimizing the effect on other employees. b. The nurses emerge from the resolution with a close personal relationship. c. A solution is identified that can be easily and quickly implemented. d. The nurses agree to a solution that is mutually beneficial.

ANS: D Feedback: The optimal goal in resolving conflict is creating a win-win solution for all involved. Speed and ease of implementation are not priority goals and may in fact lead to a simplistic or hasty solution. It may be necessary for other employees to be affected by a fair and desirable solution. A win-win solution does not necessarily lead to the development of a close relationship between the parties.

The nurse-manager is preparing for negotiations. When negotiating, what is the manager's most appropriate action? a. Be willing to win at any cost. b. Communicate only when asked direct questions. c. Compromise only as a last resort. d. Begin with a high but realistic expectations.

ANS: D Feedback: The selected starting point in negotiations should be at the upper limits of the negotiator's expectations, within reason. However, negotiators must realize they may have to come down to a lesser goal. Winning at any cost is counterproductive, and the manager should expect to compromise. Plentiful and accurate communication is necessary at all stages of negotiation.

A registered nurse (RN) was working with a nursing assistive personnel (NAP) and delegated some tasks to the NAP. The NAP exceeded his scope of practice and caused injury to a client. Ultimate responsibility for this adverse event lies with whom? a. The NAP b. The facility's director of nursing c. The unit's nursing manager d. The RN

ANS: D Feedback: The team's RN always bears the ultimate responsibility for ensuring that the nursing care provided by his or her team members meets or exceeds minimum safety standards. This is not the ultimate role of any of the other positions mentioned.

The nurse-manager is participating in negotiations that have become confrontational and unproductive. As a result, both parties have agreed to mediation. This mechanism for dispute resolution will have what characteristics? Select all that apply. a. The mediator will be a respected person from within the organization. b. Both parties are required to accept the mediator's decision. c. The mediator addresses the process but not the issues. d. The mediator meets with each group separately as well as meeting with them together. e. The mediator is an individual who has no vested interest in the outcome.

ANS: D, E Feedback: A mediator is a neutral third party who has no conflict of interest and who is from outside the organization. The mediator's decision is not binding, unlike arbitration. The mediator has a broad role that can address process as well as the issues in dispute.