New Content for Leadership Final

What is not addressed by managers when effectively implementing organizational change that promotes patient safety? A) Learn quickly as you must complete all tasks before the end of the shift B) Create and sustain trust. C) Actively manage the change process. D) Involve the staff in decision making in the redesign of the workflow.

*A) Learn quickly as you must complete all tasks before the end of the shift* Managers need to view themselves as a change coach, enabling a positive work environment for the staff. Although managers must learn and create a positive learning environment, this environment does not occur by the end of a shift or day. The environment is transformed over time.

What is the most effective strategy for an organization to take in order to maximize authority and accountability for all aspects of nursing practice in the nurses responsible for the delivery of care? A) Position management and administrative levels to coordinate and facilitate the work of the practicing nurses. B) Define in specific detail the daily activities of frontline nurses. C) Have nurses report directly to physicians. D) Develop multidisciplinary teams of care providers.

*A) Position management and administrative levels to coordinate and facilitate the work of the practicing nurses* With a focus on shared governance, effective organizations design structures to provide nurses maximum autonomy over the decisions that impact the care they deliver.

What is not an appropriate way for a manager to develop authentic leadership on a unit? A) Build a culture of teamwork. B) Collaborate and translate direction into action, warning the team of potential barriers to the vision. C) Avoid addressing complexity so that the staff does not worry and change may occur anyway. D) Organize, plan, control, and solve problems.

*C) Avoid addressing complexity so that the staff does not worry and change may occur anyway.* Managers must address complexity and facilitate change. They must communicate and encourage the dissemination of information to allow staff to be a part of the change process and be engaged in solutions. They must be fully transparent with their team to obtain the appropriate buy-in to change.

Which of the following represents outcomes of transformational leadership? A) Deadlines are met. B) Work is completed according to the rules. C) Increased job satisfaction D) Pay tends to be higher.

*C) Increased job satisfaction* People tend to have higher satisfaction when they are motivated and intellectually stimulated, as are hallmarks of the transformational leader. Regimented, deadline-oriented leadership does not tend to promote higher job satisfaction.

What action by a manager would not effectively reduce workplace stress, improve job satisfaction, or promote a positive work environment? A) Encouraging autonomy in the workplace B) Bringing in food for all shifts and encouraging social support among the team C) Building strong relationships within the leadership team as well as other peers D) Eliciting support, communicating to the team that deadlines are quickly approaching and that the department is performing poorly

*D) Eliciting support, communicating to the team that deadlines are quickly approaching and that the department is performing poorly* The manager's role is to encourage and facilitate job satisfaction while focusing on social supports that are intended to reduce stress. Autonomy and maintaining a positive work environment are paramount to ensuring a healthy workforce. Demoralizing the department by pressuring them and demeaning them is not motivating to a team.

Which of the following is not a rule of leadership? A) Maintain a positive attitude. B) Listen to people. C) Maintain balance. D) Maintain likeability.

*D) Maintain likeability* Although likeability may derive from effective leadership, it may not always be the case when leaders strive hard to do the right thing.

A new graduate nurse is considering employment opportunities. He wants to make sure he works for an organization with beliefs regarding nurse similar to his own for a good work fit. What document would NOT provide him information to help him make his decision? A) Organizational mission B) Nursing philosophy C) Organizational chart D) Product line

*D) Product line* An organization's culture is reflected in its mission statement. A philosophy of nursing describes the organization's beliefs about nursing, health, and patients. A review of the organizational chart typically demonstrates the level of empowerment and independence of nurses within the organization. A product or service line describes an integrated organizational structure focused on a specific service.

Taylor Hospital has well-defined organizational units that provide maintenance, financial services, care for cardiac patients, care for surgical patients, and so on. The organizational chart indicates that surgical units report to a surgical manager and all nursing units report to a vice president of nursing; financial services to an accountant and then to a business executive; and so on. The primary disadvantage of this organizational structure is: a. Breakdown in function and communication across specialties. b. Lack of congruence in culture and organizational values. c. Highly centralized decision making and authority. d. Wide span of control.

*a. Breakdown in function and communication across specialties* In a functional organizational structure, departments and services function according to specialty. This model supports professional expertise but can lead to silos in communication and decision making and discontinuity in patient services.

With revenue reductions and cost-saving measures, the number of managers has been reduced, which has increased the number of team leaders supervised by managers by as many as three. This change may result in: a. Decreased patient satisfaction. b. Increased efficiency in costs. c. A more positive perception of managers. d. Little change to manager-staff relationships.

*a. Decreased patient satisfaction* When a span of control becomes too large, supervision can become less effective, which can have a negative effect on staff-manager relationships and on the overall quality of patient care.

Nurses on Unit 17 complain that their manager frequently "checks up on them" and encourages little involvement in decision making and yet, during performance reviews, praises them for their outstanding performance. Nurses on Unit 18 indicate that their experience is different from that of nurses on Unit 17. The manager on Unit 18 encourages active involvement in decision making and provides authentic, growth-promoting feedback. The practices on Units 17 & 18 reflect. a. Differences in the managers' expectations of their role. b. Shaping of the workplace behavior of employees. c. Different approaches to cooperation and collaboration. d. Recognition of institutional priorities.

*a. Differences in the managers' expectations of their role* Management theory addresses how managers address employees' concerns and needs and the interactions of managers with employees. Expectations of the managerial role affects expectations of self as the manager and of others. McGregor's (1960) Theory X and Theory Y made two basic opposing assumptions about employees and how the manager should interact with them. Theory X suggests that people do not like their work and that lower-order needs are more important. Theory Y adopts an optimistic view in which people are seen as capable of self-direction and autonomy.

The hospital administration gives approval to the chief nursing officer to hire clinical nurse specialists in staff positions rather than in administrative positions. A clinical specialist who has staff authority but no line authority typically is able to: a. Function through influence. b. Take complete responsibility for the care of clients. c. Interview and hire staff nurses for designated nursing units. d. Be granted functional authority to determine standards of nursing care and enforce them.

*a. Function through influence* Staff positions provide support to line positions but have no direct accountability for staff or patient outcomes and therefore function through influence.

The nurse executive at the local hospital began working there 20 years ago and has risen to the highest designation in nursing. This career style is known as: a. Linear b. Spiral c. Steady state d. Entrepreneurial/transient

*a. Linear* The linear career style, as described by Friss (1989), refers to vertical advancement in an organization and is of interest to those with a desire to gain organizational knowledge and different perspectives on nursing.

6. In opening a new dialysis unit, the nurse manager has to develop a philosophy for the unit. This philosophy needs to: a. Reflect the culture of the unit and its values. b. Be developed by the nursing manager on the unit. c. Identify the clients that will be served on the unit. d. Replicate the organization's philosophy.

*a. Reflect the culture of the unit and its values* A philosophy expresses the values and beliefs that members of the organization hold about the nature of their work, about the people to whom they provide service, and about themselves and others providing the services.

The primary difference between a resume & a CV is that a résumé: a. Reflects your skills, knowledge, and background in relation to a specific position. b. Offers a detailed listing of positions held and where positions were held. c. Includes a long and detailed explanation of academic and work experience. d. Provides contact information and focuses on your background, in general.

*a. Reflects your skills, knowledge, and background in relation to a specific position* A résumé is a short, customized overview of your professional life that relates to the qualifications of specific positions and how you are able to match your background to the qualifications that are desired. Provision of contact information is common to both the résumé and the CV. Résumés are more effective if details of particular positions that have been held are highlighted as compared with a detailed listing of positions held.

Steady state styles would be most likely in which of the following situations? a. Small hospital, in an isolated rural setting, with limited hierarchy b. Large urban teaching hospital c. Health network with several organizations d. Travel nurse agency

*a. Small hospital, in an isolated rural setting, with limited hierarchy* Steady state career styles (career-long commitment to a particular position) are more likely in rural settings, where commitment to the community is high and alternative career opportunities are limited.

A nurse executive is hired to restore a unit's productivity, which has decreased as the result of low staff morale. The nurse executive utilizes which of the following leadership principles? a. The leader declares the intent and goals to enhance productivity and assumes that the unit also wishes to increase productivity, which allows nurses to feel in control of the environment. b. If staff members increase productivity, then they are given opportunity to engage in learning events such as workshops and conferences. If the staff members are not satisfied, they will insist on a different leader, who will get them what they want. c. Leaders at the national level who are seeking relief for nurses in the workplace are seen as the solution to the nursing shortage. d. Workplace satisfaction depends on staffing ratios, adequate pay, and tuition reimbursement, and these are things the leader can control.

*a. The leader declares the intent and goals to enhance productivity and assumes that the unit also wishes to increase productivity, which allows nurses to feel in control of the environment* Stephen M.R. Covey suggests that Smart Trust is a method for restoring trust in organizations. Smart Trust Actions include declaration of the leader's intent and assumption by the leader that others also have positive intentions. Building trust involves signaling goals and intended actions in advance. Actions such as promising external rewards such as additional learning opportunities, workload relief, and compensation are consistent with transactional leadership, which leads to low to stable commitment and limited satisfaction.

The chief nursing officer is given the task of reviewing and revising the organization's mission, philosophy, and technology. In reviewing them, the chief nursing officer understands that they should be reflected in: a. The organizational structure. b. Line and staff responsibilities. c. The policies and procedures. d. Government regulations.

*a. The organizational structure* The mission statement is an important foundation for the organizational structure and defines technology and human resources required for the organization.

"Georgia Hospital will provide care that is a national example of consumer service" is a: a. Vision statement. b. Statement of philosophy. c. Mission statement. d. Rationale for care.

*a. Vision statement* A vision statement is an articulated goal that provides an inspirational target to which the organization aspires at some future time. A statement of philosophy expresses values and beliefs, and a mission statement provides the reason for the existence of the organization.

A young male nurse began in nursing as a staff nurse at a hospital. After 3 years, he moved to a home healthcare agency for increase in pay and taking a position as a manager in the agency. What type of motivation does this exemplify in career success? a. Internal b. External c. Spiral d. Entrepreneurial

*b. External* This type of career success is exemplified by external focus or motivation. The motivation in external focus is from tangible measures such as salary and promotions.

In matrix organizational structures, a nurse manager understands that this type of structure: a. Is a simplified organizational structure. b. Has both a functional manager and a service or product-line manager. c. Arranges departments strictly according to function. d. Promotes harmony in organizational decision making.

*b. Has both a functional manager and a service or product-line manager* Matrix structures are complex, integrated organizational structures that involve both functional and service or product-line managers. In this structure, team members or teams from various functional departments may combine to complete a project or program, thereby becoming responsible to both their functional department manager and their product-line manager.

To develop a curriculum vitae, or résumé, a nurse must develop a personal data file. The goal of a personal data file is to: a. Create an opportunity to be interviewed. b. Have a listing of facts about your professional life. c. Have a tool in place for marketing yourself. d. Create a document that lists your skills.

*b. Have a listing of facts about your professional life* A personal data file enables storage and recall of career-specific details that can be retrieved and shaped for a specific purpose using cut and paste approaches rather than creating whole new documents.

"At Thoroughcare, we provide health care for women and children in transition" is an example of a: a. Vision statement. b. Mission statement. c. Goal statement. d. Statement of philosophy.

*b. Mission statement* Mission statements provide a reason or rationale for the existence of the organization and are indicative of the structure of the organization and of who consumes the services provided.

The chief nursing officer and the dean of the School of Nursing believe that by establishing rules and regulations and controlling the environment, this partnership will: a. Promote professional medical authority, autonomy, and responsibility. b. Need a degree of flexibility to engender success. c. Be essential for self-governance. d. Provide for the establishment of medical committees.

*b. Need a degree of flexibility to engender success* Bureaucratic structures have a centralized command structure (chain of command) with a clear division of labor and well-articulated and commonly accepted expectations for performance. Rules, standards, and protocols ensure uniform actions and limit individualization of services and variance in workers' performance. Although bureaucracy enhances consistency, by nature, it limits employees' autonomy and thus the potential for innovations.

A nurse is applying for a new position. This position is one in which she will serve as a liaison between a hospital and a school of nursing. The nurse has to update her résumé to include her teaching experience. The goal of creating a curriculum vitae is to: a. Have a listing of facts about your professional life. b. Provide potential employers with information about where you are in your career. c. Respond quickly whenever a position becomes available. d. Be certain you can recall facts for a prospective position

*b. Provide potential employers with information about where you are in your career* A curriculum vitae provides an all-inclusive but not detailed listing of your professional life. This approach allows a prospective employer to find the most recent information quickly and gain a sense of where you are in your career.

A young male nurse began in nursing as a staff nurse at a hospital. After 3 years, he moved to a home healthcare agency. After 2 years, he was promoted to a managerial position and now has returned to another hospital as a new director of nursing. This career style is known as: a. Linear b. Spiral c. Steady state d. Entrepreneurial/transient

*b. Spiral* The spiral career style, as described by Friss (1989), involves an in-and-out and up-and-down approach to opportunities.

At Hospital XYZ, staff members on Y3 have dealt with the third head nurse in three years. Donna, the current head nurse, lacks confidence in patient-nurse relationships, and scheduling and other processes are routinely left to the last minute. Staff members approached Donna first and then administration with their concerns about Donna's effectiveness as a leader. The staff was told that the problem is likely staff related, that it is simply an unhappy group, and that there is nothing that will be done further about their concerns. The philosophy of the organization indicates that "open, transparent communication between staff and management is desired and supported," and that "innovation and creative thinking are the foundation of the organization's progress." In assessing this situation as a newly hired senior executive, you anticipate that: a. Staff members will resolve the conflict on their own. b. The situation will lead to ongoing disgruntlement and attrition. c. No further discussion or concerns will come out of the situation. d. The head nurse will be able to resolve the conflict on her own.

*b. The situation will lead to ongoing disgruntlement and attrition* Lack of congruence between the stated philosophy of the hospital and the experienced organizational culture does not support either the staff or the charge nurse and likely will result in ongoing frustration, confusion, and morale, which could result in increased attrition.

A hospital is working toward becoming a Magnet™ hospital. The chief nursing officer is aware that professional nursing departments of the future will: a. Not be directed by nurses. b. Be virtual organizations. c. Be designed to maintain nursing standards of practice. d. Be entitled to have client care departments.

*c. Be designed to maintain nursing standards of practice* Hospitals that are successful in recruiting and retaining nurses have found that the major contributing characteristic to success is a nursing department that is structured to provide nurses the opportunity to be accountable for their own practice. Accountability is guided by nursing standards of practice and thus, successful nursing departments emphasize maintenance of these standards.

In the Unity Healthcare organization, decisions, including those at the unit level, are made by a group of senior executives. Rules for employees are clear, and nursing care is delineated by procedures and protocols. This exemplifies: a. Transformational leadership. b. Transactional leadership. c. Bureaucratic organization. d. Chaos theory.

*c. Bureaucratic organization* Organizational structure refers to the organization of a work group, rather than to its leadership, and includes where decisions are made and what the relationships are between groups. In the example given, power is centrally located, with all decisions regarding policies and procedures flowing from this central location, which is characteristic of bureaucratic organizations.

Collaborative partnerships between hospitals and schools of nursing are examples of hybrid organizational structures. A hybrid organizational structure: a. Has many divisions of labor. b. Best fits long-term care units. c. Has a mixture of the characteristics of various organizational types. d. Places the authority for decision making closest to the places where workers perform.

*c. Has a mixture of the characteristics of various organizational types* Hybrid structures include characteristics of various organizational types and reflect the needs of the situation and the environment.

The facilities department is experiencing some challenges and is undergoing reorganization. Because of your familiarity with systems theory, you: a. Know that this challenge is their issue and that it has nothing to do with your unit. b. Understand that such events are localized and do not have an impact on the organizational culture. c. Know that the nature of challenges and reorganization in facilities will have an impact on other areas. d. Anticipate that your prior experiences with facilities have no effect on the current situation.

*c. Know that the nature of challenges and reorganization in facilities will have an impact on other areas* By nature, a system such as an organization is an interacting collection of parts that together make up the whole. Changes to one part will affect other parts and the system as a whole.

To retain supervisory staff members, the director of nursing develops a mentoring program. The best person to be a mentor for a new supervisor in a leadership position is someone who has: a. Been in exactly the same position and can relate to the new supervisor's problems. b. Had vast leadership opportunities and likes to talk about his or her past experiences. c. Leadership experience and time to spend communicating with the new supervisor about his or her experiences. d. People who can help the new supervisor get what he or she needs to make the organization grow quickly and prosper in the process.

*c. Leadership experience and time to spend communicating with the new supervisor about his or her experiences* Mentors need to have experience and some success in the leadership area of interest, as well as interest in the future development of the novice. The mentor can be geographically distant or close and able to provide advice and feedback.

Which of the following situations is most likely to result in a productive, whole work situation? a. Amy, RN, 5 years of experience in the emergency department. Amy accepts a position working with older clients in a home health agency because she has relocated and this is the only full-time position available. b. Adam, RN, 8 years of experience in various nursing positions, including that of a nurse manager. Adam accepts a new nurse manager position because he has a family and wants more regular hours. He is most comfortable working in direct client care. c. Louise, RN, 10 years of experience in an emergency department. She accepts a position as a case manager in home health care, working with older clients. She especially enjoys working with older adults and wants to take on leadership and management challenges. d. Courtney, RN, a new graduate. Courtney is getting comfortable with delivering nursing care as an RN. She is offered a position on surgery as a permanent team leader. The unit has had a great deal of turnover recently, and only limited mentorship is available.

*c. Louise, RN, 10 years of experience in an emergency department. She accepts a position as a case manager in home health care, working with older clients. She especially enjoys working with older adults and wants to take on leadership and management challenges* The whole of any work situation is composed of two elements: person and position. A productive, whole work situation results when a person's talents and strengths are successfully blended with expectations of the position. Of the situations described previously, the one most likely to result in a productive, whole work situation is that of Louise, who, although her experience has not been in home health, is interested in both the roles and the responsibilities of the position, as well as the target group being served. She also considers the group being served as an area in which she demonstrates strength.

A well-written letter of resignation is critical to: a. First announce your intent to resign. b. Formally signal discontent in your current position. c. Maintain a positive relationship with your former organization and colleagues. d. Fulfill your legal obligations as a departing employee.

*c. Maintain a positive relationship with your former organization and colleagues* A well-written resignation letter outlines your intent to leave the organization and appreciation of the organization but should follow an initial meeting with your manager to first discuss your intention. A well-written letter maintains a positive relationship with the organization.

A new CEO has been hired at Valley Hospital who proposes to change the centralized organizational structure that was put in place ten years ago, based on widespread consultation with staff. The proposed structure involves substantial flattening of the organizational structure, with significant decision making being made at the point-of-care and an emphasis on interprofessional collaboration. There is a great deal of discussion about the balance between hospital-wide budget decision making and unit-based decision making. This discussion represents: a. Chaos theory. b. Organizational redesign. c. Organizational reengineering. d. Restructuring.

*c. Organizational reengineering* Reengineering involves a total overhaul of an organizational structure. It is a radical reorganization of the totality of an organization's structure and work processes. In reengineering, fundamentally new organizational expectations and relationships are created. Redesign is a technique to analyze tasks to improve efficiency, and restructuring is a technique to enhance organizational productivity.

In which of the following situations would you expect low morale and frustration? a. Statement of philosophy indicates "We value our staff." When staff members leave, careful evaluation is done to determine whether staff should be replaced by full- or part-time employees. b. Practices include annual staff recognition celebrations. During times of change, staff members are actively included in issue identification and solution finding. c. Recruitment ads promise opportunities for advancement for everyone. Promotions are given only to individuals with long-standing service and entrenched relationships. d. The vision indicates that there is strong commitment to lead in research. The organization has tried to implement a strong campaign to attract leading nurse researchers but has experienced difficulty in doing so.

*c. Recruitment ads promise opportunities for advancement for everyone. Promotions are given only to individuals with long-standing service and entrenched relationships* Although frustration may occur with external factors that affect ability to act on values and aspirations, lack of congruence between what is espoused as a value within the organization (such as promising advancement as an incentive to join the organization) and what is actually done (such as restricting advancement to internal candidates with much organizational history) can cause low morale and confusion.

A primary care clinic is established in Pleasantville to provide comprehensive services to infants, children, and families within the community. The executive director of the clinic oversees physician and nursing services for infants, children, and families; a neurodevelopmental clinic; psychology, family counseling, and social work services; nutritional counseling; speech and hearing services; and physiotherapy. This type of organizational structure is known as: a. Hierarchical. b. Bureaucratic. c. Service-line. d. Matrix

*c. Service-line* In service-line structures (sometimes called product lines), the functions necessary to produce a specific service or product are brought together into an integrated organizational unit under the control of a single manager or executive.

A unit manager recently graduated as a clinical nurse specialist with a focus in gerontology. She applied to take a certification exam. Certification is designed to recognize: a. Basic knowledge in a specified area. b. Advanced practice in functional roles. c. Special knowledge beyond basic licensure. d. Continued competence as a registered nurse.

*c. Special knowledge beyond basic licensure* Certification is an expectation in some settings for career advancement in advanced practice or in specialized areas and goes beyond basic preparation.

In the Unity Healthcare organization, communication flows: a. Laterally b. Bottom to top c. Top to bottom d. Intermittently

*c. Top to bottom* In a bureaucratic organization, communication flows vertically top to bottom.

During an interview for a manager's position, you find the supervisor and staff unfriendly. Responses to questions are met with vague responses. After the interview, you decide not to pursue the position. What follow-up, if any, is most appropriate? a. There is no need for you to do anything further. You likely will not be offered the position anyway. b. You should file a complaint with Human Resources about the supervisor's lack of interviewing skills. c. You should send a thank-you note to the interviewer, indicating appreciation for her time. d. You should call and leave a voicemail, indicating your disinterest in the position.

*c. You should send a thank-you note to the interviewer, indicating appreciation for her time* Even if you are disinterested in the position or think that the interview has gone badly, an appropriate follow-up is a thank-you note to the interviewer. This recommended follow-up creates a positive impression and may leave open the possibility of future interactions.

Which of the following needs revision on a résumé or CV? a) John Jones 87 Highway Drive City, MI 79110 [email protected] b) M. Howes Anyway Highway City, MO 77700 H: 777-777-0000 e-mail: [email protected] c) Dr. L. Jones 99 Carway Drive City, NY 84003 H: 999-999-0000 Cell: 999-000-9999 d) Tanya Jones 67 Honeywell Drive City, MO 66907 [email protected]

*d)* *Tanya Jones* *67 Honeywell Drive* *City, MO 66907* *[email protected]* When including Web or e-mail addresses, it is important to use addresses that are not overly casual or that communicate personal information.

Which of the following would be the most appropriate mission statement for a nursing center? a. "At Plentyville, we provide rehabilitative services for addicted adolescents." b. "Georgiatown provides treatment and prevention services for county residents." c. "At Heart, our aim is to provide services that lead the nation in health education and research." d. "At Coeur, we strive to achieve optimal pain management with patients who are experiencing chronic pain."

*d. "At Coeur, we strive to achieve optimal pain management with patients who are experiencing chronic pain"* The mission statements of nursing centers are oriented toward achieving optimal health status for a defined group of patients or consumers rather than being treatment or maintenance or social-support oriented.

At Orangetown Hospital, the nursing department is developing a mission statement for nursing. Which would be a suitable mission statement? a. "Nursing provides services for patients admitted to Orangetown Hospital." b. "To participate fully in the professional services offered by Orangetown Hospital." c. "To lead by the lamp; services for seniors." d. "At Orangetown, the nursing department provides caring services that recognize the diversity of clients and promote optimal health with clients through partnership, education, and interprofessional collaboration."

*d. "At Orangetown, the nursing department provides caring services that recognize the diversity of clients and promote optimal health with clients through partnership, education, and interprofessional collaboration"* A nursing mission statement within an organization needs to establish the reason for nursing within the organization and lays out relationships with clients, the community, and other disciplines.

You are offered an opportunity to take a temporary leave from your position as a nurse manager to lead a technology implementation project. Which of the following reasons for accepting the opportunity is most consistent with developing a solid career path? a. You are pressured to do so by your supervisor. b. The organization has no other suitable candidate for the position. c. You have limited knowledge of information technology and no real interest, but this will increase your knowledge. d. Accepting a position outside of your established skill set may establish you organizationally as an innovative, adaptable leader.

*d. Accepting a position outside of your established skill set may establish you organizationally as an innovative, adaptable leader* Although giving into organizational or supervisory pressure may bring an enhanced learning and organizational profile, what is to be gained needs to be assessed against your career goals, interest, and aspirations. Increasing and expanding your skill set within defined career interests is a valid reason to consider a chance opportunity.

Sarah is a clinical nurse educator in the dialysis unit at Pines Health Center and provides education, consultation, and training support. Sarah has: a. Direct responsibility for patient care. b. Direct accountability for patient outcomes. c. An authority relationship to staff. d. An influence over patient outcomes.

*d. An influence over patient outcomes* In a staff position, Sarah supports line positions in accomplishing the primary goals and objectives of the unit and provides support, counsel, and advice, but she has limited or no authority for decision making.

Nancy is a staff nurse who works on a rehabilitation unit. Nancy tells you that the assistants are experiencing difficulty with the new lift and wonders what your thoughts are on organizing an in-service training. Nancy is exhibiting which trait of a follower? a. Provides a vision for safety that is communicated b. Thrives on taking risks in identifying the problem with safety c. Coordinates the development of knowledge and skills necessary to use the lift d. Assumes responsibility for identifying a safety concern and concedes authority for solution to you

*d. Assumes responsibility for identifying a safety concern and concedes authority for solution to you* Communication of a vision and risk taking are leader traits, whereas coordination is associated with manager traits. Taking responsibility while conceding authority to the leader is characteristic of followers.

A new director of nursing in a small rural hospital wants to make changes from the traditional model of governance to a shared-governance model. Select the characteristic below that best describes the traditional organizational structure in which a staff nurse is assigned to carry out nursing tasks for clients but is not given the chance to provide input into forming the policies and procedures by which care is delivered or the standards by which care is evaluated: a. Bureaucratic b. Decentralized c. Delegated authority and responsibility d. Delegated responsibility but no authority

*d. Delegated responsibility but no authority* In traditional structures, decision-making authority (right to act) is held by a centralized decision-making body, so that staff members have responsibility for certain functions but do not participate in decisions related to those functions.

A statement such as "We believe in the right of patients to make choices and to have care that is sensitive to their preferences and needs" is a _____ statement. a. Mission b. Goal c. Vision d. Philosophy

*d. Philosophy* Philosophy statements capture significant beliefs and values of the organization.

In preparing for a fair interview process as a hiring manager, you should: a. Put water out for the candidates. b. Ensure that you know the names of all candidates. c. Dress comfortably and professionally. d. Prepare a schedule of questions to be asked of all candidates.

*d. Prepare a schedule of questions to be asked of all candidates* Although providing water, knowing names, and dressing appropriately sets a professional and respectful tone for the interview, developing a schedule of questions to be asked of all candidates is important for gathering comparative data and ensuring equitable treatment.

Role theory has its underpinnings in management theory. Management theories influence managers' leadership styles. Which of the following theories would a nurse manager be most likely to follow when redesigning the staffing schedule? a. Humanistic b. Productivity c. Psychological d. Quantum

*d. Quantum* Quantum theory is one way a manager can serve as an agent of change when patient care work/workflow must be redesigned. Quantum theory recognizes the need to understand behaviors and relationships before changing them, the connectedness of parts such as workflow and relationships, and the need to be analytical, flexible, and empathetic.

Because of rapid turnover and the ongoing hiring of new graduates, the skill levels of staff in a busy CCU are varied. Senior staff are becoming burned out with the need to provide mentorship and guidance to new staff. As the manager, you propose the addition of a nurse in advanced practice to provide consultation and education for staff. This position is termed a(n): a. Hierarchical position. b. Ancillary. c. Line position. d. Staff position.

*d. Staff position* Line personnel have authority for decision making, whereas personnel in staff positions provide education, support, advice, and counsel. The nurse in the advanced practice is providing advice and support through education as well as consultation.

A cover letter & a resume together should be no longer than ________ page(s). a. Two b. One c. Four d. Three

*d. Three* Two pages is recommended for a résumé & one for a cover letter.

After a newly hired director of nursing has reviewed the hospital's strategic plans, she develops a timeline for achieving those plans. The new leader is: a. Not expecting that novice leaders will have a vision. b. Demonstrating mistrust of the abilities of her staff to implement the plans. c. Instituting deadlines against which the performance of staff will be evaluated. d. Translating a global document into realistic plans for nursing.

*d. Translating a global document into realistic plans for nursing* Followers need three things from leaders: direction, trust, and hope. Developing timelines for the strategic plan involves translating a vision into reality and being able to communicate a vision meaningfully, which is an example of a leader's influencing behavior.

Before beginning her own nursing agency, a nurse worked with other temporary nursing agencies in nine states. This career style is known as: a. Linear b. Spiral c. external d. internal

*d. internal* (new) This is an example of internally motivated career success for the nurse. She set a goal and achieved the goal, meeting her own internal focus and resulting in her career success. *d. Entrepreneurial/transient* (old) The entrepreneurial/transient career style, as described by Friss (1989), is appealing to nurses who enjoy variety in experiences.

Which of the generations is challenged by sharing leadership with other generations? A) Baby Boomers B) Generation Y C) Generation X D) Generation Z

A) Baby Boomers Baby Boomers are more likely to want to do the work themselves than to rely on someone else who may not have the same work ethic as they have. They tend to see the younger generations as less dedicated to excellence and less willing to work as hard as they do.

Planning is a process designed to achieve goals in dynamic, competitive environments. As a new manager, what is the first step you will undertake to develop a strategic plan of action for a congestive heart failure program? a. Search the environment to determine changes that may affect the organization. b. Appraise the organization's strengths and weaknesses. c. Identify the major opportunities for and threats to the organization. d. Identify and evaluate the various strategies available to the organization.

ANS: A Assessment of the external environment is the first step in the strategic planning process.

The chief nursing officer has to write a strategic plan. The most difficult stage in the strategic planning process is: a. assessment of the external and internal environment. b. review of mission statement, goals, and objectives. c. identification of strategies. d. implementation of strategies

ANS: A Determination of strengths, weaknesses, opportunities, and threats requires openness to what is being said and observed and is critical to setting the stage for relevant responses in the latter phases of strategic planning.

The clinic nurse understands that the advantages of planning include: a. assisting staff in critical thinking and improving decisions. b. orienting people to react instead of act. c. forcing managers to be cost-efficient and cost-effective. d. focusing on activities, not results.

ANS: A Effective planning means that everyone in the organization manages his own work and sees how it relates to organizational goals. Being proactive means "aggressive planning" that ensures that decisions are improved and are oriented toward organizational goals.

Which of the following represents an effective goal statement? a. Involve patients and families in planning health care. b. To revise clinical guidelines for incontinence care from evidence within 6 months. c. Patients and families are partners first in care planning. d. To acquire $4 million in additional funding within 12 months to support clinical education programs for dementia.

ANS: A Goal statements formalize targets for an organization. Objectives include the word to and an action word, and specify dates for attainment. Mission statements convey values and beliefs of the organization.

To meet the social and human needs of a target market, it is critical to: a. assess the needs and priorities of the target market. b. revise the organization's mission statement to reflect external needs. c. assess the internal culture and needs. d. develop highly sophisticated media.

ANS: A Marketing emphasizes the identification and meeting of human and social needs, which can only be known through assessment of the needs of the consumer (as opposed to the needs of the organization).

Northwestern Hospital has decided to implement peer review. As a clinical leader in the Emergency Department, you have overall responsibility for ensuring that this is in place by next month. The most important step in this process is to: a. provide an educational session for staff on peer review. b. revise the mission statement, objectives, and performance standards. c. develop objectives and performance standards with employees. d. implement objectives and performance standards.

ANS: A Once a strategic plan has been developed, the next step is open communication and execution of the specific plan, which, in this instance, is peer review.

The reasons cited by nursing administrators for not planning in a systematic manner include: a. lack of understanding of the planning process. b. lack of knowledge regarding the internal and external operations of the organization. c. not enough hours in the day for both day-to-day operations and planning. d. delegation of the task to subordinates.

ANS: A The nurse manager should participate in strategic planning and quality initiatives with the governing body. Lack of knowledge is a common reason for nonparticipation in planning initiatives.

A clinic nurse developed objectives for a diabetic education program. The characteristics of well-written objectives include that they should be what? (Select all that apply.) a. Achievable b. Understandable and specific c. People-oriented d. Manager-oriented e. Means-oriented f. Measurable

ANS: A, B, F The S.M.A.R.T. acronym describes the attributes of objectives: specific, measurable, agreed-upon, reasonable (achievable), and time-bound.

In assessing the internal environment, the strategic planning team at Pacific Hospital discovers that 90% of staff members have no idea what the current mission statement means. This is most likely related to: a. the level of abstraction inherent in mission statements. b. development of the statement by the administration team with no other staff involvement. c. outdated goals and objectives contained in the mission statement. d. failure to provide action statements within the mission statement.

ANS: B A mission statement reflects the beliefs of the organization in relation to those it serves and services it provides, and it communicates the direction of an organization. Covey (1990) believes that the process of developing the mission statement is vital to an organization's success and should involve everyone.

Assessment of the needs of the consumer or client (in developing a strategic marketing plan) focuses on: a. present needs only. b. present and future needs. c. the development of surveys. d. secondary analysis of existing data.

ANS: B Assessment of needs takes into account needs of the consumer now and for the future, using a variety of data-gathering techniques. Future orientation aids in anticipating how marketing and programs will need to shift to meet those needs.

Shifts such as changes in the percentage of seniors in the population, governmental initiatives in health care, and the influence of income on health status are factors in the __________ environment. a. public b. macro c. competitive d. social

ANS: B The external environment in strategic marketing planning includes the public, competitive, and macro environments. Demographic, social, and political factors are included in the macro environments.

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

ANS: B To put a strategic plan into place for marketing, it is necessary to conduct an external assessment.

Pacific Hospital's team develops a process to include staff in development of the mission statement. Which of the following statements would indicate that the staff has been able to develop an effective mission statement? a. Pacific Hospital will increase its sustainability by increasing revenue streams within the next 3 years. Revenue streams are important to our hospital and are a driving force in our sustainability in the face of insurer and government funding changes. b. Pacific Hospital has a desire to relate to its community to enable appropriate identification of programming needs by July. c. Pacific Hospital will provide family-centered care to the community of Pacific Rim. It is committed to delivering a full spectrum of services that foster collaborative partnerships among clients, families, and the hospital, and it utilizes evidence-based practice to guide planning and interventions. d. To provide health promotion programs for school-aged children

ANS: C An effective mission statement reflects the values and direction of the organization. Included in the statement are beliefs about individuals, health, practitioners, and the relationship of the organization to practice, research, professionalism, and/or education.

Nurses are valuable partners in marketing strategies because they: a. are more likely than other members of the organization to use marketing tools. b. have a strong background in using evidence to support decisions. c. have close involvement with patients, who are the target group for marketing. d. constitute the largest staff group in most healthcare organizations.

ANS: C As nurses are directly involved with patients who use services and who are the target group for marketing efforts, nurses have excellent insights into patient needs.

To conduct assessment of the internal environment, the strategic planning team for Pacific Hospital: a. invites community members and staff of the hospital to an evening focus group session. b. discusses what it sees as the primary threats and opportunities in demographic shifts affecting the hospital. c. invites all levels of staff to focus groups on the effectiveness of the hospital environment, including information systems and staffing. d. asks the board to provide a summary of major opportunities for the future.

ANS: C Assessment of the internal environment should include all levels of staff and facilitates feedback on effectiveness of strengths and weaknesses of systems and processes within the institution.

A private ambulance clinic established a few streets away from Pacific Hospital markets its services as quality-based within caring relationships. The clinic is part of the __________ environment. a. public b. macro c. competitive d. social

ANS: C The competitive environment includes factors and elements that compete for resources with another organization. These elements may include those in public and macro environments.

At the beginning of the strategic planning processes, Pacific Hospital learns that nursing staff members are uncomfortable with utilizing evidence-based practice, and that staff perceives that only limited resources are available to support translation of evidence into their usual practice. Because this issue has been identified, the management team determines that a plan of action is required to address the issue. Who should be involved at this point? a. Nursing unit managers b. Staff nurses c. All staff d. Administration

ANS: C The first phase in planning is conducting an assessment of the external and internal environments. Assessment of the internal environment should include all levels of staff and facilitates feedback on effectiveness of strengths and weaknesses of systems and processes within the institution.

From your observation of planning activities in the organization, you have noticed that planning and decision making occur at various levels of the organization. The nurse manager has overall responsibility for which of the following? a. Sending out postcards b. Organizing a telephone follow-up c. Monitoring ongoing activities and projects d. Listing the patient population

ANS: C The nurse manager should articulate organizational decision making for the criteria model adopted by the organization and monitor ongoing implementation of the plan.

The executive team at Hospital XYZ develops a polished strategic plan that includes a mission statement, goals, and objectives. The executive team involves the marketing team, so that the plan can be communicated internally and externally. After 2 years, no significant progress has been made toward any of the goals. What has been omitted in the plan? a. Planning b. Marketing c. Integrated financial planning d. Customer focus

ANS: C Without the inclusion of a business plan with the strategic plan and integration of financial planning and allocation of resources execution of the strategic plan can become paralyzed, even with the most effective communication of the strategic plan itself.

After an extensive campaign to ensure that the community surrounding Pacific Hospital has been exposed to the emphasis of excellence in clinical care that occurs through the use of evidence, the marketing team finds that the public perception has changed little. This determination is made possible through: a. marketing surveys. b. focus groups. c. informal feedback. d. comparison of data against benchmarks.

ANS: D Developing benchmark data at the beginning of a project enables comparison of later data against the benchmark to determine if a marketing plan has met its objectives.

Benchmarks in the strategic marketing planning process are useful in: a. establishing programs. b. setting targets. c. rewarding employees. d. measuring progress.

ANS: D Establishing benchmarks enables measurement of the interim and final achievements of programs.

Which of the following represents a well-written objective? a. Hospital-acquired infections are reduced, and procedures to reduce infections are implemented. b. To increase staff satisfaction and to decrease burnout. c. To increase the health of the community. d. To implement evidence-based practice on nursing units, as evidenced by adoption of evidence-based processes, by June 1.

ANS: D Objectives are specific (begin with word to followed by an action word; specify single result to be achieved; and specify a target date for attainment) and measurable (provide level of accomplishment at the end).

After a year, the staff at Pacific Hospital is frustrated, and implementation of evidence-based practice has gone poorly. In responding to this situation, the strategic planning team at Pacific Hospital: a. recommends that the mission, objectives, and goals of the hospital be reassessed. b. revises the goal statements in the strategic plan. c. consults an external team on preparation of materials on evidence-based practice. d. holds focus groups with staff to determine what kinds of issues, challenges, and obstacles have occurred in implementation.

ANS: D On a consistent basis, the strategic plan is reviewed at all levels to determine whether the execution of goals, objectives, and activities is on target. As stated, a sense of flexibility regarding the objectives is important to consider, and objectives may change as a result of legislation, budget changes, and change in structure or other environmental factors. Involving staff enables development of creative methods to ensure that necessary changes occur.

A community-based pain management program is being planned for your region. As a coordinator of a home care agency, you have been requested to develop a conceptual framework, mission statement, philosophy, and objectives for the program. In what order will you pursue this endeavor? a. Objectives, philosophy, and mission statement b. Philosophy, objectives, and mission statement c. Philosophy, mission statement, and objectives d. Mission statement, philosophy, and objectives

ANS: D The development of the mission statement is the first step in defining the purpose and direction of the organization after an assessment has been completed.

In implementing the strategic plan for effective utilization of evidence to guide nursing practice at Pacific Hospital, the nursing unit managers take the next step, which is the implementation. Implementation most likely would involve: a. revisiting the mission statement and objectives. b. reevaluating external and internal factors affecting evidence-based practice. c. preparing a budget to support implementation. d. developing unit-based objectives related to the plan.

ANS: D The previous planning (assessment of internal and external environments, development of a mission and plan, and allocation of resources) has already been completed. The next step involves adapting the strategic plan to the nursing units.

What items would be included on a CV but not on a résumé? A) Licensure type and states where licenses are held B) List of professional activities throughout career C) Educational preparation and degrees awarded D) Contact information including address and phone

B) List of professional activities throughout career A CV includes extensive listing of all prior professional activities, but a résumé is focused on details pertinent to a specific position. Some items, such as contact information, educational preparation, and licensure, would be included on both résumés and CVs.

When caring for a patient who had a hip replacement that morning, a nurse is providing what level of care? A) Primary B) Secondary C) Tertiary D) Essential

B) Secondary Secondary Care - disease focused or restorative care Primary Care - preventive care Tertiary Care - specialized or consultative health care

A nurse has accepted a new position in a different organization and is composing a resignation letter for the manager of her current position. What items, if included in the letter, is likely to prevent the nurse from being rehired in the same organization in the future? A) An offer to negotiate a resignation date around department needs B) A summary of the verbal resignation discussion with the manager C) A list and full description of co-workers' annoying off-duty behaviors D) A positive statement about what has been learned from the position

C) A list & full description of co-workers' annoying off-duty behaviors The resignation letter should be honest yet diplomatic. There may be a future time when you would like to return to the organization, so maintain a positive tone about what you have gained by working in that organization.

To maximize the coordination of care, provide seamless transitions, and improve quality of care, organizations are increasingly turning to which organizational structure? A) Academic medical centers B) Public health institutions C) Accountable care organizations D) Proprietary, investor-owned organizations

C) Accountable care organizations Accountable care organizations (ACOs) are designed to coordinate care, provide chronic disease management, and improve the overall quality of care. Proprietary organizations are investor owned, and they operate with the specific intent of earning a profit by providing healthcare services to individuals who can afford to pay for these services. Public health institutions provide health services to individuals under the support and/or direction of the local, state, or federal government. Academic medical centers are focused on providing care while providing education for physicians and other health professionals.

As a nurse manager, you have been asked to be part of a design team for health services that have vertical integration. In planning for these services, your team will design a proposal that will: A) cluster like services together, such as outpatient clinics for the care of children with various developmental and medical needs. B) plan for the smooth transition of patients from the emergency services department to other units in the hospital. C) ensure that funding follows the patient from acute care to long-term care services. D) bring together acute care, ambulatory, home care, and palliative care services for the management of patients diagnosed with cancer.

D) bring together acute care, ambulatory, home care, & palliative care services for the management of pts diagnosed with cancer When organizations align to provide a full array or continuum of services, the arrangement is referred to as vertical integration. Benefits attributed to vertical integration include enhanced coordination of services, efficiency, and customer services.

Thomas has been a nurse in your ICU for 10 years. In facilitating Thomas' professional development, the nurse manager would focus on: A) certification for the ICU environment. B) discussions about how Thomas can fit with role expectations and relationships. C) possible changes to other ICU environments. D) encouraging him to lead changes that leave long-term impacts after his retirement.

D) encouraging him to lead changes that leave long-term impacts after his retirement Thomas is a mid-career professional. As such, you would expect him to be interested in honing areas of expertise (such as leadership or developing a deeper expertise in a particular area of ICU nursing) as opposed to gaining skills necessary for his work environment such as certification or becoming comfortable with his role and relationships in ICU, which would be critical to an early career nurse. Legacy building is characteristic of mid-career professionals.

A pt is admitted to a medical unit with pulmonary edema. His primary nurse admits him & then provides a written plan of care. What type of educational preparation best fits the role of primary nurse? a) Baccalaureate b) Associate c) Diploma d) LPN/LVN

a) Baccalaureate Bc of the breadth of nursing knowledge required, baccalaureate education is preferred for primary nurses.

During times of nursing shortages & increased nursing costs in health care, which of the following nursing care delivery models might come under greatest scrutiny (inspection)? a) Case method b) Team nursing c) Functional nursing d) Nurse case management

a) Case method The case method may involve total pt care provided by a RN, which, in today's costly healthcare economy, is very expensive. In times of nursing shortages, there may not be enough resources or nurses to use this model.

Your organization has made a decision to implement TCAB (transforming care at the bedside) in your hospital. As a manager, what strategies would you use to implement TCAB? (select all that apply) a) Encourage recognition among staff of their knowledge of the patient-care environment. b) With staff, select small changes for consideration. c) Select only projects that have widespread impact. d) Secure external advisors to evaluate innovation. e) Present ideas based on best practices and ask staff for advice on implementation.

a) Encourage recognition among staff of their knowledge of the patient-care environment. b) With staff, select small changes for consideration. e) Present ideas based on best practices and ask staff for advice on implementation. Transforming care at the bedside (TCAB) relies on active involvement of staff in the generation of innovative ideas to improve pt care. Staff are actively engaged in selecting innovation, planning, & evaluation of the innovations. Critical to practice changes, rapid cycle change is a process that encourages testing creative change on a small scale while determining potential impact.

In reviewing the job description of a nurse manager, the staff becomes aware that a nurse manager's role is complex. Which of the following duties are required of a nurse manager? (Select all that apply) a) Ensure unit productivity reports. b) Develop policy and legislation to protect nurses' well-being. c) Plan staffing of UNPs only. d) Prepare a unit budget that reflects unit staffing needs. e) Monitor nurse-sensitive indicators such as falls & incidence of infections.

a) Ensure unit productivity reports d) Prepare a unit budget that reflects unit staffing needs e) Monitor nurse-sensitive indicators such as falls & incidence of infections A nurse manager manages financial resources by developing business and staffing plans.

In comparing team & functional models of care, a nurse manager favors the team model. In particular, she finds that the team model: a) can be effective in recognizing individual strengths and backgrounds of staff. b) promotes autonomy and independence for the RN. c) avoids conflict because of role clarity. d) is efficient in delivering care to a large group of patients, utilizing a staffing mix.

a) can be effective in recognizing individual strengths and backgrounds of staff Team nursing delivers care to a small group of patients, using a mix of licensed and unlicensed personnel. Team nursing uses the strengths of each caregiver.

The relief charge nurse has assigned a newly licensed baccalaureate-prepared nurse to be one of the team leaders for the 3-11 shift. In making this decision, the charge nurse has overlooked this nurse's: a) clinical expertise b) leadership ability c) communication style d) conflict-resolution skills

a) clinical expertise Bc the basic education of baccalaureate-prepared RNs emphasizes critical-thinking, clinical reasoning, & leadership concepts, they're candidates for such roles. However, Benner identified 5 stages of clinical competence for nurses: 1) Novice 2) Advanced beginner 3) Competent 4) Proficient 5) Expert Benner suggests that competence is characterized by a nurse who has been on the job in the same situation 2 to 3 yrs. (Nurses who are at the novice or advanced beginner stage would be less likely than their more experienced counterparts to implement any type of delivery model effectively)

A conflict develops between an associate nurse & a primary nurse over the assessment of a pt with pulmonary edema. Based on her assessment of the pt, the associate nurse insists that it is her role to change the care plan bc she is the one who has made the assessment. As the nurse manager, you clarify that: a) it is the role of the primary nurse to make alterations based on assessment data and input. b) the associate nurse is accountable and responsible while the primary nurse is off duty and therefore is able to alter the care plan. c) neither the primary nor the associate should make changes without first consulting you as the manager. d) it really does not matter who alters the nursing care plan as it depends on situation and time to do so

a) it is the role of the primary nurse to make alterations based on assessment data and input The primary nursing model assumes that the primary nurse is accountable for patient care, even while off duty. The primary nurse is responsible for establishing the patient plan of care and therefore for altering it with the input of an associate. The associate is responsible for implementation of the established care plan when the primary nurse is off duty.

Case managed care may enhance profit in a for-profit health organization by: a) minimizing costs in high resource consumption areas. b) combining licensed and non-licensed care providers in delivering patient care. c) increasing reimbursement from third-party payers. d) reducing the amount of technology used to support clinical decision making.

a) minimizing costs in high resource consumption areas Case managed care is not revenue generating but rather revenue protecting in that better coordination of care enables efficient achievement of patient outcomes, can result in shorter length of stay, and can prevent readmission.

For a nurse manager in the functional nursing model, an approach that will assist in maintaining staff satisfaction in this specific model is: a) rotation of task assignments b) frequent opportunities for in-service education c) orientation to job responsibilities and performance expectations d) team social events in off hours

a) rotation of task assignments Although repetition of tasks increases confidence and competence, it can also lead to boredom. Rotation of tasks can assist specifically in this model to reduce the boredom that is a potential disadvantage of this model.

A facility that provides care for patients whose average length of stay is less than 30 days and to patients whose average length of stay is longer than 30 days, and who require inpatient and ambulatory care for addictions, through a spectrum of wellness and illness services and providers, would be considered: a. A healthcare network b. A tertiary care institution c. Rehabilitative d. Long-term care

a. A healthcare network Healthcare networks embrace and provide wellness and illness services, including primary, secondary, and tertiary care, through a network of providers.

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage. Sarah's actions are important in avoiding role: a. Ambiguity b. Transition c. Development d. Negotiation

a. Ambiguity Clarification of implicit and explicit expectations regarding the role assists in avoiding role ambiguity and role strain.

Sarah determines, in partnership with her patient, that current medications are not enabling her patient, a married account executive with fibromyalgia, to continue with her employment and family responsibilities. After searching for additional information on fibromyalgia, Sarah finds nonpharmacologic interventions that are supported through credible evidence. Sarah suggests that the patient, her physician, and she meet to discuss the medications and possible options and a plan of care for the patient's discharge. This action exemplifies which of the four historical concepts? a. Authority b. Responsibility c. Communication of conflict d. Autonomy

a. Authority Authority refers to the use of professional status and power to act in the patient's best interests. In this example, Sarah is using her professional status and power to set up a conference in which her patient, the prescribing physician, and she can discuss what is not working for the patient and potential options.

Sandra, an RN on the surgery unit, is assisting with a procedure in the pt exam room. The physician orders a medication to be given through IV. Sandra questions the order, based on her knowledge of the pt's history & of other meds the pt has been given. The physician reiterates the order and Sandra refuses to give it. In this instance, Sandra is demonstrating: a. Autonomy b. Accountability c. Authority d. Best practice

a. Autonomy In this situation, Sandra is exemplifying autonomy, which is the act of making independent decisions in the best interests of the patient, based on her knowledge and experience. This is analogous to the example in the text where the workers on the manufacturing floor have the independence to say "Stop the line" when something is wrong. Key to the concept of autonomy is decision making and the level of independence that is given. Accountability refers to achievement of outcomes, and authority refers to the capacity to make decisions

Which of the following will require greater attention in the future? a. Chronic disorders b. Obstetrical outcomes c. Prevention of hospital-based errors d. Team conflict resolution strategies

a. Chronic disorders

A Magnet hospital surveys the staff about job satisfaction. This type of environment, in which nurses have authority & autonomy, is linked with: a. Client satisfaction with the healthcare organization b. Organizations with a limited number of nurse managers c. Private, specialty organizations in urban areas d. Sophisticated academic health sciences universities

a. Client satisfaction with the healthcare organization Autonomy & authority in decision making that is consistent with scope of practice are linked both to higher job satisfaction and to higher patient satisfaction with care. Job satisfaction is an important indicator of the quality of patient care

As a team, you and the staff have determined that there is a need to reduce medication errors on your unit. Together, you developed the questions that you would like addressed and searched the literature for relevant research studies. Based on the evidence, you suggested a change to your practices and now are involved in implementation of these changes. Today, there was a major study released that would significantly change what you have decided to do. What are you and your staff experiencing? a. Compression complexity b. Distress c. Information lag d. Technology advancement

a. Compression complexity This situation exemplifies complexity compression, a term that means many changes are happening almost simultaneously and before one practice can be firmly implanted in our minds, we are already addressing some other new change. This compression can be distracting or useful.

You are hired as a new manager. When the offer of employment is made, you agree to at-will employment. Later, you become very concerned about the policies and practices of your organization and their impact on patient care. You speak with your supervisor several times about your concerns, but no action is taken. In considering your next steps, you: a. Consider your increased vulnerability under the terms of your employment. b. Recognize that your supervisor is more vulnerable than you are because of her more senior position. c. Are more likely as a leader to take action because you are well protected from repercussions by federal and state regulations. d. Contact your union to discuss your concerns and review your options.

a. Consider your increased vulnerability under the terms of your employment Managers of at-will employees have greater latitude in selecting disciplinary measures for specific infractions. State and federal laws do provide a level of protection; however, an at-will employee may be terminated at any time for any reason except discrimination. At-will employees, in essence, work at the will of the employer. Nurses in these positions need to know their rights and accountability

A new graduate is seeking a new position in nursing and wants to "sell" herself effectively. The best strategy is to: a. Create a resume b. Practice interviewing c. Call the personnel offices d. Create a curriculum vitae

a. Create a resume A résumé provides a customized overview of details of your professional background that relates specifically to a position for which you are applying. Resumes advertise your skills to a prospective employer.

A merger has occurred between a hospital and a local home health agency, creating new roles for the nursing staff in both agencies. The nurse managers of both systems begin to evaluate and revise patient care processes and systems. With the merger, the healthcare organization's changes are: a. Creating more jobs in the community for registered nurses b. Resulting in an overall loss of jobs for registered nurses c. Controlled by the federal and state governments d. Controlled by the insurance agency

a. Creating more jobs in the community for registered nurses Home care agencies staffed appropriately with adequate numbers of professional nurses have the potential to keep older adults, those with disabilities, and persons with chronic illnesses comfortable and safe at home. Home care is the fastest growing segment in health care and the volume of home health care may have a subsequent impact on the numbers of nurses required.

As a new nurse manager who has "inherited" a unit with high nurse turnover & complaints of pt dissatisfaction, your first course of action would be to: a. Determine levels of nurse engagement on the unit. b. Review the personnel files of nurses who have resigned. c. Interview upper management about their vision for the unit. d. Meet with your staff to clarify your vision for the unit.

a. Determine levels of nurse engagement on the unit Multiple studies demonstrate that a healthcare organization that provides a climate in which nurses have authority and autonomy has better patient outcomes, retains nurses at a higher rate, is more cost-effective, and has evidence of greater patient satisfaction than an organization in which such a climate does not exist. Organizational assessment assists in identifying the reasons for high nurse turnover and patient complaints.

To reduce reliance on overtime hours, an organization develops a strategy for floating nurses during staff shortages. To maximize patient safety & reduce costs, the healthcare organization: a. Develops a centralized pool of float nurses. b. Assigns nurses from less busy units to ones with increased acuity levels. c. Floats nurses only between units on which the nurses have been cross-trained. d. Assigns float nurses to basic care only.

a. Develops a centralized pool of float nurses A centralized pool usually includes experienced nurses who maintain a broad range of competencies. Other approaches are less satisfying for nurses, are less efficient, and may be less safe.

A nurse manager is discussing with unit staff the repeated lack of staff compliance in documenting exercise activity for post-cardiac surgery clients. The unit's licensed practical/vocational nurses are responsible for ensuring that clients carry out the prescribed exercise regimen and that the activity is documented. Using Drucker's 5 basic functions of a manager, identify appropriate functions for the nurse manager to use when addressing this situation: (select all that apply) a. Divide the necessary activities into manageable tasks, so clients adhere to the exercise regimen. b. Establish objectives and goals for each area and decide who is accountable for them. c. Allow clients to organize the activities. d. Engage in activities that motivate the team, and communicate effectively with the responsible staff members. e. Analyze, appraise, and interpret the performance of responsible staff, and communicate these findings to staff management. f. Allow clients to establish objectives and goals.

a. Divide the necessary activities into manageable tasks, so clients adhere to the exercise regimen b. Establish objectives and goals for each area and decide who is accountable for them d. Engage in activities that motivate the team, and communicate effectively with the responsible staff members e. Analyze, appraise, and interpret the performance of responsible staff, & communicate these findings to staff management Drucker's five basic functions include division of work into tasks, development and communication of goals and outcomes, motivation and communication, and analysis, approval, and interpretation of staff performance.

Nursing labor-management partnerships: a. Engage nurses at all levels in problem solving for better patient care. b. Require unions and management to negotiate in good faith regarding hours of work and wages. c. Have been shown to have negligible effects on nurse turnover and patient outcomes. d. Have typically resulted in increased polarization of nurses and management, leading to formation of collective bargaining units.

a. Engage nurses at all levels in problem solving for better patient care The development of a nursing labor management partnership is an approach that can be used in most professional nursing environments. This process recognizes nurses as leaders on all levels and provides formal and informal mechanisms for professional nurses to work together to achieve shared goals through collaboration and shared decision making or decentralized decision making. A study of a nursing labor management partnership suggested that nurse satisfaction was higher, turnover was lower, and more time was available for patient care.

A functional resume focuses on: a. Experience and skills gained in positions. b. Positions held and specific roles in the positions. c. Academic qualifications and achievements. d. Relating skills and experience to qualifications in a specific position.

a. Experience & skills gained in positions Functional résumés highlight skills and experience gained rather the details of specific positions. As with résumés in general, skills and experiences are customized to create an image of an individual in a particular position.

A busy neurologic ICU and step-down unit most likely would use which patient-classification system? a. Factor evaluation b. Prototype evaluation c. Hybrid system d. AHRQ system

a. Factor evaluation A factor evaluation system is considered more objective than a prototype evaluation system. It gives each task, thought process, and patient care activity a time or rating. Some patient types with a single healthcare focus, such as maternal deliveries or outpatient surgical patients, would be appropriately classified with a prototype system. Patients with more complex care needs and a less predictable disease course, such as those with pneumonia or stroke, are more appropriately evaluated with a factor system

Knowing your professional strengths is important to: a. Finding your fit in positions and a career path. b. Maintain a professional status. c. Act in a manner that is legal and ethical. d. Understand the role expectations of a position.

a. Finding your fit in positions and a career path Being aware of your strengths is critical in determining what you will bring to a position and can be used to find your fit and possible career path. Knowledge and experience are important in maintaining the privilege of belonging to a profession and of behaving ethically and legally.

The nurse manager is anticipating changes on the unit because of managed care. It is up to the manager to "sell" the staff on this care concept. A goal of managed care that the staff must understand is that managed care is: a. Grounded in business theory b. Useful for long-term patients only c. Designed to reduce unit resources and staff d. Not concerned with the best interests of clients

a. Grounded in business theory Managed care combines delivery of needed care with business principles of efficiency and cost. Nurse managers who know business principles become conduits for ensuring safe, effective, affordable care

In capitation, which of the following scenarios is most likely to occur? a. If the costs of caring for a patient are less than the capitated amount, the organization realizes a profit. b. If the capitated amount is less than the costs of caring for a patient, the organization realizes a profit. c. In capitation, profit is not directly tied to the costs for provision of care. d. Capitation has little or no effect on the aims and purposes of providing care.

a. If the costs of caring for a patient are less than the capitated amount, the organization realizes a profit When organizations align to provide a full array or continuum of services, the arrangement is referred to as vertical integration. Benefits attributed to vertical integration include enhanced coordination of services, efficiency, and customer services.

As a nurse manager in a for-profit hospital, you are interested in promoting teaching programs for physicians, because evidence suggests that hospitals with teaching programs tend to promote better care for patients. Your administration indicates that it cannot support your ideas or proposal because of: (select all that apply) a. Increased salary costs. b. Duplication of tests and procedures. c. Graduate medical education. d. Potential damage to reputation through learner error.

a. Increased salary costs b. Duplication of tests and procedures c. Graduate medical education Teaching hospitals tend to incur higher costs because of the salaries required for supervision of physicians, duplication of tests and procedures through the learning process, longer times required to process patients, costs of state-of-the art technology, biomedical research, and stand-by capacity of specialized care. Because of the additional costs, few for-profit agencies and organizations support teaching programs.

With the help of a federal grant, the local school nurse has established a spreadsheet that contains relevant nursing data so that she can analyze children's health. School health programs are: a. Increasingly seen as primary care sites for children. b. Providing only health education programs for children and their parents. c. Capable only of providing referrals for health problems to primary care providers. d. Funded exclusively by local authorities.

a. Increasingly seen as primary care sites for children Traditionally, school health programs were organized to control infectious disease outbreaks, treat and control on-site injuries, and educate parents and children about basic health. Increasingly, schools are being seen as primary healthcare sites for children.

A necessary leadership strength for nurses of the future is: a. Inspiring others to work their best to create the future b. Understanding the nuances of fundraising to make up funding shortfall c. Guarding the tendency of other professions to encroach on nursing roles d. Adapting work life to an aging nursing workforce

a. Inspiring others to work their best to create the future Senge said that all leadership is really about is people working at their best to create the future. Predictions of the future highlight the importance of interprofessional teams and of a shift towards understanding the importance of health care.

Senior executives at Hospital A determine that the hospital will engage in a strategic planning process after changes in healthcare funding and concerns expressed in the community about care that is being delivered at the hospital. The senior executives decide on a participatory process in which staff are widely consulted regarding input about the organization and the external environment and are actively invited to be part of decisions related to the mission statement, goals, and objectives. For true shared governance to be seen as part of this approach: a. It must be evident in the outcomes of the process that staff and senior executives have partnered on the decisions. b. Stakeholders must be assured of the value of their input even though final decisions rest with senior executives. c. Publications must clearly outline how staff input was solicited and obtained. d. Staff must be reassured that significant concerns will be kept in mind even if they have not been addressed in planning documents.

a. It must be evident in the outcomes of the process that staff and senior executives have partnered on the decisions Shared governance demands participation in decision making. When partnership, equity, and ownership are not involved, then shared governance has not occurred, and publication and expressions of appreciation for input will not be seen as representative of shared governance

During a discussion of concern about approaches used with aggressive patients in the Emergency Department, several staff members express concern for their safety. As a leader, the nurse manager should: a. Look directly at speakers and acknowledge their comments. b. Promise to implement each suggestion that is made. c. Implement the idea that receives the most discussion. d. Listen but implement the plan that she had in mind before the discussion began.

a. Look directly at speakers and acknowledge their comments One of the five rules for leaders is to listen to the constituents—in this instance, the staff members who have safety concerns. Active listening in the United States means establishing direct eye contact and asking probing questions. Listening does not obligate the leader to any one course of action. Action will be based on what is best for the group.

A nurse manager in a for-profit environment finds it difficult to recruit staff. This difficulty may be most related to aggressive profit goals and: a. Lower salary compensation for staff. b. Rising expectations of impoverished and indigent individuals for services. c. Poor orientation and retention practices for staff. d. An overwhelming emphasis on accepting learners from health disciplines.

a. Lower salary compensation for staff For-profit hospitals tend to have lower wage and salary costs that are most likely connected to aggressive goals for profit.

As the unit manager, you post the staffing plan & compliance reports. This initiative is aimed at: a. Maintaining unit morale b. Complying with national requirements c. Demonstrating patient outcomes d. Inviting staff participation in decision making

a. Maintaining unit morale Hospitals are responsible for monitoring the extent to which actual staffing matches the staffing plans, making revisions as necessary. The Joint Commission accreditation reviews staffing plans against any obvious staffing deficiencies and patient care concerns. Posting of the staffing plan is required in some states so that staff may view it. Adequate staffing, as demonstrated through a staffing plan, and compliance reports contribute to staff morale.

The adage "leaders are born and not made" reflects which of the following ideas around leadership? a. Management can be taught; leadership depends on abilities. b. Mentorship is important in developing innate skills of leaders. c. Leadership is a natural skill that cannot be refined or developed. d. Succession planning and formal education related to leadership are ineffective.

a. Management can be taught; leadership depends on abilities Leadership is an abilities role that is reflective of rich personal experience. It can be developed and refined through such strategies as coaching, mentorship, and reflection. Management can be taught and learned.

Organizational culture includes: (select all that apply) a. Norms b. Traditions c. Behaviors d. Values

a. Norms b. Traditions c. Behaviors d. Values Organizational culture, the reflection of the norms or traditions of the organization, is exemplified in behaviors that illustrate values and beliefs.

A nurse manager notices that Nathan, an RN who has been on the unit for approximately 3 years, has a particular interest in technology and seems to be very enthused about working with software and hardware at home. She speaks with Nathan and asks him if he would lead investigation of software applications on the unit. This is an example of: a. Opportunity b. Delegation c. Role negotiation d. Role transition

a. Opportunity Nathan's nurse manager recognizes Nathan's interest in technology as an opportunity for the unit and as an untapped resource that can be used to meet unit goals.

A nurse manager must also consider a number of internal variables that will affect staffing patterns. An internal variable to be considered is: a. Organizational staffing policies b. State licensing standards c. American Nurses Association d. Consumer expectations

a. Organizational staffing policies State licensing standards outline what a nurse can do. Internal policies determine what a nurse may do in a particular setting as well as the amount of flexibility that is allowed to manage times of high and low volumes, as well as changes in acuity. Organizational policies can put the nurse manager in a situation where patient safety cannot be maintained or financial obligations met.

Martin, the unit manager, receives complaints from community agencies that patients who have been discharged from his unit seem to lack understanding about their disorder and immediate strategies for managing elements of their care. Martin checks the patient teaching sheets and notes that the sheets are initialed by staff. He calls the agencies and indicates that teaching has been done. Potential outcomes of Martin's actions include: (select all that apply) a. Poor morale on the unit b. Disruption in community relationships c. Corruption of patient-staff relationships d. Patient outcomes for quality care are met

a. Poor morale on the unit b. Disruption in community relationships c. Corruption of patient-staff relationships When management accountability for activities is not accepted, then relationships suffer, professional practice is diminished, and self-esteem suffers.

The ED staff decides to use a collective bargaining model for negotiation rather than a traditional trade union model. A traditional trade union model is characterized by: a. Positional conflict b. Management support of labor's initiatives c. A spirit of trust between management and labor d. An ability to resolve complaints

a. Positional conflict Collective bargaining encompasses management support of labor's initiative, a spirit of trust between labor and management, and resolution of problems. It replaces the positional conflict that has been associated with traditional trade unions. Models such as the interest-based problem solving (IBPS) model seek to avoid positional conflicts such as those between labor and management that do not take into account the opposing party in any way

In developing curricula that will address needs based on forecasts for the future, nursing educators need to contemplate: (select all that apply) a. Prevention strategies b. Leadership skills and knowledge c. Violence de-escalation strategies d. Strategies for job security

a. Prevention strategies b. Leadership skills and knowledge c. Violence de-escalation strategies Future forecasts suggest that health factors such as obesity that are implicated in the development of chronic disorders will increase, as will chronic disease. Leadership skills have been identified as a key competence for nurses of tomorrow, and competence with technology will be needed as technology continues to revolutionize health care. Rather than emphasizing job security, nurses will need to be prepared to be in an environment with many options and episodic employment.

The chief nursing officer develops a mentoring program to help new staff members adjust to their new jobs. The main purpose of mentoring is: a. Promoting staff retention b. Promoting staff attrition c. Developing new role expectations d. Promoting staff supervision

a. Promoting staff retention Mentoring has been identified as important to staff retention.

Nurses in an ED, in an inner-city neighborhood characterized by high levels of violence, are concerned with low levels of security presence in their department. Security levels have recently been decreased and the nurses question why this has occurred. An appropriate action would be to: a. Provide nurses with information about rationale for recent changes in security staffing. b. Refer the matter to the head of security and let her deal with it. c. Provide mentors who can help nurses diffuse aggressiveness. d. Accept the security levels as a consequence of funding realities.

a. Provide nurses with information about rationale for recent changes in security staffing Workplace advocacy is an umbrella term encompassing activities within the practice setting. Workplace advocacy includes an array of activities undertaken to address the challenges faced by nurses in their practice settings. The focus of these activities is on career development, employment opportunities, terms and conditions of employment, employment rights and protections, control of practice, labor-management relations, occupational health and safety, and employee assistance. The objective of workplace advocacy is to equip nurses to practice in a rapidly changing environment. One manifestation of workplace advocacy is ensuring that relevant information is shared about decisions that affect practice so that further data gathering and decision making (in this instance about security levels and nurse safety) is informed.

The difference between staffing & scheduling is that staffing: a. Puts the right person in the right position b. Puts the right person in the right time and place c. Refers to the number of nursing hours per patient per day d. Looks after interpretation of benefits and compensation

a. Puts the right person in the right position Nursing staffing involves planning for hiring and deploying qualified human resources to meet the needs of a group of patients. Scheduling, on the other hand, is a function of implementing the staffing plan by assigning unit personnel to work specific hours and days of the week.

The successful integration of informatics into healthcare settings is key to: a. Quality decision making related to management of resources and patient care. b. Accessing current information about business practices. c. Meeting the modern-day expectations of staff regarding technology use. d. Speeding up calculations and decisions in budget development.

a. Quality decision making related to management of resources and patient care The use of informatics to research evidence and alternative models of delivery, to compare data and solutions with those of other managers, and to enhance the coordination and delivery of patient care can assist managers in making solid decisions about resource utilization. The use of informatics is embraced by Generation X-ers and Millennials who grew up with technology, but may be more difficult for older staff

Which of the following actions is most representative of how health care of the future might be delivered? As a nurse leader, you: a. Refer families who require immediate help to a local food bank. You also work with local agencies and families to establish a mothers collective in which mothers learn about nutrition and prepare low-cost, nutritious meals that are shared with the mothers in the collective. b. Work together with a local agency to set up a free clinic in which addicts and the homeless can receive free health care and prescriptions for immediate needs. c. Ensure that individuals who are admitted to your unit are asked about their smoking history and that preoperative and postoperative planning takes into account how smoking will affect status during and after surgery. d. Address the health of those who are overweight and obese on your unit by ensuring that hospital meals offer nutritious, healthy food choices that are satisfying.

a. Refer families who require immediate help to a local food bank. You also work with local agencies and families to establish a mothers collective in which mothers learn about nutrition and prepare low-cost, nutritious meals that are shared with the mothers in the collective

To maintain patient safety, studies suggest that scheduling should avoid: a. Rotating shifts b. Weekends c. 8-hour shifts d. Mandatory overtime

a. Rotating shifts Rotating shifts & overtime past 12 hours are shown to increase nurse error & jeopardize pt safety

In assisting new graduates to make the role transition to graduate nurse, Ted, the unit manager initiates which of the following? a. Self-check list to assess competencies that have been strengthened b. Discussions that focus on what the new graduates have yet to learn c. Fixed target dates for acquisition of competency and transition to RN role d. Frequent formal meetings to provide feedback on performance and areas to be strengthened

a. Self-check list to assess competencies that have been strengthened Transition to the new role is facilitated through reflection and ongoing development of awareness of strengths (as compared with a focus on weaknesses) and of weaknesses. The value of the employee may not depend on quickness in making the role transition.

Which of the following is an outcome of managed care? a. Shift of patients to outpatient and home health services b. Less complexity in funding sources c. Less complexity in rules for consumers to follow d. Greater consistency in the quality of care

a. Shift of patients to outpatient & home health services A goal of managed care is to reduce the cost of expensive acute hospital care by focusing on out-of-hospital preventive care & illness follow-up care, which has led to shifts in where health care is delivered.

A nurse manager in one hospital values a colleague who is a few years older and has more experience in nursing management. The colleague works in another hospital, but they meet for lunch once a month. In these meetings, they share their feelings about nursing management and their lives. The function of a mentor that is missing in the relationship is: a. Sponsorship b. Role modeling c. Social interaction d. Mutual positive regard

a. Sponsorship Sponsorship involves building the competency of the mentee through exposure or by creating opportunities for achievement in order for the mentee to develop a reputation of competence.

Becky graduated five years ago and is keenly interested in pursuing leadership opportunities. She has been active in learning about leadership through workshops and Internet research and recently began a graduate degree program with a focus on nursing administration. She has excellent clinical skills and eagerly accepts responsibility for various projects on the unit. Her sarcastic and sometimes aggressive behavior tends to alienate other staff members on the unit. In coaching Becky, you: a. Suggest that she reflect on situations in which she has had a positive influence and consider how her interactions contributed to the situation. b. Suggest that she not consider leadership roles because her interaction skills are more suited to roles in which she has limited opportunities to work with others. c. Ask staff members on the unit with whom she works to provide her feedback about ways in which her behavior irritates or turns them away. d. Encourage her to continue her graduate courses, as information about strategies and technical aspects of the role will compensate for negative interactions.

a. Suggest that she reflect on situations in which she has had a positive influence and consider how her interactions contributed to the situation. Leadership involves radiating positive energy and the ability to inspire and motivate others. Management can be taught through formal instruction, but leadership is attained through reflection on rich personal experience.

As a nurse manager, you would expect which of the following to be the major contributor to funding and revenues in your organization? a. The federal government b. Medicare c. Medicaid d. Blue Cross/Blue Shield

a. The federal government The federal government is responsible for both Medicare and Medicaid and is the largest and most influential health insurance program in the United States. The federal government is the primary payer of healthcare costs in the United States.

While interviewing for a nurse manager position, Ann is asked to give an example of a situation in which she demonstrated leadership. Which of the following examples exemplifies leadership? a. Through research and investigation of best practice and practice-based evidence, she proposed a change in the management of incontinence in elderly patients. b. She ensures that new policies related to parenteral infusions are implemented consistently within her team. c. When asked by her students about institutional policies, she readily and patiently interprets policies to facilitate quality care. d. She organizes the team and delegates responsibilities effectively in providing nursing care

a. Through research and investigation of best practice and practice-based evidence, she proposed a change in the management of incontinence in elderly patients. Nurse managers have the responsibility of day-to-day decisions for their units and interpret established policy, procedures, and mandates. They meet their goals by organizing, staffing, controlling, and solving problems. By contrast, leaders develop a vision and translate that direction into action

After being interviewed for the unit manager position, the staff nurse reflects on the interview process. The staff nurse is aware that leadership begins: a. Within b. Through a relationship with a mentor c. With the job description d. With the chief nursing officer of the organization

a. within People notice differences in workplaces and tend to choose those that evidence a high degree of trust between leaders and followers. Stephen M.R. Covey suggests that trust begins with self and that leaders must focus first on developing character and confidence, which is their credibility. Credibility enables leaders to trust themselves and gives others someone or something that they can trust.

The nurse manager at a cardiac rehabilitation unit was asked to select a care delivery model. Which of the following methods would be the most cost-effective? a) Functional method b) Case management method c) Primary care method d) Team method

b) Case management method Team nursing, functional nursing, and case management are all considered efficient, cost-effective methods of care delivery because they enable utilization of various types of healthcare providers (rather than baccalaureate nurses in direct car e, which is the primary nursing method). Case management is considered particularly cost-effective in patient care settings because it maintains quality care while streamlining costs for high-risk, high-volume, high-cost patient populations and seeks the active involvement of the patient, the family, and diverse healthcare professionals.

In hiring nurses during the transition from team nursing to a primary nursing model, Benner's work would suggest that you give priority to nurses who are at LEAST at which level of competency? a) Advanced beginner b) Competent c) Proficient d) Novice

b) Competent Nurses who have less than 2 or 3 yrs experience in primary nursing and/or less than 2 or 3 years of nursing experience will likely require more assistance than other nurses, which will put a greater demand on the unit during a time of transition.

When interviewing an applicant for an RN position, the nurse manager describes the unit's care delivery system as one in which the nursing assistants are cross-trained to perform specific tasks & the RNs complete all treatment, med administration, & discharge teaching. The nurse applicant knows this nursing care delivery strategy to be: a) The case method b) Functional nursing c) Primary nursing d) Nurse case management

b) Functional nursing Functional model of nursing - method of providing pt care by which each licensed & unlicensed staff member performs specific tasks for a large group of pts

In transitioning to a primary nursing model, it's important for a nurse manager who enjoys a high level of control over pt care to understand that his or her decision making at the patient care level: a) is increased b) is decreased c) is relinquished d) remains the same

b) is decreased The nurse manager who is considering movement to primary nursing needs to consider how the role of the manager changes, as well as the roles of the staff. The role of decision making at the patient care level is relinquished to the primary nurse, and the role of manager becomes that of facilitator, coach, mentor, role model, and clinical resource.

You're considering putting forward a proposal to move the model of care from team nursing to a primary nursing hybrid: patient-focused care model. In considering this proposal, you recognize that significant costs specific to operationalizing this model are related to: a) implementation of an all-RN staff complement b) significant changes in the physical structure of units c) orientation of staff to new roles and responsibilities d) testing and piloting technology at the bedside

b) significant changes in the physical structure of units This particular model includes a focus on patient care that includes multidisciplinary teams & assistants at the bedside. Services, including laboratories & pharmacies, are decentralized to bring them closer to where care is delivered

A small rural hospital has been designated as a critical access hospital. It has 40 beds & an average occupancy of 34 beds. To prepare the staffing, the chief nursing officer computes the occupancy as being: a. 90% b. 85% c. 75% d. 60%

b. 85% Occupancy (%) = daily pt count / # of beds on unit [34/40, or 85%]

Recruiting among the emerging workforce (18- to 35-year-olds) is a challenge for healthcare agencies. Marketing brochures should address the leadership and vision of the healthcare agency. Which of the following workplace environments will attract applicants in the emerging workforce? a. A highly professional environment b. A nurturing and receptive environment c. An environment highlighted by lots of meetings, so staff members can have lots of input d. A totally online environment, so staff members will not have to interface with uncaring colleagues

b. A nurturing & receptive environment A study of student nurses who represent this age group indicates that they want a leader who is receptive, approachable, a team player, and motivating.

As a nurse manager, you have been offered a position at a Veterans Administration hospital. In accepting the position, it is important for you to understand that veterans' hospitals provide: a. Primary care and are privately funded b. A range of services and are responsible to government and taxpayers c. Secondary care only and are publicly administered and funded d. Services to veterans under an HMO

b. A range of services and are responsible to government & taxpayers Veterans Administration hospitals provide a range of services to Veterans and are responsible to government and thus to taxpayers, who support the hospitals.

Government and third-party payers announce reduction of compensation for the delivery of patient services. Hospital STV has a flat organizational structure. After the funding announcements, senior officials at the hospital meet and make decisions regarding cost containment of new revenue streams. This action is consistent with: a. The practice of leaving financial decisions with senior officials who understand the total context of funding. b. A tendency to concentrate decision making during economic downturns at the top administrative level. c. A need to make expedient decisions that are likely to be poorly received by staff. d. Ensuring that decisions with regard to cost are made equitably across all departments.

b. A tendency to concentrate decision making during economic downturns at the top administrative level During times of economic downturn, decisions tend to become very centralized to avoid risk. History demonstrates that increasing the breadth of input during these times is more effective than narrowing it.

As a new manager, you reflect on what professional development would be most valuable to assist you in taking on this role. Which of the following would you most likely identify? a. Opportunities to hone clinical skills that are used most often on the unit that you will manage. b. A workshop on conflict management and communication skills. c. Attendance at a conference on global health care economics. d. Attendance at a workshop on survey tool development and statistical measurement.

b. A workshop on conflict management and communication skills Patrician et al. (2012), in a qualitative descriptive study that explored the professional development needs of nursing leaders, developed a number of recommendations that were based on what charge nurses indicated about their needs. The recommendations included education and orientation to the role, managing performance and development of staff, and communication skills. Additional education should be focused on unit finances and patient relations. Leadership support was found to be pivotal for charge nurses to feel successful or hinder their work

To project staffing needs & avoid understaffing, it is important that nurse managers consider which of the following? a. Maximum productive hours b. Average non-productive hours c. Minimum benefit hours d. Maximum vacation time

b. Average non-productive hours To avoid understaffing, average nonproductive or benefit hours need to be taken into account, so the unit is properly staffed when staff members are off.

The new head nurse on G Unit has been the subject of a great deal of discussion and complaining during breaks. She is a competent nurse of tremendous integrity with approximately 30 years' experience. Her predominant method of problem solving and communication is through meetings, which can go over the allotted time. The staff may: a. Be represented by a high number of Baby Boomers. b. Be presenting different generational values and attitudes than the head nurse. c. Be unresponsive to her transactional leadership style. d. Want a leader rather than a manager.

b. Be presenting different generational values and attitudes than the head nurse Leaders who come out of the Baby Boomer generation may be more comfortable with collective action than followers who come out of the Emerging Workforce generation, who are more comfortable with interactions if they are seen as having value for them and with activities if they are seen as having benefit. A group that is highly weighted toward the Emerging Workforce generation may find the approach of a leader who is part of the Baby Boomer generation frustrating and may not understand the meaning or value of the meetings.

A particular classification system assigns revenue according to the functional capacity of patients and the progression of patients during their stay in rehabilitation units. More independent patient activities, such as prompted voiding, require higher staff utilization than dependent activities but do not result in increased staff resources. This is an example of: a. Bureaucracy b. Concern related to the validity of classification systems c. Inadequate reliability of classification systems d. Inappropriate subjectivity in making judgments about staffing

b. Concern related to the validity of classification systems Validity of categories and implications for staffing levels are in question in this situation because staffing levels are not reflective of the levels of

To enhance team leadership skills for your team leaders, you arrange opportunities for: a. Certification b. Continuing education c. Graduate courses d. Volunteerism

b. Continuing education Continuing education provides systematic learning opportunities that augment existing skills and knowledge for delivery of quality care and advancement of career goals. Graduate and certification courses provide advanced knowledge and skills.

The hospital administrator approves a case management position for a new rehabilitation unit to help reduce costs. In developing the job description, the nurse manager understands that a key element of case management is: a. Managing of care by nurse managers. b. Coordination of resources for effective outcomes. c. Rapid discharge of clients to decrease costs. d. Managing of care for outpatient clients only.

b. Coordination of resources for effective outcomes The key to effective case management is proactive coordination of care from the point of admission to accomplish appropriate and effective outcomes. Case management involves components such as case selection, multidisciplinary assessment, collective planning, coordination of events, negotiation, and evaluation and documentation of the outcomes of patient status in measures of cost. Case management is employed in a variety of settings

The ED staff members are concerned that working long hours without rest puts patient safety at risk. One staff member decides that she will risk her job and become a whistleblower. Whistle-blowing is an appropriate recourse when management: a. Disregards due process when disciplining a nurse. b. Delays responding to repeated efforts to provide safe care. c. Hires nurses who are not a part of the union during a strike. d. Refuses to bargain in good faith with the elected bargaining agent.

b. Delays responding to repeated efforts to provide safe care Whistle-blowing is often a result of organizational failure, including failure of the organization to respond to serious danger or wrongdoing created within the environment, which, in this instance, involves conditions that put the patient at risk

A manager who is concerned with ensuring that patients on her surgical unit have the necessary information to make informed choices is: a. Practicing legal nursing care b. Demonstrating respect for patient rights c. Avoiding risks d. Likely experiencing staff issues with informed consent

b. Demonstrating respect for patient rights In demonstrating respect for and advocacy for informed consent, the nurse manager is reflecting a professional philosophy. Professional nurses are ethically and legally accountable to the standards of practice and the accompanying nursing actions delegated to others. Conveying high standards, holding others accountable, and shaping the future of nursing are inherent behaviors in the role of a manager

As a senior executive, you are keen to develop your hospital as a learning organization. Part of your purpose in translating this vision into practice is to: (select all that apply) a. Retain funding from third-party payers. b. Develop leaders. c. Maintain and/or improve quality of care. d. Stay abreast of new knowledge and evidence.

b. Develop leaders c. Maintain and/or improve quality of care d. Stay abreast of new knowledge and evidence Learning organizations are concerned with providing opportunities and incentives for individuals and groups to engage in lifelong learning, in recognition of the positive impact that learning has on patient outcomes and staying abreast of new knowledge. Lifelong learning and reflection are also characteristics of leaders

Nurses on the dialysis unit notice that changes in labeling of fluids have meant several alarming near miss in terms of wrong administration of fluids. They take this concern to the unit manager. As an advocate of nurse autonomy, the most appropriate response in this situation would be to: a. Ensure that the nurses are aware of the reasons for the change and how the decision was made about the new labels. b. Discuss concerns about the labels and develop potential solutions that take into account changes that can be made at the local level and those that need system intervention. c. Suggest that the staff wait until they have become more familiar with the labels before taking further action. d. Tell the staff that you will notify the pharmacy about these concerns and leave it up to the pharmacy to decide what should be done.

b. Discuss concerns about the labels and develop potential solutions that take into account changes that can be made at the local level and those that need system intervention Participation in decision making regarding one's practice is an appropriate expectation for professional nurses, provides for greater autonomy and authority over practice decisions, contributes to supporting the professional nurse, and is a major component of job satisfaction. Autonomy is encouraged through supportive management and through unit-level support of changes without the need for complex, multilevel approval of changes that can be made locally.

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage. Sarah finds that she has begun to think negatively about the way nursing care is delivered on her nursing unit. She often wishes that she was back on her old unit and in her familiar staff nurse role. This behavior: a. Is natural when assuming a new position. b. Diverts energy from internalization of Sarah's new role. c. Is justified if practices are deficient on the new unit. d. Reflects Sarah's astuteness as a clinician.

b. Diverts energy from internalization of Sarah's new role By focusing on the weaknesses of the unit, Sarah may lack the energy to internalize the new role—a step that is critical to being an effective leader. As a new manager, Sarah must learn how to access resources in the organization. Approaching the organization as a foreign culture, Sarah can keenly observe the rituals, accepted practices, and patterns of communication within the organization. This ongoing assessment promotes a speedier transition into the role of manager.

Your organization is in the middle of re-designing patient care units, with decisions based on best practices and various other sources of evidence. In the middle of the transition, there is a temporary halt called to the transition because of a re-design of the health care system and greater emphasis on primary care. What would be a healthy response to this situation? a. Salvage as much of the original planning as possible so as to reduce expenditures. b. Engage in consultation to create innovative solutions that bridge the existing plans and the new directions. c. Abandon the current planning in favor of addressing the new trends. d. Continue with the current planning because trends come and go.

b. Engage in consultation to create innovative solutions that bridge the existing plans and the new directions Stability and total chaos are the ends of a continuum. Moving in some way between those two ends suggests that we live in a constant state of disequilibrium in which we strive toward stability while recognizing we experience chaos. As we continue to move from "traditional" practices to evidence-based ones and from a heavy focus on tertiary care to one that values primary care, we can assume that we might experience more chaos. Chaos can lead to new learning and new, innovative solutions. As nurses, it is important to be able to function in an evolving environment.

The chief nursing officer utilizes the hospital's workplace advocacy to help the overwhelmed ED staff. Workplace Advocacy is designed to assist nurses by: a. Creating professional practice climates in their institutions b. Equipping them to practice in a rapidly changing environment c. Negotiating employment contracts d. Representing them in labor-management disputes

b. Equipping them to practice in a rapidly changing environment Workplace advocacy encompasses a number of activities that enable nurses to control the practice of nursing and to address challenges that they face in the practice setting. These activities include career development, employment rights, employment opportunities, and the labor-management relationship. The aim of workplace advocacy is to proactively equip nurses to practice within a rapidly changing environment, rather than to negotiate contracts or provide representation in employment disputes

The local health department nurse manager has developed and implemented a disaster readiness plan as part of a community service. Community services: a. Care for the specific needs of individual families in the community. b. Focus on the treatment of community-wide problems rather than on individual health problems. c. Do not include services provided by public health departments. d. Provide personal health follow-up for all acute care hospitalizations.

b. Focus on the treatment of community-wide problems rather than on individual health problems Community services, including public health departments, are focused on the treatment of the community rather than that of the individual. These funds provide personal health services, care for communicable diseases, services for children with birth defects, mental health care, investigation of epidemiology, and treatment of bioterrorism threats and attacks. Monies are allocated also for environmental services and for health resources.

In accomplishing the goal of breakfast for children in elementary school, Leanne is particularly effective in approaching businesses with the needs that the group has determined and articulating the ways that the group has found for businesses to participate. Leanne is exemplifying: a. Leadership b. Followership c. Professionalism d. Knowledge of context

b. Followership Effective followership involves active and loyal involvement in an agenda that has been established. In this role, Leanne is supporting and operationalizing the agenda and strategies that have been established within the group

A local hospital has formed a corporate partnership with a reputable HMO (health maintenance organization). The nurse manager has had to educate staff and personnel about the financial implications of this partnership. A Health Maintenance Organization (HMO): a. Provides more expensive care than other types of insurance plans. b. Has a centralized administration that directs and compensates physician services. c. Pays physicians on a fee-for-service basis. d. Does not pay as much for acute care as other practice plans.

b. Has a centralized administration that directs and compensates physician services The HMO is a configuration of healthcare agencies that provide basic and supplemental health maintenance and treatment services to voluntary enrollees who prepay a fixed periodic fee without regard to the amount of services used. HMOs have a centralized administration that directs and pays salaries for physician practice (e.g., HMOs).

Nursing professionals in the twenty-first century will accomplish most of their work: a. Through teams of internationally prepared professionals b. In teams and through group work c. Through long-term, secure jobs d. In competitive environments and work groups

b. In teams and through group work The future is about teams and group work. Competition will be out and collaboration will be in. Job security will be out and career options will be in. Our brightest and best may leave more often than they do at present to pursue career options internationally.

Martin, the unit manager, receives complaints from community agencies that patients who have been discharged from his unit seem to lack understanding about their disorder and immediate strategies for managing elements of their care. Martin checks the patient teaching sheets and notes that the sheets are initialed by staff. He calls the agencies and indicates that teaching has been done. Martin's follow-up to complaints from the community is: a. Appropriate and indicates that he has assumed accountability for the actions of his staff. b. Indicative that he does not clearly understand the concept of accountability. c. Indicative of strong support for his staff and their autonomy. d. Important in clarifying the difference between his accountability and that of the community in patient care.

b. Indicative that he does not clearly understand the concept of accountability Accountability refers to the achievement of desired outcomes. If community agencies are noticing that limited or no change in patient behavior has occurred despite teaching on the unit, then the staff has not achieved accountability, and he is not holding his unit responsible for the outcomes. Martin is also demonstrating lack of accountability

On Unit 62, the nurses and the unit manager have been involved in shared decision making related to the model of nursing care delivery that the unit will adopt. All individuals have participated and been involved in decision making and implementation of changes. When issues arise during implementation, it is expected that: a. Accountability resides entirely with the unit manager. b. Individual expertise will be utilized to provide solutions, but that responsibility for the change is shared. c. No one really has any accountability or responsibility for the changes. d. This will contribute to widespread skepticism among the staff about the probability of success.

b. Individual expertise will be utilized to provide solutions, but that responsibility for the change is shared High-performing organizations provide for participation by all stakeholders, and each stakeholder shares responsibility and risk. This kind of environment is more satisfying for nurses and is characterized by optimism and trust

Which of the following nurses is MOST likely to inspire others to do their best? a. Nancy, RN, is an individual who enjoys details and organization. She regularly leaves notes for the next shift about what has been done incorrectly or omitted. b. Jim, RN, has been involved in nursing for several years and is well liked by patients and families. He continually searches for new knowledge and skills, and his sense of humor and optimism are infectious. c. Clara has been the head nurse on Unit 3Y for years. She is quiet but enjoys patients and their families. She has not been to a conference in years because the unit is her entire life. d. Karen is a team leader. She is extraordinarily vigilant about ensuring that everyone is treated fairly in assignments. She is also very conscientious about care and regularly checks up on what everyone is doing to ensure that it is done correctly.

b. Jim, RN, has been involved in nursing for several years and is well liked by patients and families. He continually searches for new knowledge and skills, and his sense of humor and optimism are infectious To be inspired, people must have a positive leader who radiates energy, a zest for learning, and an interest in the common good, and is engaged in self-renewal. This leader is hopeful and optimistic. Leaders, not managers, inspire others to work to their highest level.

Your unit has a number of patients who have undergone limb amputation. In working with the clients, you begin to think beyond therapies such as pharmacotherapeutics and surgery and you explore biomechanics, robotics, mind-body approaches, and cognitive behavioral therapies as possibilities in working with these clients. You begin to amass information in a number of areas with which you previously had little familiarity. According to the Wise Forecast Model©, you are a. Acting wildly b. Learning wildly c. Engaging in interprofessional care d. Increasing your complexity compression

b. Learning wildly The first step, learn widely, means that we must extend our sources of knowledge beyond our role and clinical areas of interest. In fact we must extend our learning beyond nursing and health care. Widely might encompass another discipline such as architecture or engineering.

Budgeting and protection of revenues is a function of: a. Leadership. b. Management. c. Team leadership. d. Followers.

b. Management Managers address complex issues such as planning, budgeting, and allocating resources, whereas leaders address change.

The nurse manager plays a unique role in institutional management in that the nurse manager: a. Encourages shared decision making b. Models professional nursing behavior c. Interprets healthcare trends and their impact on revenues d. Coordinates care and allocates resources

b. Models professional nursing behavior Encouragement of shared decision making, coordination of resources, and interface between internal and external factors and a unit are all associated with effective management but could be performed by a manager from any discipline. The nurse manager's unique role is modeling professional behavior

Tracy is an RN case manager who interfaces between the Centers for Medicare and Medicaid. Tracy's responsibilities most likely would include: a. Managing physician-led research. b. Monitoring physician documentation of the need for medical care. c. Determining which services are designated fee-for-service. d. Identifying errors in physician diagnoses.

b. Monitoring physician documentation of the need for medical care Nurse case managers serve as interfaces for the Centers for Medicare & Medicaid Services (CMS) and are key in monitoring compliance with Conditions of Participation (CoP) elements. The case managers routinely monitor for appropriate physician documentation of medical necessity and other required CoP elements.

As a nurse manager, it is important to become a "future thinker." Which is an example of a "future thinker"? a. Keeping traditional practices b. Moving toward evidence-based practices c. Finding less need for more knowledge d. Believing that macromarketing will be a necessity

b. Moving toward evidence-based practices Future forecasts include evolutions in power, structure, and knowledge; rapid change in the healthcare system; the demise of macromarketing; and increased evidence-based practice.

A group of managers is meeting to discuss ideas related to the successful implementation of evidence-based practice on their units. Susan has been asked by the director of care to assume leadership of these discussion groups. After two such sessions, Susan expresses disappointment to her mentor that the group seems disinterested in her ideas and that they are listening to Ken, who has much less experience with leadership. In discussing this with Susan, the mentor understands that leadership: a. Is a designated role b. Must be earned c. Is more likely to be taken by someone who is more talkative d. Rarely is taken over by someone with less experience

b. Must be earned A person can have an impressive title, but title or designation does not make the person a leader. A leader must have the ability to inspire others to follow

The starfish analogy is exemplified in which of the following? a. A unit manager resigns after continued tension between the administration and her regarding implementation of primary nursing. The primary nursing project dies. b. Nurses try to establish a clinic that provides ambulatory care to parents and young children in an impoverished neighborhood. Community members advocate for funding from political leaders and insurers. c. Alana, a new graduate, promotes continence care based on evidence. When she presents her ideas, senior staff refuses to consider it. d. The head of a community health service moves on to another position. Programs are disbanded.

b. Nurses try to establish a clinic that provides ambulatory care to parents and young children in an impoverished neighborhood. Community members advocate for funding from political leaders and insurers The starfish analogy points to the connectivity that we have with one another and how we influence and are influenced by others all the time. This affords many opportunities for leadership that are dependent not on formal titles but on opportunities to shape the work at hand.

The Sunny Long-Term Care Facility has experienced numerous difficulties with staff relationships, despite its success in maintaining financial viability and judicious use of resources. Staff members complain that the primary concerns of the facility include applying policy, saving money, and ensuring that lawsuits are avoided. There is little trust in, and involvement of, staff members. This facility may be: a. Well managed and well led b. Overly managed and not well led c. Poorly managed and well led d. Overly led and overly managed

b. Overly managed and not well led This organization is concerned primarily with coordination of resources, application of current policy, and economic issues connected to the present. These behaviors are consistent with the management role. There is little evidence that the organization displays leadership, which involves trust, belief, hope, and vision.

Several changes are introduced to a unit, including changes to familiar clinical procedures and the use of WOWs to enable bedside documentation. You, as unit manager, anticipate which of the following will contribute most to complexity compression? a. Meaning of the change b. Pace of changes c. Previous experiences with change d. Confidence of the leader in the value of the change

b. Pace of changes

Staff members on your unit raise concern that there is rising acuity on the unit & lack of responsiveness in addressing these needs through appropriate staffing. They point to increased incidences of adverse & sentinel events on the unit. To address this concern, your hospital organization would do best to: a. Implement a patient classification system immediately. b. Participate in databases that compare the outcomes and staffing levels versus those of institutions similar to yours. c. Provide increased numbers of staff to the unit. d. Ignore such concerns because acuity is variable.

b. Participate in databases that compare the outcomes and staffing levels versus those of institutions similar to yours Staff morale suffers both when acuity models indicate a gap between staffing and acuity and when there is no model but perceived acuity that is not being addressed. A truer approach is to monitor patient outcomes and participate in national databases that measure staffing levels through comparison with like institutions.

A nurse staffing plan takes into account: a. Specific nurse-to-patient ratios per shift b. Participation of nurses in projecting staffing needs c. Compensation and benefits for each level of staff d. The occupancy load of a unit

b. Participation of nurses in projecting staffing needs Nurse staffing plans employ nursing judgment and flexibility that is based on acuity, nurse experience, and unit configuration rather than set nurse-to-patient ratios. The American Nurses Association has opted to support the nurse staffing committee as the approach to ensure safe staffing. In 2013, national legislation was introduced that requires all acute care hospitals to establish a committee made up of 55% direct care RNs.

The nurse manager in the Emergency Department needs to implement new staffing patterns. As a transformational leader, the nurse manager should: a. Explain in detail how well the new idea will work. b. Reinforce how this change will respond to the ideas and solutions generated by staff members. c. Reason with staff members that the new idea will save money and allow more free time. d. Imply that raises will be smaller than anticipated if the new idea is not accepted.

b. Reinforce how this change will respond to the ideas and solutions generated by staff members Transformational leadership inspires and motivates others through influence and persuasion rather than through rewards (e.g., free time) and punishment (e.g., smaller raises). This type of leader listens to the views of others (such as those of the staff members), empowers others to lead (such as in generating solutions for staffing problems), finds ways to remove barriers, and serves as an advocate for those who care for patients.

As a result of Amy's coaching, Sarah, a nursing graduate of 5 years, completes a ROLES assessment. This assessment is helpful in: (select all that apply) a. Identifying her clinical knowledge b. Role development c. Areas of conflict in expectations d. Expected work time commitments

b. Role development c. Areas of conflict in expectations d. Expected work time commitments A ROLES assessment is useful in identifying, confirming, and visualizing responsibilities, opportunities, lines of communication, expectations of self and others for the position, and support. This is particularly useful in identifying areas of conflict in expectations, including conflict between the manager's own expectations and those of staff and supervisors and in negotiating role expectations.

The nurse manager, as the leader of the unit's "customer (client) first" initiative, has asked the staff nurses to develop and administer a survey to every client before discharge. In asking the staff nurses to accomplish this task, the nurse manager is demonstrating: a. Accountability b. Shared leadership c. A common purpose d. Independence in the nursing manager's role

b. Shared leadership Healthy work environments are facilitated by involving staff and others in decision making; gaining access to information is one characteristic of shared decision making. Shared decision making enables staff to feel valued in policy development and in directing and leading.

The style of leadership that Kari is exhibiting is likely to: a. Ensure that the organization is financially stable. b. Stifle innovative thinking about ways to move out of financial jeopardy. c. Lead to apathy and disinterest in the organizational goals. d. Lead to decreased attrition of staff on her unit.

b. Stifle innovative thinking about ways to move out of financial jeopardy Whether or not the organization achieves financial stability is a function of financial envisioning and planning, but the style of leadership (transactional) that Kari is demonstrating is likely maintaining the status quo within the organization, without generating creative and innovative ideas to address the financial issues. Staff commitment is low to stable, and conformity to organizational goals is motivated by external rewards.

A nurse executive who considers herself a Baby Boomer will have the challenge of convincing the emerging workforce of the necessity of committee meetings. One of the primary reasons that the Baby Boom generation appears to have so many meetings in the work environment is that: a. They feel more comfortable in a group. b. They find that the journey to the solution is as important as the solution itself. c. They were deprived of collective action opportunities in the past and now feel that solutions are better when many people have input. d. Baby Boomers are aging and need the respite from work that meetings offer, so they can recuperate from the physical demands of the work environment.

b. They find that the journey to the solution is as important as the solution itself Baby Boomers mistrust authority and trust in collective action, based on successes with social movements in their formative years.

Kari, a head nurse on the dialysis unit, has been informed during budget planning meetings that budget cuts are likely. She discusses this at the next unit meeting and tells staff members that unless they do their jobs well, their positions may be terminated, and there will be no replacement. Kari is enacting which management style? a. Transformational b. Transactional c. Trusting d. Truthful

b. Transactional Transactional leaders tend to rely on position and power, and they tend to reward and punish according to performance and conformity with expectations

A nurse manager uses many sources of data when planning the unit's workload for the year. Which of the following data must be considered in the planning? a. Hours of operation of the unit b. Trends in acuity on the unit c. Maximum work stretch for each employee d. Weekend requirements

b. Trends in acuity on the unit Acuity levels are determined through classification systems, which determine the nursing resources required.

Nurses in the CCU are unhappy and frustrated with their nurse manager. They complain that "nothing is ever good enough for him." These statements suggest that the nurse manager's goals may be: a. Measurable b. Unrealistic c. Attainable d. Too low

b. Unrealistic Nurse managers who are successful in motivating staff often provide an inclusive environment that facilitates clearly set, achievable goals that can result in both team and personal satisfaction

On your curriculum vitae, which of the following is the recommended approach for listing employment & educational history information? a) 1979 RN Diploma 1985 BScN 2002 MN b) 2002 Mount Rush Health Center Staff Nurse 1997 Cedar Falls Clinic Staff Nurse 2007 Kilkarney Rehab Center Case Manager c) 2007 MN 2005 BScN d) 1997 Sturgeon County Hospital Head Nurse 2002 Sturgeon County Supervisor 2007 Sturgeon County Director

c) 2007 MN 2005 BScN Information that is included in the body of the curriculum vitae should always be in reverse chronological order so that the most recent and, presumably, most relevant job information appears first.

You are the nurse manager of a nursing service organization that provides around-the-clock care to clients in their homes. To achieve maximum reimbursement for a client who is recovering from a hip replacement, the nursing staff most likely will follow the nursing care guidelines presented in the: a) Nursing care plan b) Physician's orders c) Critical pathway d) Clinical practice guidelines

c) Critical pathway Critical pathway - outlines outcomes, clinical standards, & interventions for a pt in each phase of treatment. - Goal = effective coordination of care across various staff & levels of care.

A pt complains to the charge nurse that she has no idea who her nurse is on any given day. "I ask one nurse for my pills & she says, 'That's not my job.' I ask the pill nurse about my lab tests & she says that I should ask another nurse." The nursing care delivery model most likely employed in this situation is: a) Differentiated practice b) Team nursing c) Functional nursing d) Case management

c) Functional nursing Functional team nursing involves licensed and unlicensed personnel who perform specific tasks for a large number of patients. A disadvantage of functional team nursing is the fragmentation of care. The physical and technical aspects of care may be met, but the psychological and spiritual needs may be overlooked. Patients become confused with so many different care providers per shift. These different staff members may be so busy with their assigned tasks that they may not have time to communicate with each other about the patient's progress.

The case method of care delivery could be best justified in which of the following scenarios? a) Stable patient population with long-term care and family needs b) Acute care surgical unit with predictable post-surgical outcomes and many technical procedures c) Pediatric intensive care unit that heavily involves families as well as patients d) Home healthcare environment with patients at varying levels of acuity

c) Pediatric intensive care unit that heavily involves families as well as patients This model is especially useful in the care of complex pts who need active symptom management provided by an RN, such as the care of the pt in a hospice setting or an ICU. This method would be justifiable delivery in the pediatric intensive care unit, where the status of pts can change rapidly & where complex functions of care involve both pts & families.

In a small rural nursing home, a director of nursing decides, because of a shortage of nurses, to implement a partnership model to help with basic tasks that comply with state rules regarding delegation. What type of design constitutes a partnership care delivery model? a) RN and LPN/LVN b) RN and RN c) RN and medication assistants d) RN and certified nurses' aides

c) RN and medication assistants The partnership care delivery model is a variation of primary nursing in which an RN works with a consistent assistant, who performs basic nursing functions consistent with state delegation rules.

To effectively delegate in a team nursing environment, the RN team leader must be familiar with the legal and organizational roles of each group of personnel and must: a) be able to effectively communicate with patients b) build relationships with physicians c) be able to adapt to daily changes in staffing d) adapt in communicating information to her supervisor

c) be able to adapt to daily changes in staffing A particular challenge in team nursing is that staff mixes and staff may change daily because of individual schedules and shortages

A nurse manager questions the true difference between primary nursing & total patient care. After careful consideration of both models, the nurse manager concludes that primary nursing differs significantly from total patient care in: a) breadth of nursing knowledge and expertise required b) intention to provide holistic nursing c) degree of task orientation d) levels and types of assessment

c) degree of task orientation Significant overlap can be seen between primary nursing and total patient care in terms of breadth of assessment and knowledge required to provide holistic care. A primary difference is that nurses in the total care model assume accountability while on shift, whereas primary nurses assume responsibility from time of admission to discharge and 24 hours a day.

In considering whether or not to accept a job offer as a nurse manager at a Magnet® hospital, you look at an environment that you might encounter as a head nurse at the hospital. You determine that you could expect to: a) find it difficult to recruit new staff b) see rapid turnover of staff on your unit c) find nurses who exemplify interest in quality care d) find limited interest in excellence in the nursing environment

c) find nurses who exemplify interest in quality care Magnet® hospitals exemplify hospitals whose focus processes attract and retain nurses who value and promote quality care and excellence in nursing environments.

In a job interview for a staff position, which of the following indicates your knowledge of pt safety? a. "Will I be able to get overtime hours on your unit?" b. "If there is an opportunity to work extra shifts, I would really like that." c. "Is there a strategy in place to reduce the number of overtime hours on the unit?" d. "I see no reason why I wouldn't be able to work overtime."

c. "Is there a strategy in place to reduce the number of overtime hours on the unit?" Overtime, whether voluntary or mandatory, to fill staff vacancies is seen as a risk to both patients and nurses because it is more likely to lead to compromised decision making and technical skills because of fatigue.

Nathan tells you that he has selected nursing as a career because many jobs are available and he will have job security. Your best response to Nathan is: a. "With many young people going overseas, many jobs and options will be available. Stable jobs and job security will be part of the nursing employment market." b. "The job market for nurses will be diminished with funding cuts to hospitals." c. "The employment prospects for nurses are positive with many options to choose from. Flexibility and adaptability are essential to income security." d. "It is unlikely that nursing will survive in the long term with funding cuts and a declining population of seniors."

c. "The employment prospects for nurses are positive with many options to choose from. Flexibility and adaptability are essential to income security." Employment for nurses continues to be positive, although roles will change in a rapidly changing environment, which will increase options. With the number of options available and sporadic work opportunities, nurses will need to be flexible and able to adapt rapidly. Job security will be out; career options will be in.

During performance appraisal interviews, Joanne's nurse manager notices Joanne's excitement when she talks about how she has helped patients on a rehab unit understand the complexities of their regimens. When Joanne's nurse manager asks her about her career path plans, Joanne says that she wants to become a nurse administrator. The best response to Joanne would be: a. "Nursing administration is rewarding. What experiences would help you along this path?" b. "You do not appear excited about nursing administration. Unless you are excited by that career path, I wouldn't advise going in that direction." c. "You seem to find teaching others very rewarding. Have you considered that as a possible career path?" d. "You are too inexperienced to consider administration. Work for a few years, and then consider administration."

c. "You seem to find teaching others very rewarding. Have you considered that as a possible career path?" Joanne evidences excitement about teaching patients, and although administration could be a rewarding path for her, education might be a better option for her to consider. Looking at job aspects that are rewarding is helpful in determining which career direction to pursue.

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage. After a year, Sarah successfully transitions into the nurse manager role and considers taking the examination to become a certified nurse executive. Amy advises her that this is not possible because Sarah will need: a. A graduate degree b. At least a nursing diploma c. 24 months of experience d. 5 years of successful experience

c. 24 months of experience Nurses with baccalaureate preparation and holding a nurse executive position with at least 24 months of experience can take the examination to become a certified nurse executive.

The hospital administration is discussing the possibility of closing hospital beds in your unit because of a nursing shortage and the increased amount of overtime required to care for patients. As the leader on the unit, which of the following examples best demonstrates your transformational leadership style? a. Your entire staff walks out on strike. b. Your staff sends an ultimatum to the clinic director demanding higher pay. c. A group of your staff members goes to the administration to propose closing of a different unit. d. A group of your staff members goes to the administration to request that they be allowed to work the overtime hours.

c. A group of your staff members goes to the administration to propose closing of a different unit Commitment to the vision that has been created is seen in the ability of the leader to influence, motivate, and persuade others. The transformational leader can motivate employees by encouragement of novel, innovative thinking. Drenkard (2013) describes true transformational leadership as occurring when the leader "created an environment that brought leaders and followers together to solve problems, create new ways of doing work, and manage change together" (p. 57)

Scheduling is a function of implementing the staffing plan by assigning unit personnel to work specific hours and specific days of the week. To retain nursing staff, the nurse manager must incorporate into the schedule plan: a. All weekends off b. All holidays off c. A variety of scheduling options d. Rotating shifts

c. A variety of scheduling options Creating a flexible schedule with a variety of scheduling options that leads to work schedule stability for each employee is one mechanism likely to retain staff, which is within the control of nurse managers.

Healthcare organization XYZ provides women's health services on an inpatient basis (average stay of less than 30 days). This facility would likely be considered: a. Primary care, specialized b. Tertiary care, long-term c. Acute care, specialized d. Public care, specialized

c. Acute care, specialized The AHA defines an acute care hospital as a facility in which the average length of stay is less than 30 days. Because of the focus on women's health services, it would also be considered specialized.

The nurse manager of a unit was demoted to staff nurse 6 months ago. Because of being near retirement, the former nurse manager wanted to be employed at the hospital and was offered a position on the same unit. The former nurse manager complains often about how infrequently the current nurse manager is available on the unit and argues with physicians and co-workers. Clients have complained about the attitude of the nurse. The behavior of the former nurse manager can be best explained as being caused by: a. Overwork in the staff nurse position b. Inadequate mentoring in the new role c. Anger as a stage of the grieving process d. Demotion as a threat to personal identity

c. Anger as a stage of the grieving process When an employment relationship ends or changes unexpectedly, grieving occurs. One of the phases in grieving is anger.

A business condition that may assist forecasting but add to the complexity of change is: a. Consulting with professional groups about change. b. Researching about trends on futuristic sites. c. Asking patients to examine options for change d. Building profit projects and sustainability into planning.

c. Asking patients to examine options for change Stalk and Butman suggests that asking the customer for feedback on options may assist with forecasting. Adopting this strategy runs counter to current practice and would increase the complexity of healthcare planning and forecasting.

In addition to providing coaching, a nurse mentor may provide counseling to the mentee. For counseling to be successful, the mentor must: a. Provide a quiet environment away from the unit. b. Keep the focus on technical and management responsibilities. c. Assure confidentiality. d. Present assignments that stretch the intellectual and technical ability of the mentee.

c. Assure confidentiality Counseling provides opportunity for the mentee to share personal concerns. For counseling to be successful, confidentiality must be assured.

In an inner-city area, a group of nurses meet and develop a plan to negotiate with local businesses to support a breakfast program for young elementary schoolchildren. This is an example of: a. Community development b. Collective bargaining c. Collective action d. Shared governance

c. Collective action Collective action refers to activities undertaken by a group of people with common interests and, in this example, by a group of nurses who are interested in the welfare of children in their community

A factor evaluation system: a. Utilizes financial data to determine number of staff-to-patient ratios. b. Utilizes DRGs to determine acuity on a unit. c. Combines interventions and time required for interventions to determine levels of care required. d. Combines financial resources and nursing interventions to determine patient contact hours.

c. Combines interventions and time required for interventions to determine levels of care required A factor evaluation system considers tasks, thought processes, and patient care activities and gives them a time or rating. These are then used to determine the number of patient care hours required.

In evaluating weekend mortality rates, the head nurse on the cardiac unit is surprised to find that they are higher than on weekdays. In exploring the reasons for this apparent anomaly, the head nurse focuses on: a. Availability of diagnostic personnel b. Availability of physicians c. Communication with on-call providers d. Acuity level of patients

c. Communication with on-call providers Studies to date of off-peak hours (weekends and nights) are limited, but those that have been done indicate increased mortality during weekends and nights, when staff work with fewer and often less experienced staff and when there may be strained communication among on-call healthcare providers.

An example of a career is: (select all that apply) a. Employment in short-term contract jobs in business, nursing, and whatever is available. b. Involvement in an area of practice that is regulated. c. Continuous employment in the same position and the same arrangement for 20 years. d. Moving into and out of nursing positions in various cities while pursuing travel and education that develop understanding of global health.

c. Continuous employment in the same position and the same arrangement for 20 yrs d. Moving into and out of nursing positions in various cities while pursuing travel and education that develop understanding of global health Career refers to progression of skills, consistency, knowledge, and/or status. This movement through nursing life is predicated on having a vision of a career as opposed to a series of jobs. Career styles can be defined as linear, steady state, entrepreneurial, or spiral. Deepening skills in one area is an example of a steady state career style, whereas moving into and out of positions in various cities can characterize an entrepreneurial style. Involvement in a regulated field defines a professional interest but not necessarily a career.

Who of the following might be the BEST mentor for Becky, a new nurse manager on the cardiac unit who has 4 years of previous clinical experience? a. Sam, near retirement. He has 20 years of clinical nursing and recently assumed role of head nurse in an interim capacity because of the incumbent's illness. b. Leslie, who has been a clinical educator at the institution for a number of years. She has tired of her role and aspires to become a nurse manager. She looks at mentorship as an opportunity to understand the role better. c. Courtney, who has been a nurse manager for 3 years. Her staff and supervisor value her skills and her leadership acumen and championship of innovation. d. Ben, who was nurse manager for 3 years, soon after graduation. He left the role because he was uncomfortable with the expectations and has been a team leader on surgery for 15 years.

c. Courtney, who has been a nurse manager for 3 yrs. Her staff & supervisor value her skills and her leadership acumen and championship of innovation A mentor needs to have sufficient professional experience and organizational authority so that he or she can mentor the career of the mentee. Mentors need competencies that include interpersonal and communication effectiveness, risk taking and creativity, and ability to inspire change.

The Emergency Department nurses' decision to organize for the purpose of collective bargaining is being driven by a desire to: a. Establish the staffing pattern that will be used. b. Determine the hours that one is willing to work. c. Create a professional practice environment. d. Protect against arbitrary discipline and termination.

c. Create a professional practice environment Historically, nurses were reluctant to unionize. However, concern with safety of care and quality of care, especially when tension is present in a work environment, makes unionization more desirable. U.S. Supreme Court rulings have provided for RN-only units and protection to practice according to what the profession and licensure status require nurses to do

A nurse manager has worked rapidly to bring the staff to accept changes in the unit's mission, so that downsizing can be avoided. This nurse manager is using quantum leadership by: a. Focusing on past concerns related to the mission. b. Teaching staff members how to self-manage themselves. c. Determining accurately the direction of change in the institution. d. Requiring all staff members to review and reinforce their technological skills.

c. Determining accurately the direction of change in the institution The manager is using change theory to have the staff develop and therefore buy into the changes. Determining the direction of change for the institution allows the manager to work using change theory to guide staff for changes.

The unit leader on an inpatient psychiatric unit of a large hospital has been in the position for 3 months. The unit leader is frustrated by how little time is available to work with clients and how few changes have been implemented in that time. The phase of role transition being experienced is the role of: a. Acceptance b. Negotiation c. Discrepancy d. Internalization

c. Discrepancy Role discrepancy is an experience that includes a gap between what is expected and what is occurring and can lead to disillusionment, discomfort, and frustration. If the unit manager values the relationship and sees the differences between performance and expectations as correctable, then the manager is likely to stay in the role.

In planning a new wing, the nurse manager complies with the workplace safety requirements of the Occupational Safety & Health Administration (OSHA). Which of the following groups is considered to be at high risk for violence in the workplace? a. Pediatric staff b. Postsurgical unit staff c. Emergency Department staff d. Medical oncology unit staff

c. Emergency Department staff Nurse managers have responsibility for both patient and staff safety. High-risk areas, such as the Emergency Department, require special attention.

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage. After beginning her new position, Sarah finds that she spends a great deal of time in direct patient care. Her staff begins to complain that they are never able to find her when they need her, and that some aspects of her responsibilities fall behind, such as scheduling. Sarah is most likely: a. Lacking an understanding of the nurse management role. b. Attempting to prove her clinical skills to the nursing staff. c. Experiencing difficulty in unlearning old roles. d. Lacking enjoyment in her new role.

c. Experiencing difficulty in unlearning old roles Role transition involves transforming one's identity. Although any of the answers listed might be correct, as a new manager, her confidence in her clinical skills suggests that she is having difficulty in the transformation process and in unlearning her role as a clinician.

A nurse manager at a home healthcare service has resigned to take a position at a local ambulatory care center. She has been hired because of her expertise in TJC accreditation. To initiate the changes, the nurse manager has to be knowledgeable about the differences between a home healthcare institution and an ambulatory care center, which is a primary care institution. Primary care institutions are facilities that provide: a. Rehabilitative or long-term care b. Disease-restorative care c. First access to care d. Only outpatient services

c. First access to care The spectrum of care services provided are typically described as primary care (first-access care), secondary care (disease-restorative care), and tertiary care (rehabilitative or long-term care). Ambulatory care centers are an example of primary care.

A nurse manager is experiencing considerable conflict among staff members because of weekend staffing coverage. During a called staff meeting, the nurse manager asks the disgruntled staff to meet as a group and determine the best staffing practices. In doing this, the nurse manager is using the concept of collaboration to: a. Demonstrate interdependence. b. Depict flexibility and broadmindedness. c. Focus all energies of staff members on a best possible strategy. d. Defuse the possibility that staff members will escalate their discontent when staffing the unit on weekends

c. Focus all energies of staff members on a best possible strategy When collaboration is used to solve a conflict or to create new directions, the energies of all parties are focused on solving the problem versus defeating the opposing party and creating the "best possible" versus an "okay" direction. When groups come together and mutual expectations are discussed and fostered, communication and collaboration are enhanced, which results in a more structurally empowered workforce.

Which aspect of our tradition and history in nursing may impede our movement towards future-oriented thinking? a. Lack of confidence b. Focus on the discipline of nursing c. Focus on details in the everyday practice d. Mistrust of trends and new evidence

c. Focus on details in the everyday practice

The chief nursing officer has been developing her portfolio for years. What is the chief nursing officer modeling? a. Her clinical expertise b. Affection for tradition c. Her employability d. Her busy professional life

c. Her employability Being employed is no longer sufficient; we must be employable. A portfolio outlines achievements and experiences that communicate employability.

The new nurse manager feels pulled between the expectations of staff, the demands of hospital administrators, and family obligations. According to Hardy (1978), unrelieved role stress and strain will lead to: a. Frustration and anger b. Alienation of family and friends c. Low productivity and performance d. Physical symptoms and acute illness

c. Low productivity & performance Unrelieved role stress and strain leads to focusing energy into negative thoughts and feelings, which can leave the manager fatigued and therefore less likely to be productive or to perform well.

Based on studies of workplace environments for nurses and future projections, the workplace of the future will be: a. Less intense because of more technology. b. About the same as it is now. c. More intense because of more technology d. Fluctuating between intense periods and less intense periods.

c. More intense because of more technology Technology will continue to revolutionize health care and contribute to complexity compression. In addition to access to knowledge, electronic records, and current applications of technology, technology will include robotics, which will change how chronic disease can be managed, and bioengineering will make possible interventions that do not yet exist.

In order to plan long term, you consider what the client of the future will look like. Which of the following client profiles would best capture shifting demographics and trends in health care? a. Younger, knowledgeable about health options b. Female, uses emergency care services for parents and children c. Older, one or more chronic disorders, diverse background d. Male, various occupationally generated disorders, diverse ethnic background

c. Older, one or more chronic disorders, diverse background

An important aspect of managing the costs on a unit is to plan accurately for staffing needs. Nurse managers use staffing plans to: a. Assign staff on the unit on a daily basis. b. Ensure that days off are planned for the staff. c. Outline the number of individuals by classification on a per-shift basis. d. Predict the numbers and classifications of float staff needed to augment regular staff.

c. Outline the number of individuals by classification on a per-shift basis A nurse manager needs to manage financial resources by developing staffing plans. Staffing plans plan for minimum number of professional nurses required on a unit at a given time or to the amount of minimum staffing in an extended-care facility or prison, based on regulatory guidelines.

What would be the most appropriate focus in developing a business plan for a nurse-owned home healthcare service? a. Programs to educate the community on preparing healthy meals for a limited cost b. Reduction of injuries from alcohol-related accidents c. Pain management for patients with low back pain d. Reduction of falls among seniors

c. Pain management for patients with low back pain Nurse-managed and nurse-owned healthcare services are part of a growing number of organizations that extend health care beyond that offered through traditional services. Growth in these organizations and services has been spurred by the implementation of the prospective payment system, which resulted in early discharge of many patients from acute care facilities. These nurse-managed and nurse-owned services focus on the care of individuals and families rather than on community-based outcomes for populations such as older adults, or on community-based issues such as injuries related to drunk driving.

An experienced staff nurse applies for a distinct position of patient advocate at a new clinic. Based on the various tools available to her, which of the following should she bring to her interview to best present her skills? a. Résumé b. Annual evaluations c. Portfolio d. Patient advocacy project

c. Portfolio A portfolio enables prospective employers to view evidence of significant achievements and responsibilities that would be pertinent to the position.

Thomas has been a nurse in your ICU for 10 yrs. In facilitating Thomas' professional development, you would focus on: (select all that apply) a. Certification for the ICU environment. b. Discussions about how Thomas can fit with role expectations and relationships. c. Possible specializations within the ICU environment. d. Encouraging him to lead changes that leave long-term impacts after his retirement.

c. Possible specializations within the ICU environment d. Encouraging him to lead changes that leave long-term impacts after his retirement Thomas is a mid career professional. As such, you would expect him to be interested in honing areas of expertise (such as leadership or developing a deeper expertise in a particular area of ICU nursing) as opposed to gaining skills necessary for his work environment such as certification or becoming comfortable with his role and relationships in ICU, which would be critical to an early career nurse. Legacy building is characteristic of mid career professionals.

Professional associations: a. Set regulatory requirements and establish entry requirements for nursing. b. Offer graduate programs for clinical and career advancement. c. Provide opportunities for career networking and support. d. Are open to all individuals who meet the criteria for membership.

c. Provide opportunities for career networking and support Professional associations are frequently, although not always, voluntary groups whose members provide leadership in issues and policies of interest to nurses. Professional associations also offer networks of nurses with similar interests.

While making rounds, a night supervisor finds a unit with a low census and too many staff members. The night supervisor is performing as a statutory supervisor when he or she: a. Assigns nurses to care for specific clients b. Develops a protocol for unlicensed personnel c. Recommends transferring a nurse to another service d. Teaches a nurse to use a new piece of equipment

c. Recommends transferring a nurse to another service The night supervisor is acting in accordance with the National Labor Relations Act, which would enable the supervisor to assign nurses to care

In Hospital STV, senior administration is strongly oriented toward fiscal and social conservatism. The nursing department is deeply concerned with the provision of quality to the community, which includes a high number of poor and unemployed. To accomplish the goals of the nursing department, resources need to be allocated that administration is not able to allocate. Nursing and administration: a. Are engaged in shared governance b. Are involved in an irreconcilable conflict of interests c. Represent separate subcultures in the institution d. Represent union and nonunion conflict

c. Represent separate subcultures in the institution Institutions can have several subcultures, which are represented by unique features and distinct ideologies. Subcultures can be congruent and can support healthy relationships in the organization, or they may be separated and characterized by tensions that may be irreconcilable and destructive. From the information given in this scenario, it is not evident that shared governance, union presence, or irreconcilable differences are present

John, a new nurse manager, complains to his colleague that he feels very uncomfortable with the conflict between what he thinks he should be doing as the manager and what his supervisor thinks he should be doing. According to Hardy's role theory, John is experiencing: a. Stress b. Role stress c. Role strain d. Role exploration

c. Role strain According to Hardy, role strain is the subjective feeling of distress that occurs when role stress or a social condition of conflicting demands or difficult conditions is present.

As the clinical director of 24 employees, you have been asked to explain to staff members why they are not getting a raise this year, even though they have been working short-handed for many months and patient satisfaction scores have never been higher. Because you believe yourself to be a transformational leader, you will approach this problem by: a. Telling the assistant clinical director and asking her to share the bad news with the other staff members. b. Posting a note on the bulletin board that includes the phone number of the chief nursing officer, so anyone who has complaints may express them. c. Showing staff members the budget and asking for input about how to cut costs so that raises will be possible in the future. d. Meeting with a small group of seasoned staff members and asking them how to break the news.

c. Showing staff members the budget and asking for input about how to cut costs so that raises will be possible in the future Transformational leadership involves engaging those being led and inspiring shared vision in moving toward a goal that all will accept as desirable. This involves enabling and empowering others to believe that their input and effort will make a difference in solving problems

A nurse manager has been employed in the same facility for 20 years and has held the same position. This career style is known as: a. Linear. b. Spiral. c. Steady state. d. Entrepreneurial/transient.

c. Steady state Career styles that are marked by selecting and staying in a role throughout a career are characterized as steady state.

Your organization is in the middle of re-designing patient care units, with decisions based on best practices and various other sources of evidence. In the middle of the transition, there is a temporary halt called to the transition because of a re-design of the health care system and greater emphasis on primary care. As a manager in this situation, your staff experience a gap between what they expected (the original re-design of the units) and what is actually happening (a need to integrate primary care in some way). According to Selye, the nurses on your nursing team are likely experiencing what? a. Eustress b. Distress c. Stress d. Compression

c. Stress Selye described stress as being on a continuum between stress that is positive (eustress) and stress that is negative (distress). Because individuals perceive the same event differently, from the information that is given, it is not possible to determine whether the nurses experience the events as eustress or distress; what is most likely is that the nurses are experiencing stress, which is what occurs when there is a gap between expectations and what is actually occurring.

A stroke unit experiences numerous changes related to implementation of new technology, a changed nursing care delivery model, and staff turnover within a period of 6 months. Staff members begin to show signs of reluctance to implement any more changes. This exemplifies: a. A poor relationship between leaders and staff b. Lack of knowledge regarding the importance of changes c. Striving to achieve stability in the midst of great disequilibrium d. The importance of chaos in promoting adherence with established practices

c. Striving to achieve stability in the midst of great disequilibrium Stability and chaos are at opposite ends of a continuum. When chaos is present, change occurs but life may seem uncontrollable. Resisting further change is a move toward establishment of equilibrium.

In reviewing the current delivery model, the nurse manager is aware that a demographic change that will have a significant effect on the healthcare delivery systems of the future is: a. Changes in staffing patterns b. Increasing reports of violence in the workplace c. The increasing percentage of the population that will be over age 65 d. Escalations in the cost of health care

c. The increasing percentage of the population that will be over age 65 A demographic change that will significantly impact the healthcare system of the future is the increasing proportion of individuals 65 years and older. By 2025, more than 18% of the population is expected to be 65 years and older, which means that new healthcare organizations will evolve as the system attempts to maintain older adults in the community for as long as possible.

In working with Cheryl, her mentor suggests that it is really important for Cheryl to engage in self-appraisal and to know her strengths. This observation is based on an understanding that: a. Self-confidence comes automatically out of leading. b. Self-confidence requires constant self-affirmation of strengths. c. There is little external motivation and affirmation in leadership. d. Supervisors of leaders rarely provide feedback.

c. There is little external motivation and affirmation in leadership Followers usually hold opinions about decisions that are made; these opinions can be favorable or not, which means that external motivation and affirmation are rare. Leaders have to be confident in their own abilities and enthused about the vision that they have created.

You notice that wait times in your Emergency Department are growing longer, because of factors such as increases in the numbers of persons with chronic disorders, discharge of patients into the community at a higher level of acuity, and limited resources for transfer of inpatients. You begin to think about an application that would use your knowledge of the Emergency Department but also software and business applications and wonder if this would reduce wait times. You have not encountered anything similar to this idea. According to the Wise Forecast Model©, you are in what phase? a. Wild thinking b. Act widely c. Think wildly d. Learn widely

c. Think wildly

A group of patients with early Alzheimer's disease and their spouses approach you regarding help with the establishment of a local Alzheimer's Society for the support and education of affected individuals and their families. As a manager in an ambulatory care clinic, you would advise that: a. Self-help groups are, by nature, directed, funded, and led by those requiring help, and that the patients and families should need no help from your clinic. b. Your healthcare organization will be pleased to help as long as your organization financially takes over responsibility for direction, leadership, and management. c. Through partnership, you will provide supports, if possible, that the patients & spouses themselves identify as necessary in the establishment of the group. d. The services that the patients and spouses are proposing are likely being offered somewhere else already.

c. Through partnership, you will provide supports, if possible, that the patients & spouses themselves identify as necessary in the establishment of the group Self-help groups often are made up of, and are directed by, peers who have healthcare needs. A growing trend is the development of community-based geriatric organizations in partnership with healthcare organizations. The request of the patients and their spouses indicates that this service is needed in the community and that they are looking for assistance in setting up the Alzheimer Society rather than having your agency take over the management of the group.

A nurse is interviewing for a manager's position. Which of the following actions is considered a role preview? a. Formal commitment of the employment contract b. Improving role performance c. Touring the unit d. Disillusionment about the expectations of the job

c. Touring the unit Touring the unit enables the candidate to assess further whether this organization will assist in growth and also to make a positive impression on the potential employer.

To prepare staffing schedules, a nurse manager needs to calculate paid nonproductive time. When calculating paid nonproductive time, the nurse manager considers: a. Work time, educational time, and holiday time. b. Paid hours minus worked hours. c. Vacation time, holiday time, and sick time. d. Paid hours minus meeting time.

c. Vacation time, holiday time, & sick time Nonproductive hours = hours of benefit time (include vacation, holiday, & personal/sick time)

The American Nurses Association has advocated for the Registered Nurse Safe Staffing Act. This legislation is based on ANA Safe Staffing Principles and takes what factors into consideration for planning staffing on a nursing unit? a) Patient acuity and complexity b) Education and training of the nurses c) Technology available and use on the unit d) All factors listed are to be considered

d) All factors listed are to be considered ANA supports the nurse staffing committee as the approach to ensure safe staffing. For the last decade, the ANA has advocated for a RN Safe Staffing Act. The legislation is based upon the ANA Safe Staffing Principles (Box 13-2) & considers the following: - RN educational preparation, professional certification, and level of clinical experience - The number and capacity of available healthcare personnel - Geography of the unit - Available technology - Intensity, complexity, & stability of patients

Complex care of acutely ill pts is required on a surgical unit, which utilizes differentiated nursing practice as its model of care delivery. On what is the concept of differentiated nursing practice based? a) Licensure status b) Experience in the agency c) Leadership capabilities d) Education and expertise

d) Education and expertise Differentiated nursing practice - models of clinical nursing practice defined or differentiated by: - level of education - expected clinical skills or competencies - job descriptions - pay scales - participation in decision making

When hiring a case manager for a rehabilitation setting, you would most likely consider a: a) registered nurse with a master's degree. b) physiotherapist with a background in stroke rehabilitation. c) social worker with a background in counseling. d) health professional with advanced background who is client and outcome focused.

d) health professional with advanced background who is client and outcome focused Case managers can come from a variety of disciplines but should have advanced preparation with the particular at-risk population being served, be comfortable in an advocate role, and be outcome and patient focused.

The nurse manager is comparing functional nursing & primary nursing for potential adoption. The nurse manager determines that patient & nurse satisfaction in primary nursing are: a) similar to those in functional nursing b) not of significance in either model c) low by comparison with functional nursing d) high when compared with functional nursing

d) high when compared with functional nursing Although some studies suggest there is little difference between functional nursing and primary nursing, primary nursing tends to be more satisfying for RNs, who enjoy a high level of accountability and autonomy in decision making. Patient satisfaction is also high, as patients form close therapeutic relationships with the nurse because of the continuity of the relationship. Functional nursing is criticized for low patient satisfaction and potential staff dissatisfaction related to boredom and an autocratic approach to management.

In an acute care unit, the nurse manager utilizes the functional nursing method as the care delivery model. The nurse manager's main responsibility is the needs of the: a) department b) unit c) staff d) patient

d) patient In a functional nursing model, where other team members are focused on performing specific tasks, the nurse manager assumes primary responsibility for patient outcomes.

The nurse case manager is working with a client admitted for end-stage renal disease. The case manager's major goal during this hospitalization for this pt is to: a) implement the care pathway on admission. b) provide direct nursing care throughout the hospitalization. c) supervise the nursing staff members who implement the care map. d) prevent additional hospitalizations resulting from complications of the client's disease.

d) prevent additional hospitalizations resulting from complications of the client's disease The goals and outcomes established in a critical pathway are designed to support the aims of case management, which are shortened hospital stays and prevention of hospital readmissions.

Awareness & use of power have been challenging for nurses in general bc of: a. Incidences of punishment by authority figures b. Too little time in the workplace to collectively develop power strategies c. Lack of cohesiveness and unity among nurses d. A tradition of obedience to authority

d. A tradition of obedience to authority Rituals and traditions such as the Nightingale Pledge have emphasized the need for the "good nurse" to be obedient to authority. This prevailing attitude has made it difficult for nurses, who typically spend considerable time in the workplace and who have opportunity through their work in teams to develop cohesiveness and unity, to develop awareness and use of power

A strategy to increase RN staff retention at Valley Hospital includes: a. Better compensation and benefits b. Clearer position descriptions c. Lay-offs of nursing assistants d. Adequate staffing to meet acuity levels

d. Adequate staffing to meet acuity levels Over the past decade, a significant amount of research has been done in the United States to evaluate links among nursing staffing, workloads, skills mix, and patient outcomes. An analysis of this research demonstrates that ensuring adequate staffing levels has been shown, among other things, to improve nurse retention and job satisfaction.

Collective action is effective in: a. Ensuring that needs of nurses are placed ahead of other disciplines b. Defining nursing as a profession c. Advising patients of the needs of nurses d. Amplifying the influence of individuals

d. Amplifying the influence of individuals Individuals may have limited influence in achieving various purposes such as advancement of quality care or of the profession, whereas collective action helps to define and sustain individuals in achieving the desired purposes

In looking at an organizational chart for her institution, Jennifer notes that nursing is led at the senior level by a non-nurse executive. Jennifer expresses concern that this is a reflection of how nursing is viewed within the organization. Jennifer's comments reflect: a. A concern that resource allocation will be made on a business and not a professional model. b. The dissatisfaction that occurs when lack of autonomy is given to nurses. c. Concern with the nonadvancement of nursing practice in the institution. d. An awareness of how organizational culture is reflected in organizational structure.

d. An awareness of how organizational culture is reflected in organizational structure The organizational chart reflects the formal structure of the organization and can reflect predominant beliefs, values, and relationships in the organization. Exclusion at senior executive levels of nurse leaders may reflect institutional beliefs about how resources are allocated, the degree of autonomy given to staff, and involvement of key groups in decision making

You are the nurse manager for a not-for-profit health service for the homeless and for drug users in an impoverished neighborhood. As the manager, your concern about sustainability is related to: a. The possibility of violence b. An increase in prescription drugs available for abuse c. Decisions of the public board d. An increase in uncompensated care events

d. An increase in uncompensated care events Public and nonprofit hospitals are tax exempt and have a concomitant responsibility to provide mandated community service such as delivering care to the poor and indigent. To keep a nonprofit status, facilities must make a good-faith effort to provide community service and charity care. Nonprofit organizations located in impoverished urban and rural areas are often economically disadvantaged by the amount of uncompensated care that they provide.

In the past year, you have noticed an increase in patient falls on your unit. In reading studies related to staffing and patient outcomes, you realize that you will need to plan for: a. Higher patient care hours b. Safer facilities c. Institution of a patient classification system d. An increased number of RN positions

d. An increased number of RN positions Lower fall rates are shown to be related to higher total nursing hours and a higher percentage of nursing hours supplied by RNs.

Which of the following strategies is most important in developing a strong vision? a. Seeking out evidence to support trends and out-of-the-box thinking b. Spending time with others with whom we discuss ideas c. Setting up focus groups to provide information on current realities d. Being honest and open about what we think for the future

d. Being honest & open about what we think for the future Regardless of how we go about developing our vision (gathering evidence, testing ideas with others), honesty and openness are foundational to a strong vision.

A nurse manager's responsibility for financial management involves making budgetary decisions. Budgets that allow the nurse manager to allocate resources at the unit level allow: a. Minimal nurse manager input. b. Limited rationale for budgetary requests. c. Budgetary allocations at the executive nurse level. d. Budgetary decision making at the point-of-service (POS).

d. Budgetary decision making at the point-of-service (POS) In organizational structures where decision making occurs at the POS, nurse managers are given some self-control, which includes preparing and implementing a budget that meets the long- and short-term needs of their unit without requiring hierarchical approval.

Which of the following is not important in a positive work environment, as defined by the AONE? a. Clear, open, trustful communication b. Accountability and clarity of roles and responsibilities c. Participatory decision making d. Challenge and striving for excellence

d. Challenge and striving for excellence Clear and open communication, accountability and clarity of roles, and participatory decision making are considered by the AONE to be important to a healthy environment. Challenge and excellence are not specifically identified by the AONE as important to healthy work environments.

To move beyond stereotypical thinking and toward thinking about the future, which of the following would be most consistent with thinking wildly in the Wise Forecast Model©? a. Listing everything that we know about our current situation b. Defining which practices will remain unchanged and which will change c. Asking someone with a great deal of experience to share ideas about best practice d. Challenging current and future practices with questions of "what if?"

d. Challenging current and future practices with questions of "what if?" Thinking wildly includes creating wild questions. Sometimes they are what lead to a wild idea.

A stroke unit experiences numerous changes related to implementation of new technology, a changed nursing care delivery model, and staff turnover within a period of 6 months. Staff members begin to show signs of reluctance to implement any more changes. The phenomenon experienced by the staff is termed: a. Eustress b. Care process c. Stereotypical thinking d. Complexity compression

d. Complexity compression Complexity compression refers to many changes occurring simultaneously before time is sufficient to assimilate the change.

Which of the following patients would be most likely to be covered under Medicare? a. Jim, who lives on the street and has occasional infections b. Alysha, who is on social assistance and has a 5-year-old daughter with frequent ear infections c. Karen, a housewife, 45 years of age, whose husband recently abandoned the family d. Dan, who is 68 years of age and in good health

d. Dan, who is 68 yrs old & in good health Medicare = federal gov program for individuals 65+ & with certain permanent illnesses (end-stage renal disease) Medicaid = provides health care for the poor

A nurse manager must consider a number of external variables when preparing the personnel budget & projecting the unit's staffing needs. An external variable to be considered is: a. Organizational staffing policies b. Staffing models c. Changes in services that will be offered d. Department of Health licensing standards

d. Department of Health licensing standards Licensing regulations of the state can determine staffing models. Staffing regulations can dictate the number of professional nurses required on a unit at any given time.

After several months in the role of manager of a dialysis unit, Maryanne finds herself still questioning the gap in expectations between her and her staff and management and is also questioning if she can reconcile her concerns about quality care with the strong cost containment orientation of the facility. At this point, Maryanne is in which stage of role transition? a. Internalization b. Acceptance c. Development d. Discrepancy

d. Discrepancy At this point, Maryanne is still experiencing discomfort and disillusionment with the gap between what she expected and what others expect of her in the performance of her role as manager. She is considering the significance and fit of the relationship for her, which is consistent with role discrepancy.

Electronic health records (EHRs) are being instituted at Pleasant Valley Hospital. Some of the staff on Unit 4 complain to the manager that acquiring the technologic skills required is too time consuming. They question its value in patient care. The manager responds that: a. The use of technology is inevitable in our technologically oriented society. b. The hospital is no longer able to find the space to accommodate paper record keeping. c. The initiative is being driven by decision makers higher up in the hierarchy and there is no choice. d. EHRs will increase effectiveness of care by enhancing coordination and improving patient outcomes.

d. EHRs will increase effectiveness of care by enhancing coordination and improving patient outcomes As technology improves, informatics must be integrated with budget and personnel as a critical resource element. Basing practice on evidence-based care can assist in making solid decisions about resources and in leading and encouraging staff toward positive changes in patient outcomes. EHRs, for example, are expected to enhance coordination of care, improve health outcomes, and increase accuracy of diagnoses.

John is interested in leadership positions within his nursing organization. Al-though he has been on the same unit for 10 years, he has attended two workshops during that time and has steadfastly refused opportunities to engage in leadership development opportunities or other learning offered as part of the hospital's succession planning strategy. He says that he is interested in a leadership role primarily because it will give him a more stable work schedule and will enable him to spend more time with his family. In coaching John, it would be important to: a. Affirm that his years of service and stability on the unit are the most important attributes for assumption of a leadership role. b. Reinforce that his concern with maintaining balance outside work would be a key factor in selecting him for a leadership position. c. Encourage him to consider the financial rewards of the position, as well as the positive effect on his work schedule. d. Encourage him to seek out new experiences and learning that will complement his existing strengths derived from experience and his interest in life-work balance

d. Encourage him to seek out new experiences and learning that will complement his existing strengths derived from experience and his interest in life-work balance According to Covey, effective leaders continually engage in learning and self-renewal, as well as in maintaining a balanced life, radiating positive energy, believing in other people, being concerned with the common good, and being synergistic.

As a nurse manager, you embrace the usefulness of resources such as Smart Bed. This behavior is important to: a. Budget development b. A manager's role c. Succession planning d. Encouragement of staff utilization of technology

d. Encouragement of staff utilization of technology Informatics such as Smart Bed facilitates effectiveness and efficiency in care. By becoming an early adopter of technology, staff members, particularly older staff, who may be less comfortable with technology, are encouraged to value its use in care delivery and management.

You are a nurse manager in a facility that is part of a national system of specialized hospitals that provide services to children and that is funded and managed through a religious charity organization. This system emphasizes compassionate, faith-based care. What level of consolidated system is represented in this example? a. First level b. Second level c. Fourth level d. Fifth level

d. Fifth level Consolidated systems tend to be organized into five levels. The fifth level involves special interest groups that own and operate units along religious lines, teaching interests, or related special interests that drive their activities. In this examp le, the facilities are funded and managed by a religious organization that provides care that is congruent with its particular faith-based values.

The Wellington Mental Health Institute is fully accredited by the AOA and not directly by the CMS. This means that the Wellington facility: a. Could not accept mental health patients who were Medicare beneficiaries. b. Would be able to care for only Medicaid and not Medicare beneficiaries. c. Has not met the standards set by the CMS as determined by an external review panel. d. Has been reviewed and accredited by the AOA, which is a deeming authority for CMS.

d. Has been reviewed and accredited by the AOA, which is a deeming authority for CMS CMS accreditation or external review of an organization's compliance with the standards set by the CMS can be conducted by the AOA, which is a deeming authority for CMS.

As a nurse manager, you identify that a shift in nursing care models might increase patient and staff satisfaction and avoid downsizing. Administration is reluctant to adopt this approach because downsizing is seen as critical to reduction of costs. To leverage your ideas, you: a. Ask staff to send e-mails to administration encouraging consideration of your option. b. Invite a senior member of administration to your staff meeting, so you can tell him what you are planning. c. Write a letter of complaint to a member of the institutional board about the lack of openness of the administration. d. Identify influential members of your nurse manager group with similar ideas and request an opportunity to meet with administration to discuss options.

d. Identify influential members of your nurse manager group with similar ideas and request an opportunity to meet with administration to discuss options Staff members often look to nurse managers to lead them in addressing workplace issues with higher levels of administration. To do this, nurse managers must possess the ability to address power sources in the work environment and to define power-based strategies, such as in organizing a following of other nurse managers with similar concerns.

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage. Sarah finds that she is comfortable with the expectations of staff and her supervisor regarding her management role and responsibilities and has been able to effect a strong commitment to quality clinical care on the unit. At this point, Sarah has likely attained this role: a. Development b. Acceptance c. Symmetry d. Internalization

d. Internalization Role internalization is achieved when the manager experiences performance of the role as being congruent with his or her own beliefs. Role acceptance refers to accepting the contract and making a public announcement of the acceptance.

Susan, a new graduate on the dialysis unit, appears to take Kari's remarks very seriously and works even harder, often volunteering for extra assignments. She also is often in Kari's office, advising of successes with her patients and of the extra effort that she is committing. This behavior suggests that Susan: a. Is fearful of losing her job. b. Lacks understanding of Kari's leadership style. c. Is not intimidated by Kari's leadership style. d. Knows how to "play the game."

d. Knows how to "play the game." Followers under transactional leadership feel secure about what will happen next or what is needed to be rewarded; therefore, they learn to "play the game."

A nurse manager in a hospital is deeply concerned that senior administration makes decisions about budgetary directions that affect staffing and other resources without sharing the rationale for changes or demonstrating concern as to how these changes may affect patients or staff. She says she does not feel respected and is emotionally tired as a result. This situation represents: a. Bureaucratic organization. b. Realities of current health care. c. Negative organizational culture. d. Lack of engagement by administration

d. Lack of engagement by administration (new) Organizational culture refers to the basic assumptions and values of an organization and whether they contribute to relationships and decision making that is marked by empowerment, information sharing, and truthfulness. Positive work cultures contribute to a perception of being respected in the work environment. Collaborative organizational cultures are essential for nurse managers to proactively work in today's complex healthcare environment in a manner that engages them in their work. Interpersonal relationships can be fostered with organizational designs fostering a culture of collaboration, reward and recognition, communication, and a mentoring environment. This demonstrates a lack of engagement by the administration. d. Quantum leadership (old) Organizational culture refers to the basic assumptions and values of an organization and whether they contribute to relationships and decision making that is marked by empowerment, information sharing, and truthfulness. Positive work cultures contribute to a perception of being respected in the work environment. Collaborative organizational cultures are essential for nurse managers to proactively work in today's complex healthcare environment in a manner that engages them in their work. Interpersonal relationships can be fostered with organizational designs fostering a culture of collaboration, reward and recognition, communication, and a mentoring environment.

An interviewee for a nurse manager position asks for a copy of the organizational chart. Organizational charts provide information about the role component of: a. Expectations b. Opportunities c. Responsibilities d. Lines of communication

d. Lines of communication No matter what role an individual is in, multiple relationships exist with individuals including supervisors and peers. Roles incorporate patterns of structured interactions between the manager and people in these groups. Organizational charts provide information about relationships and lines of communication in the organization.

A nursing informatics specialist hired by Blue Cross/Blue Shield (a form of third-party payers benefit packages that uses specific standards to approve a period of time for the use of inpatient & community health services) is participating in: a. Critical pathways b. Healthcare networks c. Health maintenance organizations d. Managed care

d. Managed care Managed care strives to contain costs (e.g., through limitation of time in care) while maintaining quality. Managed care combines care delivery with financing and provides comprehensive services for a fixed prepaid fee. Group practice plans take various forms. One form has a centralized administration that directs and pays salaries for physician practice (e.g., HMOs).

During an employment interview for the manager's position in a home health agency, the applicant asks questions about the medical director and about retention of staff. The nurse executive assures the applicant that the agency has few personnel problems and receives excellent support from the medical director. The applicant knows that the agency has a 50% turnover rate and has had three medical directors in the past year. The nurse executive is: a. Unaware of the turnover rate and difficulties with the medical director. b. Lying about the problems and hoping to resolve them by hiring the applicant. c. Denying that the agency has a turnover problem with staff or medical directors. d. Minimizing the challenges of the position to make a positive impression on the applicant.

d. Minimizing the challenges of the position to make a positive impression on the applicant During the dating phase or preview period in the role transition process, the potential employer attempts to make a favorable impression, which may result in minimizing the challenges of the position.

Seth is hired as the nurse manager for a surgical unit. After a year, the hospital reorganizes, and his position is lost. In leaving the unit, it is important for Seth to: a. Engage in clarifying why the hospital did not state its expectations for the unit at the time of hiring. b. Hire a lawyer to represent his interests during this unexpected role transition. c. Seek counseling to deal with his shock and anger. d. Negotiate a reasonable settlement.

d. Negotiate a reasonable settlement When role transition occurs as a result of restructuring, the unit manager should request and negotiate reasonable compensation and assistance, even if it is not offered initially by the employer.

The number of adverse events such as falls and pressure ulcers on your unit is increasing. An ideal staffing plan to address this issue would include which of the following? Increasing the: a. Total number of staff on the unit b. Staff and RN hours per patient c. Total number of staff, and implementing 12-hour shifts d. Number of RNs and number of RNs with experience on the unit

d. Number of RNs and number of RNs with experience on the unit Studies show that adverse events such as falls & pressure ulcers can be reduced by increasing the number of RNs on a unit (relative to other personnel) and utilizing experienced RNs. Overtime and 12-hour shifts are linked to greater incidence of errors.

The staff members in a local Emergency Department are experiencing stress and burnout as the result of excessive overtime. The staff decides to unionize to negotiate for better working conditions. The increase in unionization within health care may be attributed to the: a. Movement from being "blue-collar workers" to being "knowledge workers" b. Excess profits in health care c. Level of risk that exists for health care d. Number of people who are involved in health care

d. Number of people who are involved in health care As technology replaces unskilled workers, fewer workers are available for trade-union organizing, which has led to declines in union memberships. Nurses represent a large pool of workers who may be available for union organizing in the face of the declining pool available elsewhere.

In developing an orientation program, the hospital educator breaks essential organizational information down into chunks, which she develops as online modules. This is an application of which of Drucker's functions of management? a. Establishment of goals and objectives b. Motivation and communication c. Analysis and interpretation of performance d. Organization of activities into manageable tasks

d. Organization of activities into manageable tasks Organizing the information into online modules is an application of Drucker's organizational analysis and the division of activities, decisions, and relations into manageable tasks.

Role theory has its underpinnings in management theory. Management theories influence managers' leadership styles. Which of the following styles would a nurse manager be most likely to follow when redesigning the staffing schedule? a. Humanistic b. Authoritarian c. Flexibility d. Participative

d. Participative Participative style of leadership allows for the input by the participants involved to have input to the decision process. This assists in making change easier and is one way a manager uses this leadership to lead the unit.

Which of the following is an example of an HMO? a. Nurse practitioners are paid promptly at discounted fees for each service rendered at a women's health clinic. b. Physicians in a large urban center are reimbursed for visits made to their clients. c. Physicians are paid for each service delivered to enrolled patients through a prepaid plan. d. Patients pay fixed annual fees for ambulatory care services, regardless of actual utilization of health services.

d. Patients pay fixed annual fees for ambulatory care services, regardless of actual utilization of health services Fee-for-service systems provide compensation to healthcare providers in group practices based on fee-for-service, which in PPQs means that fees are paid promptly but at a discounted rate. HMOs are configurations of healthcare agencies that provide health maintenance and services for enrolled patients for a fee that is preestablished regardless of utilization of service.

A nurse manager working for a not-for-profit organization should be familiar with the regulations that impact the organization. Not-for-profit organizations: a. Pay dividends to stockholders b. Have funds that are redirected to the organization for maintenance and growth c. Have no paid employees d. Pay no taxes

d. Pay no taxes Not-for-profit organizations, often referred to as voluntary organizations, are controlled by voluntary boards and provide services to both paying and charity clients. Funds are redirected toward maintenance and growth as opposed to profit shares for stockholders. Historically, non-profit organizations have been exempt from paying taxes as they commit to providing an important community service.

The senior executive praises John for the positive patient evaluations that his unit has received. As an effective leader, John: a. Thanks the senior executive for having confidence in him and celebrates by going out to a special restaurant. b. Points out the impact that the changes he has initiated have had on the unit. c. Advises the senior executive that the mission statement and goals are important to him. d. Points out the contributions of his staff to the outcomes and shares the praise with his staff.

d. Points out the contributions of his staff to the outcomes and shares the praise with his staff An effective leader is eager to share the glory with those who have worked with him or her to achieve outcomes and success. The act of acknowledging the achievement to the senior executive and of sharing the positive feedback with his staff empowers the staff and builds a support base for the leader. REF: Page 41 TOP: AONE competency: Communication and Relationship-Building

As a nurse manager on a urology unit, you note that there has been a marked increase in medication errors on the unit. Which of the following actions would be consistent with the National Database of Nursing Quality Indicators (NDNQI) measures? a. Staff are consulted regarding improvements in interprofessional approaches to patient care. b. Nursing staff are asked for input regarding the purchase of new medication carts. c. A recognition program is developed to acknowledge nurses who have provided safe and exemplary care utilizing skills in the staffing mix to optimize the delivery of patient care. d. Recent changes in staffing mixes are examined to determine if the timing of changes coincides with the increase in errors.

d. Recent changes in staffing mixes are examined to determine if the timing of changes coincides with the increase in errors. The NDNQI measures are specifically concerned with patient safety and aspects of quality of care that may be affected by changes in the delivery of care or staffing resources. The quality indicators address staff mix and nursing hours for acute-care settings, as well as other care components. The NDNQI project is designed to assist healthcare organizations in identifying links between nursing care and patient outcomes.

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage. A strategy that may help to make the transition to her management role and to respond to relationships and situations in her new position is: a. Avoiding discussion of her personal beliefs with staff until she is ready to do so. b. Finding a network of clinicians with interests similar to her own. c. Researching clinical literature to maintain her clinical assessment skills for the unit. d. Recognizing her strong commitment to care in the management process through journaling.

d. Recognizing her strong commitment to care in the management process through journaling During the transition period, it is important to recognize, use, and strengthen values and beliefs, translate these for staff, and adapt behaviors to the situation. Understanding personal and professional beliefs and values assists in helping the manager respond to situations and relationships.

The new head nurse on telemetry has been in the position for 3 months. The head nurse and the administrator disagree on how much time the head nurse should allot to various aspects of the role. Staff members on the unit complain that the head nurse is unavailable for clinical concerns because of being off the unit while attending meetings. To facilitate the process of role transition, the head nurse should: a. Develop policies consistent with the head nurse's prior workplace. b. Attend a workshop on how to deal with difficult people. c. Decide to give the position 3 more months and then leave if things do not improve. d. Schedule a series of meetings with staff and the administrator to clarify expectations.

d. Schedule a series of meetings with staff and the administrator to clarify expectations During role transition, it is important for the manager to negotiate the role by writing down the manager's expectations of the role and determining the expectations of others (staff, supervisors) in order to clarify expectations and reduce or ameliorate role ambiguity and role strain. Weinstock (2011) suggests that it takes up to a year to understand the role, system, and boundaries in a new position.

Your healthcare organization has a decentralized system for scheduling. As part of this process, after you have developed a draft schedule, you may need to: a. Seek budgetary approval b. Balance personal schedules against institutional needs c. Negotiate the schedule with unit staff d. Submit the schedule to a centralized staffing office for review

d. Submit the schedule to a centralized staffing office for review In a decentralized model, you may be completely responsible for approving all schedule changes and for development of the schedule, or you may need to submit a draft to a centralized office for review and determination of supplemental staff. Balancing personal schedules and negotiation describes staff self-scheduling models.

In a nurse managers' meeting, strategies for ways to help retain staff are discussed. One strategy for assisting nurses in developing collective action skills is: a. Accepting the practice of "going along to get along" b. Attending as many workshops as practical c. Spending as much time as possible in clinical settings d. Taking the opportunity to work with a mentor

d. Taking the opportunity to work with a mentor Mentoring facilitates development and adoption of positive interaction and other skills that facilitate good decision making. Optimism, trust, and decision making are important in collective action and shared decision making and contribute to job satisfaction and lower turnover in staff

You have just hired a recent graduate. The graduate is thrilled with the opportunity that she has been given, as well as with the idea that "working means no more essays, tests, or assignments!" She indicates that she has no intention of touching a book, journal, or health information Website for a "long time." Which of the following would be your best response? a. The expectations and design of educational programs means that new graduates are better prepared for the workforce. b. The new graduate will still have to learn, but it will be job-specific learning. c. An ideal learning plan for nurses emphasizes followership. d. The amount and intensity of knowledge demands lifelong learning that includes assessment of relevancy of knowledge for practice.

d. The amount and intensity of knowledge demands lifelong learning that includes assessment of relevancy of knowledge for practice

As a nurse manager, you have been asked to assist in designing a subacute facility for open heart patients who require further complex care after hospitalization. In setting up the facility, which of the following would require reassessment? a. Patients admitted to the facility must have adequate health insurance to cover the services provided. b. A local nurse education program asks you if nursing students can gain clinical experience with recovering surgical patients in the facility. c. Public funding will be provided to enable care of patients who have an ordinary course of recovery. d. The facility is an older house that is more than 30 minutes away from the acute care center.

d. The facility is an older house that is more than 30 mins away from the acute care center Because of the types of patients being accepted for care and the distance of the subacute facility from acute care, emergency response and seamless transfer issues in the event of an unanticipated crisis must be addressed. As a nurse manager, an important part of your position may be assisting to develop strategies to maximize the benefits and minimize the risks in this situation.

While explaining the importance of developing leadership skills among nurses to a group of first-year nursing students, Natalie, a nursing unit manager, emphasizes that: a. Most nurses are not expected to assume leadership roles. b. The role of nurse leadership is only at the bedside, ensuring that patient care is performed according to established standards. c. Only individuals in formal leadership roles are expected to be leaders. d. The public depends on nurses to assume leadership in moving consumer advocacy concerns forward.

d. The public depends on nurses to assume leadership in moving consumer advocacy concerns forward The complexity of nursing and the healthcare environment demands that all nurses assume roles of manager, leader, and follower, depending on the situation. Nurses are involved in providing leadership in direct patient care, in leading others at a unit or organizational level, in moving the profession forward, and in participating in legislative and policy arenas. Consumers depend on nursing leadership to carry the healthcare agenda forward.

The director of nursing has been observing staff interactions in a 20-bed coronary care unit. Based on her observations, which of the following staff members is an obvious leader? a. The unit secretary who knows everyone's business b. The chief nursing officer who is in charge and is responsible for nursing services c. The chief cardiologist who admits the largest number of patients and brings in more revenue than any other physician d. The staff nurse who persuades other staff members to practice by making evidence-based decisions

d. The staff nurse who persuades other staff members to practice by making evidence-based decisions Leaders are those who do the best job of sharing their vision of where the followers want to be and how to get there. It is the ability to inspire others to bring a vision (such as evidence-based decision making) to reality and is not necessarily tied to status or information flow.

Nursing research has indicated that the foundation for becoming a nursing leader is the ability to: a. Write effectively b. Speak two or three languages c. Focus on day-to-day priorities d. Think futuristically

d. Think futuristically Whether you are a leader, a follower, or a manager, being able to visualize in your mind what the ideal future is becomes a critical strategy. A vision can range from that of an individual to that of a group or to a whole organization.

To prepare for the orientation of newly hired nurses, the nurse manager plans a presentation outlining the concept of healthcare networks. Healthcare networks are: a. Units that provide only primary care services. b. Owned by the institutions. c. A feature of all public institutions. d. Units that provide a full spectrum of services.

d. Units that provide a full spectrum of services Healthcare networks are interconnected units. Their aim is serving large regional populations. d. Units that serve large populations (old)

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage. Sarah finds a mentor, Amy, who has been in the role of unit manager for 3 years and has a similar interest in clinical excellence. During their frequent meetings, Amy provides assistance with learning aspects of the manager's role, including technical aspects, such as how to interpret budget printouts and to achieve budget outcomes. The success of Amy's coaching depends on: a. Clarity of Amy's information. b. Organizational support for the mentor relationship. c. The congruence of Amy's beliefs with Sarah's beliefs. d. Willingness of Sarah to receive feedback.

d. Willingness of Sarah to receive feedback Coaching provides information about how to improve performance and learning aspects of the role. Coaching requires willingness on the part of the mentee to accept feedback.