NUR 108 Ch 10 Leadership, Managing and Delegating
The registered nurse (RN) has received orders to perform an unsafe practice on a client. The RN voices concern with the physician who gave the order, but the physician refuses to change the order. Whom should the nurse consult next regarding the order? The client The charge nurse The nurse manager The licensed practice nurse (LPN)
The charge nurse The RN should follow the proper channels for communication and consult the next direct supervisor. The next direct supervisor would be the charge nurse and then the nurse manager. The client and the LPN should not be consulted.
The registered nurse (RN) and unlicensed assistive personnel (UAP) are working together to admit a pediatric client to a nursing unit. Which task would be inappropriate for the RN to delegate to the UAP? Initiating intravenous therapy Securing the client on a papoose board Soothing the client during the procedure Gathering equipment needed for intravenous therapy
Initiating intravenous therapy When delegating, the RN must determine the skill level and education of the UAP, the client's condition and the complexity of that condition, and the potential for harm. Initiating intravenous therapy is reserved for the RN due to the potential for harm and the scope of the UAP. The UAP can assist the nurse by obtaining equipment, securing the client, and soothing the client.
Which are examples of personal leadership skills necessary for nurse leaders? Select all that apply. Knowledge of all nursing Communication Problem solving Religious values Self-evaluation
Problem solving Self-evaluation Communication Communication, problem solving, and self-evaluation are three of the four basic nursing leadership skills. Religious values are personal and may contribute to a person's strength, but are not included in what is needed for a public leader. No individual nurse can ever know everything there is to know about nursing.
On a medical unit, the nurses complain that they have no voice in the decisions that are made in the operation of the unit. The nurses state they are always told by the nurse manager to perform tasks instead of being asked. Which of these best describes the leadership style of the nurse manager? Autocratic Democratic Laissez-faire Nondirectional
Autocratic This nurse manager, by not soliciting staff feedback and telling the staff what to do rather than ask, would be demonstrating autocratic leadership. Democratic leadership involves equal sharing of power between the leader and the staff; everyone is working together toward a mutual vision and goals. Laissez-faire leadership, which is also known as nondirectional leadership, gives power to the group rather than the leader.
A nurse manager is educating the staff on new forms of charting. Within the education session, the manager sets a goal for complete use of the charting. Through goal setting, the manager is acting as: an educator. a leader. a guide. a clinical specialist.
a leader. Leadership is the ability to influence others to strive for a vision or goal or to change. Thus, goal setting is the act of a leader. Although educators may set educational goals, the primary focus of an educator is teaching. A guide provides advice but does not set goals. A clinical specialist develops expert skills and knowledge in one specific area of practice.
Which of these statements reflects the expected functioning at a hospital that has achieved Magnet status? Nursing administration is in control of all decision-making. Most client outcomes have improved but are not at target range. Staff nurses are developing innovative solutions to problems. There is a decreased rate of retention among the nursing staff.
Staff nurses are developing innovative solutions to problems. A hospital that has achieved Magnet status has recognition of quality client care that is provided by nursing staff who are professional and well-qualified. The staff nurses participate in self-governance and, therefore, work toward innovative solutions to problems. Having an increased turnover among staff nurses and a lack of quality client outcomes would not be characteristics of a Magnet hospital.
A nurse is working as part of a group on developing strategies to meet the health care needs of the children being served by the facility. The nurse identifies the need for expanded play therapy programs. The nurse works to motivate others in the group and promote a common vision. The nurse and the group communicate openly and honestly with the others involved, focusing on the process as well as the outcomes. The nurse is exhibiting which style of leadership? Transactional Transformational Laissez-faire Democratic
Transformational Transformational leaders are unique in their ability to inspire and motivate others. They create intellectually stimulating practice environments and challenge themselves and others to grow personally and professionally, and to learn. Gifted in creating a common vision, they demonstrate passion for their vision and keep others similarly focused. They communicate honestly and openly, and can express emotions as well as ideas as they share themselves with others. Transactional leadership style is based on a task-and-reward orientation. With laissez-faire leadership, also called nondirective leadership, the leader relinquishes power to the group, such that an outsider could not identify the leader in the group. Democratic leadership, also called participative leadership, is characterized by a sense of equality among the leader and other participants. Decisions and activities are shared.
Following a myocardial infarction (heart attack), a client begins to recognize the need to increase exercise, eat a low-fat diet, and implement relaxation techniques. According to Lewin, this client is in which stage of the change process? Prizing Unfreezing Moving Refreezing
Unfreezing Unfreezing is stage in the change process in which the person recognizes the need for change and the dissolution of previously held patterns of behavior. Unfreeze, move (or change), refreeze, also known as the Kurt Lewin Change Model, is a method for managing change within a client or organization. For a client to change, the client must be melted (unfreeze), poured into a mold (move), and frozen again in the new shape (refreeze). Prizing is not a component of the model.
In a nursing unit, the RN delegates nursing tasks to the nursing assistant. Keeping in mind the delegation guidelines, which statement denotes the right communication for the nursing assistant? "Discontinue the IV solution." "Dispose of the disconnected IV set." "Inspect the site for thrombophlebitis." "Check the infusion rate."
"Dispose of the disconnected IV set." The statement, "Dispose of the disconnected IV set" is in accordance with the delegation guidelines of right communication. The nurse should provide all the necessary information to carry out the assigned task. The other statements do not follow the delegation guideline of right communication. The tasks mentioned in the other instructions are not a nursing assistant's role.
The nurses who provide care on a medical unit are skeptical about the planned change from a traditional narcotic cupboard to a computerized medical supply and management system. Which statement best demonstrates mistrust about the benefits of this proposed change? "I've heard those machines don't even cut down on medication errors like they say they do." "There's no way that I'm going to be able to learn to deal with a computer." "I think that they want us to use these machines just so they can track our work activity closer." "Those machines cost a fortune and there are way better ways to spend that money."
"I've heard those machines don't even cut down on medication errors like they say they do." Resistance to change takes many forms, including doubts about the benefits of a change. Expressing doubt that a new process will reduce medication errors expresses such a doubt. Fears about the necessary learning, cost, and effects on workload are also common points of resistance, but these do not focus on the purported benefits.
The designated charge nurse on the telemetry unit organizes and facilitates the unit meetings, makes assignments, and performs staff evaluations. This nurse's power to lead is of which type? Implied Situational Democratic Explicit
Explicit This nurse's official assigned role gives this nurse explicit power by virtue of that assignment. Implied power arises when a person who has no official assigned role assumes a leadership role by virtue of the force of the person's personality and charisma. Situational and democratic are types of leadership rather than power.
The new nurse is having difficulty managing the time required to care for a group of complex clients and is several hours behind in completing nursing interventions. Which intervention should the nurse complete first? Administer a dose of digoxin that is two hours behind schedule. Perform a dressing change to an abdominal abscess that is three hours behind schedule. Obtain discharge orders for a client who is ready to be transferred to a long-term nursing facility. Complete a medication reconciliation form on a client who has recently been admitted to the hospital.
Administer a dose of digoxin that is two hours behind schedule. The first step in time management is to determine which tasks are priority. Digoxin is a critical client medication and therefore takes priority over the other options. Dressing changes, discharge orders, and completing facility forms can be delayed until critical tasks are complete.
A registered nurse (RN) is working on a medical-surgical unit with an experienced licensed practical/vocational nurse (LPN/LVN). Which tasks are appropriate for the RN to delegate to the LPN/LVN? Select all that apply. Administer oral aspirin and lisinopril to the client with hypertension Insert a nasogastric tube in a client with absent bowel sounds Perform an initial assessment for a new admission Reinforce a postsurgical abdominal dressing Teach a client with diabetes how to administer insulin
Administer oral aspirin and lisinopril to the client with hypertension Insert a nasogastric tube in a client with absent bowel sounds Reinforce a postsurgical abdominal dressing Administration of oral medication, insertion of nasogastric tubes, and dressing changes are all within the scope of practice for a LPN/LVN. Patient education and the performance of an initial assessment for a new admission would be outside of the scope of practice for the LPN/LVN and should not be delegated. The RN should make the initial assessment as well as provide education for the client.
The new nurse is evaluating the effectiveness of the assigned nurse mentor. Which characteristic should the new nurse recognize as being inappropriate for the nurse mentor to role model? Providing daily feedback to the new nurse Introducing the new nurse to members of the interdisciplinary team Encouraging the new nurse to enroll in continuing education courses Advising the new nurse to consult the nurse mentor before making decisions regarding client care
Advising the new nurse to consult the nurse mentor before making decisions regarding client care Effective mentors should provide feedback to the mentee, encourage opportunities for continued growth, and provide resources that will be supportive in the new role of nurse, including members of the interdisciplinary team. Effective mentors should promote confidence in the new nurse in the decision making process. Requiring the new nurse to report to the nurse mentor before making decisions can hinder the new nurse's confidence level.
Conflict has emerged on a nursing unit due to the perception by new graduates that some of the more experienced nurses are manipulating the client assignment to ensure a lighter workload during night shifts. How should the manager of the unit best address this conflict? Arrange a meeting where the issue can be discussed and addressed by as many of the nurses as possible. Gather evidence over the next several weeks in order to determine if the practice is indeed happening. Arrange for the newer nurses to organize the client assignment for a trial period. Reassure the new graduates that the more experienced nurses are acting in the interests of both staff and clients.
Arrange a meeting where the issue can be discussed and addressed by as many of the nurses as possible. Open, explicit, and participatory conflict resolution that is based on collaboration is an effective strategy for the management of conflict. Gathering evidence does not directly address the conflict that currently exists and reassurance may be unwarranted and false. Allowing the new graduates to create the client assignment may perpetuate selfish practices and does not resolve animosity between the two camps.
The registered nurse (RN) is preparing to delegate tasks to an unlicensed assistive personnel (UAP). Which task would be appropriate for the RN to delegate to the UAP? Assessing oxygen (O2) saturation Calculating fluid volume resuscitation Monitoring intracranial pressure (ICP) Measuring intravenous therapy intake
Assessing oxygen (O2) saturation When delegating, the RN must determine the skill level and education of the UAP, the client's condition and the complexity of the condiiton, and the potential for harm. Assessing O2 saturation is within the scope of a UAP. Monitoring ICP, measuring intravenous therapy intake, and calculating fluid volume resuscitation should be performed by a licensed professional.
The registered nurse on a busy telemetry floor is delegating tasks to an unlicensed assistive person (UAP). Which task is appropriate for the UAP to complete? Bathing a combative client Inserting an indwelling urinary catheter Taking an order over the telephone from a physician Assessing a client's wound
Bathing a combative client Bathing a client, whether combative or not, is within the scope of practice of a UAP. Skills such as inserting an indwelling catheter, taking a physician order, and assessment must be completed by licensed nurses, however.
A nurse can improve one's skill with time management by taking which action? Allowing the flow of the day to control how time is managed Setting priorities without involving clients or their families Starting each day as a new day without considering the previous day Evaluating success with accomplishment of goals in client care
Evaluating success with accomplishment of goals in client care Time management is a skill that can be improved for nurses by taking time during the day to evaluate whether goals have been accomplished and then setting new priorities based on this. Goals and priorities should be established at the beginning of each day, and clients and their families should be involved in this. At the end of the day, a nurse should look back and determine what has and has not been accomplished; this helps to set a time line for the next day. If a timeline is not set each day, then the nurse will allow the flow of the day to control the day, rather than having a plan for what needs to be accomplished.
A nurse leader is planning to change the scheduling process to improve staffing on the unit. Which would be the next step in implementing this change? Explore the pros and cons of potential scheduling models. Describe to the staff how the change will be implemented. Develop a timetable for making the change to a new system. Select a group of nurses to help champion the change process.
Explore the pros and cons of potential scheduling models. Before beginning to plan the process of change, a nurse leader should fully explore different model options and select the new system to be implemented. After selecting the new system, the nurse leader can begin the process for the change by describing how the change will be implemented, along with the timetable of implementation, and enlist supporters from the staff, who will champion the cause.
The nurse manager calls a staff into a unit meeting to discuss patient satisfaction. During the meeting, several staff members assume control. The nurse manager does not intervene to regain control of the group. Which type of leadership style is the nurse embodying? Quantum Autocratic Democratic Laissez-faire
Laissez-faire Laissez-faire leadership style involves the leader relinquishing power or control to the group. Democratic leadership style involves sharing the decision making process and activities with others who have an interest. Autocratic leadership style involves assuming control over the decisions and activities of the group. Quantum leadership style involves seeing an organization and members as interconnected and collaborative. This style involves change as continually unfolding, and frequently incorporates technology.
The charge nurse on the orthopedic unit believes in giving the staff as much power as possible. The nurses are allowed, among other things, to create their own work schedules, provide dates and times for unit meetings, and create the agendas, to which the charge nurse contributes. The charge nurse's style of leadership can be described as which? Democratic Laissez-faire Autocratic Transformational
Laissez-faire With laissez-faire leadership, the leader relinquishes power to the group. Autocratic leadership involves the leader assuming complete control. Democratic leadership displays a sense of equality among the leader and other participants. Transformational leaders create intellectually stimulating practice environments and challenge themselves and others to grow personally and professionally and to learn.
How might one define leadership? Leadership is the process of planning, organizing, directing, and controlling activities. Leadership is the process of guiding, educating, motivating, and directing others. Leadership is the process by which the leader shares power with others. Leadership is the process of interviewing, hiring, and firing personnel.
Leadership is the process of guiding, educating, motivating, and directing others. Leadership may be viewed as the process of guiding, educating, motivating, and directing the activities of others toward attaining goals. Management includes planning, organizing, directing and controlling activities. Empowerment is the process by which the leader shares power with others. It is the manager who interviews, hires, and fires.
A nurse manager best demonstrates effective leadership characteristic by which action? Being very structured and rigid with the unit flow Knowing all information about the unit processes Indicating an interest in becoming a role model Sharing a vision for the unit and enlisting support
Sharing a vision for the unit and enlisting support The nurse leader on a nursing unit should have a vision for the unit and be able to share this with the staff in order to enlist support and cooperation among the staff. The nurse leader should already be a role model, rather than just demonstrating interest. This would be related more to someone who was developing leadership qualities. The nurse leader should be flexible, not rigid, and does not have to know all information about the unit; rather, the nurse leader needs to know what resources are available among the staff and other leadership in helping reach expected goals and outcomes.
The registered nurse (RN) wants to delegate a task to an unlicensed assistive personnel (UAP) but is unsure if the task can be delegated. What is the best resource for the RN to use in determining if the task is appropriate? The medical practice act website A nurse mentor or a nurse preceptor A more experienced nurse working on the same unit The nurse practice act or facility's policy and procedures
The nurse practice act or facility's policy and procedures The RN should consult the nurse practice act or the facility's policy and procedures. The nurse mentor or preceptor and the more experienced nurse are good resources, but may mistakenly give inaccurate information. The medical practice act is designed to govern physician practice and may not contain information on the task that is to be delegated.
Which attributes should be characteristic of a nurse mentor? Select all that apply. Is supportive Is resourceful Is driven by financial reward Embraces disruptive conflict Demonstrates leadership abilities Is an experienced, licensed professional Deconstructs health care networks
Is supportive Is resourceful Demonstrates leadership abilities Is an experienced, licensed professional Mentors should demonstrate characteristics that will help the less experienced person grow in the profession. Mentors should be supportive, resourceful, experienced, respectable, and trustworthy leaders. Mentors do not receive financial compensation for their effort as preceptors typically do. Mentors should not embrace conflict that is disruptive to tasks. Mentors should build and use health care networks, not deconstruct them.
A nurse aspires to work independently in obstetrics and gynecology in a rural, impoverished setting. Which advanced practice role would be most suitable for this nurse? Women's nurse practitioner Adult nurse practitioner Family nurse clinical specialist Nurse midwife
Nurse midwife Rural, impoverished areas are in need of advanced practice nurses. The advanced practice nursing role best suited to this nurse's interests is that of nurse midwife, which requires advanced education and certification in the care of women during uncomplicated pregnancy and delivery. A rural, impoverished area would be less likely to have a women's nurse practitioner. Adult nurse practitioner and family nurse clinical specialist do not relate as closely to this nurse's interest in obstetrics and gynecology.
After a nurse manager implements a solution to the problem of delays in obtaining supplies, the first task for the manager is to: ask the staff members for other solutions. plan to monitor the supply cabinets. assess whether the desired results have occurred. make an appointment with the chief nursing officer.
assess whether the desired results have occurred. The nurse manager must evaluate the results of the efforts to determine whether the desired results have occurred. The nurse manager should solicit input from staff members about potential solutions before, not after, implementing a solution. Monitoring the supply cabinets would be more appropriate if the problem were suspected drug diversion by staff but would be unnecessary for evaluating for improvement in delays for obtaininig supplies. Making an appointment with the chief nursing officer is not necessary and would not help the nurse manager evaluate the change in procedure related to obtaining supplies. Reference:
The primary responsibility of the nurse manager is to: provide direct client care. evaluate nursing care plans. direct discharge planning. create unit plans and budgets.
create unit plans and budgets. The primary responsibility of a nurse manager is to create plans and budgets for the unit as a whole. Staff nurses are responsible for direct patient care, discharge planning, and evaluating nursing care plans.
A nurse manager reviews an employee's contribution to the nursing division annually. This process is: interpreting quality indicators. employee's job satisfaction survey. performance appraisal. reward and development survey.
performance appraisal. Performance appraisal is typically conducted annually. Each organization determines a reward structure to define and to acknowledge success. Interpreting quality indicators pertains to evaluation of general client care, not of an individual nurse. An employee's job satisfaction survey is a tool that allows the employee to give feedback on the employee's satisfaction with work, not a review of the employee's contribution conducted by the nurse manager.
An inner-city hospital is seeing a declining client census. The nurse managers begin to strategically plan to determine ways to increase their client population. In the implementation of these strategies, they also evaluate their success and failure and renew their plan. This activity is: directive initiatives. continuing processes. controlling client outcomes. problem solving.
problem solving. Management involves getting a job done or accomplishing a goal. The process they use is similar to the problem-solving process, which is based on the scientific or research method. The nurses are not making directive initiatives. Although this work is a continuing process, this description is too vague. Nurses cannot control patient outcomes; they can only hope to improve them by making changes that may or may not work.
The nurse is delegating care to an unlicensed assistive personnel (UAP). Which intervention would be most important for the nurse to perform independently? Assess the client with difficulty breathing Obtain a postprandial blood sugar reading Measure the client's blood pressure Assist the client with turning in bed
Assess the client with difficulty breathing Any assessment is the responsibility of the registered nurse. A UAP is able to measure vital signs, assist with turning, and measure blood pressure or blood sugar.
The nurse has recently been promoted to nurse manager on an oncology unit and has decided to be the sole decision maker regarding issues that concern the unit. Which type of leadership style is the nurse embodying? Quantum Autocratic Democratic Laissez-faire
Autocratic Autocratic leadership style involves assuming control over the decisions and activities of the group. Democratic leadership style involves sharing the decision making process and activities with others who have an interest. Laissez-faire leadership style involves the leader relinquishing power or control to the group. Quantum leadership style involves seeing an organization and members as interconnected and collaborative. This style involves change as continually unfolding, and frequently incorporates technology.
A nurse manager is trying to resolve a conflict between the day and night shifts. The nurse manager wants to convince the involved persons to set aside their differences, determine a priority common goal having to do with improved client care, and accept mutual responsibility for achieving this goal. The nurse manager is using which type of conflict resolution? Avoiding Collaborating Competing Compromising
Collaborating Collaborating has all parties set aside previously determined goals, determine a priority common goal, and accept mutual responsibility for achieving this goal. This requires mutual respect, honest communication, and shared decision making. Avoidance, as a method of conflict resolution, involves looking the other way and doing nothing to resolve the conflict. Competing has one side winning at the expense of the other. Compromising means that each side gives up something of equal value.
The nurse manager for the psychiatric unit sees that there are major conflicts between the day and night shift staff. The nurse manager suggests that each shift put aside their differences for a time and determine a common major goal. Which conflict resolution style does the nurse manager display? Avoiding Competing Collaborating Smoothing
Collaborating With the collaborating approach to conflict resolution, there is a joint effort to resolve the conflict with a win-win solution. All parties set aside previously determined goals, determine a priority common goal, and accept mutual responsibility for achieving this goal. With avoiding there is awareness of the conflict situation, but the parties involved decide to either ignore the conflict or avoid or postpone its resolution. Competing is an approach that results in a win for one party at the expense of the other. Smoothing is an effort to complement the other party and focus on agreement rather than disagreement, thus reducing the emotion in the conflict. The original conflict is rarely resolved with this technique.
A nurse is caring for a client with pneumonia. Which task is most appropriate for the nurse to delegate to an experienced unlicensed assistive personnel (UAP)? Assessing for shortness of breath Instructing the client about the need to alternate activity with rest Obtaining vital signs every 4 hours Administering nebulizer treatments as needed
Obtaining vital signs every 4 hours Having the UAP obtain vital signs every 4 hours is most appropriate, as it is within the UAP's scope of practice to perform this task. Assessment, teaching, and administration of medication are not in the current scope of practice for UAPs.
Which style of leadership is rarely used in a hospital setting because of the difficulty of task achievement by independent nurses? Democratic Autocratic Laissez-faire Transformational
Laissez-faire In laissez-faire leadership, also called nondirective leadership, the leader relinquishes power to the group, such that an outsider could not identify the leader in the group. Autocratic leadership, also called directive leadership or authoritarian leadership, involves the leader assuming control over the decisions and activities of the group. Transformational is often described as charismatic; transformational leaders are unique in their ability to inspire and motivate others. Democratic leadership, also called participative leadership, is characterized by a sense of equality among the leader and other participants.
Two staff nurses on a unit disagree with one another over certain key aspects of providing client care. The nurse manager of the unit arranges a meeting with the charge nurse and the two staff nurses at a mutually agreed-upon time to discuss this situation. This activity is most accurately described as what? Conflict resolution Problem solving Delegation Client protection
Conflict resolution Nurse managers frequently encounter conflict between employees and between themselves and employees. Unresolved conflict can lower morale and threaten quality care. Conflict resolution, also known as conflict management, is a process to work through conflicts in a way that minimizes negative effects and promotes positive consequences. In this scenario, the nurse manager is practicing conflict resolution by bringing the parties involved in the conflict together to discuss possible solutions. Problem solving consists of using generic or ad hoc methods in an orderly manner to find solutions to problems. In a way, conflict resolution is a type of problem solving, in which the problem to be solved is the relational conflict between two or more people. Delegation is the assignment of any responsibility or authority to another person to carry out specific activities. Client protection refers to preventing harm to the client, such as when the nurse keeps client data private.
The nurse manager who asks staff members to give suggestions on how to improve collaboration between nurses and physicians is exhibiting what style of leadership? Laissez-faire Democratic Autocratic Transactional
Democratic The nurse manager who involves staff members in decision-making by asking for suggestions is exhibiting a democratic style of leadership. Autocratic leadership style would be exhibited by a leader who gave staff little opportunity to give feedback or suggestions. Transactional leadership also involves little input by staff into decision-making and is instead focused on providing rewards when tasks are completed. A leader with a laissez-faire style would give all control to staff members to determine how to improve collaboration.
After talking with a group of staff nurses on the medical-surgical unit, the nurse manager identifies a need for change. When developing a plan for change, which question would the nurse manager need to ask first? Is the behavior something that can be changed? Are there individuals within the group who might resist the change? Is the group ready for making the change? How quickly can the change be made?
Is the behavior something that can be changed? Before planning to make a change, a nurse manager should first ask whether or not the situation or behavior is amenable to change. Considering this question may reveal a behavior not amenable to change. Then other questions to ask would include: How does the group function as a unit? Certain forces within a group may favor change, whereas other forces may resist it; is the person or group ready for change and, if so, at what rate can that change be expected to be accepted? The pace of change must be consistent with the person's or group's readiness to assimilate change. Readiness involves both the ability and willingness to change; are the changes major or minor? A series of small changes may be more easily accomplished than one large, dramatic change.
A nurse leader on a unit allows the staff to make all decisions and direct themselves, including filling out the work schedule. The nurse leader is practicing which leadership style? Autocratic Democratic Laissez-faire Transformational
Laissez-faire In laissez-faire leadership, also called nondirective leadership, the leader relinquishes power to the group, such that an outsider could not identify the leader in the group. The democratic leadership style is characterized by a sense of equality among the leader and other participants. The autocratic leader assumes complete control over the decisions and activities of the group. Transformational leaders create intellectually stimulating practice environments and challenge themselves and others to grow personally, to grow professionally, and to learn.
The nurse and unlicensed assistive personnel (UAP) are working together to admit a client newly diagnosed with diabetes to a nursing unit. Which task would be inappropriate to delegate to the UAP? Measuring blood pressure Offering sugar-free popsicles Performing a fingerstick blood glucose test Monitoring insulin requirements
Monitoring insulin requirements When delegating, the RN must determine the skill level and education of the UAP, the client's condition and the complexity of the condition, and the potential for harm. The nurse should monitor the client's need for insulin. The UAP can monitor blood pressure, offer nurishment, and perform a fingerstick blood glucose test. The UAP should report the result of the fingerstick blood glucose test to the nurse, and the nurse should determine the need for insulin based on physician orders.
A nurse manager has asked the staff to create a plan to improve patient outcomes. In the past, the staff have not met deadlines. How can the nurse manager use transactional leadership style to ensure that the deadline is met? Ask politely. Demand efficiency. Give extensions as needed. Offer 2 days of paid vacation.
Offer 2 days of paid vacation. The transactional leadership style involves a task and reward system. Paid vacation is a reward for meeting the deadline. Asking politely, demanding efficiency, and giving extensions are not rewarding behaviors.
A registered nurse is delegating activities to unlicensed assistive personnel (UAP) on a hospital unit. Which activities could this nurse normally delegate? Select all that apply. The determination of a nursing diagnosis for a client with breast cancer Giving a bed bath to a client Planning education for a client with a colostomy Taking routine vital signs Administering medications to clients Transferring a client to another floor
Taking routine vital signs Transferring a client to another floor Giving a bed bath to a client The nurse should be familiar with guidelines for delegating nursing care. The nurse could delegate the following tasks to UAP: giving a bed bath to a client, taking routine vital signs, and transferring a client to another floor. The nurse could not delegate the administering of medications, planning client education for a client with a colostomy, or the determination of a nursing diagnosis.
A client is received into the emergency department after getting shot in the chest. The client is hemorrhaging profusely and is in hypovolemic shock. The nurse calls a code blue. What type of leadership style will be most effective during the management of the code? Autocratic leadership Laissez-faire leadership Democratic leadership Transactional leadership
Autocratic leadership Autocratic leadership will be most effective in this scenario. Autocratic leadership involves the leader assuming control over the decision and activities of the group. During code blue, a leader is needed to direct the actions needed and make quick decisions to positively affect the client. Laissez-faire leadership would ultimately lead to the demise of the client. Democratic leadership could possibly delay the client receiving life-sustaining measures and would be less effective than autocratic leadership. Transactional leadership would involve a reward system which would be unethical in this situation.
A staff nurse is talking with a clinical nurse leader and asks, "What exactly do you do?" Which statement by the clinical nurse leader would be appropriate? "I'm an administrator involved with client care." "My position is one of management." "I collaborate with health care teams to promote client care." "I'm an advanced practice nurse with a specific specialty area."
"I collaborate with health care teams to promote client care." A clinical nurse leader is a master's-prepared nurse who has earned the certified CNL credential and works collaboratively with the health care team to facilitate, coordinate, and oversee care provided to clients. This role is not considered an administrative or management role, but rather one of leadership in all health care settings. Clinical nurse specialists are advanced practice nurses with specialist education in a defined area of practice.
Two nurses are having a disagreement over who will take the next admission to the unit. The nurse manager asks one of the nurses to take the admission and explains that this will be considered a personal favor. Which style of conflict resolution did the nurse manager display? Accomodating Avoiding Competing Collaborating
Accomodating The nurse manager is displaying a conflict resolution style of accommodating by asking one of the nurses to accept the assignment of the admission. If the nurse manager had ignored the situation, this would have been the avoiding style of conflict resolution. With a competing style, the nurse manager would have told the nurse to accept the admission, rather than asking the nurse. If collaborating is the conflict resolution style used, the nurse manager would have discussed the situation with both nurses in order to achieve a solution to this conflict.
A nurse informs the client that the client has no choice and must take a bath in the morning. What type of leadership does this exemplify? Directive leadership Participative leadership Shared governance Institutional governance
Directive leadership Directive (also known as autocratic or authoritarian) leadership describes a leader who makes all the decisions and tells followers what to do. Democratic, or participative, leadership style and shared governance involve sharing the decision-making process and activities with others who have an interest. Institutional governance is governance by the institution.
The nurse is conducting an in-serve on change theories. Which example should the nurse include in the presentation illustrating Lewin's three stages of change? Nurses work in groups to care for clients. Physicians collaborate with nurses. Quality client care is provided. Staff voice concerns among themselves about the requirement of mandatory overtime. A unit meeting is called to discuss the issues with management. The mandatory overtime requirement is reinforced by management. A need for a safer intravenous therapy pump is identified. New intravenous therapy pumps are purchased and training for staff nurses is provided. Intravenous therapy pumps are placed on the nursing unit for client care. Multifunctional machines monitor clients' vital signs. Data from the machines is used to create trends in clients' health. The trends are compared to national norms and used to determine if measures can be taken to improve client care.
A need for a safer intravenous therapy pump is identified. New intravenous therapy pumps are purchased and training for staff nurses is provided. Intravenous therapy pumps are placed on the nursing unit for client care. Lewin's three stages of change are: unfreezing - recognizing need for change; moving - initiating change after planning; and refreezing - making change operational. Identifying a need for new intravenous therapy pumps, training staff to use the pumps, and then placing the pumps for client care is the only option that illustrates Lewin's stages.
The chief nursing officer (CNO) wants to encourage nurses in the hospital to become clinical nurse leaders (CNL) and is reviewing a roster of nurses working on the medical-surgical unit. Which nurse should the CNO recognize as being qualified to take the CNL examination? An RN who attended a diploma program, has 20 years of nursing experience, is a bedside nurse, is reliable, and provides quality client care An with a BSN who is a case manager; has 16 years of nursing experience, is trustworthy, and provides compassionate client care An RN with an MSN who is a nurse manager, has 7 years of nursing experience, is supportive, and is engaged in community service activities An RN with an ADN who is a charge nurse, has 5 years of nursing experience, is honest, and is enrolled in BSN courses
An RN with an MSN who is a nurse manager, has 7 years of nursing experience, is supportive, and is engaged in community service activities The RN with an MSN who is a nurse manager, has 7 years of nursing experience, is supportive, and is engaged in communitiy service activities is the only nurse qualified to become a CNL. The American Association of Colleges of Nursing requires an RN to have at least a master's degree to be eligible to become a CNL.
The charge nurse on a postoperative surgical unit is responsible for making client assignments for staff nurses. Two staff nurses have voiced not wanting to assume care for any new postoperative surgical clients during their shifts. How can the charge nurse resolve this conflict using the strategy of compromise to address the immediate concerns of the two staff nurses? Coerce the staff by complimenting on them on how well they care for new postoperative surgical clients. Consult with the nurse manager to decide how postoperative surgical clients should be assigned to the two nurses. Approach both nurses to discuss incentives that can be given for agreeing to accept new postoperative surgical clients. Reassign all nurses' clients in a manner that ensures the two staff nurses will not have to care for new postoperative surgical clients.
Approach both nurses to discuss incentives that can be given for agreeing to accept new postoperative surgical clients. Compromise involves approaching all involved parties and finding a mutually agreeable solution. For this conflict, the charge nurse should discuss what can be done to make the two staff nurses agree to accept the new clients. Coercing the staff, consulting with the nurse manager, and reassigning the clients do not involve compromise among the charge nurse and the staff nurses.
A nurse manager is planning to introduce to the staff a new procedure for documenting supplies used for clients on a medical-surgical unit. Several of the staff members say to the nurse manager, "Why do we have to change the procedure? The one we're using is working just fine." Which action would be important for the nurse manager to take first? Explain the change using simple, concise language. Inform them that the change will occur in steps. Emphasize the advantages of the change. Involve all affected by the change in planning.
Explain the change using simple, concise language. To overcome resistance to change, the nurse manager first needs to explain the proposed change to all affected people in simple, concise language. Once that is accomplished, then the nurse manager would list the advantages of the proposed change, both for the individual and for members of the group; relate the proposed change to the person's or group's existing beliefs and values; help overcome resistance by providing opportunities for open communication and feedback; and indicate clearly how the change will be evaluated. If possible, introduce change gradually. Involve everyone affected by the change in the design and implementation of the process; provide incentives for commitment to change, such as money, status, time off, or a better working environment.
The nurse manager notices a trend in nurses routinely arriving to work late. How can the nurse use the transactional leadership style to get nurses to arrive to work on time? Allow the nursing staff to develop a plan to decrease tardiness within the unit. Emphasize the importance of arriving to work on time during a monthly unit meeting. Monitor time clock reports on a monthly basis and enter all nurses who have not been tardy into a raffle for a paid day vacation. Generate a report of nurses who routinely arrive to work late and set an example by firing the nurse who has been tardy the most.
Monitor time clock reports on a monthly basis and enter all nurses who have not been tardy into a raffle for a paid day vacation. Transactional leadership style involves creating a reward system to get the desired outcome. Entering the nurses who have not been tardy is the only option that provides a reward. Allowing the nursing staff to assist in correcting the problem is an example of democratic leadership style. Emphasizing the importance of arriving to work on time is an example of autocratic leadership. Firing is an example of coercive power.
A charge nurse on a medical-surgical unit is asked by the nurse manager to serve as a mentor to another staff nurse who is less experienced. Which of these would best describe this role? The charge nurse is being paid to supervise the staff nurse. The staff nurse is learning about all the hospital policies from the charge nurse. The charge nurse is providing support for the staff nurse in new responsibilities. The staff nurse is orienting to the unit as a newly hired nurse.
The charge nurse is providing support for the staff nurse in new responsibilities. A mentor is not a paid position, but, instead, is a person who provides support and encouragement to a less experienced nurse who is learning new responsibilities for a current role or an expanded one. Preceptorship typically is a paid position, and is provided for a new or experienced nurse who is training for a new position on a unit. The preceptor would teach the new nurse about hospital policies and procedures, as well as supervise the nurse in daily assignments.
The nurse recognizes that a new mother is having difficulty breastfeeding. The nurse demonstraties various positions in which to hold the baby while feeding. The nurse also educates the mother on ways to ensure proper latching. The new mother attempts to breastfeed the baby again using the new techniques and is successful. Which statement in this scenario illustrates Lewin's stage of refreezing? The nurse also educates the mother on ways to ensure proper latching. The nurse recognizes that a new mother is having difficulty breastfeeding. The nurse demonstrates various positions in which to hold the baby while feeding. The new mother attempts to breastfeed the baby again using the new techniques and is successful.
The new mother attempts to breastfeed the baby again using the new techniques and is successful. Refreezing involves making a change operational, or a part of one's everyday life. The mother feeding the baby using new techniques is an example of refreezing. The nurse recognizing that a new mother is having difficulty breastfeeding is an example of unfreezing, in which the need for a change is recognized. The nurse educating the mother on ways to ensure proper latching and demonstrating various positions in which to hold the baby while feeding are examples of moving, in which change is initiated after a careful process of planning.
A nurse is in charge of a large group of employees on a busy surgical floor. Today's care must be completed early due to a special event involving most of the employees. Which management style would work best in this situation? Authoritarian Coercive Democratic Laissez-faire
Authoritarian With authoritarian, or autocratic, leadership, the leader determines, dictates, and directs the activities of the group, with no input from the followers on decisions. It is particularly effective when decisions for a large group need to be made quickly and efficiently, as in this scenario. Coercion--involving forcing actions upon the staff--is not a recognized leadership style and, in any case, would not be an advisable approach as it would likely trigger resistance in the group and be counterproductive. Democratic leadership is appropriate when the task, or decision at hand, is not one that requires urgent action, when subordinates can be expected to make meaningful contributions, and when their input can be taken into account. Laissez-faire management provides little or no direction; coworkers develop their own goals, make their own decisions, and take responsibility for their own management.
The nurse manager in a critical care unit actively listens to the staff and engages the staff to offer decisions regarding problem solving and implementing these decisions. What type of managerial mindset does this manager exhibit? Collaborative mindset Reflective mindset Analytical mindset Action mindset
Collaborative mindset The collaborative mindset involves listening more than talking, and allowing people to take initiative and control their own work. The reflective mindset allows managers to mentally digest experiences and reflect on them in a different way. The analytical mindset encourages introspection so that one can recognize biases and see things in a unique new way. The action mindset mobilizes energy to change while being sensitive about the capabilities of the team and the direction that is needed.
A registered nurse checks the American Nurses Association (ANA) regulations prior to delegating tasks to unlicensed assistive personnel (UAP) on a burn unit. Which principles regarding the regulation, education, and use of UAP are recommended by the ANA? Select all that apply. It is the health care institution that determines the scope of nursing practice. It is the LPN who supervises any assistant involved in providing direct client care. It is the purpose of assistive personnel to work in a supportive role to the registered nurse. It is the role of the assistive personnel to carry out tasks to enable the professional nurse to concentrate on nursing care for the client. It is the role of the LPN to assign nursing duties to the UAP. It is the registered nurse who is responsible and accountable for nursing practice.
It is the role of the assistive personnel to carry out tasks to enable the professional nurse to concentrate on nursing care for the client. It is the purpose of assistive personnel to work in a supportive role to the registered nurse. It is the registered nurse who is responsible and accountable for nursing practice. The nurse must be familiar with the delegation guidelines when working as a registered nurse. The purpose of assistive personnel is to work in a supportive role to the registered nurse. It is the role of the assistive personnel to carry out tasks to enable the professional nurse to concentrate on nursing care for the client. It is the registered nurse who is responsible and accountable for nursing practice. It is the nursing practice act of each state, not the health care institution, that deternines the scope of nursing practice within a given state. The LPN does not supervise the assistant, the RN does. It is not the role of the LPN, rather the RN, to assign nursing duties.
A registered nurse serves as the chair of the Nursing Practice Committee for the hospital. The meetings of this committee do not have a planned agenda; members of the committee who are interested in a particular topic feel free to suggest it and then to lead the subsequent discussion. This chair's leadership style could be most accurately termed what? Laissez-faire Decentralization Democratic Autocratic
Laissez-faire Little or no direction is provided in laissez-faire management: coworkers develop their own goals, make their own decisions, and take responsibility for their own management. Democratic leadership, also known as participative or shared leadership, involves members of the group taking a more participative role in the decision-making process. Autocratic leadership, also known as authoritarian leadership, is characterized by the leader's individual control over all decisions and little input from group members. Decentralized decision-making is any process in which the decision-making authority is distributed throughout a larger group.
The proficient nurse wants to become a more effective leader. Which step would be most appropriate for the nurse to take to achieve this goal? Become a preceptor and work extra shifts on the nursing unit. Promote a healthy work environment and become a nurse mentor. Start a transformational change on the nursing unit and engage staff in the movement. Review the Nurse Manager Leadership Collaborative model and write delegation competencies.
Promote a healthy work environment and become a nurse mentor. Research indicates that a nurse can become a more effective leader by striving to become an authentic leader, developing leadership skills including reviewing modules such as the Nurse Manager Leadership model and incorporating knowledge into personal practice, promoting a healthy work environment, engaging staff to commit their best effort at work, and assisting new nurses to transition into the RN role through mentorship or preceptorship. Working extra shifts would not help leadership skills. Abruptly starting transformational change on a unit and engaging staff could disrupt harmony on the unit. Writing delegation competencies would not improve leadership skills.
The nurse manager is aware that nurses in the operating room are concerned about a proposed change in their working hours. Which is the nurse manager's best approach to addressing this problem and the nurses? Relate the proposed change to the group's existing beliefs and values. Discourage the nurses from discussing the problem because the change is going to occur. Explain the rationale for this change in an e-mail to each of the nurses. Discuss the disadvantages for the hospital if the change is not made.
Relate the proposed change to the group's existing beliefs and values. Approaches to overcoming resistance to change include relating the proposed change to the group's existing beliefs and values; explaining the rationale for change in clear, concise language and allowing for opportunities of open discussion; and listing the advantages of this change both for individuals and the group. Discouraging dialogue, using email to address concerns, and ignoring staff concerns are ineffective managerial communication skills.
Two new nurses are requesting the same preceptor for unit orientation. Both new nurses have been very vocal about being unhappy if they do not receive their choice of preceptor. Which illustrates the nurses using a compromise approach to conflict resolution? The nurses ignore each other's request for the preceptor. The nurses agree to allow the preceptor to decide which nurse to precept. The nurses agree that one nurse will obtain the preceptor for orientation in exchange for that nurse working each weekend. The nurses agree to have the preceptor precept one nurse at the beginning of the orientation and the other at the end.
The nurses agree to have the preceptor precept one nurse at the beginning of the orientation and the other at the end. Compromise involves both parties willingly relinquishing something of equal value. The nurses' decision to share the preceptor, with one having the preceptor at the beginning of the orientation and the other at the end, demonstrates compromise. The nurses ignoring each other's request illustrates avoidance. Allowing the preceptor to decide which nurse to precept encourages competition. Competition involves a win-lose approach to conflict. The nurses agreeing that one nurse will obtain the preceptor for orientation in exchange for that nurse working each weekend illustrates accommodation. Accommodation involves one party deciding to let the other party win in exchange for something else of value.
The registered nurse (RN) wants to delegate measuring a client's urinary output to an unlicensed assistive personnel (UAP). Which factors should the nurse consider before delegating the task? The complexity of the activity, age of the UAP, and predictability of the outcome Predictability of the UAP, the amount of time required for the task, and RN's skill level The stability of the patient's condition, potential for harm, and complexity of the activity The context of the other patient needs, the desired outcome, and autonomy of the patient
The stability of the patient's condition, potential for harm, and complexity of the activity RNs should consider the following when delegating tasks to UAPs: qualifications and capabilities of the UAP (not the age of the UAP or the RN's skill level), stability of the patient's condition (not the autonomy of the patient), complexity of the activity to be delegated (not the time required to complete the activitiy), potential for harm, predictability of the outcome (not the predictability of the UAP or the desired outcome), and overall context of other patient needs.
