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

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.

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.

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 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.

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.

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.

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.

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.

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.

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 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.

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.

Which statement concerning a budget is true? a. A budget's reliability decreases if it is prepared significantly in advance of the funding period. b. Budgets should be created as far in advance is possible. c. A budget is revised every 3 months during a fiscal year. d. Budgets are reliable only when expenses are fixed.

ANS: A Feedback: A budget that is predicted too far in advance has greater probability for error. For this reason, it is not desirable to create a budget too far in advance.

Determine the nursing care hours per client day (NCH/PPD) if the following staffing existed for a 24-hour period (unit census = 10): 12 midnight to 12 noon, 1 registered nurse, 1 licensed vocational nurse 12 noon to 12 midnight, 1 registered nurse, 1 licensed vocational nurse, 1 unit clerk (8 hours only) a. 5.6 NCH/PPD b. 4.8 NCH/PPD c. 5.0 NCH/PPD d. 6.2 NCH/PPD

ANS: A Feedback: A total of 56 hours of nursing was worked in 24 hours (unit clerks are counted in NCH/PPD) and the census was 10 clients. Dividing the total number of nursing care hours by the census (56 divided by 10) yields an NCH/PPD calculation of 5.6 NCH/PPD.

A nurse-manager is working in the context of an accountable care organization (ACO). What task will this manager most likely perform? a. Coordinating care for Medicare clients b. Providing community-based illness prevention c. Health promotion d. Determining whether clients' care plans are justified

ANS: A Feedback: ACOs exist to better coordinate care for Medicare patients across care settings. Health promotion and illness prevention would be lesser concerns. In this particular context, justifying clients' care plans would not be the nurse's major task.

A nurse-manager is chairing a workplace committee. What should the manager prioritize in this role? a. Keeping members on task and promoting productivity b. Promoting members' career development c. Resolving interpersonal conflicts and preventing groupthink d. Providing information on each agenda item

ANS: A Feedback: Although all the items may be something the chairperson does, the primary responsibility is to keep members on task so that committee work gets completed. This is prioritized because it best reflects the main purpose of a committee, which is to collectively address specific tasks and challenges in the workplace.

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.

The majority of patients whose care is organized by case management have contact with the health-care system in what acute care setting? a. Emergency department b. Ambulatory clinics c. Primary care provider offices d. Perioperative setting

ANS: A Feedback: Because 50% to 80% of admissions in most hospitals enter via the emergency department, case management often begins there in the acute care setting.

A nurse-manager has recently learned that the health-care facility will be moving toward a case management approach. What factor is most likely driving this change? a. The need to address cost-effective options for care b. The need to provide challenging work for nurses and other members of the care team c. The need to enhance professionalism throughout the organization d. The need to obtain magnet designation

ANS: A Feedback: Case management addresses each client individually, identifying the most cost-effective providers, treatments, and care settings possible. It is not an explicit requirement of magnet designation and it is not primarily motivated by a need to stimulate nurses or increase professionalism.

What is the primary focus of case management in prioritizing client care? a. Assessing each client's needs individually b. Minimizing costs to the organization c. Minimizing costs to the patient d. Applying the principles of team nursing

ANS: A Feedback: Case management is largely dependent on individualized assessments of each patient's specific needs. The patient's needs supersede costs, even though cost containment is an important consideration. Case nursing does not necessarily entail a team nursing care delivery model.

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.

The nurse-manager at a long-term care facility is participating in fiscal planning for the first time. What is fiscal planning? a. A learned skill that improves with practice b. A job role of the facility business manager c. Part of the organizing phase of the management process d. Reactive, based on political, social, and economic forces

ANS: A Feedback: Fiscal planning is a learned skill and must include nursing management input. It should be proactive, not reactive, and it is part of the planning process of management.

An organization is considering the adoption of flexible budgeting. What advantage will this type of budgeting provide to the organization? a. Increased ability to adapt to changing circumstances throughout the year b. Increased reimbursement from state and federal agencies c. Longer budget cycles d. Increased opportunities for staff to participate in the budget process

ANS: A Feedback: Flexible budgeting allows for adjustments throughout the year based on volume. Flexible budgets do not necessarily involve longer budget cycles or more participation by staff. Flexible budgeting has no effect on reimbursement policies.

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-manager is working with a committee that is showing evidence of groupthink. What characteristic of the committee would show evidence of this phenomenon? a. Members of the committee are unwilling to take risks with new ideas. b. The committee prefers to make decisions by consensus. c. The committee members want to take turns chairing the meetings. d. Membership in the committee is frequently changing.

ANS: A Feedback: Groupthink occurs when group members fail to take adequate risks by disagreeing, being challenged, or assessing discussion carefully. A preference for a rotating meeting chair does not necessarily indicate groupthink, nor does a preference for working by consensus. Unstable membership is not a desirable characteristic of a committee, but this does not directly indicate groupthink.

The nurse-manager of a community health clinic is participating in budget planning for the next year. The manager will most likely assign the most money to what expenditure category. a. The personnel budget b. Short-term capital acquisitions c. The operating budget d. Supplies and equipment

ANS: A Feedback: Health care is labor-intensive; therefore, the personnel budget makes up the largest expense. In most circumstances, the other options represent lower expenditures.

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 can directly address one of the Institute of Medicine's recommendations to improve practice environment by: a. facilitating open communication and shared decision making. b. advocating for caps on the maximum allowable nurse-patient ratio. c. adopting a functional nursing model whenever the setting allows. d. becoming a nurse navigator who is centered on patients' needs.

ANS: A Feedback: Interdisciplinary teamwork is accomplished through interdependent collaboration, open communication, and shared decision making. The Institutes of Medicine future of nursing has expand opportunities for nurses to lead and diffuse collaborative improvement efforts with physicians and other members of the health-care team to improve practice environments.

The nurse is working on a unit whose culture has become firmly entrenched? What solution should the nurses on the unit best propose? a. New leadership b. A decrease in workload c. Collaboration with a unit that is not entrenched d. Increased administration support

ANS: A Feedback: It is extremely difficult to change a unit culture without new leadership. A change in administrative support or even a reduction in workload will not necessarily challenge the established culture. Collaboration with a unit that is not entrenched may be beneficial, but new leadership is likely the most effective solution.

Which client would be most likely to qualify for Medicaid? a. An adult client who earns $750.00 per month b. A veteran who sustained injuries in combat c. A Native American client who lives on a reservation d. A child who requires physical therapy to recover from traumatic injuries

ANS: A Feedback: Low income is the primary criterion for Medicaid. Veterans do not automatically qualify, nor do Native American clients. Some individuals with long-term disabilities qualify, but recovery from acute injuries would not normally cause an individual to qualify.

A large health-care organization is reconsidering the model of patient care delivery. What factor should be prioritized in this decision? a. Patient needs b. Staff expertise c. Cost d. Physical layout of the facility

ANS: A Feedback: Many factors need to be considered when a change in care delivery is being selected. Central among these, however, is the interests of patients. Costs, staffing, and facilities must be considered, but the needs of patients are paramount.

The emergency room nurse is assessing a patient who has presented with an exacerbation of recently diagnosed irritable bowel syndrome. The patient states that he is "overwhelmed" and "bewildered" by the mix of diagnostic tests, appointments, and consultations since he was diagnosed. What is the nurse's best action? a. Acknowledge the difficulty of the patient's circumstances and arrange for a nurse navigator. b. Validate the patient's concerns and liaise with the clinical nurse-leader (CNL). c. Offer to mediate between the patient and the case manager. d. Offer to accompany the patient to any upcoming appointments.

ANS: A Feedback: Nurse navigators help patients and families navigate the complex health-care system by providing information and support. It would not be possible for the ED nurse to perform this role on an ad hoc basis. A CNL focuses on quality of care in a specific setting and less on helping patients navigate the larger health-care system. Offering to mediate between the patient and the case manager does not address the patient's expressed concern.

A nurse-manager is reviewing the organizational chart of a health-care facility before accepting a job offer. When reviewing the organizational chart, the nurse should: a. be aware that the informal structure of the organization cannot be discerned from the chart. b. confirm the accuracy of the chart with the human resources department. c. try to meet with the people at the top of the chart, if possible. d. review the qualifications of each person on the chart.

ANS: A Feedback: Organizational charts convey the formal structure of an organization, but they do not include informal structures. It is impractical and unnecessary to review every individual's qualifications. Unless there are reasons to doubt the accuracy of the chart, it is unnecessary to confirm with the human resources department. Unless the manager is applying for a top-level position, it is often unnecessary and impossible to meet with the people at the top of the chart.

Primary care nursing is organized so that the patient is at the center of the structure. How many nurses have 24-hour responsibility for care planning and coordination for the patient? a. One b. Two c. Three d. Four

ANS: A Feedback: Primary care nursing is organized so that the patient is at the center of the structure. One nurse has 24-hour responsibility for care planning and coordination.

What was the primary reason for the development of the prospective payment system? a. Skyrocketing health-care costs following the advent of Medicare and Medicaid b. The passage of the Health Maintenance Act of 1973 c. The introduction of the Health Security Act to Congress d. A coalition held by the three largest private insurers in 1975

ANS: A Feedback: Prospective payment systems were the result of skyrocketing medical costs in the United States. They are not generally attributed to the Health Maintenance Act, the Health Security Act, or a coalition of insurers.

What is an implication of responsibility accounting for a nurse who manages a hospital unit? a. The manager is accountable for the way that resources on used on the unit. b. The manager has a responsibility to submit the unit budget on time each year. c. The organization's financial officer works with manager regarding budget approval. d. The budgeting process must be transparent and data must be made publicly available.

ANS: A Feedback: Responsibility accounting requires that someone must be responsible for all revenue, expenses, assets, and liabilities. As a result, the leader-manager may be held accountable for the financial results of the operating unit. Collaboration and timeliness are characteristics of prudent budgeting, but these are not implications of the principle of responsibility accounting. For most organizations, the budgeting processing is not revealed to the public.

A nursing supervisor has been given the responsibility for increasing the frequency and thoroughness of nursing assessments on a hospital unit. However, the supervisor does not have the authority to enforce new guidelines for assessment or assign consequences for noncompliance. What is the most likely outcome of this scenario? a. The desired outcome will not be achieved. b. The assessments will improve, but the nurses will be resentful. c. The supervisor will need to use unauthorized enforcement. d. The assessments will improve as a result of collaboration.

ANS: A Feedback: Responsibility without authority often causes role confusion and makes it difficult for a manager to enforce a necessary change. This is likely to cause the failure of the initiative. Without binding incentives and disincentives, it is unlikely that change will occur. Spontaneous collaboration is possible, but role confusion is more likely. The use of unauthorized enforcement could be problematic for the manager and would be most likely avoided due to the associated risk.

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.

What aspect of a client's care is most likely to be influenced by the Patient Protection and Affordable Care Act (PPACA)? a. The number of health insurance plans that the client can choose between b. The likelihood that the client will have to seek out-of-state treatment c. The client's ability to act as the "gatekeeper" of his or her own care d. The client's ability to qualify for Medicaid

ANS: A Feedback: The Affordable Care Act was aimed at increasing consumers' options for obtaining health insurance. It did not alter the criteria for Medicaid. In most forms of managed care, the client does not act as the "gatekeeper" for his or her own care. Out-of-state treatment was not a focus of the PPACA.

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.

Which statements regarding fiscal planning are true? Select all that apply. a. Social influences affect fiscal planning. b. A successful fiscal planner must be creative. c. An understanding of economic forces is necessary to perform fiscal planning. d. Practical experience is a key to being a good fiscal planner. e. Subordinates should be excluded from fiscal planning.

ANS: A, B, C, D Feedback: Fiscal planning is not intuitive; it is a learned skill that improves with practice. Fiscal planning also requires vision, creativity, and a thorough knowledge of the political, social, and economic forces that shape health care. Subordinates should be included in the process.

Which statements demonstrate an understanding of the factors that should be considered when a change in the care delivery system is being proposed? Select all that apply. a. "We have determined that our level of care would improve if we provided it differently." b. "It's questionable whether our current nursing staff is large enough to support the proposed change." c. "We will discuss our proposed change with the multidisciplinary team members." d. "Administration has been supportive of the planned change in our care delivery system." e. "We're going to make our decision based on which option is newest in the literature."

ANS: A, B, C, D Feedback: If evaluation of the present system reveals deficiencies, leaders and managers need to examine available resources and compare those with resources needed for the change. Therefore, openness to change and a willingness to examine available resources are necessary. Interdisciplinary collaboration is essential and support from high-level administration is needed as well. Decisions should not be based simply on which model is newest or most innovative.

Which components are considered a part of an organizational structure? Select all that apply. a. The individuals included in the group b. Lines of communication c. Decision-making process d. Channels of legitimate authority e. Organizational culture

ANS: A, B, C, D Feedback: Organizational structure refers to the way in which a group is formed (membership), its lines of communication, and its means for channeling authority and making decisions. Organizational culture is an important aspect of every organization but this is not conveyed in the organizational structure.

The leadership of a large health-care organization has arranged a series of meetings with stakeholders. What individuals or groups would be included in this category? Select all that apply. a. A community group that advocates for the rights of people addicted to drugs b. Representatives from the labor union that represents many staff members, an external organization, or individual c. A community group that promotes client safety in health care d. Members of the local media e. The surgeons and anesthetists who work in the operating room

ANS: A, B, C, E Feedback: Stakeholders are those entities in an organization's environment that play a role in the organization's health and performance or that are affected by the organization. Stakeholders may be both internal and external, they may include groups. As a result, groups that focus on client safety or a particular vulnerable population would be considered stakeholders. As well, staff members or the organizations representing their interests would be considered stakeholders. The media would not normally play a role in the organization's health and performance or be affected by the organization.

Which statements are true concerning a bureaucratic organization? Select all that apply. a. It is commonly referred to as a line organization. b. It is typically found in large health-care organizations. c. It is rooted in individual personalities. d. They resemble Weber's original design of organization. e. Its authority is represented by its staff organizational chart.

ANS: A, B, D, E Feedback: Bureaucratic organizational designs are commonly called line structures or line organizations. Their structure is illustrated by an organizational chart. These designs are common in large health-care organizations and are based on Weber's original conceptualization. Policies and rules govern the organization rather than individual personalities.

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.

An experienced registered nurse has begun a position as a clinical nurse-leader (CNL). In this role, what tasks should the nurse perform? Select all that apply. a. Collaborating with the interdisciplinary team b. Guiding patients and families through the health-care system at various sites c. Coaching nurses to provide evidence-based care d. Introducing quality improvement initiatives e. Preceptoring senior nursing students

ANS: A, C, D Feedback: The CNL role involves close collaboration with the interdisciplinary care team, leading nurses on the unit to ensure high-quality care and introducing quality improvement measures. Guiding patients and families through the health-care system at various sites is more congruent with a nurse navigator role. A CNL focuses on high-level leadership at the clinical site and would be less likely to be a preceptor because that role focuses on direct patient care.

The top-level managers of a hospital have chosen to apply for magnet designation. The decision to grant this designation will be largely based on what factor? a. Input from local nursing educators and academics b. The findings from an onsite visit by assessors c. The results of a local public opinion survey d. Review of the organizational chart

ANS: B Feedback: A detailed onsite visit is a major component of the magnet accreditation process. Nurse educators from outside the organization would not normally be consulted, and a public opinion survey is not normally taken. Accreditors would review the organizational chart, but this is a lesser piece of data compared with the results of a site visit.

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 recent switch to a new laundry provider at a long-term care facility has been described as "cost-effective." What does this imply about the change in laundry service? a. It is the least expensive service available. b. It is worth the cost. c. It is reimbursable. d. The cost was anticipated.

ANS: B Feedback: Cost-effective does not necessarily imply the cheapest, but it requires that the expenditure be worth the cost. The other options are not characteristic of the term cost-effective.

Which statement demonstrates an intervention focused on the primary disadvantage of team nursing? a. "We are working with one fewer team member today." b. "The team will be meeting for a care report update in 5 minutes." c. "Our patient assignment is comprised of both males and females." d. "We will be having a member of the float pool on our team today."

ANS: B Feedback: Disadvantages to team nursing are associated primarily with improper implementation rather than with the philosophy itself. Frequently, insufficient time is allowed for team care planning and communication. This can lead to blurred lines of responsibility, errors, and fragmented patient care. None of the other options address a known disadvantage of team nursing.

Which patient would be most likely to benefit from a disease management approach within the context of case management? a. A client who is being treated for a ruptured tympanic membrane b. A client who has chronic obstructive pulmonary disease (COPD) c. A client who has been diagnosed with a postpartum hemorrhage (PPH) d. A client being treated for a transfusion reaction after receiving packed red blood cells

ANS: B Feedback: Disease management is most often focused on the management of long-term, chronic diseases rather than acute health problems.

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.

During the budgetary process, a nurse-manager and the other members of the fiscal planning team are considering factors that may affect the accuracy of the budget. What factor should the team prioritize? a. Legislation regarding client safety b. Possible changes in reimbursement policies c. Depreciation of capital equipment d. Establishment of new HMOs in the region

ANS: B Feedback: Historically, there have been significant changes in reimbursement policies that have happened quickly. These changes threaten the accuracy of budgeting. Depreciation is more predictable and changes in client safety regulations usually do not have such significant effects on the budget process. The emergence of an HMO would not be expected to affect an organization's budget.

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 is participating in introducing a shared governance model to a health-care organization. What is the manager's best action? a. Remove lines of authority. b. Form joint practice committees. c. Eliminate performance appraisals. d. Increase the number of first-level managers.

ANS: B Feedback: In shared governance, the organization's governance is shared among board members, nurses, physicians, and management. Joint practice committees are developed to assume the power and accountability for decision making, and professional communication is egalitarian rather than hierarchical. Shared governance does not require a complete removal of lines of authority or the elimination of performance appraisals. Shared governance would not require more first-level managers.

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.

The managers of an HMO have argued against a proposed decrease in deductibles, citing a risk of moral hazard. What phenomenon would show that the managers' concerns were justified? a. Members of the HMO adopt high-risk behaviors because they know that treatment is available. b. Members of the HMO use more health-care services because of the reduced cost. c. Members are reluctant to comply with the HMO regulations. d. Members leave the HMO for other HMOs that have more favorable terms.

ANS: B Feedback: Moral hazard is the risk that the insured will overuse services just because the insurance will pay the costs. This does not denote an increase in high-risk behavior, noncompliance with regulations, or abandonment of the HMO by consumers.

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.

Which characteristic of an organization would suggest that flattening is occurring? a. There is a collective spirit. b. There is reduction in the administration levels. c. There are shared work goals across units. d. There are formal and informal systems are in place to address conflicts.

ANS: B Feedback: Reducing the numbers of administration levels is called flattening the organization. A collective spirit, shared work goals, and adequate structures for conflict resolution are not related to organizational flattening.

A clinical site has a diverse skill mix that includes registered nurses, practical nurses, and UAPs. Senior management is proposing a shift from team nursing to primary nursing. What effect will the skills mix have on this transition? a. Implementation of primary nursing will likely require hiring more UAPs and laying off some RNs. b. Implementation of primary nursing will likely require hiring more RNs, and laying off some UAPs. c. With adequate resources, primary nursing can be successfully implemented with the existing skills mix. d. Primary nursing is most successful if every member of the team providing direct patient care is an RN.

ANS: B Feedback: Shifting from a team approach to a primary care nursing approach would typically necessitate an increased number of licensed RNs and a reduction in UAP.

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.

A nurse-manager is participating in the budgeting process. What task should the manager perform first? a. Creating a spending plan b. Determining what needs to be covered in the budget c. Identifying the organization's strengths and weaknesses d. Determining how to maximize cost-effectiveness

ANS: B Feedback: The first step in the budgetary process involves assessment. That is, the manager must assess what needs to be covered in the budget. Creating a plan and maximizing cost-effectiveness occur after the assessment. Identifying the organization's larger strengths and weaknesses is not an explicit part of the budgetary assessment.

What changed the structure of Medicare payments from a retrospectively adjusted cost reimbursement system to a prospective, risk-based one? a. Zero-based budgets b. Diagnosis-related groupings c. Prospective payment system d. Incremental budgets

ANS: B Feedback: The impetus of diagnosis-related groupings changed the structure of Medicare payments from a retrospectively adjusted cost reimbursement system to a prospective, risk-based one. None of the other options were involved in the change.

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.

The leader-manager of several inpatient units is participating in fiscal planning. During this process, the leader-manager should: a. assume primary responsibility for the organization's budgetary planning goals. b. monitor and evaluate all aspects of the unit's budget control. c. encourage broad participation of subordinates in the budgetary process. d. control unpredictable census variations that may undermine the personnel budget.

ANS: B Feedback: The manager's responsibility is to monitor all aspects of the unit's budget in the unit under his or her leadership. However, the leader-manager does not have primary responsibility for budgeting, which usually lies with a chief financial officer. There is often minimal participation by subordinates in fiscal planning, and it is often not possible to control variations in the census.

A manager has accepted a new position and there are more than 20 people who directly report to the manager. What description of this manager's role is most accurate? a. The manager's workload is unrealistic. b. The manager has a large span of control. c. The manager has a top-level management position. d. The manager is working in a poorly designed organization.

ANS: B Feedback: The number of people directly reporting to any one manager represents that manager's span of control and determines the number of interactions expected of him or her. Without knowing more about the manager's role, there is no way of knowing if the workload is unrealistic or if this is a top-level position. This manager's large span of control is not necessarily a marker of a poorly designed organization.

A nurse-manager is part of a committee that has been commissioned to change the care delivery model at a health-care facility. When planning this change, the nurse and the other committee members should be aware that this process will: a. be difficult to implement without hiring staff who have experience with the new model. b. affect social relationships and group functioning in the workforce. c. require equal input from every staff member during the planning stage. d. be best conducted by objective consultants from outside the organization.

ANS: B Feedback: The nurse-leader-manager needs to be aware that redesigning work that disrupts group cohesiveness may result in increased levels of job dissatisfaction. Reorganizing care does not necessarily require individuals from outside the organization. Often, the existing staff and skills mix can be used to implement a change; hiring may not be necessary. Input from staff and other stakeholders should be sought, but it is unrealistic to expect equal input from everyone.

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 nurse-manager has been commissioned to create a new workplace committee that will focus on client safety issues. When forming this committee, the manager should: a. meet at least twice per week for the first month to create momentum. b. aim for diversity of genders and cultures among the membership. c. ensure that half of the members are the manager's subordinates and half are the manager's superiors. d. give members permission to attend meetings as often or as rarely as they wish in order to accommodate their schedules.

ANS: B Feedback: When assigning members to committees, cultural and gender diversity should always be a goal. The manager should make efforts to accommodate members' schedules, but giving members' permission to attend as rarely as they wish will compromise the group's cohesion and effectiveness. Momentum must be created after the committee is formed, but this does not necessarily require twice-weekly meetings. It is unnecessary and unrealistic to split the membership between the manager's subordinates and superiors.

A nurse has accepted a position as a staff nurse and will practice primary care nursing. The nurse will be the only RN on the team. What is an appropriate role expectation for role fulfillment? a. Planning nursing care independently of others b. Assigning work according to the expertise of group members c. Being responsible for care planning only during the shift when he or she works d. Carrying out the majority of personal care for assigned patients

ANS: B Feedback: In the primary nursing, during work hours, the primary nurse provides total direct care for that client. When the primary nurse is not on duty, associate nurses, who follow the care plan established by the primary nurse, provide care. In primary nursing, the sole RN would not plan the care without others' input. The nurse is responsible for care planning for 24 hours per day. The RN leads the planning of care but may not carry out the majority of personal care.

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.

The nurse is caring for a client who has health insurance that is a form of managed care. What are likely characteristics of this client's health-care plan? Select all that apply. a. Clients as gatekeepers of their health-care services b. A focus on prevention of illness c. Decreased emphasis on inpatient hospital care d. Capitation e. Unlimited choice of health-care providers

ANS: B, C, D Feedback: Key principles of managed care include the use of primary care providers as gatekeepers, a focus on prevention, a decreased emphasis on inpatient hospital care, the use of clinical practice guidelines for providers, selective contracting, capitation, utilization review, the use of formularies to manage pharmacy care, and continuous quality monitoring and improvement. The client's choice of health-care providers is often limited.

The nurse-manager works in a health-care facility that has applied for Magnet status. What characteristics of the organization will support the application? Select all that apply. a. Centralized decision-making environment b. Open, participatory management c. Improved patient outcomes d. High staff nurse satisfaction e. Large number of registered nurses and an absence of practical nurses

ANS: B, C, D Feedback: Magnet designation is conferred by the ANCC to health-care organizations exemplifying well-qualified nurse executives in a decentralized environment, with organizational structures that emphasize open, participatory management. Magnet-designated organizations demonstrate improved patient outcomes and higher staff nurse satisfaction than organizations that do not have Magnet status. Magnet status is not dependent of registered nurses performing roles that are otherwise performed by practical nurses.

Which statements regarding a budget are true? Select all that apply. a. Personnel costs are normally considered to be an uncontrollable expense. b. A budget contains an estimate of both expenses and income for a fixed period. c. It allows for an institution to plan for the effective use of its resources. d. The cost of supplies is an example of a variable expense. e. A mortgage is an example of a fixed expense.

ANS: B, C, D, E Feedback: A budget is a financial plan that includes estimated expenses as well as income for a period of time. Accuracy dictates the worth of a budget; the more accurate the budget blueprint, the better the institution can plan the most efficient use of its resources. Examples of fixed expenses might be a building's mortgage payment or a manager's salary; variable expenses might include the payroll of hourly wage employees and the cost of supplies. Personnel costs are usually considered to be a controllable expense, not an uncontrollable expense.

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.

The unit manager is calculating the NCH/PPD for a 24-hour period. The manager will need what data to calculate this? Select all that apply. a. The acuity level of the clients on the unit b. The total number of hours worked by nursing personnel c. The average hourly wage of the nurses on the unit d. The complexity of nursing care that was provided on a particular unit in a 24-hour time span e. The unit census

ANS: B, E Feedback: NCH/PPD by dividing the number of nursing care hours worked in 24 hours by the client census. It is not necessary to know the acuity level, the nurses' wages or the complexity of care provided, even though these variables affect budgeting.

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.

What is one of the most important differences between case management and disease management? a. Disease management referrals begin in the hospital inpatient setting. b. Disease management is a collaborative process to meet patient needs. c. High-cost population groups are specifically targeted in disease management. d. Disease management treatment is episodic.

ANS: C Feedback: Although there are many similarities between disease management and case management, the primary goal of disease management is to target high-cost disease populations. Disease management referrals may originate in the community rather than from inpatient settings. Both models are collaborative. Disease management is designed to be ongoing rather than episodic.

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 nurse-manager sits on the hospital's board of directors and there has been repeated discussion about the possibility of changing the care delivery model. What action should be performed first? a. Elicit support from internal and external stakeholders. b. Perform a cost-benefit analysis of the major alternatives for care delivery. c. Assess the strengths and weaknesses of the current delivery model. d. Plan a pilot project where the delivery model will be changed on one subacute unit.

ANS: C Feedback: Assessment of the current delivery system must precede any decision to change the delivery model. Consequently, it would be premature to start building support from stakeholders, introducing a pilot project or doing cost-benefit analysis of alternatives.

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.

During a strategic planning committee meeting to develop technology goals, several unit managers spend a considerable amount of time discussing current staffing problems. What is the primary action of the chairperson of this committee? a. Take the remainder of the meeting time to discuss staffing with all members. b. Adjourn the meeting and reschedule at a time when there are no staffing problems. c. Request that committee members return to discussing items on the agenda. d. Excuse those discussing staffing from the remainder of the meeting.

ANS: C Feedback: Committee time is wasted when agendas are not adhered to. The chairperson should avoid facilitating discussion of peripheral issues. It is unrealistic to put the committee's work "on hold" pending resolution of this problem. Dismissing the members who are discussing irrelevant issues is a heavy-handed approach that is unnecessary and which would be disruptive.

A health-care organization has undergone an organizational restructure that increases nurses' autonomy and empowerment. What effect is most likely? a. Increased interdisciplinary collaboration b. Increased communication c. Increased effectiveness of client care d. Increased client autonomy

ANS: C Feedback: Current research suggests that changing an organization's structure in a manner that increases autonomy and work empowerment for nurses will lead to more effective client care. There is no evidence that increasing the autonomy of nurses causes enhanced communication or collaboration, or that it has an effect on client autonomy.

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.

Which aspect of care at a long-term care facility most clearly suggests that a functional model of care delivery is being used? a. One nurse is assigned to provide all of a resident's care during a shift. b. Unlicensed assistive personnels (UAPs) coordinate each resident's care and occasionally delegate to practical nurses. c. Registered nurses perform all assessments while UAPs provide all feeding and hygiene. d. A pairing of one registered nurse and one practical nurse provides all the care for a designated pool of residents.

ANS: C Feedback: Functional nursing is task focused with specific tasks assigned to specific members of the care team. Having one nurse provide all of a resident's care is indicative of total patient care. No model of care ascribes a coordination role for UAP. Pairings suggest team or modular nursing.

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.

What is the name for a provision of health care in an organized system to subscribing members in a geographical area with an agreed-on set of basic and preventive supplemental health maintenance and treatment services for a fixed, prepaid charge? a. Preferred provider organizations (PPOs) b. A traditional third-party payer indemnity plan c. A health maintenance organization (HMO) d. Diagnosis-related groupings (DRGs)

ANS: C Feedback: HMOs provide health care in an organized system to subscribing members in a geographical area with an agreed-on set of basic and preventive supplemental health maintenance and treatment services for a fixed, prepaid charge. That definition does not apply to the other options.

An organization has proposed a policy stating that no more than five people should report to any single manager in the organization. What is the most likely outcome of this change in organizational structure? a. Decision making will become unpredictable. b. Workplace satisfaction will increase. c. Efficiency will decrease in the organization. d. Worker autonomy and empowerment will increase.

ANS: C Feedback: Having too few people report to a manager creates an inefficient and top-heavy organization. Decision making is likely to become similarly inefficient, although it may not become more unpredictable. This change in structure will not necessarily increase the autonomy or satisfaction of employees who may be under closer scrutiny.

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.

A registered nurse is paired with a practical nurse and the two nurses are working together to provide all the needs for a group of patients. What type of nursing care delivery are these nurses demonstrating? a. Total patient care b. Functional nursing c. Modular nursing d. Primary care nursing

ANS: C Feedback: Modular nursing uses mini-teams, typically an RN and unlicensed health-care worker(s), to provide care to a small group of patients, centralized geographically. None of the other options provide this particular staffing format.

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.

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.

A nurse-manager is advocating for a switch from team nursing to primary nursing care. What characteristic of primary nursing care should the manager describe to decision makers? a. It requires minimal RN staffing. b. It is comparatively easy to implement. c. Many nurses find it stimulating and challenging. d. It eliminates the need for UAP or practical nurses.

ANS: C Feedback: Primary care provides challenging work for nurses; however, it is not easy to implement and it can succeed with a diverse skills mix (i.e., not all RNs). It requires a comparatively large cohort of RNs.

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.

Which statement about American health-care budget spending is correct? a. A large health-care budget equals quality health-care outcomes. b. America spends less than any other industrialized country on health care. c. Outcomes related to low-birth-weight infants are worse than many other industrialized countries. d. The scarcity of resources is the biggest factor in the failure to reach outcomes.

ANS: C Feedback: Spending more does not always equate to higher quality health outcomes. The United States spends more per capita on health care than does any other industrialized country, and yet outcomes in terms of teenage pregnancy rates, low-birth-weight infants, and access to care are worse than many countries that spend significantly less.

The nurse is providing care in a setting that uses a team nursing approach. What should be integrated into the routines in the health-care facility? a. Inclusion of the patient and family as members of the team b. Opportunities for UAP and practical nurses to increase their education level c. Frequent communication between team members d. Use of multidisciplinary action plans (MAPs)

ANS: C Feedback: Team nursing is wholly dependent on close, frequent communication between the team members. Through extensive team communication, comprehensive care can be provided for clients despite a relatively high proportion of ancillary staff. The client's and family's input is vital, and frequently sought, but they are not formal members of the care team. MAPs are associated with case management, which may or may not utilize team nursing. Educational opportunities for practical nurses or UAPs are not the drivers behind team nursing.

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.

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 registered nurse is providing care in a setting that uses modular nursing. What task should the nurse perform during a shift? a. Providing every aspect of care to one half to one third of the mini-team's assigned patients b. Collaborating with another registered nurse to plan the care of all the mini-team's assigned patients c. Confirming that each member of the mini-team is completing his or her assigned tasks d. Providing total patient care to the most acutely ill patients that the mini-team is assigned

ANS: C Feedback: The modular team leader should check the work of team members. Care is divided among the mini-team members, so the RN does not provide every aspect of care to some of the patients, even those who are acutely ill. Modular nursing does not usually involve collaboration between two RNs; it is more common for each team to have only one RN.

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.

A change in the patient care delivery system has been mandated on a hospital unit. The manager can best ensure the successful introduction of a new delivery system by: a. assigning a senior registered nurse to lead the implementation. b. explaining the implications of the proposed change to patients and families. c. carefully studying the best method for implementing the planned change. d. hiring nurses who have experience in providing the new delivery system.

ANS: C Feedback: Thorough preparation is essential to the successful implementation of a new patient care delivery system. This does not necessarily require hiring new nurses who have experience with the new system; existing staff can be adequately prepared if there are sufficient time and resources. The manager should collaborate with staff but it would be an inappropriate delegation if the manager assigned a nurse to lead the transition. Explaining internal changes to patients and families is not normally necessary and would not significantly increase the chances of success.

A client is a member of an HMO and has chronic shoulder pain from an old injury. The client has decided to pursue shoulder surgery and the HMO has required a utilization review. What will this review focus on? a. The circumstances surrounding the client's original injury b. The client's baseline level of functioning c. The costs and benefits of the proposed surgery d. The profit to be made from the surgery

ANS: C Feedback: Utilization review is a process used by insurance companies to assess the need for medical care and to assure that payment will be provided for the care. Utilization review typically includes precertification or preauthorization for elective treatments, concurrent review, and, if necessary, retrospective review for emergency cases. Profits are always a relevant consideration, but many other variables would be considered. The client's baseline functioning and the circumstances of the original injury are not the primary focuses of a utilization review.

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 nurse-manager has been required to justify each item of the following year's proposed budget. The manager has been instructed that referring to the previous year's expenditures is not a sufficient justification. What type of budgeting is being used in this facility? a. Incremental budgeting b. Perpetual budgeting c. Zero-based budgeting d. Managed care

ANS: C Feedback: Zero-based budgeting begins each year with zero and requires rejustification. This is not true of the other options.

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.

A nurse is following a multidisciplinary action plan (MAP) when caring for a new patient. The nurse should identify what components within the MAP? Select all that apply. a. Cost analysis of major interventions b. Identity of the nurse navigator c. Critical path d. Nursing care plan e. Indication of times when nursing interventions occur

ANS: C, D, E Feedback: The care MAP is a combination of a critical path and a nursing care plan that shows times when nursing interventions should occur as well as variances. All health-care providers follow the care MAP to facilitate expected outcomes. It does not include cost analysis and does not necessarily involve a role for a nurse navigator.

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.

A client belongs to an HMO that is a preferred provider organization (PPO). When requiring health care, this client will most likely: a. prove that he or she has received preventive care from a provider at some point. b. pay out of pocket for care and then submit for reimbursement. c. be assessed by a nurse before being referred to a physician. d. choose between the health-care providers that are in the PPO.

ANS: D Feedback: A PPO provides financial incentives to consumers to use a select group of preferred providers and pay less for services. Clients do not normally have to pay out of pocket, and there is no obligation to demonstrate preventative care or to be assessed by a nurse before seeing a physician.

The nurse is assigned to administer medications to all patients throughout the shift. What is this an example of? a. Team nursing b. Case method nursing c. Primary care delivery d. Functional nursing care

ANS: D Feedback: Being assigned a specific task to do is part of functional nursing. None of the other options identify that connection.

A client has a managed care program that is organized on the basis of capitation. What is a characteristic of this client's health care? a. Health-care providers earn a bonus if the client remains free of disease for a predetermined length of time. b. The client pays a fixed percentage of the cost of any health care, usually between 10% and 20%. c. The program uses a "gatekeeper" to ensure appropriate utilization of services. d. The client's providers are paid the same amount each month, regardless of the client's use of services.

ANS: D Feedback: Capitation is a predetermined, negotiated payment to providers, per client, regardless of whether services are used. Providers earn more if clients use fewer services, but this is not characterized in the form of a "bonus." Capitation does not denote the payment of a fixed percentage of health-care costs. Many forms of managed care involve a gatekeeper of sorts, but this is not particular to capitation.

An older adult client has been admitted to the hospital with pneumonia and has been placed on a critical pathway. This tool will allow the care team to: a. minimize the client's out-of-pocket expenses for care. b. decrease the amount of paperwork required for reimbursement. c. minimize administrative costs. d. standardize the client's care.

ANS: D Feedback: Critical pathways are one means of standardizing care for clients with similar diagnoses. Pathways do not necessarily reduce the client's costs. Care is standardized, but this does not mean that administrative costs and documentation are always reduced.

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.

When participating in fiscal planning, a leader should perform what role? a. Monitoring aspects of budget control b. Accurately assessing personnel needs using agreed-on standards or an established client classification system c. Documenting the need for resources on a unit d. Being visionary in identifying short- and long-term unit fiscal needs

ANS: D Feedback: Leaders are visionary; the other roles of assessing needs, monitoring budget control, and documenting needs are management-related.

Which historical event is known that have had a major effect on the delivery model of nursing care? a. Emergence of antibiotic-resistant microorganisms in the 1990s b. Increases in patient empowerment during the 1970s and 1980s c. High rates of infection, death, and disability during the Civil War d. Shifts from home-based care to hospital-based care during the 1930s

ANS: D Feedback: Major shifts in the location of care from the home to the hospital underlie many of the shifts in care delivery in the early decades of the 20th century. Patient empowerment, antibiotic resistance and the Civil War are not identified as having such sweeping effects on the delivery of nursing care.

The manager is using a decision package to set funding priorities for a hospital unit. What type of budgeting is the manager most likely using? a. Flexible b. Operating c. Capital d. Zero based

ANS: D Feedback: Managers must rejustify their program or needs every budgeting cycle in zero-based budgeting. Using a decision package to set funding priorities is a key feature of only zero-based budgeting, not flexible, operating, or capital budgets.

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.

A disease outbreak in the local community caused an unprecedented increase in staffing costs. In what category of expenses should the nurse-manager place these costs? a. Controllable b. Fixed c. Capital budget d. Noncontrollable

ANS: D Feedback: Noncontrollable costs include equipment depreciation, the number and type of supplies needed by clients, or overtime that occurs in response to an emergency. This would not be a fixed cost. Personnel costs are not capital expenditures.

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 experienced nurse is applying for a position as a clinical nurse-leader (CNL). In addition to the nurse's clinical experience, what characteristic best qualifies the nurse for this position? a. The nurse currently sits on the hospital's ethics board. b. The nurse has consistently adhered to the standards of practice. c. Specialty certification in a specific area of practice. d. The nurse has a master of science in nursing degree.

ANS: D Feedback: The CNL, as an advanced generalist with a master's degree in nursing, is expected to provide clinical leadership at the point of care. CNLs have advanced knowledge and education in general practice as opposed to specialization in one primary discipline, like clinical nurse specialists. Adherence to standards of practice is a minimum requirement for nursing practice, not a specific qualifier for a CNL role. Similarly, sitting on an ethics board is a useful aspect of experience but not a specific qualifier for a CNL role.

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.

What should the leader remember when forming committees? a. Committees work best when there is an adequate supply of workers, with 10 members being the minimum. b. Willingness to work hard is the most important criterion for appointment. c. Written agendas provide excessive structure and stifle committee creativity. d. There should be sufficient expertise among committee members to accomplish the assigned task.

ANS: D Feedback: The most important criterion for committee selection is overall adequate expertise to accomplish the agenda. Effort is an important criterion for membership, but this quality is not productive unless it is accompanied by expertise. There is no absolute minimum of 10 members. Written agendas provide structure and focus for committee meetings and the manager should provide these.

A primary health-care teams (PHCT) has been established to coordinate the care of a patient with complex health-care needs. What should be the nurse's primary role in this team? a. Communicate the wishes of the patient to the other team members. b. Weigh the benefits of suggested interventions with their costs. c. Provide the patient's direct bedside care, whenever possible. d. Emphasize improved quality of life and patient-centered care.

ANS: D Feedback: The nurse can perform several tasks in the context of a PHCT, but advocating for the patient and promoting patient-centered care is a priority role that encompasses many smaller tasks (such as communicating the patient's wishes, when necessary). The nurse does not focus on financial concerns in this setting, and it is not necessary for the nurse on the PHCT to be the one to provide the majority of the patient's actual care.

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.

A patient who has just been diagnosed with lung cancer has been assigned a nurse navigator. What task should the nurse prioritize in this role? a. Providing evidence-based guidance on treatment options and treatment decisions b. Providing clinical leadership and ensuring quality for the patient's care c. Guiding the patient in an effort to provide high-quality managed care d. Guiding the patient and family through their various interactions with the health-care system

ANS: D Feedback: The primary role of a nurse navigator is to help the patient and the family navigate the complex health-care system by providing information and support. The navigator would not provide direct guidance on choosing treatment options, which are normally beyond the nurse's scope of practice. Clinical leadership is the role of the clinical nurse-leader. The role of the nurse navigator is not synonymous with managed care.

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 rural hospital is considering a sharp reduction in the range and availability of the services it provides. Before making this change, the hospital's leadership should: a. decentralize its decision-making model. b. implement shared governance. c. review its organizational chart. d. consult with local stakeholders.

ANS: D Feedback: The stakeholders are all the internal and external individuals and groups that have an interest in an organization's operations. In a rural community where few options for health care exist, it would be prudent to consult with local stakeholders before a major change in service. There is no obvious need for this organization to decentralize, implement shared governance, or review its organizational chart.

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 organization of work in a large health-care facility reflects Weber's theories around bureaucracies. What characteristic is most likely to exist in this facility? a. High flexibility in the way that work is structured b. Promotion and advancement on the basis of relationships c. Absolute autonomy of each employee d. A clear division of labor among employees

ANS: D Feedback: Weber emphasized the need for a clear division of labor. Advancement was to be based on competence, not relationships. A high degree of accountability was to exist rather than absolute autonomy. The flow of work is more structured than flexible.

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.

A nurse is practicing in a case management context and a patient has been following a multidisciplinary action plan (MAP). In the last 24 hours, it has become clear that the patient's health status is not improving as quickly as expected and the patient is deviating from the MAP. What is the nurse's best action? a. Cancel the patient's current MAP and call a meeting to select a new one. b. Document the presence of a variance in the MAP. c. Collaborate with the care team to arrange a transfer to a new setting. d. Cancel the current MAP and adopt customized, rather than standardized care.

Feedback: In care MAPs, it is necessary to provide variances when there are patient deviations, because this is a major component to case management. Deviations do not warrant a wholesale rejection of the existing MAP or case management principles. A transfer to another site may or may not be necessary, and this does not address the need to change the patient's MAP.