Test Bank For Leading and Managing in
Nursing, 8th Edition by Patricia S. Yoder-Wise,
Susan Sportsman Chapter 1-25
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Chapter 01: Leading, Managing, and Following
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
MULTIPLE CHOICE
1. A nurse manager of a 20-bed medical unit finds that 80% of the patients are older adults. She
is asked to assess and adapt the unit to better meet the unique needs of the older adult patient.
Using complexity principles, what would be the best approach to take for implementation of
this change?
a. Leverage the hierarchical management position to get unit staff involved in
assessment and planning.
b. Engage involved staff at all levels in the decision-making process.
c. Focus the assessment on the unit and omit the hospital and community
environment.
d. Hire a geriatric specialist to oversee and control the project.
ANS: B
Complexity theory suggests that systems interact and adapt and that decision making occurs
throughout the systems, as opposed to being held in a hierarchy. In complexity theory, every
voice counts, and therefore, all levels of staff would be involved in decision making.
TOP: AONE competency: Communication and Relationship-Building
2. A unit manager of a 25-bed medical/surgical area receives a phone call from a nurse who has
called in sick five times in the past month. He tells the manager that he very much wants to
come to work when scheduled but must often care for his wife, who is undergoing treatment
for breast cancer. According to Maslow‘s need hierarchy theory, what would be the best
approach to satisfying the needs of this nurse, other staff, and patients?
a. Line up agency nurses who can be called in to work on short notice.
b. Place the nurse on unpaid leave for the remainder of his wife‘s treatment.
c. Sympathize with the nurse‘s dilemma and let the charge nurse know that this nurse
may be calling in frequently in the future.
d. Work with the nurse, staffing office, and other nurses to arrange his scheduled
days off around his wife‘s treatments.
ANS: D
Placing the nurse on unpaid leave may threaten the nurse‘s capacity to meet physiologic needs
and demotivate the nurse. Unsatisfactory coverage of shifts on short notice could affect
patient care and threaten the needs of staff to feel competent. Arranging the schedule around
the wife‘s needs meets the needs of the staff and of patients while satisfying the nurse‘s need
for affiliation.
TOP: AONE competency: Communication and Relationship-Building
3. A grievance brought by a staff nurse against the unit manager requires mediation. At the first
mediation session, the staff nurse repeatedly calls the unit manager‘s actions unfair, and the
unit manager continues to reiterate the reasons for the actions. What would be the best course
of action at this time?
a. Send the two disputants away to reach their own resolution.
b. Involve another staff nurse in the discussion for clarity issues.
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c. Ask each party to examine their own motives and issues in the conflict.
d. Continue to listen as the parties repeat their thoughts and feelings about the
conflict.
ANS: C
For resolution of conflict, one should address the interests and involvement of participants in
the conflict by examining the real issues of all parties.
TOP: AONE competency: Communication and Relationship-Building
4. At a second negotiation session, the unit manager and staff nurse are unable to reach a
resolution. What is the appropriate next step?
a. Arrange another meeting in a week‘s time so as to allow a cooling-off period.
b. Elevate the next negation session to the next manager, one level above.
c. Insist that participants continue to talk until a resolution has been reached.
d. Back the unit manager‘s actions and end the dispute.
ANS: B
Part of leadership is understanding conflict resolution and ability to negotiate and manage for
resolution of issues and concerns. This situation has failed a second negotiation session,
elevation to a manager with additional training to facilitate conflict resolution is important at
this point.
TOP: AONE competency: Communication and Relationship-Building
5. The manager of a surgical area has a vision for the future that requires the addition of RN
assistants or unlicensed persons to feed, bathe, and ambulate patients. The RNs on the staff
have always practiced in a primary nursing-delivery system and are very resistant to this idea.
What would be the best initial strategy for implementation of this change?
a. Exploring the values and feelings of the RN group in relationship to this change
b. Leaving the RNs alone for a time so they can think about the change before it is
implemented
c. Dropping the idea and trying for the change in a year or so when some of the
present RNs have retired
d. Hiring the assistants and allowing the RNs to see what good additions they are
ANS: A
Influencing others requires emotional intelligence in domains such as empathy, handling
relationships, deepening self-awareness in self and others, motivating others, and managing
emotions. Motivating others recognizes that values are powerful forces that influence
acceptance of change. Leaving the RNs alone for a period of time before implementation does
not provide opportunity to explore different perspectives and values. Avoiding discussion
until the team changes may not promote adoption of the change until there is opportunity to
explore perspectives and values related to the change. Hiring of the assistants demonstrates
lack of empathy for the perspectives of the RN staff.
TOP: AONE competency: Knowledge of the Health Care Environment
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6. As the RN charge nurse on the night shift in a small long-term care facility, you‘ve found that
there is little turnover among your LPN and nursing assistant (NA) staff members, but they
are not very motivated to go beyond their job descriptions in their work. Which of the
following strategies might motivate the staff and lead to greater job satisfaction?
a. Ask the director of nursing to offer higher wages and bonuses for extra work for
the night LPNs and NAs.
b. Allow the LPNs and NAs greater decision-making power within the scope of their
positions in the institution.
c. Hire additional staff so that there are more staff available for enhanced care, and
individual workloads are lessened.
d. Ask the director of nursing to increase job security for night staff by having them
sign contracts that guarantee work.
ANS: B
Hygiene factors such as salary, working conditions, and security are consistent with
Herzberg‘s two-factor theory of motivation; meeting these needs avoids job dissatisfaction.
Motivator factors such as recognition and satisfaction with work promote a satisfying and
enriched work environment. Transformational leaders use motivator factors liberally to inspire
work performance and increase job satisfaction.
TOP: AONE competency: Communication and Relationship-Building
7. The nurse manager wants to increase motivation by providing motivating factors for the nurse
on the unit. What action would be appropriate to motivate the staff?
a. Collaborate with the human resource/personnel department to develop on-site
daycare services.
b. Provide a hierarchical organizational structure.
c. Implement a model of shared governance.
d. Promote the development of a flexible benefits package.
ANS: C
Complexity theory suggests that systems interact and adapt and that decision making occurs
throughout systems, as opposed to being held in a hierarchy. In complexity theory, every
voice counts, and therefore all levels of staff would be involved in decision making. This
principle is the foundation of shared governance.
TOP: AONE competency: Communication and Relationship-Building
8. The nurse manager has been asked to implement an evidence-based approach to teach ostomy
patients self-management skills postoperatively. The program is to be implemented across the
entire facility. What illustrates effective leadership in this situation?
a. The training modules are left in the staff room for times when staff are available.
b. The current approach is continued because it is also evidence-based and is more
familiar to staff.
c. You decide to implement the approach at a later date because of feedback from the
RNs that the new approach takes too much time.
d. An RN who is already familiar with the new approach of volunteers to take the
lead in mentoring and teaching others how to implement it.
ANS: D
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Followership occurs when there is acquiescence to a peer who is leading in a setting where a
team has gathered to ensure the best clinical decision making, and actions are taken to achieve
clinical or organizational outcomes. Followership promotes good clinical decisions and use of
clinical resources.
TOP: AONE competency: Communication and Relationship-Building
9. You overhear a new graduate RN telling a nurse colleague that leadership and management
belong to the unit manager, not to her. As a nursing colleague, what do you know to be true in
regard to the statement?
a. The statement is correct. Leadership is not the role of the staff nurse.
b. The new graduate would benefit from further understanding of her role as a
professional, whose influence may affect the decision making of patients,
colleagues, and other professionals.
c. The new graduate has been influenced by nurse leaders and managers who leave
for other positions.
d. The general perception is that nurse leaders and managers are not satisfied in their
jobs.
ANS: B
Care coordination that involves the intersection of individual, family, and community-based
needs requires that nurses have self-confidence, knowledge of organizations and health
systems, and an inner desire to lead and manage. There is often a view that leadership is
isolated to those holding managerial positions, and that a direct care nurse is subject to
following by adhering to the direction of others. Such views fail to acknowledge that to be a
nurse requires each licensed individual to lead, manage, and follow when practicing at the
point-of-care and beyond.
TOP: AONE competency: Leadership
10. The charge nurse walks into Mr. Smith‘s room and finds him yelling at the LPN. He is
obviously very upset. The charge nurse determines that he has not slept for three nights
because of unrelieved pain levels. The LPN is very upset and calls Mr. Smith an ―ugly, old
man.‖ The charge nurse acknowledges the LPN‘s feelings and concerns and then suggests that
Mr. Smith‘s behavior was aggressive but was related to lack of sleep and to pain. The charge
nurse asks, ―Can you, together with Mr. Smith, determine triggers for the pain and effective
approaches to controlling his pain?‖ This situation is an example of what?
a. Lack of empathy and understanding for Miss Jones
b. Concern with placating Mr. Smith
c. Leadership behavior
d. Management behavior
ANS: C
The situation between Mr. Smith and Miss Jones is a complex situation involving unrelieved
patient symptoms and aggressiveness toward a staff member. Providing engaged,
collaborative guidance and decision making in a complex situation where there is no
standardized solution reflects leadership.
TOP: AONE competency: Leadership
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11. After assessing an older adult patient in long-term care who has been slowly deteriorating for
weeks, the nurse manager calls the family and asks them to come in, as the patient is dying.
What is the most likely basis for the nurse manager‘s request?
a. An established clinical pathway
b. Confirmatory scientific evidence
c. Unit protocol
d. Experience
ANS: D
The nurse manager is employing knowledge and experience in determining that the patient is
dying, because the course of dying is not standardized and cannot be determined by clinical
pathways.
TOP: AONE competency: Knowledge of the Health Care Environment
12. Chart audits have revealed significant omissions of data that could have legal and financial
guideline ramifications. The unit manager meets with the staff to discuss audit findings and to
find approaches that will address the gaps in charting and achieve desired goals. What is the
manager demonstrating?
a. Leadership
b. Management
c. Decision making
d. Vision
ANS: B
The process of guiding others to meet established goals, outcomes, and procedures is
management. This can require collaborative decision making to determine how best to reach
predetermined goals and follow established practices.
TOP: AONE competency: Knowledge of the Health Care Environment
13. A family is keeping vigil at a critically ill patient‘s bedside. Distant family members call the
unit continuously asking for updates and expressing concern. The nurse speaks with the
distant family members and states she is referring them to the hospital social worker, whose
role is to work with family in this situation. What role is the nurse assuming through this
action?
a. Manager
b. Leader
c. Follower
d. Laissez-faire
ANS: A
As a manager, you are concerned with managing and coordinating resources to achieve
outcomes in accordance with established clinical processes. Referral to a social worker
alleviates demand on staff time and is consistent with hospital procedures.
TOP: AONE competency: Communication and Relationship-Building
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14. A family is keeping vigil at a critically ill patient‘s bedside. The nurse approaches the unit
manager with concern over the family dynamics for the patient concerned there are
patient-family conflicts based on patient‘s wishes. The nurse suggests that the patient‘s
provider may need to discuss the treatment plan with the family. The unit manager states he
will arrange a discussion with the patient‘s provider and ask the nurse to support the
provider‘s decisions. What is the role of the nurse in this situation?
a. Leadership
b. Management
c. Follower
d. Evidence-based
ANS: C
In the followership role, you bring to the manager your concerns about concerns for patients
and the outcomes and accept the direction given by the manager in response to your concerns.
TOP: AONE competency: Knowledge of the Health Care Environment
15. The manager calls the staff together to assess a situation in which the family of a seriously ill
patient is anxious and is absorbing a great deal of staff time in consultation, discussion, and
questioning of treatment decisions. Staff members are becoming distanced from the family.
After inviting the concerns of staff, the manager explains that the organization values
patient-centered care and that evidence supports that acting as an advocate and a listener is
helpful to families. The manager asks the staff for ideas and strategies that are effectively
patient-centered in dealing with families in similar situations. What is the role of the nurse
manager in this situation?
a. Leadership
b. Management
c. Follower
d. Visionary
ANS: A
As a leader, the manager is providing and communicating vision and direction based on
evidence and experience. The manager is engaging others in decision making that moves them
toward the vision with a reasonable level of risk taking.
TOP: AONE competency: Leadership
16. The manager of a unit is finding it difficult to work with a new graduate nurse. The new nurse
has many ideas; however, his manner of presenting them irritates the manager. After
reflection and discussion with others, the manager recognizes that she feels threatened by his
behavior. She comes to understand that the new nurse is trying to establish his own role on the
unit; is not trying to challenge her; and needs guidance, coaching, and affirmation. What is the
nurse manager demonstrating in this situation?
a. A positive self-concept
b. Deepening self-awareness
c. Leadership
d. Acquiescence
ANS: B
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Stepping outside oneself to envision the situation while assuming ownership is a component
of emotional intelligence. This is an example of self-awareness to identify the resolve to
self-conflict in this situation.
TOP: AONE competency: Professionalism
17. As the head of a nursing program, you consistently invite the ideas of your team about
innovations in teaching, community partnerships, and curriculum design and invite
participation in decisions. Many of these ideas have been implemented successfully, and your
staff members are keen to try on other ideas. What is the leadership you are employing?
a. Situational
b. Trait-based
c. Contingency-based
d. Transformational
ANS: D
Transformational leadership involves attending to the needs and motives of followers, which
results in creativity, improvement, and employee development.
TOP: AONE competency: Professionalism
18. As a leader on a rehab unit, the manager encourages all staff members to see themselves as
having a role in decision making and quality care. The manager sees their role as involving
particular responsibilities in decision making but not as a hierarchal role. What is this view of
the role consistent with in this situation?
a. Trait theories
b. Complexity theory
c. Situated theory
d. Emotional intelligence
ANS: B
Complexity theory involves envisioning each member of the team involved in decision
making, management, and leadership, with the leader not seen in a hierarchal relationship to
other team members.
TOP: AONE competency: Leadership
19. A staff nurse has been recently promoted to unit manager. During the time on the unit, the
nurse formed a strong social network among staff, has promoted the development of
relationships between staff and workers in other areas of the organization, and has formed
relationships that generate ideas from patient organizations and the local nursing education
program. According to complexity theory, what principle is being engaged?
a. Empowerment
b. Systematic thinking
c. Development of networks
d. Bottom-up interactions
ANS: C
According to complexity theory, social networks evolve around areas of common interest and
are able to respond to problems in creative and novel ways.
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TOP: AONE competency: Knowledge of the Health Care Environment
20. According to the complexity theory, what would be the focus of measurement?
a. Cost per hospital day
b. Bed utilization
c. Infection rates
d. Staff morale and budgets
ANS: D
According to complexity theory and the principle ―Think systematically,‖ one cannot ignore
objective data or nonmeasurable data, as both inform decisions.
TOP: AONE competency: Business Skills
21. During a staff meeting held to discuss developing a mission statement for the unit, the idea of
placing patient needs first is discussed. What is considered when the suggestion by the
manager is for the unit mission to be derived from the organization mission?
a. Empowering
b. A leadership task
c. A symbol
d. A management task
ANS: B
According to complexity theory, leadership task, which are similar to values, reflect the
patient-centered philosophies and values-driven characteristics that define an organization and
give it personality.
TOP: AONE competency: Knowledge of the Health Care Environment
22. A dispute arises between an RN and an LPN over a patient issue. The tension continues
between the two and begins to affect other staff members, who are drawn into the conflict.
Over time, the team becomes polarized toward either the RN or the LPN. How might this
situation be prevented?
a. Expediency in responding to the initial dispute, once it became apparent that it
could not be resolved by the two parties themselves
b. Asking other staff members what the real issues were in the dispute between the
RN and the LPN
c. Reassigning one of the parties to another unit when it became apparent that the two
individuals could not resolve the dispute themselves
d. Calling a staff meeting at the onset of the dispute to allow the team and the RN and
LPN to discuss the initial dispute
ANS: A
The initial step in conflict resolution should have involved an expedient response to the issues
and putting a focus on the issues involved in the dispute between the LPN and RN through
negotiation involving the two parties, before the dispute involved others.
TOP: AONE competency: Communication and Relationship-Building
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23. The unit is shifting from primary nursing to a team model in an effort to contain costs. Staff
members are upset about the change and ask for a meeting to discuss the new model. After
hearing their concerns related to reduction in professional autonomy, what is the initial
response by the manager to address the concerns?
a. Acknowledge the loss.
b. Explain the reasons for change, emphasizing the need to reduce costs.
c. Repeat the information several times, giving detailed budget overviews.
d. Adjourn the meeting and provide explanation through e-mail.
ANS: A
Visioning involves engaging with others to assess the current reality, specify the end point,
and then strategize to reduce differences. This requires trusting relationships that acknowledge
the differences in values and ideas. When done well, the nurse manager and the nurses within
a unit experience creative tension that inspires working in concert to achieve desired goals.
TOP: AONE competency: Communication and Relationship-Building
MULTIPLE RESPONSE
1. A new graduate nurse wonders about the directions that her preceptor has given her regarding
management of incontinent, confused patients. The new nurse brings the preceptor
evidence-based information she located regarding incontinence interventions for confused
patients and asks to talk about the guidance that given after the preceptor reviews the
information in the article. What is the new nurse demonstrating in this situation? (Select all
that apply.)
a. Assertiveness
b. Followership
c. Management
d. Insubordination
ANS: A, B
This is an example of followership in which a staff nurse is demonstrating assertive behavior
and presenting evidence that may influence the decision making of her nurse leader and
manager.
TOP: AONE competency: Knowledge of the Health Care Environment
Chapter 02: Quality and Safety
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
MULTIPLE CHOICE
1. In an effort to control costs and maximize revenues, the Rehabilitation Unit at Cross Hospital
reduced the number of its managers and increased the number of units for which each
manager was responsible. Within a year, the number of adverse events on the units had
doubled. How do the increase in adverse events relate to decreased managers?
a. The overload of staff nurse duties
b. Resistance to change by staff
c. A change in reporting system for everyone
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d. Fewer clinical leaders to facilitate best practice
ANS: D
Eliminating barriers to the implementation of best practices is the role of managers and
leaders. When there are insufficient resources for leadership to encourage a culture in which
evidence-based practice is embraced, frontline nurses recognize this as a stumbling block for
delivering quality care.
TOP: AONE competency: Knowledge of the Health Care Environment
2. The Rehabilitation Unit at Pleasant Valley Hospital has a high number of falls. What
interventions might assist to reduce the number of falls on the unit?
a. Determining who is responsible for the falls
b. Strengthening unit policies to avoid inappropriate admissions
c. Encouraging involvement of nurses in education related to falls and safety
d. Ensuring that patients are appropriately restrained if they are at risk for falls
ANS: C
The IOM (2010) emphasizes the need for nurses to engage in lifelong learning and to use
evidence and best practices to inform practice and ensure safety.
TOP: AONE competency: Professionalism
3. How would the nurse executive begin to increase safety in patient care areas of the Valley
Hospital?
a. Asking the community what the safety issues are
b. Consulting with a management expert about staffing schedules
c. Ensuring that the senior nursing officer attends the board meetings
d. Instituting improved practices to reduce needlestick injuries
ANS: C
The IOM report (2004) highlighted the importance of the attendance of the senior nurse
executive at board meetings to be a key spokesperson on safety and quality issues.
TOP: AONE competency: Knowledge of the Health Care Environment
4. During review of back injuries, it is determined that a large number of injuries are occurring
in spite of mechanical lifts being used. Furthermore, it is determined that some lifts are
outdated. In addressing this concern, the unit manager:
a. meets individually with nurses who are observed to be using the lifts incorrectly to
review the correct procedure.
b. after consultation with the staff about the review, orders new lifts to replace older
ones that are malfunctioning.
c. blames the system for inadequate funding for resources.
d. reviews the system of reporting incidents to ensure that appropriate reporting is
occurring.
ANS: A
The involvement of staff nurses in safety on the unit is imperative in improvement of quality
and the provision of patient care. This is a relationship engagement by the manager to engage
the nurses and building these relationships improves quality.
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TOP: AONE competency: Communication and Relationship-Building
5. What did the IOM Health Professions Education report highlight as a concern for patient
safety?
a. A normal risk in professional practice
b. A result of disciplinary silos
c. A reflection of frontline staff
d. Related to systems errors
ANS: B
The IOM Health Professions Education report (2004) highlighted the education of health
disciplines in silos as a major concern in patient safety and endorsed five recommendations.
One to be increased and improved communication between the health disciplines.
TOP: AONE competency: Knowledge of the Health Care Environment
6. A nurse manager is implementing strategies to support the steps in the AHRQ Team
Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS 2.0) What
does the manager include in the implementation?
a. Train staff in teamwork skills to work with patients who have difficulty
communicating in English.
b. Rules and decisions are made through centralized processes.
c. You monitor the performance of each staff member closely.
d. Preference is given to increasing staff numbers rather than staff credentials.
ANS: A
One of the most widely used evidence-based teamwork systems to improve communication
and teamwork skills to improve patient safety within organizations is the AHRQ Team
Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS 2.0).
Teamwork is one of the key safety initiatives that can transform a healthcare culture.
TOP: AONE competency: Knowledge of the Health Care Environment
7. After consulting with practice environments about quality and safety concerns in health care,
a dean in a health care program implements what to improve quality and safety in health care?
a. A nursing program that emphasizes the development of a strong disciplinary
identity.
b. Programming that stresses discipline-based research.
c. Partnerships with health care to develop software for the reporting of adverse
events.
d. An interdisciplinary program for nurses, pharmacists, and medical practitioners
that emphasizes collaborative learning teams.
ANS: D
Health Professions Education identified that education related to health disciplines in silos
leads to compromised communication and inability to function as an integrated whole for
patient-centered care.
TOP: AONE competency: Knowledge of the Health Care Environment
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8. What would be the primary emphasis in designing and implementing a quality, safe healthcare
environment?
a. Evidence-based practice
b. Informatics
c. Staffing
d. The patient
ANS: D
Focusing on the patient moves care from concern about who controls care to a focus on what
care is provided to and with patients, which was an aim identified in the IOM report Crossing
the Quality Chasm.
TOP: AONE competency: Knowledge of the Health Care Environment
9. The nurse is educating older adult patients on staying safe in the healthcare system. What
information does the nurse include in the teaching?
a. The need to understand and record all medications being taken.
b. Bringing their own linens and other personal items to the hospital.
c. Washing hands frequently while in a healthcare environment and using a hand
sanitizer.
d. Following closely the directions and orders of healthcare providers.
ANS: A
Patients should be encourage to keep a list of medications they are taking including herbal
medications and share those with their healthcare provider.
TOP: AONE competency: Knowledge of the Health Care Environment
10. As a nurse manager on the West Surgery Unit, you are interested in increasing patient safety
and reducing morbidity and mortality on your unit. What recommendations would be
consistent with the IOM The Future of Nursing report?
a. Careful screening of nursing staff for substance use and abuse
b. Increased RN staffing on the unit
c. Salary and benefits that reflect nursing accountabilities
d. Increase in the percentage of baccalaureate-prepared nurses to 80%
ANS: D
The Future of Nursing advocates for having 80% of the nursing population at a
baccalaureate-prepared level. This recommendation reflects research that suggests that
improved mortality and morbidity rates occur with a better educated work force.
TOP: AONE competency: Knowledge of the Health Care Environment
11. On the West Surgery unit, you want to institute a new system for checking armbands that
evidence suggests may increase safety in medication administration. The system involves
technology. What strategy may assist with rapid adoption of the technology and system?
a. Employ a centralized decision-making approach.
b. Use simulators for initial practice to build confidence.
c. Bring in a nurse consultant who is familiar with the technology.
d. Use early adopters among the staff as leaders and role models in implementation.
ANS: D
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The Institute for Healthcare Improvement (IHI) is dedicated to rapid improvement in patient
care through a variety of mechanisms such as rapid cycle change. Rapid cycle change
diffuses innovation and changes quickly through early adopters who share information and
energy over time and act as role models for others.
TOP: AONE competency: Knowledge of the Health Care Environment
12. To achieve Nurse-Sensitive Care Standards developed by the NQF, you advocate for which of
the following in your health facility?
a. Evidence-based practice to reduce the prevalence of pressure sores
b. Implementation of informatics at the bedside
c. Staff-manager conferences to review reporting of adverse medical events
d. Patient councils to review food, recreation, and nurse-patient relations
ANS: A
The National Quality Forum (NQF) outlines nursing-centered intervention measures related to
prevalence of pressure sores, ventilator-associated pneumonias, volunteer turnover, nursing
care hours per day, and skill mix of staff.
TOP: AONE competency: Knowledge of the Health Care Environment
13. You notice that Sally, a student on your unit, is giving information to an anxious young teen
who seems very uncertain about preparation for an upper GI series. After Sally leaves the
room, you ask her what she thought her conversation with the patient. What is the appropriate
response for you to give Sally?
a. Encourage her to ask the patient if he has questions or concerns about the
procedure.
b. Advise her to consider providing the patient with more information.
c. Suggest that she leave some brochures on the procedure with the patient.
d. Suggest that she also provide teaching to the adolescent‘s parents.
ANS: A
The nurse can encourage patients to take a larger role in care by asking questions and
expressing concerns.
TOP: AONE competency: Communication and Relationship-Building
14. The NQF provides a model for advancement of healthcare quality that could be used in
healthcare organizations. What does the use of this model by the Centers for Medicare and
Medicaid Services specificity link with adverse patient events for healthcare facilities?
a. Staffing
b. Funding
c. Composition of executive councils
d. Composition of consumer-based councils
ANS: B
The Centers for Medicare and Medicaid Services (CMS) have adopted a policy based on the
NQF‘s ―Never Events.‖ The CMS will no longer pay for patient conditions or events that
result from poor practice while patients are under the care of a health professional.
TOP: AONE competency: Knowledge of the Health Care Environment
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15. Pleasant Valley Hospital has amended its safety practices and policies. What has the hospital
elected to emphasize accordance with changes by The Joint Commission (TJC)?
a. Safety goals specific to Pleasant Valley
b. Decision-making processes
c. Sufficient staffing for safe care
d. Increased numbers of baccalaureate-prepared RNs
ANS: A
When TJC, a not-for-profit organization that accredits healthcare organizations, changed its
focus from processes to outcomes, it emphasized patient safety and issues setting-specific
annual patient safety goals.
TOP: AONE competency: Knowledge of the Health Care Environment
16. What would managers and staff review annually in order to ensure compliance with The Joint
Commission (TJC) to improve patient safety?
a. Appropriateness of charting terms and abbreviations
b. Nursing hours per patient
c. Acuity of patient admissions
d. Wait times for care
ANS: A
The Joint Commission issues setting-specific patient goals annually, as well as a list of
―do-not-use‖ terms, abbreviations, and symbols and sentinel events.
TOP: AONE competency: Knowledge of the Health Care Environment
17. How would a nurse manager and the staff prepare for redesignation as a Magnet®Hospital?
a. Commit staff resources over a 6-month period to updating procedure manuals.
b. Educate staff through meetings and training sessions regarding appropriate
answers to questions.
c. Prepare a manual that outlines orientation procedures and ensure that all safety
issues are addressed.
d. Ensure that there are empirical data to support review of patient outcomes, actions
taken, and results of actions.
ANS: D
Through the Magnet®model, organizations must demonstrate how they provide excellence in
five areas. Between designation and redesignation as a Magnet®organization, greater
emphasis is placed on empirical quality results.
TOP: AONE competency: Knowledge of the Health Care Environment
18. Sarah is a second-year nursing student. The clinical instructor overhears Sarah telling a patient
that she ―always‖ checks patients‘ bracelets before giving medication and she is not sure how
the nurses on the unit ―get away with‖ not making more errors than they do. The clinical
instructor pulls Sarah aside and explores with her how her communication might affect the
patient and what it reflects about her beliefs related to the team. What competency does this
action outline?
a. QSEN
b. IHI
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c. DNV/NIAHO
d. AHRQ
ANS: A
The Quality and Safety Education for Nurses (QSEN) project provides resources related to
competencies that prelicensure and graduate students need to develop to serve as safe
practitioners. These competencies include leading and managing, teamwork and collaboration.
TOP: AONE competency: Knowledge of the Health Care Environment
19. What does the SBAR approach to patient safety encourage?
a. Consistency in assessment and practices
b. Continuing education
c. Multidisciplinary approaches
d. Patient feedback
ANS: A
The use of SBAR (Situation, Background, Assessment, and Recommendation) checklists are
designed to decrease omission of important information and practices.
TOP: AONE competency: Knowledge of the Health Care Environment
20. As a manager in a new nursing home, where might you consult for guidance and evidence to
support the development of safe patient practices?
a. Hospitals
b. Business
c. Industry
d. Outpatient clinics
ANS: A
Practices that were once mostly studied in hospital settings are now scrutinized for
implementation in other settings, such as outpatient clinics, rural settings, and nursing homes.
TOP: AONE competency: Knowledge of the Health Care Environment
21. What facilitate the development of decision-making skills related to safe patient care for a
nurse manager?
a. Regular reflection on decisions
b. A culture of perfectionism
c. Recognition of who should be held responsible for individual errors
d. A culture of trust between the staff and you
ANS: A
Reflection on how well decisions were enacted enables knowledge of the complexity of
situations and ramifications of the decisions made. Reflection enables elimination of strategies
and methods that are inappropriate in meeting needs and aids in narrowing choices of best
actions to take.
TOP: AONE competency: Leadership
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22. Mary, an 85-year-old patient with cognitive impairment and gross instability, wanders
continuously. Lately, she has fallen twice, and the family demands that she be restrained. As
the unit manager, you have initiated a least restraint practice. What is an appropriate action in
this situation?
a. Setting up a nursing team meeting to review practices
b. Calling the family to inform them of the practice
c. Initiating a multidisciplinary and family meeting to focus on Mary‘s needs
d. Restraining Mary to satisfy the family‘s wishes
ANS: C
Crossing the Quality Chasm emphasizes the importance of rendering care with the client
(client-centered) rather than to the client. In this situation, the patient includes family in
transparent discussions about quality needs and takes a team approach that involves healthcare
professionals, the family, Mary‘s needs, and evidence associated with safe practice.
TOP: AONE competency: Knowledge of the Health Care Environment
23. A client requires an appendectomy. The surgeon explains the procedure and asks the client to
sign the consent. The patient speaks very little English and looks worried. What is the
appropriate action by the nurse?
a. Suggest that an interpreter explain the procedure to the client and answer any
questions.
b. Ask the client if he has any questions.
c. Draw a picture to show the incision.
d. Not intervene.
ANS: A
Encouraging patients to ask questions when there are doubts and concerns and ensuring
understanding before surgery is performed are ways in which nurses can support patients in
having greater influence in their own care. In this situation, asking an interpreter to help
enables access to information for the patient and active assessment of his understanding.
TOP: AONE competency: Knowledge of the Health Care Environment
24. As the manager on an acute care medical unit, you note that the incidence of medication errors
has increased since the implementation of staffing changes. What is an important stratagem to
reduce errors?
a. Revisit reporting standards for medication errors in your organization.
b. Ensure that medication errors are consistently reported.
c. Provide staff with additional education related to safe practice in medication
administration.
d. Involve RN staff in determining reasons for errors and practice solutions to
increase the safety of medication administration.
ANS: D
Keeping Patients Safe: Transforming the Work Environment of Nurses (2004) identified many
past practices that had a negative impact on nurses, and thus on patients, and recommended
the inclusion of nurses in direct care in decision making involving their practice. Future of
Nursing: Leading Change, Advancing Health (2010) also emphasizes the role of nurses as
leaders in changes that improve health.
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TOP: AONE competency: Professionalism
MULTIPLE RESPONSE
1. What patients would be considered ―at risk‖ consumers during a healthcare visit? (Select all
that apply.)
a. Clyde requires an anticoagulant. He tells the nurse about his medications. He does
not include an herbal supplement.
b. George is very shy and withdrawn. He asks the nurse to leave him alone.
c. Sarah is a new parent who finds that nurses on the children‘s unit are very helpful.
She is eager to accept all suggestions, including those that she does not yet
understand.
d. Claude is booked for bowel surgery. His doctor explains about the colostomy.
Later, Claude tells his wife that he really doesn‘t know what the doctor meant by
colostomy.
ANS: A, C, D
Safer health care involves the patient as an active consumer who keeps and brings a list of all
medications, including natural remedies and questions if there are doubts, concerns, or lack of
understanding.
TOP: AONE competency: Knowledge of the Health Care Environment
Chapter 03: Ethical and Legal Issues in Nursing
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
MULTIPLE CHOICE
1. The manager in the coronary care unit believes an important ethical consideration in
performance evaluations is to include the employee‘s good qualities and give positive
direction for professional growth. What ethical principle does this represent?
a. Justice
b. Fidelity
c. Beneficence
d. Nonmaleficence
ANS: D
Nonmaleficence refers to ―doing no harm.‖ For a nurse manager following this principle,
performance evaluation should emphasize an employee‘s good qualities and give positive
direction for growth. Destroying the employee‘s self-esteem and self-worth would be
considered doing harm under this principle.
TOP: AONE competency: Professionalism
2. A staff nurse in the area that you manage has excelled in the delivery of patient education.
You are considering implementing a new job description that would broaden her opportunity
to teach patients and orient new staff members to the value of patient education. What ethical
principle is being reinforced?
a. Justice
b. Fidelity
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c. Paternalism
d. Respect for others
ANS: C
The principle of paternalism allows one person to make partial decisions for another and is
most frequently deemed to be a negative or undesirable principle. Paternalism, however, may
be used to assist persons to make decisions when they do not have sufficient data or expertise.
Paternalism becomes undesirable when the entire decision is taken away from the employee.
TOP: AONE competency: Professionalism
3. A patient refuses a simple procedure that you believe is in the patient‘s best interest. What two
ethical principles are in conflict in this situation?
a. Fidelity and justice
b. Veracity and fidelity
c. Autonomy and beneficence
d. Paternalism and respect for others
ANS: C
Autonomy refers to the freedom to make a choice (e.g., refuse a procedure), and beneficence
to doing good (performing a procedure that will benefit the patient).
TOP: AONE competency: Professionalism
4. An individual in a wheelchair is applying for the position of receptionist in an outpatient
clinic. What does the nurse manager understand based on The Americans with Disabilities
Act of 1990 requirements for employers?
a. Make reasonable accommodations for persons who are disabled.
b. Allow modified job expectations for persons recovering from alcoholism.
c. Hire disabled individuals before hiring other qualified, nondisabled persons.
d. Treat, for purposes of employment, homosexuals and bisexuals as disabled.
ANS: A
The purposes of the ADA are to eliminate discrimination against persons with disabilities and
to provide consistent, enforceable standards to address discrimination in the workplace.
TOP: AONE competency: Business Skills
5. A staff nurse, who was fired for reporting patient abuse to the appropriate state agency, files a
whistleblower lawsuit against the former employer. What reason would the court provide to
uphold a valid whistleblower suit claiming retaliation by the nurse?
a. Previously reported the complaint, in writing, to hospital administration.
b. Threatened to give full details of the patient abuse to local media sources.
c. Was discharged after three unsuccessful attempts at progressive discipline had
failed.
d. Had organized, before filing the complaint, a work stoppage action by fellow
employees.
ANS: A
An employer is unable to fire an employee who, in good faith, reports what is believed to be a
violation of a law, rule, or state or federal law.
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TOP: AONE competency: Knowledge of the Health Care Environment
6. In keeping with standards of The Joint Commission (TJC), the nurse manager organizes an
orientation for new staff members. As part of the orientation, the nurse manager reviews the
employee handbook. What is the basis that binds employers to statements in the employee
handbook?
a. Under the doctrine of apparent agency
b. Under the doctrine of respondent agency
c. Based on the employee‘s or the employer‘s expectations
d. Based on the theory that the handbook creates an explicit contract
ANS: C
The handbook is an implied contract and frames the employment contract. This contract binds
the employer to meeting the handbook statements.
TOP: AONE competency: Knowledge of the Health Care Environment
7. To reduce the incidence of falls in a skilled nursing unit, the nurse manager contacts the risk
manager. Risk management is a process that attempts to identify potential hazards and:
a. compensate for previous injuries.
b. eliminate these risks before anyone else is harmed.
c. supersede the need for staff members to file incident reports.
d. discipline staff members who have been involved in previous incident reports.
ANS: B
Risk management involves taking proactive steps to identify and eliminate risks and liability.
TOP: AONE competency: Knowledge of the Health Care Environment
8. One means of ensuring that the nurses floated to other patient care areas in healthcare
organizations are qualified to work in the areas they are floated is:
a. employing additional staff to assist with orientation processes.
b. cross educating staff members to other areas of the institution.
c. transferring patients to units where the staffing pattern is optimal.
d. orienting staff members to all patient care areas as part of their general orientation
to the institution.
ANS: B
Nurses should be floated to units as similar as possible to their own to decrease the potential
for liability. Negotiating cross-training, a proactive approach to temporary staffing problems,
reduces the potential for liability.
TOP: AONE competency: Knowledge of the Health Care Environment
9. A colleague asks you to give her your password access so that she can view her partner‘s
healthcare record without using her login. This request violates the patient‘s right to:
a. privacy.
b. confidentiality.
c. undue authorization of treatment.
d. protection against slander.
ANS: A
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Privacy refers to the right to protection against unreasonable and unwarranted interference
with the patient‘s solitude. Privacy standards limit how personal health information may be
used or shared and mandate safeguards for the protection of health information. Institutions
can reduce potential liability in this area by allowing access to patient data, either written or
oral, only to those with a ―need to know.‖ Persons with a need to know include physicians and
nurses caring for the patient, technicians, unit clerks, therapists, social service workers, and
patient advocates. Others wishing to access patient data must first ask the patient for
permission to review a record.
TOP: AONE competency: Knowledge of the Health Care Environment
10. On your nursing unit, you employ LPNs, RNs, and advanced practice nurses. You will need to
be familiar with at least:
a. two nursing practice acts.
b. two nursing practice acts in most states.
c. one nursing practice act.
d. one nursing practice act and a medical act.
ANS: C
In all states, you will need to be familiar with at least one nursing practice act. In some states,
there may be two nursing practice acts if RNs and LPNs/LVNs come under different licensing
boards.
TOP: AONE competency: Knowledge of the Health Care Environment
11. A nurse on your inpatient psychiatric unit is found to have made sexually explicit remarks
toward a patient with a previous history of sexual abuse. The patient sues, claiming
malpractice. What conditions do not apply in this situation and do not support malpractice?
a. Injury
b. Causation
c. Breach of duty
d. Breach of duty of care owed
ANS: A
By virtue of employment, the nurse owes a duty of care to the patient; this care has been
breached by a nurse, who would be expected to know that this behavior violates usual
standards of care. The resultant injury, the fifth malpractice element, must be physical, not
merely psychological or transient. In other words, some physical harm must be incurred by
the patient before malpractice will be found against the healthcare provider, which is not
evident in this situation where the action did not involve physical harm.
TOP: AONE competency: Knowledge of the Health Care Environment
12. As a charge nurse, you counsel your RN staff member that they have satisfied their duty of
care by notifying a child‘s physician regarding concerns about deterioration in the child‘s
status at 0330 hours. The physician does not come in to assess the child and does not provide
additional orders. The child dies at 0630 hours. As the charge nurse, you could be held liable
for what?
a. Professional negligence
b. Assault
c. Avoidance
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d. Murder
ANS: A
Professional negligence can be asserted when there is failure to do what a reasonable and
prudent nurse would do in the same situation. In this situation, the charge nurse might have
advocated further for the patient in light of the evident seriousness of the child‘s condition.
TOP: AONE competency: Knowledge of the Health Care Environment
13. The parents of a toddler who dies after being brought to the ER launch a lawsuit, claiming that
the failure of nurses to pursue concerns related to their son‘s deteriorating condition
contributed to his death. How is senior nurse executive named in the suit?
a. As a global respondent
b. Under the doctrine of respondent superior
c. As a frivolous action
d. Under the element of causation
ANS: B
Known as vicarious liability, the doctrine of respondent superior makes employers
accountable for the negligence of their employees, using the rationale that the employee could
not have been in a position to have caused the wrongdoing unless hired by the employer.
TOP: AONE competency: Knowledge of the Health Care Environment
14. During a staff shortage, you hire an RN from a temporary agency. The RN administers a
wrong IV medication that results in cardiac arrest and a difficult recovery for the patient.
Liability in this situation:
a. is limited to the temporary agency.
b. is restricted to the RN.
c. could include the RN, the agency, and your institution.
d. may depend on the patient‘s belief regarding the employment relationship.
ANS: D
Apparent agency may apply here because your liability and that of your institution could be
established if it can be shown that the patient believes that the RN was an employee of yours
and of your institution.
TOP: AONE competency: Knowledge of the Health Care Environment
15. You volunteer at a free community clinic. A 13-year-old girl presents with chlamydia. The
team leader at the clinic advises that:
a. the state-defined age of legal consent is 18; therefore, no treatment can be
delivered.
b. the teen is underage and should be referred to the family general practitioner.
c. care can be provided as long as consent is voluntary and information about
treatment and options is provided.
d. treatment is provided as long as telephone consent is obtained from a parent or
legal guardian.
ANS: C
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All states have a legal age for consent; generally, this age is 18. However, emancipated
minors, minors seeking treatment for substance abuse, and minors seeking treatment for
communicable diseases can provide their own consent.
TOP: AONE competency: Knowledge of the Health Care Environment
16. Three gravely ill patients are candidates for the only available bed in the ICU. As the
supervisor, you assign the bed to the patient with the best chance of recovery. This decision
reflects which of the following ethical principles?
a. Beneficence
b. Autonomy
c. Veracity
d. Nonmaleficence
ANS: A
Beneficence refers to doing what‘s good for the patient; in this situation, doing what‘s good
means providing care to the patient with the best likelihood of recovery.
TOP: AONE competency: Professionalism
17. Which ethical principle is primarily involved in informed consent?
a. Veracity
b. Autonomy
c. Beneficence
d. Nonmaleficence
ANS: B
Autonomy refers to the right to choose freely, which is inherent in informed consent.
TOP: AONE competency: Knowledge of the Health Care Environment
18. The principle that requires nurses to uphold a professional code of ethics, to practice within
the code of ethics, and to remain competent is which of the following?
a. Veracity
b. Autonomy
c. Fidelity
d. Honesty
ANS: C
Fidelity refers to promise keeping or upholding one‘s promise to practice as a reasonable and
prudent nurse would do and in an ethically competent manner.
TOP: AONE competency: Professionalism
19. Mr. M. complains to you that one of your staff asked him details about his sexual
relationships and financial affairs. He says that these questions were probing and unnecessary
to his care, but he felt that if he refused to answer, the nurse would be angry with him and
would not provide him with good care. Mr. M.‘s statements reflect concern with:
a. privacy.
b. confidentiality.
c. veracity.
d. informed consent.
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ANS: A
Privacy protection includes protection against unwarranted intrusion into the patient‘s affairs.
TOP: AONE competency: Knowledge of the Health Care Environment
20. To satisfy duty of care to a patient, a nurse manager is legally responsible for all of the
following except:
a. notifying staff of changes to policies related to medication administration.
b. scheduling and staffing to ensure safe care.
c. delegating in accordance with practice acts.
d. supervising the practice of the physician.
ANS: D
Legally, the nurse manager is accountable to nursing practice standards, standards for nurse
administrators, and hospital policies and procedures.
TOP: AONE competency: Knowledge of the Health Care Environment
21. In a telehealth organization, a nurse who is licensed in New York and Pennsylvania provides
teaching to a patient who resides in Pennsylvania. The patient charges that the teaching failed
to provide significant information about a potential side effect, which led to delay in seeking
treatment and untoward harm. Under which state nurse practice act and standards would this
situation be considered?
a. New York
b. Pennsylvania
c. Neither New York nor Pennsylvania
d. Both New York and Pennsylvania
ANS: B
Under the law, the state in which the patient resides and not the state where the nurse holds his
or her license determines the state nurse practice act that is considered.
TOP: AONE competency: Knowledge of the Health Care Environment
22. A member of a patient‘s family calls the nurse manager of the palliative care unit to express
concern that a member of the family, who died on the weekend, had requested analgesics from
the RNs on duty. An RN came with the analgesic nearly 45 minutes later, just after the patient
had died. The manager is aware that the unit was especially busy that weekend because many
patients were seriously ill, staff had called in ill, and the staffing manager was unable to
completely replace staff who were absent. The manager is deeply troubled that the family
member had to die in pain because it violates what she knows should have been done. This
manager is experiencing:
a. compromised agency.
b. moral distress.
c. moral sensitivity.
d. moral dilemma.
ANS: B
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Moral distress is experienced when nurses cannot provide what they perceive to be best for a
given patient. Examples of moral distress include constraints caused by financial pressures,
limited patient care resources, disagreements among family members regarding patient
interventions, and/or limitations imposed by primary healthcare providers.
TOP: AONE competency: Professionalism
23. While walking past a patient‘s room, you overhear one of the RN staff telling a patient that
the patient has no right to refuse chemotherapy treatment because the family and the doctor
think the treatment is the best option for the patient. This patient is 40 years of age and alert.
When you meet later to discuss what you heard with the RN, it is important to:
a. discuss how statute law enforces the right of the doctor, but not of families, to
ensure that patients comply with recommended treatment plans.
b. discuss that statute law provides for patient autonomy and refusal of treatment.
c. remind the nurse to provide clearer explanations to aid in the patient‘s
comprehension of the treatment and compliance.
d. acknowledge the nurse‘s role in ensuring that she does not fail in her duty of care
for the patient.
ANS: B
Statute law states that the patient must be given sufficient information, in terms he or she can
reasonably be expected to comprehend, to make an informed choice. Inherent in the doctrine
of informed consent is the right of the patient to informed refusal. Patients must clearly
understand the possible consequences of their refusal.
TOP: AONE competency: Professionalism
MULTIPLE RESPONSE
1. One of your staff nurses asks for your advice because a patient refuses to sign a consent for
surgery. The patient says that he won‘t sign because he doesn‘t understand the nature of the
surgery. You advise that: (Select all that apply.)
a. consent must not be coerced.
b. the patient has a right to choose not to consent.
c. the patient must sign the consent because the doctor wants him to sign.
d. witnessing a consent is related only to the voluntary nature of the signature.
ANS: A, B, D
Consent must be voluntary and not coerced; the patient must understand what he is signing,
must have legal capacity, and must understand the consequences of refusal. Witnessing a
consent means attesting to the voluntary nature of the patient‘s signature.
TOP: AONE competency: Knowledge of the Health Care Environment
2. With regard to nursing practice, nurse managers are held responsible for: (Select all that
apply.)
a. practicing within legal guidelines established under state law and nurse practice
acts.
b. ensuring that nursing staff under their supervision are currently licensed to
practice.
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c. referring all errors in nursing judgment to state discipline boards.
d. ensuring that physicians are properly licensed to provide care on patient care units.
ANS: A, B
Nurses are responsible for knowing and practicing under state law and nurse practice acts.
Managers are responsible for monitoring staff practice and ensuring that staff hold current,
valid licensure.
TOP: AONE competency: Knowledge of the Health Care Environment
Chapter 04: Toward Justice
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
MULTIPLE CHOICE
1. According to Leininger, ―cultural imposition‖ is a major concern in nursing because nurses
have a tendency to impose their values, beliefs, and practices on patients of other cultures.
The discussion topic most likely to be without cultural imposition would be:
a. abortion.
b. wound management.
c. blood transfusion.
d. advance directives.
ANS: B
Abortion, blood transfusion, and advance directives are heavily imbued with values, beliefs,
and practices that may be different between patients and nurses.
TOP: AONE competency: Communication and Relationship-Building
2. Cultural diversity is the term used to describe a vast range of cultural differences. Events have
symbolic meanings for the nurse manager and the staff. The event that would be most likely to
provide symbolic meaning to a nurse manager and staff is a:
a. task force formed to commemorate a New Year‘s celebration in the Western
tradition.
b. project to provide Christmas gifts to the children in a daycare program.
c. celebration of National Nurses Week with the focus on cultural care.
d. task force to develop a poster for the unit depicting religions of the world.
ANS: C
Human cultures have material items or symbols such as artifacts, objects, dress, and actions
that have special meaning in a culture. National Nurses Week, with a focus on nursing
interests, reflects the culture of nursing.
TOP: AONE competency: Communication and Relationship-Building
3. One of the staff nurses on your unit makes the comment, ―All this time I thought Mary was
black. She says she is Jamaican.‖ The best response would be to say:
a. ―Who cares what she is?‖
b. ―What did you think when you learned she was Jamaican?‖
c. ―Why did you assume she was black?‖
d. ―We have never had a Jamaican on this unit.‖
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ANS: B
The response of the nurse manager invites cultural awareness, which involves
self-examination and in-depth exploration of one‘s own biases, prejudices, and assumptions.
TOP: AONE competency: Communication and Relationship-Building
4. As a nurse manager, you notice that Maria, a Hispanic nurse aide, is visibly upset. When you
ask her if something is wrong, she becomes tearful and says, ―Why is it that when John and I
work together in giving patients care, he jokes about my being ―a little fat Mexican‖? The
nurse manager‘s best response is, ―Do you think he:
a. is sensitive to your culture?‖
b. wants to learn more about you?‖
c. has been hurt and wants to hurt others?‖
d. is stereotyping you without thinking?‖
ANS: D
Prejudices enable us to predict behaviors and make sense of situations but constrain our
understanding and development of new insights.
TOP: AONE competency: Communication and Relationship-Building
5. The nurse manager of a unit is asked by a family member of a dying Native American patient
if it is possible to have the patient‘s eight-member family recite the rosary by the bedside. The
manager responds affirmatively. The nurse manager is most likely exhibiting behavior related
to:
a. acculturation.
b. ethnocentricity.
c. cultural diversity.
d. cultural sensitivity.
ANS: D
Cultural sensitivity involves the capacity to feel or react to ideas, customs, and traditions
unique to a group of people.
TOP: AONE competency: Communication and Relationship-Building
6. A 66-year-old native Chinese patient, hospitalized for a myocardial infarction, asks the nurse
manager about seeing his ―acupuncture doctor‖ for treatment of his migraine headache. The
best response to this patient would be:
a. ―How long have you been using acupuncture treatment?‖
b. ―Do you think acupuncture relieves your pain satisfactorily?‖
c. ―What have you told your heart specialist about your migraines and treatment?‖
d. ―Have you tried nonprescription pain medication or been given a prescription drug
for your headaches?‖
ANS: A
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Acknowledging the patient‘s use of acupuncture demonstrates cultural sensitivity through
acknowledgement of treatments that would be consistent with the patient‘s cultural
interpretation of illness and responses to it. The other responses indicate lack of cultural
sensitivity as well as cultural imposition, in that the nurse diverts the line of inquiry toward
interventions that would be common to the nurse‘s experience of health care in Western
cultures.
TOP: AONE competency: Communication and Relationship-Building
7. Maintaining a culturally diverse staff and working with a culturally diverse patient population
is an important function of a nurse manager who works in the hospital of a large medical
center. On your palliative care unit, you have recently received complaints from families
about ineffective pain management for their family members and you determine this occurs
primarily when certain nurses are working. What approach might you take to resolve the
concerns of the families, patients, and potentially, the staff?
a. Reinforce to staff that practice guidelines support as-needed analgesia for the
terminally ill.
b. Ask staff input on the development of stricter guidelines to ensure that all
terminally patients are given sufficient analgesia.
c. Encourage conversation with patients and among staff that facilitates learning
about cultural beliefs and priorities in dying.
d. Advise families that the administration of analgesia is based on the expert clinical
judgment of nurses who are familiar with care of patients in palliative care.
ANS: C
The cultural and religious backgrounds of nurses influence their perceptions of
dignity-conserving care. For example, foreign-born Catholic nurses stated the dying
experience should not be altered by analgesics to relieve suffering or by attempts to hasten
death by forgoing curative therapy or by other means. Approaches to working with
differences in the diverse cultural and religious backgrounds of patients, families, and nurses
alike include taking time to have conversational chats with patients in end-of-life and with
colleagues that will facilitate learning about each other and provide care that fits with the
patient‘s cultural beliefs about dying.
TOP: AONE competency: Communication and Relationship-Building
8. Because an increasing number of Hispanic patients are being admitted, a nurse manager
designs a staff-development program to help her staff understand the Hispanic culture. A
nurse should understand that culture is determined by which of the following?
a. Behavior
b. Love for people
c. Shared vision
d. Genetic predisposition
ANS: A
Culture is determined by behaviors and beliefs and develops slowly.
TOP: AONE competency: Communication and Relationship-Building
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9. The nurse manager for a unit‘s culturally diverse staff creates a staff-development program so
the professional nursing staff members can enhance their understanding of cultures on the
basis of published literature. The literature reveals that the following characteristic is inherent
in a culture. It:
a. develops over time.
b. maintains a strong work ethic.
c. changes easily.
d. develops quickly.
ANS: A
Culture is a patterned behavioral response that evolves slowly as times change. The culture
may or may not maintain a strong work ethic.
TOP: AONE competency: Communication and Relationship-Building
10. In designing programs through your institution to address the health needs of Hispanics in
your community, you most likely would develop programs related to:
a. diabetes.
b. cardiovascular disease.
c. cancer.
d. asthma.
ANS: A
Hispanics with diabetes are twice as likely to die from diabetes as non-Hispanics.
TOP: AONE competency: Knowledge of the Health Care Environment
11. Within the deaf culture, there is considerable disagreement about the use of SEE (Signed
Exact English) and ASL (American Sign Language). This is indicative of:
a. dominant versus nondominant behaviors.
b. the need to recognize diversity within groups.
c. the impact of cross-culturalism.
d. how language separates subgroups.
ANS: B
When working with various cultural groups and diversity, it is important to recognize that
diversity also exists within groups. Cultural differences among groups should not be taken in
the context that all members of a certain group or subgroup are indistinguishable.
TOP: AONE competency: Communication and Relationship-Building
12. When interviewing a candidate for a nursing position who has an Aboriginal background, you
recognize that the candidate‘s lack of eye contact reflects the candidate‘s:
a. lack of confidence.
b. professional behavior.
c. cultural sensitivity.
d. ethnicity.
ANS: D
Ethnicity refers to groups of people who are classified according to common racial, tribal,
religious, linguistic, or cultural backgrounds.
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TOP: AONE competency: Communication and Relationship-Building
13. When interviewing a candidate for a nursing position who has an Aboriginal background, you
recognize that the candidate‘s lack of eye contact reflects the candidate‘s cultural sensitivity.
You are exhibiting:
a. acculturation.
b. cultural sensitivity.
c. ethnocentrism.
d. transculturalism.
ANS: B
Cultural sensitivity refers to the affective capacity to feel, convey, or react to ideas, habits,
customs, or traditions unique to a group of people. In this situation, acknowledgement of the
candidate‘s background in relation to eye contact demonstrates cultural sensitivity.
TOP: AONE competency: Communication and Relationship-Building
14. Mary joins 5W nursing unit. Mary is a new graduate who is anxious to fit in. She soon learns
that some of her ―book learning‖ is being criticized by her colleagues, so she adapts her
practice to what others on the unit are doing. She is demonstrating:
a. cultural awareness.
b. cultural sensitivity.
c. acculturation.
d. cultural marginality.
ANS: C
In accepting the practices of the dominant group on the unit, Mary is demonstrating
acculturation.
TOP: AONE competency: Communication and Relationship-Building
15. At Health Center XYZ, staff members on the rehabilitation unit have a head nurse who is
intolerant of error and publicly chides anyone who makes a mistake. Over time, the rules on
the unit dictate that mistakes are hidden and that areas of concern related to the functioning of
the unit are discussed in tub rooms and are never openly discussed during periodic meetings.
New staff members are quickly made to realize that silence is expected. The situation
described is an example of:
a. ethnicity.
b. work environment.
c. work culture.
d. marginalization.
ANS: C
Culture develops over time, is essential to survival, is learned and shared by members, and
changes with difficulty.
TOP: AONE competency: Knowledge of the Health Care Environment
16. As a nurse manager, you have hired two new staff members who have recently come to the
United States from other countries. Which of the following strategies might indicate your
efforts to assist these staff members with acculturation to your unit?
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a. Analyze a recent situation with them in which an order with a physician was not
clarified and explore their beliefs about nurse-physician relationships.
b. Expect them to behave in ways that are expected of staff who have grown up and
been educated in the United States.
c. Stress to these new staff that your unit is a ―family‖ and that staff members take
pride in saying that they are from Unit 4.
d. Recognize that culture develops over time and leave them alone to figure out
differences between their culture and that of the unit.
ANS: A
Acculturation refers to adapting to a particular culture. Assimilation occurs when individuals
now define themselves as members of the dominant culture and is evidenced by when
individuals say they are from where they live and practice. When individuals grow up within a
culture and take on the characteristics of that culture, it is referred to as socialization.
Assisting the staff to recognize differences in the relationships between physicians and nurses
on the unit and those in their country of origin is assisting adaptation or acculturation and is
promoting positive patient outcomes.
TOP: AONE competency: Communication and Relationship-Building
17. During managers‘ meetings, Lindsay is surprised by the forthrightness of male managers. She
finds that, during discussions, she would be more likely to say:
a. ―I wonder if we should consider changing our policy on performance appraisals?
What do you think?‖
b. ―Sean, your approach to appraisal is completely off track and does not reflect
available evidence.‖
c. ―The system that has been developed needs to be implemented. We have already
spent enough time in discussion.‖
d. ―Forget about change in this policy. It is fine as it is.‖
ANS: A
Males and females in the workplace are likely to have different management styles, and
although not all males are authoritative or females more participatory, women are likely to use
more participatory and inclusive methods.
TOP: AONE competency: Communication and Relationship-Building
18. As a manager, you are responsible for two separate units: a CCU and a cardiac step-down
unit. The organization and relationships on these units are distinct and very different from one
another. Your decision has been to support the uniqueness of these units because each is
effective in different ways in providing patient care. This approach is consistent with which
principle?
a. Transculturalism
b. Cross-culturalism
c. Multiculturalism
d. Acculturation
ANS: C
Multiculturalism refers to maintaining several different cultures, such as the uniqueness of
different work units. Cross-culturalism means mediating between/among cultures, and
transculturalism denotes bridging significant differences in cultural practices.
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TOP: AONE competency: Communication and Relationship-Building
19. During performance appraisal, you praise Xia for her attention and care to nursing details.
You suggest that her care would be further enhanced by greater acknowledgment of patients‘
feelings. Xia bursts into tears and leaves the office. Later, you learn that criticism is perceived
as akin to failure in Xia‘s culture. You reflect on how you could modify your approach in the
future to acknowledge different cultural interpretations of feedback. Your response is
indicative of:
a. bias.
b. cultural awareness.
c. cultural diversity.
d. ethnocentricity.
ANS: B
Cultural awareness involves self-examination and in-depth exploration of one‘s own cultural
and professional background, including biases, prejudices, and assumptions, including
assumptions about thinking modes and decision making.
TOP: AONE competency: Communication and Relationship-Building
20. Individuals living with asthma, who also live in poverty, are much less likely to seek early
care and are more likely to go to emergency rooms for assistance. This example reflects:
a. stereotyping.
b. cultural diversity.
c. ethnocentricity.
d. transcultural care.
ANS: D
Transcultural care involves consideration of health beliefs and practices between genders
among races, ethnic groups, and those with different socioeconomic status.
TOP: AONE competency: Communication and Relationship-Building
21. Sarah, RN, complains to you that a male nurse from a different culture sits very close during
charting and leans toward her when speaking. In responding to Sarah, you consider that
differences across cultures that are relevant to this situation include:
a. eye contact.
b. personal space.
c. harassment.
d. expressions of feeling.
ANS: B
Body movements, eye contact, gestures, verbal tone, and physical closeness when
communicating are all part of a person‘s culture. For the nurse manager, understanding these
cultural behaviors is critical in accomplishing effective communication within the diverse
work force population.
TOP: AONE competency: Communication and Relationship-Building
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22. A new graduate RN joins your unit. After a few weeks, she complains about some of her peers
on the unit and compares their practices negatively to what she learned in her nursing
program. She also is vocal about how she has learned so much here that she did not learn in
her program. She is best described as:
a. having cultural sensitivity.
b. experiencing cultural diversity.
c. experiencing cultural marginality.
d. experiencing acculturation.
ANS: C
The new graduate is caught between two cultures at this point—work and education—and
expresses feelings of belonging to neither.
TOP: AONE competency: Communication and Relationship-Building
23. In caring for a patient from an East Indian culture, the staff expresses frustration that many
people are in the room at any one time, which interferes with care. As the nurse manager, you
provide leadership in understanding that this behavior of the family and friend network
reflects:
a. lack of understanding of the seriousness of the patient‘s illness.
b. lack of communication between family members.
c. the social organization of friendships and family networks in East Indian culture.
d. lack of caring about the hospital environment by the friends and family.
ANS: C
The Giger and Davidhizar Transcultural Model identifies six phenomena to assess provision
of care for patients who are from different cultures, including social organizations, which
include how relationships are formed and expressed in different cultures.
TOP: AONE competency: Knowledge of the Health Care Environment
24. Sarah, one of your RNs, tells you that she can‘t understand why Jim, an Aboriginal patient,
wants to do a smudge. Sarah‘s response is based on her:
a. cultural marginality.
b. circle of familiarity.
c. cultural understanding.
d. acculturation.
ANS: B
The ―circle of familiarity‖ refers to constrained interpretation based on one‘s values, attitudes,
and beliefs.
TOP: AONE competency: Communication and Relationship-Building
MULTIPLE RESPONSE
1. As a nurse manager, you have to be effective in managing a culturally diverse staff. Which of
the following nurse manager attributes would assist you in addressing the cultural needs of
your staff? (Select all that apply.)
a. Stereotyping of others
b. Respecting others
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c.
d.
e.
f.
Understanding the importance of language
Encouragement of potential in all staff
Age bias
Disrespect for others
ANS: B, C, D
Cultural competence involves knowledge of diverse cultural and ethnic groups, including
knowledge of staff members and respect for others and their cultural differences.
TOP: AONE competency: Communication and Relationship-Building
Chapter 05: Healthy Workplaces, Healthy Workforce
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
MULTIPLE CHOICE
1. As a nurse manager, you observe a staff nurse who over the past few weeks has become
withdrawn and has had several absences due to minor ailments. Your best action would be to:
a. ask the nurse if she is okay during report.
b. refer the nurse to the employee assistance program.
c. ask the nurse to meet with you for a few minutes before she leaves for the day.
d. write a note to the nurse advising her that her work attendance must improve.
ANS: C
Stress can lead to emotional symptoms such as depression and a variety of ailments. Meeting
with the nurse privately may assist in identifying stress and possible solutions.
TOP: AONE competency: Business Skills
2. The nurse manager of a unit has lost many staff members, and the unit is now staffed with a
large number of agency and traveling nurses. She knows that the agency and traveling nurses
are all contracted to stay on the unit for the next 3 months. One way to improve morale and
decrease stress in the unit would be to:
a. plan a social event and include the agency and traveling nurse staff members.
b. plan unit-based social events for your remaining permanent staff members.
c. request hospital-based ―floating‖ nurses to substitute for the temporary staff.
d. implement team nursing.
ANS: A
Social support, in the form of positive work relationships, can be an important way to buffer
the effects of a stressful work environment. Including all staff in the social event enables those
who are not normally part of the team to experience this support and provides an opportunity
for the staff as a whole to develop supportive relationships.
TOP: AONE competency: Communication and Relationship-Building
3. As a nurse manager, the one activity you should not overlook is:
a. posting the yearly rotation schedule.
b. reviewing vacation requests.
c. scheduling staffing for holidays 6 months in advance.
d. anticipating staff sick days.
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ANS: B
Free time and vacation time are needed for individuals to recharge. If time for work is more
than 60% of wake time, or when self-time is less than 10% of wake time, stress levels
increase.
TOP: AONE competency: Business Skills
4. A nurse manager has decided that she must institute some personal time-management steps to
survive work and home life. Her first step should be to:
a. determine what takes up so much of her time and energy.
b. organize her personal and work spaces.
c. purchase a handheld personal digital assistant to help remind her of important
meetings.
d. determine her personal and professional goals.
ANS: D
Personal time management refers, in part, to ―the knowing of self.‖ Self-awareness is a critical
leadership skill, and being self-aware and setting goals helps managers determine how their
time is best spent.
TOP: AONE competency: Leadership
5. A hospice nurse has been feeling very stressed at work because of both the physical strain and
the emotional drain of working with clients with AIDS. She tries to walk 1 to 2 miles three
times a week and to talk regularly with her husband about her work-related feelings. One
reasonable stress-management strategy would be to:
a. start taking yoga lessons.
b. make an appointment to meet with a psychiatrist.
c. start jogging 5 to 6 miles every day.
d. plan to go out for a drink with fellow nurses after work every day.
ANS: A
Stress relief techniques include 30 minutes of exercise five times a week, as well as
techniques such as yoga that relieve mental stress.
TOP: AONE competency: Leadership
6. The nurse manager is implementing a shared governance model to help with communication
and decision making. Although staff members like the concept, change is difficult. Staff
nurses feel:
a. more empowered.
b. more communicative.
c. less stressed.
d. more powerless and devalued.
ANS: D
Change can lead to feelings of being overwhelmed and powerless, especially if complexity
compression or rapid, intense changes have been involved.
TOP: AONE competency: Business Skills
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7. The chief nursing officer listens to nurse managers verbalize their feelings of personal stress.
One common source of a personal ―trigger‖ seems to be:
a. the death of a loved one.
b. perfectionism.
c. getting married.
d. losing a job.
ANS: B
Personal ―triggers‖ are events or situations that have a profound effect on specific individuals.
A personal trigger might be a specific event, as in the death of a loved one, an automobile
accident, losing a job, getting married, a new relationship, divorce, the birth of a child, or just
about any major life event.
TOP: AONE competency: Business Skills
8. The staff development educator presents a series of programs on stress management to the
nurse managers. Research has indicated that an individual‘s ability to deal with stress is
moderated by psychological hardiness. Psychological hardiness is a composite of:
a. commitment, control, and challenge.
b. commitment, powerlessness, and passivity.
c. commitment, control, and passivity.
d. decreased isolation, challenge, and passivity.
ANS: A
Some people have the capacity to accept changes in life with good humor and resilience,
which, in turn, influences behavior that prevents illness. Hardiness involves the capacity to
manage time and stress, to reframe situations positively, and to commit.
TOP: AONE competency: Leadership
9. The chief nursing officer understands that a nurse manager can exhibit stress that is related to
trying to keep up with the number of electronic messages that arrive, as well as trying to
remain accessible to staff. What is a strategy that would assist the manager to manage the
information overload effectively?
a. Ignore messages unless they are labeled as important.
b. Determine who is most likely to send useful or important information or requests.
c. Check e-mail messages once a day.
d. Encourage face-to-face meetings rather than e-mail.
ANS: B
Reduction of stress related to information overload requires the development of
information-receiving and information-sending skills. Information-sending skills include
determining most common sources of useful data, labeling files and folders to which e-mail
messages can be directed, deletion of e-mails, and focusing on the most important pieces.
Information-sending skills include keeping e-mail messages short (and calling if the message
needs to be long) and considering the most appropriate medium for messages (telephone, fax,
face-to-face).
TOP: AONE competency: Professionalism
10. In helping nurse managers to manage their time, the chief nursing officer suggests that they:
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a.
b.
c.
d.
maintain a perfectionistic attitude.
set up a complaint list.
have good negotiation skills.
have good information literacy skills.
ANS: D
Time can be saved by using information technology effectively, as it assists with effective
data retrieval and information gathering and with communication related to a variety of needs
in the management setting.
TOP: AONE competency: Business Skills
11. Which of the following statements would best define stress? Stress is:
a. the comfortable gap between how we like our life to be and how it actually is.
b. everyday life, both the highs and the lows.
c. a consequence or response to an event or stimulus that can be positive or negative.
d. identical to distress.
ANS: C
Stress is defined as a gap between how we would like our lives to be and how they actually
are and as a consequence or response to an event or stimulus. It is not inherently bad
(distress), and whether highs and lows are seen as distress or eustress is dependent on each
individual‘s interpretation of the event.
TOP: AONE competency: Business Skills
12. In a job interview for a nursing position, Marley can be assured that which of the following
will occur?
a. Both eustress and distress
b. Only eustress
c. Only distress
d. Neither eustress nor distress
ANS: A
Eustress is defined as stress that is pleasant in nature, and distress is defined as stress of an
unpleasant nature. One can assume that every interview has both of these stresses.
TOP: AONE competency: Business Skills
13. Which one of the following statements has been proven to be true?
a. Recent research has found that women do not have a unique physiologic response
to stress.
b. Both men and women interpret the same stressor in the same manner without
regard to past experiences.
c. Stress influences the immune system in one complex manner.
d. Stressors that are identical do not necessarily have similar effects on each
individual.
ANS: D
Stressors may be unique to certain environments, situations, and persons or groups, and
individuals may respond to the same stressor in different ways.
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TOP: AONE competency: Business Skills
14. An example of role stress occurs when:
a. the director of the ICU and the manager of the surgical unit wish to hire the same
new employee.
b. two part-time staff members are hired to work in a unit, but the job expectations
for them are not clear, and the head nurse expresses disappointment in their
performance.
c. the nurse manager for the ICU wants to advocate for more staff and finds it
difficult to find data to substantiate his proposal.
d. line managers believe that support staff use their technical knowledge to intrude on
their authority.
ANS: B
Role stress is an additional stressor for nurses. Viewed as the incongruence between
perceived role expectations and achievement, role stress is particularly acute for new
graduates. Failure to comply with expectations can lead to role conflict. Role conflict and role
ambiguity are major sources of conflict for nurses.
TOP: AONE competency: Business Skills
15. A staff nurse approaches the unit manager and indicates to her that because of her father‘s
death in the previous month, she is now finding it very difficult to do her work effectively.
This would be considered a(n)
stress.
a. internal source
b. familial
c. burnout
d. external
ANS: D
External stress is outside and removed from the work setting, but it is considered work-related
stress because of the impact it has on the worker.
TOP: AONE competency: Business Skills
16. Sources of occupational stress in nursing include all except which of the following?
a. Authoritarian leadership
b. Concern about moral wrongdoing by colleagues
c. Multiple changes in a short time
d. Rotating shifts
ANS: A
Ethical distress, complexity compression, rotating shifts, high acuity levels, rotating shifts,
and workload are all sources of work-related stress for nurses.
TOP: AONE competency: Business Skills
17. Mr. T. Jones and Mr. R. Smith are both going to become residents in Sunny Haven Lodge.
Mr. Jones views it as an opportunity to socialize and meet new friends. Mr. Smith views this
as abandonment by his family and is worried that the care will be inadequate. Each senior
perceives the situation differently. This is a good example of stress that is:
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a.
b.
c.
d.
both a positive stressor and a negative stressor.
occurring only because of age.
positive in both cases.
harmful in both cases.
ANS: A
Some researchers have determined that stress is a person-environment process in which the
person appraises the situation as taxing or not. Appraisal is an important concept that explains
why two people react in different ways to the same situation. Stress can be viewed as positive
(eustress) or negative (distress).
TOP: AONE competency: Business Skills
18. Jeff, an RN in his 30s, has lost a parent, just purchased a new home, and is laid off with 6
months‘ severance pay. At the same time, Jerry, an RN in his 50s, is financially secure and is
asked to take early retirement with a buyout. How will the two men react to the emotional and
physical influences and the sequence of stress?
a. The younger man will feel more stress.
b. The two men may or may not feel the same amount of stress.
c. The older man will feel more stress.
d. Neither man will experience any stress.
ANS: B
The response to similar stressors does not always result in a similar experience of stress in
individuals. Responses are mediated by the appraisal of the event as well as by factors such as
gender, personality, lifestyle, and age.
TOP: AONE competency: Business Skills
19. Social stressors are considered a major factor in the stress nurses experience in the healthcare
system. Which of the following is not considered to be a social stressor?
a. High amounts of stress in the nursing home environment
b. Changes in the current healthcare system such as nursing strategies
c. Disruptive behavior coming from physicians and other healthcare workers
d. Stress triggers such as self-criticism and overanalyzing
ANS: D
Personal stress triggers such as self-criticism are considered intrapersonal stressors;
environmental factors such as change, work environment, and interactions with others are
considered social stressors.
TOP: AONE competency: Business Skills
20. After several months of heavy patient loads in the Emergency Department and inability to
secure sufficient and experienced staff, the department is especially taxed by a train accident
that brings in many seriously injured individuals. You observe that Rama ignores the requests
of several of the injured, even when time is available to care for them and is rude to two older
adult patients. You are concerned that Rama is evidencing which state?
a. Hardiness
b. Depression
c. Role ambiguity
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d. Depersonalization
ANS: D
A characteristic of burnout is depersonalization, a state characterized by distancing oneself
from the work itself and developing negative attitudes toward work in general (Greenglass et
al., 2001). Depersonalization is commonly described as a feeling of being outside one‘s body,
feeling as if one is a machine or robot, an ―unreal‖ feeling that one is in a dream or that one
―is on automatic pilot.‖ Generally, subjective symptoms of unreality make the nurse uneasy
and anxious. Nurses pushed to do too much in too little time may distance themselves from
patients as a means of dealing with emotional exhaustion.
TOP: AONE competency: Business Skills
21. ―Stress-buffering‖ behaviors can be elicited to reduce stress. All of the following behavioral
coping responses can be used by nurse managers to reduce and manage stress except:
a. distancing oneself from work.
b. using cognitive reframing to change irrational thoughts.
c. refusing a request to sit on a committee to evaluate scheduling software.
d. exercising regularly.
ANS: A
Achieving balance between work and leisure is a useful strategy for stress reduction.
Distancing, however, can be a sign of depersonalization that includes negative attitudes as
well and is a characteristic of burnout.
TOP: AONE competency: Business Skills
22. The education consultant at St. Joseph Hospital is giving a workshop on cognitive reframing.
The consultant explains that cognitive reframing reduces stress by:
a. aiding individuals in identifying positive stressors.
b. helping people realize that negative thinking causes emotional distress.
c. eliminating negative stressors.
d. replacing positive self-statements with negative irrational beliefs.
ANS: B
Cognitive restructuring is a therapy that aids individuals in discovering that their irrational
thoughts can be replaced with responses that are more rational. It enables individuals to gain a
sense of control over the situation and can change ―I‘ll never …‖ to ―I can …‖ or ―She always
…‖ to ―Sometimes she …‖ It is an approach that allows individuals to replace negative
thoughts and statements with others that are more realistic and helpful.
TOP: AONE competency: Business Skills
23. Time management is very essential for the nurse manager. Which of the following is not a
good time-management technique?
a. Decide what not to do.
b. Learn to say ―No.‖
c. Learn to delegate.
d. Break down your workload into smaller, manageable tasks.
ANS: D
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To manage time successfully, it is important to break down your workload into smaller,
manageable tasks. Developing PERT and Gantt charts will aid in dealing with larger, complex
projects. Both charts can be used to outline how an individual will approach a large project.
TOP: AONE competency: Leadership
24. As a unit manager, you chair the unit meetings. For each meeting, you consider and establish
the purpose of the meeting. Second, you prepare an agenda. Arrange the following steps in an
order that would make the meetings productive and successful.
1. Distribute an agenda.
2. Distribute minutes.
3. Select team members.
4. Start on time.
5. Keep the meeting focused and directed toward accomplishing the set objectives.
Select the correct order from the following options:
a. 1, 2, 4, 5, 3
b. 4, 1, 2, 5, 3
c. 3, 1, 4, 5, 2
d. 3, 4, 2, 1, 5
ANS: C
Planning, organizing, and keeping the group on task are critical in ensuring that meetings are
productive and that time is managed well.
TOP: AONE competency: Leadership
MULTIPLE RESPONSE
1. High levels of work-related stress affect all but which of the following? (Select all that apply.)
a. Job satisfaction
b. Absenteeism and turnover
c. Nurses‘ health
d. Client welfare
ANS: A, B, C, D
Many writers and researchers have found that these work-related areas are adversely affected
by stress.
TOP: AONE competency: Business Skills
Chapter 06: Translating Research into Practice
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
MULTIPLE CHOICE
1. The chief nursing officer at a local hospital seeking Magnet® status creates staff development
classes concerning translation of research into practice (TRIP). What best describes TRIP?
a. Conducting an integrative review of the literature
b. Searching the literature for a systematic review
c. Providing the results of research studies to practitioners
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d. Applying strategies that aid in adoption of research in practice
ANS: D
The science of how research is adopted is known as translation science, the science of
translating research into practice (TRIP). The primary aim of research utilization is to activate
the change process to move research findings into practice to improve patient outcomes.
TOP: AONE competency: Leadership
2. The chief nursing officer at a local hospital seeking Magnet® status creates staff development
classes about incorporating evidence-based practice in nursing. What best describes
evidence-based practice?
a. Applying best research evidence to care of patients
b. Using research-based information to develop practice guidelines
c. Conducting a randomized control trial to determine effectiveness of handwashing
techniques
d. Developing standards for practice
ANS: A
Evidence-based medicine is derived from evidence-based medicine and involves integration
of the best research evidence with clinical expertise and the patient‘s unique values and
circumstances in making decisions about the care of individual patients. It is focused on
searching for, appraising, and synthesizing the best evidence to address a specific clinical
practice problem.
TOP: AONE competency: Knowledge of the Health Care Environment
3. As a nurse manager, you trial a new pain scale on your unit that is supported by numerous
research studies. You compare the patient outcomes with the new scale against the existing
scale. Feedback from staff suggests that the new scale is too difficult for patients who have
limited language skills and who are already under duress to understand. The difficulty in
implementing the new scale refers to testing:
a. efficacy.
b. effectiveness.
c. practice failure.
d. comparative error.
ANS: B
Comparing the effectiveness of interventions can help to address the needs of clinicians in
determining best practices for their patients. Comparative effectiveness research (CER) is the
―generation and synthesis of evidence that compares the benefits and harms of alternative
methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the
delivery of care‖ (Institute of Medicine, 2009, p. 29). Efficacy is testing an intervention or
treatment in a traditional randomized clinical trial under carefully controlled conditions and is
used to determine whether an intervention or treatment works, whereas effectiveness is testing
whether the intervention or treatment works in the real world of practice.
TOP: AONE competency: Knowledge of the Health Care Environment
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4. The nurse manager wants to use evidence-based recommendations to prevent
ventilator-associated pneumonia. What is the critical first step to effectively gather evidence
for guiding practice?
a. Develop the clinical question.
b. Identify the databases to be used.
c. Appraise the evidence.
d. Integrate available evidence with unit expertise.
ANS: A
Identifying the question may be the most challenging part of the process. Once the clinical
question has been identified, writing it down will help in moving on to the next step of
gathering evidence.
TOP: AONE competency: Leadership
5. A strategic goal for nursing in the facility developed by the chief nursing officer is to
implement an evidence-based practice program. What is an appropriate strategy that can be
used by a nurse manager who is beginning to implement an evidence-based practice program
on the unit?
a. Conducting a review of adverse events and incident reports
b. Soliciting input from staff members
c. Reviewing specialty organization guidelines
d. Identifying patients with extended lengths of stay
ANS: B
Stakeholders need to be involved early, and staff members need to be involved when
initiatives involve direct patient care. Involvement assists in understanding issues and
concerns, motivations, and unmet needs.
TOP: AONE competency: Communication and Relationship-Building
6. The nurse manager of an ICU wants to implement the revised policy and procedure on central
line catheter care. What would be the most effective method of getting the staff nurses to
incorporate a new evidence-based practice into their care?
a. Conducting an interactive educational workshop
b. Distributing educational materials on clinical units
c. Sharing the results of a chart audit with staff
d. Providing staff with a short DVD on the topic
ANS: A
Suggestions for effective strategies that promote behavioral change in health professionals
include active involvement strategies such as face-to-face information sessions in small
groups and one-to-one interactions. Other approaches have mixed or few results.
TOP: AONE competency: Communication and Relationship-Building
7. Before implementation of the new policy and procedure on central line catheter care, the nurse
manager uses an appraisal system to evaluate the evidence. What is important in using an
appraisal system to evaluate the evidence gathered in preparation for development of a new
protocol?
a. Limiting the search to randomized clinical trials
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b. Matching the appraisal tool to the type of evidence
c. Eliminating qualitative research studies
d. Using only preprocessed evidence
ANS: B
Appraisal tools are specific to the number of studies, as well as to the study design (type of
evidence), type of review, and strategy for determining the applicability of evidence to your
practice.
TOP: AONE competency: Knowledge of the Health Care Environment
8. To help staff nurses adjust to using research in practice, what strategy would the nurse
manager use?
a. Attendance at a regional research conference
b. Formal classes in electronic search techniques
c. Establishing a journal club
d. Issuing reports on the adverse consequences of outdated practices
ANS: C
Journal clubs provide opportunities for engagement in reading research and considering how
it might be applied to clinical practice problems, which is considered very effective in
behavioral change.
TOP: AONE competency: Communication and Relationship-Building
9. What is a strategy that can be used by a small community hospital with limited resources to
develop an evidence-based nursing practice program?
a. Hiring a nurse researcher
b. Partnering with nurse researchers at a local university
c. Subscribing to journals devoted to evidence-based nursing
d. Including research competencies in managers‘ job descriptions
ANS: B
Partnering with nurse researchers assists in providing nurse researcher expertise and
leadership to organizations that do not have the size or the resources to hire nurse researchers.
TOP: AONE competency: Communication and Relationship-Building
10. Tara, the unit manager, is explain to her colleague her recent project, which involves seeking
the most effective approaches to incontinence care, with the intention of adopting
evidence-supported approaches on her dementia care unit. Her colleague suggests that
translation of research into practice is:
a. less important than knowledge-generating research, which is required to advance
the nursing profession.
b. a priority of all healthcare practitioners to improve patient care.
c. characterized by lack of knowledge about how to use evidence to guide practice.
d. so difficult that it is useless to begin the query in the first place.
ANS: B
The National Institutes of Health identified translational research or getting research into the
hands of practitioners to improve patient care, as a priority.
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TOP: AONE competency: Knowledge of the Health Care Environment
11. After searching the literature, Tara, the unit manager develops a table that outlines the
findings of studies on management of incontinence. She then examines the studies in terms of
risk and whether the findings fit within her practice context and for her population of
moderately to severely cognitively impaired patients. This is which phase of a research
utilization model?
a. Preparatory
b. Validation
c. Evaluation
d. Application
ANS: C
The third phase, comparative evaluation and decision making, involves making a decision
about the applicability of the studies by synthesizing cumulative findings; evaluating the
degree and nature of other criteria, such as risk, feasibility, and readiness of the finding; and
making a recommendation about using the findings of the studies.
TOP: AONE competency: Knowledge of the Health Care Environment
12. The clinical guidelines for management of incontinence developed by the Registered Nurses
Association of Ontario (RNAO):
a. reflect practice that is fiscally directed and sound.
b. articulate practice recommendations developed from synthesis and review of
evidence.
c. are intended to increase awareness of issues in incontinence management.
d. reflect a compilation of information from a variety and range of sources related to
incontinence.
ANS: B
The evidence-based practice (EBP) movement has grown exponentially with scientific
publications, establishment of collaboration centers, resources on the Web, and grants focused
specifically on translating of research into practice. A number of evidence-based nursing
centers have been established around the world. These centers have teams of researchers who
critically appraise evidence and then disseminate protocols for the use of evidence in practice.
In this example, clinical guidelines have been developed by a professional nursing
organization on the basis of best possible evidence on incontinence management. Although
issues may be raised in the recommendations, the purpose is to guide practice for the purposes
of better patient care.
TOP: AONE competency: Knowledge of the Health Care Environment
13. Marie is a long-term staff nurse on the rehab floor. Her unit manager has been eager to adopt
evidence-based recommendations related to family-centered care on the unit. Marie‘s
response has been that she rarely has time to provide care to patients, let alone families, and
that there is no good reason to do anything different than what she is already doing. An
approach that may gain Marie‘s support of the idea is to:
a. invite Marie to review the studies for herself.
b. suggest that she does not need to provide family-centered care.
c. avoid discussion of the idea with her until she initiates it.
d. secure the support of her closest colleagues on the unit.
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ANS: D
As a skeptic, Marie, who is a late majority adopter, needs pressure from colleagues to move
her toward support of the recommendations. The translation of research into practice requires
that nurse leaders and managers understand group dynamics, individual responses to
innovation and change (such as the response of late majority adopters), and the culture of their
healthcare organization.
TOP: AONE competency: Communication and Relationship-Building
14. You are excited by evidence supporting the use of workstations on wheels (WOWs) at the
bedside to improve documentation and patient outcomes. You have disseminated the
information through discussions and e-mails and are now ready to begin the process of
considering implementation on the unit. To develop positive attitudes toward the use and
implementation of the technology, you would discuss your ideas with (Rogers‘ diffusion of
innovations theory):
a. Harvey, RN, a technology guru, who enthusiastically tries on all new software.
b. Berta, RN, who thoughtfully considers evidence and regularly uses it to try new
approaches in her practice.
c. Carol, LPN, who is positive about new ideas but looks to her friends for their ideas
about whether or not to try something new.
d. Ben, a 10-year veteran of the unit, who wonders why technology should be used at
all. He says that he will use it when there is no chance of security breaks.
ANS: B
Berta is the one with whom you should now have informed conversations, because she is an
early adopter who is respected for her thoughtful acquisition and critique of knowledge and
application of knowledge to practice. Berta, an early adopter (Rogers‘ characteristics of
innovation adopters), is more effective in this stage than Harvey, an innovator who may be
seen as open to all new ideas regardless of merit.
TOP: AONE competency: Communication and Relationship-Building
15. The implementation of saline flushes for capped angiocatheters across all areas of practice in
the facility is an example of:
a. how multilevel and interprofessional application of a procedure can slow adoption
of EBP.
b. how competition among disciplines can lead to negative patient outcomes.
c. the reluctance of hospital administrators to act on recommendations from EBP.
d. how a safe, well-known practice outweighs the benefits of adopting a newer
practice.
ANS: A
The translation of research into practice operates at four levels: The individual healthcare
professional, healthcare groups or teams, organizations, and the larger healthcare system or
environment. The adoption of saline flushes illustrates the challenges of communicating EBP
to other disciplines and organizations and of the involvement of different levels. This
particular innovation needed endorsement by nurses, physicians, and pharmacists, as well as
by administrators who needed evidence of lost savings to support adoption.
TOP: AONE competency: Leadership
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16. Which of the following would be most effective for the staff nurses in implementing the
findings of a new clinical treatment for problems associated with bowel motility?
a. Lecture by a nurse practitioner
b. Workshop for the nurses that involves discussion of case studies and application of
evidence
c. Discussion of the findings on the bulletin boards at the workstation
d. Education of unit opinion leaders regarding the evidence presented in the studies
ANS: B
Current research suggests that translation of research into practice is best facilitated through
interactive learning such as workshops. Least effective strategies included didactic learning
and distribution of learning materials.
TOP: AONE competency: Communication and Relationship-Building
17. Which of the following is an effective approach in the appraisal of research studies?
a. Accept only studies that use a RCT design.
b. When ranking research studies, choose RCTs over qualitative studies.
c. Select only studies with a large sample size.
d. Evaluate the quality of the research against the standards for that type of research.
ANS: D
While randomized controlled trials (RCTs) are generally considered the gold standard for
research, it is important to assess not only the method but also the quality of the study and its
applicability to the question that is being asked. The quality of all studies should be appraised
against the standards accepted for that type of research.
TOP: AONE competency: Knowledge of the Health Care Environment
18. Within a multisite healthcare system, the most appropriate strategy for translation of research
would be:
a. widespread development of protocols using EBP at unit levels.
b. dissemination of EBP and recommendations to individuals, units, and the
organization.
c. development of the skills of individual managers on how to build guidelines based
on EBP.
d. establishment of an interdisciplinary center to guide and lead the translation of
research findings into practice.
ANS: D
At a systems level, the most appropriate approach would be establishing a center that leads in,
guides, and promotes EBP across and at various levels.
TOP: AONE competency: Knowledge of the Health Care Environment
19. At an organizational level, which of the following strategies would assist in ensuring that EBP
is incorporated into nursing care?
a. Formation of nursing-only implementation teams
b. Restriction of evidence to RCTs
c. Formation of a network of individuals doing research and/or interested in research
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utilization
d. Avoidance of partnership with experienced researchers
ANS: C
Collaboration, partnerships, and consideration of a variety of evidence appropriate to the
clinical questions are important in ensuring translation of evidence into practice.
Collaboration is considered particularly critical and can occur through practice-based
networks.
TOP: AONE competency: Knowledge of the Health Care Environment
20. Which of the following is most accurate regarding evidence-based practice?
a. Evidence-based practice replaces continuous quality improvement.
b. Evidence-based practice began with medicine and assists in determining which
medical models can be applied in nursing practice.
c. Effective and efficient care can already be demonstrated, which means that EBP
will soon become redundant.
d. EBP is generally recognized across disciplines and by policymakers as
state-of-the-art clinical practice.
ANS: D
EBP is recognized across nursing and other disciplines as reflective of state-of-the-art clinical
practice, as it is based on best available evidence.
TOP: AONE competency: Knowledge of the Health Care Environment
21. Which of the following is a meta-analysis?
a. Review of 35 studies on nurse work satisfaction to determine the significance of
the aggregated research findings
b. Review of multiple chart audits to determine which errors are being reduced
through implementation of evidence-based guidelines
c. RCT comparing the effectiveness of a local anesthetic in reducing the pain of
venipuncture in young children
d. Analysis of factors contributing to nurse burnout and dissatisfaction at emergency
room sites
ANS: A
Meta-analysis statistically combines the results of several similar studies to determine whether
aggregate findings are significant.
TOP: AONE competency: Knowledge of the Health Care Environment
22. Once evidence related to the use of prompted voiding in patients with cognitive impairment
has been appraised and integrated with practice, it is important to:
a. consider whether patients‘ families see this as necessary for the well-being of
family members.
b. search large databases such as CINAHL to amass further evidence.
c. clarify the clinical practice question.
d. solicit input regarding integration with practice.
ANS: A
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EBP is the integration of best research evidence with clinical expertise and the patients‘
unique values and circumstances. In this situation, the family‘s values and preferences would
be considered. Search of databases, clarification of the question, and gaining staff input would
occur in the process.
TOP: AONE competency: Knowledge of the Health Care Environment
23. As the unit manager, you are interested in determining whether patient autonomy is preserved
through informed consent in surgical settings. You determine that participatory action
research is the best method to address this question. Which of the following is consistent with
a participatory action research design?
a. You interview 125 patients who have recently undergone surgery and transcribe
the interviews to determine themes. Themes are validated with an expert in
informed consent.
b. You circulate a questionnaire to patients who recently underwent surgery and ask
for their opinions regarding consent. Data is analyzed and the findings distributed
to administration and other groups.
c. An audit is undertaken of signed consents for treatment, to determine if the consent
is properly witnessed and signed. Findings are used to inform changes in policies.
d. You meet with a patient group to determine which questions should be asked about
patient informed consent and what issues might be encountered and addressed
during the research.
ANS: D
In participatory action research (PAR), the members of the community being studied are
integral members of the research team and are involved in identifying the questions and
addressing the issues involved in the implementation of the research project.
TOP: AONE competency: Knowledge of the Health Care Environment
24. Volunteers in a study are assigned randomly to groups. Some of the volunteers receive an
herbal supplement that is reputed to control nausea, and some of the volunteers are assigned to
a control group where a placebo is administered. This is an example of a(n):
a. longitudinal study.
b. RCT.
c. meta-analysis.
d. appraisal tool.
ANS: B
RCTs, or randomized controlled trials, always involve testing of a treatment through the
random assignment of subjects in the study to an experimental or treatment group or to a
control group that receives a placebo.
TOP: AONE competency: Knowledge of the Health Care Environment
MULTIPLE RESPONSE
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1. A nurse manager introduces prompted voiding into nursing practice on a unit, which is
supported by clinical guidelines based on evidence-based practice. The nurses on the unit
resist implementation, indicating that the bathroom facilities are too far away for efficient
implementation of the guidelines, and that resources are too few to accomplish the initial
voiding observations. For the nurse manager in this situation, it is important to have further
discussion with the staff regarding: (Select all that apply.)
a. compatibility of this intervention with the values of staff on the unit.
b. advantages of prompted voiding over incontinence products and catheterizations.
c. usefulness of prompted voiding with the particular population of patients on the
unit.
d. feasibility of the program with respect to unit design.
ANS: A, B, C, D
Various theories related to the translation of evidence into practice point to strategies for
success in introducing innovation and EBP on units, including determination of how well the
innovation fits with the values of the staff; benefits of this practice or innovation over current
practice; appropriateness of the innovation or practice for the target group for which the
practice is intended; and the feasibility of the innovation from a variety of perspectives,
including the physical design or layout of a unit.
TOP: AONE competency: Leadership
Chapter 07: Gaining Personal Insight: Being an Effective Follower and Leader
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
MULTIPLE CHOICE
1. As a new nurse manager, you are aware of leadership, management, and followership
principles. What is the first step to becoming an effective leader?
a. Being an effective follower
b. Taking a class on leadership
c. Taking a class on management
d. Getting an advanced degree
ANS: A
Being an effective follower is the first step in becoming an effective leader. A leader may take
classes on leadership and classes on management and secure and advanced degree. The first
step to effective leadership is effective followership.
TOP: AONE competency: Leadership
2. As a nurse manager, you are a leader in health care and on the unit you manage. Looking at
the larger picture of health care and patient environment on the unit, what is your primary role
when evaluating the care provided on your nursing unit?
a. Focus on cost outcomes.
b. Assess staff for contentment on unit.
c. Ensure quality patient care on unit.
d. Provide education to the staff of the unit.
ANS: C
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Your primary role is a nurse manager is to ensure quality patient care is rendered. You must
also focus on cost outcomes, assess your staff frequently, and provide education to the staff.
However, as a leader in evaluating the larger picture of health care, quality care is a priority.
TOP: AONE competency: Leadership
3. The chief nursing officer (CNO) is appointed for the local hospital in a rural area. The nursing
committee agreed with the appointment of the new CNO offered the position. What is this
type of leadership position considered?
a. Formal leadership
b. Informal leadership
c. Director leadership
d. Personal leadership
ANS: A
This position is an appointed/hired position and is one of formal leadership based on the
hiring from the outside and the job description. Formal leadership positions often have a title
and are assigned leadership by the role of the position.
TOP: AONE competency: Leadership
4. The core of leadership is awareness. The text by Don Miguel, The Four Agreements, presents
a set of agreements to enhance personal growth and awareness. What is not one of the four
agreements?
a. Be impeccable with your word.
b. Take things personally.
c. Do not make assumptions.
d. Always do your best.
ANS: B
The four agreements include all with the exception of taking things personally. The second
agreement is to not take things personally. When a person speaks or engages a leader, it is
often from their reality and not reflective of your reality. Listen to their information, and
assess, then formulate decisions.
TOP: AONE competency: Leadership
5. The core of nursing leadership incorporates integration of unique qualities to include us as
individuals. Which is not considered part of leadership integration?
a. Person
b. Leader
c. Nurse
d. Position
ANS: D
Position is not considered part of leadership integration. The provided model discusses the use
of nurse, person, leader, and integration of the unique personal aspect to form the integration
of leadership.
TOP: AONE competency: Leadership
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6. A new graduate nurse has accepted a position in an intensive care unit. The nurse is assigned a
preceptor with several years of experience. The new nurse also notices the other staff seek this
nurse out for answers to questions and as a resource to the unit. What does the new nurse
consider the role of the mentor nurse?
a. A formal leader
b. A positional leader
c. An official leader
d. An informal leader
ANS: D
Formal leaders, positional leaders, and official leaders hold positions of leadership or titles. In
this scenario, the nurse is the formal leader of the unit. The nurse is noted to be an informal
leader is one who does not hold an actual leadership title, but leads from an informal position
based on experience and behavior.
TOP: AONE competency: Leadership
7. The manager of a nursing unit is having difficulty working with a new graduate nurse. The
new graduate nurse is excited and full of ideas she wants to try. The manager decides to
journal her feelings regarding the new nurse and her feelings. What is the nurse manager
practicing in this situation?
a. Leadership
b. Reflection
c. Knowledge
d. Action
ANS: B
Using reflection to evaluate her own feelings, the nurse manager is practicing self-awareness
to go beyond the surface and evaluate self for determination of personal feelings. This is a
higher level of thinking and assist in exploring one‘s individual thoughts and experiences.
TOP: AONE competency: Leadership
8. A staff nurse is taking leadership classes in an advanced degree program as the nurse wants to
become a manager. The instructor requires the students to create a journal and make notes of
their feelings when they experience conflicts at work over the next few weeks. The
assignment calls for the use of reflection. What is the purpose of this assignment?
a. Log of conflicts which occur
b. Reflection for self-awareness in conflict situations
c. Assess the students conflict management skills
d. Analysis of student lead conflicts
ANS: B
The use of journaling, when done with self-reflection and use of value to evaluate situations
and reflect, assist in self-awareness of situations. In this instance, the instructor is wanting the
students to use self-awareness through evaluation of conflict occurrences.
TOP: AONE competency: Leadership
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9. The nurse manager is working with a group of new nurses. The new nurses ask questions
about leadership and the role of a manager in leading nursing. The manager shares she has
incorporated her core values and beliefs into her role and responsibilities as a nurse manager.
What type of leadership has she described?
a. Positional leadership
b. Personal leadership
c. Formal leadership
d. Information leadership
ANS: B
The manager has described the use of personal leadership. This incorporates core values and
beliefs of the person to improve their role and responsibilities.
TOP: AONE competency: Leadership
10. Excellent leaders need to have or develop the skills of empathy and expressiveness when
dealing with others in the workplace. This is also known as understanding and managing own
feelings and emotions as well as discerning the emotions of others. What is this an example of
required by good leaders?
a. Social awareness
b. Self-awareness
c. Emotional intelligence
d. Intellectual ability
ANS: C
Emotional intelligence is defined as understanding and managing our emotions with the added
awareness of discerning the emotions of others. Many organizations will assess leaders for
their level of emotional intelligence to assist the individuals understanding their ability to
relate to others.
TOP: AONE competency: Leadership
11. A nurse manager when in the formal leadership position attempts to translate the picture or
vision of her facility across for the staff nurses. The manager is faced with a staff who is
resistant to the vision of the facility. What is the theory the manger needs to incorporate to be
effective?
a. Model the Way
b. Inspire a Shared Vision
c. Challenge the Process
d. The Four Agreements
ANS: B
In this instance, the nurse manager needs to utilize the theory of Inspire a Share Vision. This
is an expectation of leaders to be able to contribute by translating the big picture vision to the
staff.
TOP: AONE competency: Leadership
12. The manager is using self-reflection to gain insight into improving the leadership skills. By
using self-awareness what does a leader develop?
a. New knowledge
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b. Personal growth
c. Improved self esteem
d. Management skills
ANS: A
By using the self-awareness, and essential task for leadership the leader cultivates personal
insights and new knowledge of themselves as a leader. Personal growth may or may not occur
with self-reflection, improved self-esteem is not guaranteed, and management skills are not
obtained.
TOP: AONE competency: Leadership
13. In developing leadership skills, one should focus on authentic leadership. The theory of
authentic leadership focuses on various factors. What is the top priority in development of
authentic leadership?
a. Honest relationships
b. Organizational task
c. Accomplishment of goals
d. Exploring others
ANS: A
The top priority in development of authentic leadership is development of honest
relationships. Valuing what each person brings to the group trusting the group, exploring other
ideas, accomplishing goals, and being ineffective organizer are important. However,
development and honest relationships is the foundation of authentic leadership.
TOP: AONE competency: Leadership
14. As a leader in nursing, one must seek new insights and establish personal tools to improve
their lifelong learning. Which behavior by manager would be a concern for a chief nursing
executive?
a. Journaling for self-reflection
b. Authentic relationships
c. Complacent behavior
d. Improved knowledge of staff
ANS: C
A chief nursing officer should be concerned if a manager demonstrates complacent behavior.
A manager should continually seek to improve leadership skills. All other options are ways to
improve personal leadership.
TOP: AONE competency: Leadership
15. The charge nurse of a unit is asking the staff what patients they had the day before to make
assignments for the day. A new nurse complains about having the same patients every day.
The charge nurse considers the new nurse‘s request to be assigned to different patients for
today. What type of leadership is the charge nurse displaying?
a. Informal leadership
b. Formal leadership
c. Favoritism
d. No leadership displayed
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ANS: B
The charge nurse is using formal leadership to assigning patients to the nurses for today. By
asking the staff she is gathering input she uses to make assignments. And is demonstrating
good leadership skills. She has the authority based on the position in a formal leadership
model to make the assignments for the day.
TOP: AONE competency: Leadership
16. A staff nurse is the person on the unit everyone seeks for input and asks questions. What type
of leadership position is the staff nurse displaying?
a. Position leadership
b. Informal leadership
c. Personal leadership
d. Formal leadership
ANS: B
Informal leaders are individuals who influence others and are engaged with those who listen
and follow. An informal leader may be assigned a formal leadership position and still
demonstrate that rates the informal leadership.
TOP: AONE competency: Leadership
17. At the end of a shift, the charge nurse shares with the new nurse that she had done an
excellent job with a difficult patient that day. The new nurse was upset by the way the family
of the patient had treated her. She shared her feelings with the charge nurse. The charge nurse
offered to change the assignment the following day. What is the charge nurse displaying?
a. Emotional intelligence
b. Comportment
c. Compassion
d. Management of conflict
ANS: A
The charge nurse is demonstrating emotional intelligence. Emotional intelligence requires an
individual to relate to others based on emotions and social awareness of situations. The charge
nurse displayed emotional intelligence by supporting the new nurse and offering to change the
assignment the next day.
TOP: AONE competency: Leadership
18. Which of the following is an example of a formal leadership position on a nursing unit?
a. Staff nurse
b. Unit secretary
c. Unit manager
d. Nursing assistant
ANS: C
The unit manager of a nursing unit and is a formal leadership position. A formal leadership
position is defined as a role that exerts influence over others and they are in charge.
TOP: AONE competency: Leadership
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19. A new nurse leader wants to be the best leader she can. The nurse takes classes, finds a
leadership mentor, seeks input from her unit, and employs other strategies for leadership
development. What is another strategy for the leader to develop and improve leadership
skills?
a. Proactive learning
b. Ignoring feedback
c. Being in charge
d. Authoritative position
ANS: A
Being an effective leader requires wanting to be proactive in their learning to develop
effective leadership skills. Good leaders do not ignore feedback, they take authoritative
positions when required, and do not come across as being in charge but rather as being a
leader of a group.
TOP: AONE competency: Leadership
20. A staff nurse wants to become a charge nurse. What is one of the most effective methods for
the staff nurse to incorporate to effectively transition to charge nurse?
a. Read a book on charge position.
b. Integrate prior experience to new role.
c. Do things the way always done.
d. Change units to be a charge on different unit.
ANS: B
The most effective way for transitioning to a new role is to integrate all prior knowledge and
experience with the essential competencies of the new role.
TOP: AONE competency: Leadership
MULTIPLE RESPONSE
1. As a nurse manager and the leader of the unit, you are aware of multiple avenues for learning
leadership traits. Which avenues would you pursue for learning leadership traits? (Select all
that apply.)
a. Attending professional conferences
b. Reading books on leadership
c. Joining professional organizations
d. Connecting with other leaders in the organization
e. Experiences from new nurses
ANS: A, B, C, D
TOP: AONE competency: Leadership
Chapter 08: Communication and Conflict
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
MULTIPLE CHOICE
1. A group of staff nurses is dissatisfied with the new ideas presented by the newly hired nurse
manager. The staff wants to keep their old procedures, and they resist the changes. Conflict
arises from:
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a.
b.
c.
d.
group decision-making options.
perceptions of incompatibility.
increases in group cohesiveness.
debates, negotiations, and compromises.
ANS: B
Conflict involves disagreement in values or beliefs within oneself or between people that
causes harm or has the potential to cause harm. Conflict may result from the interaction of
interdependent people who perceive incompatibility and the potential for interference.
TOP: AONE competency: Communication and Relationship-Building
2. Two staff nurses are arguing about whose turn it is to work on the upcoming holiday. In trying
to resolve this conflict, the nurse manager understands that interpersonal conflict arises when:
a. risk taking seems to be unavoidable.
b. people see events differently.
c. personal and professional priorities do not match.
d. the ways in which people should act do not match the ways in which they do act.
ANS: B
By definition, conflict involves a difference in perception between two or more individuals.
TOP: AONE competency: Communication and Relationship-Building
3. The nurse manager is aware that conflict is occurring on her unit; however, she is focused on
preparing for a state health department visit, so she ignores the problem. What factor can
increase stress and escalate conflict?
a. The use of avoidance
b. An enhanced nursing work force
c. Accepting that some conflict is normal
d. Managing the effects of fatigue and error
ANS: A
Avoidance as a conflict-management style prolongs conflict and tends to escalate conflict.
TOP: AONE competency: Communication and Relationship-Building
4. The nurse manager decides to use a mediator to help resolve the staff‘s conflict. A basic
strategy for truly addressing this conflict is to:
a. identify the conflicting facts.
b. be determined to resolve the conflict.
c. schedule a meeting time for resolution.
d. have a clear understanding of the differences between the parties in conflict.
ANS: D
It is important for each person in the conflict to clarify the conflict as ―I see it‖ and how ―it
makes me respond‖ before all the persons involved in the conflict can define the conflict,
develop a shared conceptualization, and resolve their differences.
TOP: AONE competency: Communication and Relationship-Building
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5. Sarah, a staff nurse on your unit, witnesses another nurse striking a patient. Sarah wants to
remain friends with her colleague and worries that confrontation with her colleague or
reporting her colleague will destroy their relationship. Sarah is experiencing which type of
conflict?
a. Intrapersonal
b. Interpersonal
c. Organizational
d. Professional
ANS: A
Intrapersonal conflict occurs within a person when confronted with the need to think or act in
a way that seems at odds with that person‘s sense of self. Questions often arise that create a
conflict over priorities, ethical standards, and values. Some issues present a conflict over
comfortably maintaining the status quo and taking risks to confront people when needed,
which can lead to interpersonal conflict.
TOP: AONE competency: Communication and Relationship-Building
6. The chief nursing officer plans a series of staff development workshops for the nurse
managers to help them deal with conflicts. The first workshop introduces the four stages of
conflict, which are:
a. frustration, competition, negotiation, and action.
b. frustration, conceptualization, action, and outcomes.
c. frustration, cooperation, collaboration, and action outcomes.
d. frustration, conceptualization, negotiation, and action outcomes.
ANS: B
Thomas (1992) determined that conflict proceeds through these four stages in this particular
order.
TOP: AONE competency: Communication and Relationship-Building
7. After using a mediator to resolve a conflict between the nurse manager and two staff nurses,
the chief nursing officer decides to:
a. observe to make sure the conflict has been resolved.
b. fire both staff nurses.
c. reassign both staff nurses.
d. reassign the nurse manager.
ANS: A
The nurse leader should follow up to determine if the conflict has been resolved because, in
professional practice environments, unresolved conflict among nurses is a significant issue
that results in job dissatisfaction, absenteeism, and turnover, as well as in decreased patient
satisfaction and poorer quality in patient care.
TOP: AONE competency: Leadership
8. A nursing instructor is teaching a class on conflict and conflict resolution. She relates to the
class that conflict in an organization is important, and that an optimal level of conflict will
generate:
a. creativity, a problem-solving atmosphere, a weak team spirit, and motivation of its
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workers.
b. creativity, a staid atmosphere, a weak team spirit, and motivation of its workers.
c. creativity, a problem-solving atmosphere, a strong team spirit, and motivation for
its workers.
d. a bureaucratic atmosphere, a strong team spirit, and motivation for its workers.
ANS: C
Differences in ideas, perceptions, and approaches, when managed well, can lead to creative
solutions and deepened human relationships. Work on conflict suggests that complete
resolution of conflict is counterproductive to the achievement of organizational goals,
organizational change, and cohesiveness of employees.
TOP: AONE competency: Communication and Relationship-Building
9. Jane has transferred from the ICU to the CCU. She is very set in the way she makes
assignments and encourages her new peers to adopt this method without sharing the rationale
for why it is better. This is a good example of a process and procedure that creates which type
of conflict?
a. Organizational
b. Intrapersonal
c. Interpersonal
d. Disruptive
ANS: C
Interpersonal conflict transpires between and among nurses, physicians, members of other
departments, and patients.
TOP: AONE competency: Communication and Relationship-Building
10. Two nurses on a psychiatric unit come from different backgrounds and have graduated from
different universities. They are given a set of new orders from the unit manager. Each nurse
displays different emotions in response to the orders. Nurse A indicates that the new orders
include too many changes; Nurse B disagrees and verbally indicates why. This step in the
process is which of the following in Thomas‘ stages of conflict?
a. Frustration
b. Conceptualization
c. Action
d. Outcomes
ANS: B
Thomas‘ Stages of Conflict include conceptualization, which involves different ideas and
emphasis on what is important or not or about what should occur.
TOP: AONE competency: Communication and Relationship-Building
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11. Mrs. Hill, aged 68, was hospitalized after a stroke. The speech therapist recommended that
oral feeding be stopped because of her dysplasia. During visiting hours, Mr. Hill fed his wife
some noodles. The nurse noticed this and stopped Mr. Hill from feeding his wife, telling him
it was the doctor‘s decision. An hour later, the nurse returned and found Mr. Hill feeding his
wife again. The nurse tried to stop him again. Mr. Hill refused and claimed that the clinical
staff was trying to starve his wife; he also threatened to get violent with the nurse. The nurse
decided to walk away and documented the event in Mrs. Hill‘s chart. According to Thomas‘
four stages of conflict, in which stage could the nurse have been more effective?
a. Frustration
b. Conceptualizing
c. Action
d. Outcomes
ANS: C
By walking away, the nurse is engaged in an action or a behavioral response, which is the
action stage of conflict that is outlined in the four stages of conflict (Thomas, 1992). In this
stage, the nurse might have used more effective strategies, such as clarifying Mr. Hill‘s views
on feeding his wife and engaging in dialogue with Mr. Hill to clarify his concerns and attempt
to reach a common goal.
TOP: AONE competency: Communication and Relationship-Building
12. Mrs. Hill, aged 68, was hospitalized after a stroke. The speech therapist recommended that
oral feeding be stopped because of her dysplasia. During visiting hours, Mr. Hill fed his wife
some noodles. The nurse noticed this and stopped Mr. Hill from feeding his wife, telling him
it was the doctor‘s decision. An hour later, the nurse returned and found Mr. Hill feeding his
wife again. The nurse tried to stop him again. Mr. Hill refused and claimed that the clinical
staff was trying to starve his wife; he also threatened to get violent with the nurse. The nurse
decided to walk away and documented the event in Mrs. Hill‘s chart. The outcome as depicted
by Thomas‘ conflict stages can be considered to be:
a. compromising.
b. confronting.
c. constructive.
d. destructive.
ANS: D
Resolution was absent because the nurse did not have time to effectively deal with the issues
in the conflict. This can lead to negativity, increased frustration, and further distancing
between individuals or groups, including between patients and nurses.
TOP: AONE competency: Communication and Relationship-Building
13. Jill is the head nurse on a unit in a large hospital. Two of the staff nurses are constantly
arguing and blaming each other, and a resolution has not occurred in months. To solve the
existing conflict, which is the most creative conflict resolution?
a. Avoiding
b. Competing
c. Compromising
d. Collaborating
ANS: D
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Collaboration, although time consuming, is the most creative stance. The collaboration
technique involves both sides in the conflict working together to develop an optimal outcome.
This results in a win-win solution.
TOP: AONE competency: Communication and Relationship-Building
14. A nurse educator is giving a workshop on conflict. During the sessions, he makes various
statements regarding conflict. All of the statements are true except:
a. conflict can decrease creativity, thus acting as a deterrent for the development of
new ideas.
b. horizontal violence involves those with similar status but little power in the larger
context.
c. interprofessional collaboration reduces unresolved conflicts.
d. all conflicts involve some level of disagreement.
ANS: A
The opposite is true because research has shown that conflict, like change, increases creativity
and allows for the development of new ideas.
TOP: AONE competency: Communication and Relationship-Building
15. Sarah is a nurse manager in a surgical unit. She is concerned about a conflict between Lucy (a
staff nurse) and one of the maintenance personnel. Sarah explains to Lucy that unsatisfactory
resolution of the conflict is typically destructive and will result in:
a. decreased frustration between the maintenance worker and her.
b. a good relationship with the maintenance department.
c. eventual resolution of the problem without further intervention.
d. decreased productivity on her part.
ANS: D
Productivity decreases with destructive conflict, whereas constructive conflict strengthens
relationships.
TOP: AONE competency: Communication and Relationship-Building
16. Staff at Valley Hospital are concerned that recent staffing cuts will affect their ability to
provide quality patient care, and they express their concerns to senior management. The CEO
of Valley Hospital makes the following statement: ―We need to contain costs because our
funding has been decreased.‖ This is a good example of which of the following conditions
that propel a situation toward conflict?
a. Incompatible goals
b. Role conflicts
c. Structural conflict
d. Competition for resources
ANS: A
Conflicts arise in four areas: goals, facts, approaches, and values. Conflicts among goals arise
from competing priorities such as the provision of quality patient care and containment of
costs.
TOP: AONE competency: Communication and Relationship-Building
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17. Kala, a unit manager, in discussing a role the CEO would like her to perform, makes the
following statement, ―I will sit on the hospital task force on improving morale if you send me
to the hospital‘s leadership training classes next week, so I can further develop my skills and
thus be more effective.‖ Which of the following conflict management styles is Kala using?
a. Collaborating
b. Avoiding
c. Negotiating
d. Accommodating
ANS: C
Negotiation involves an exchange of concessions (membership on a committee in return for
attendance at a workshop) or trading. This strategy supports a balance of power.
TOP: AONE competency: Communication and Relationship-Building
18. John is a circulating nurse in the operating room. He is usually assigned to general surgery,
but on this day he is assigned to the orthopedic room. He is unfamiliar with the routines and
studies the doctor‘s preference cards before each patient. The fourth patient comes into the
room and John prepares a site for a biopsy using a Betadine solution. The surgeon prefers
another solution. He notices what John has done and immediately corrects him by rudely
insulting John. What is the appropriate approach to conflict resolution in this example?
a. Collaboration
b. Compromising
c. Avoiding
d. Withdraw
ANS: B
Compromise involves negotiation or an exchange of concessions and supports a balance of
power.
TOP: AONE competency: Communication and Relationship-Building
19. Factors that influence the ease with which conflict is resolved include all except which of the
following?
a. Level of interdependence of the parties
b. Interprofessional collaboration
c. Expression of one‘s own needs and ideas
d. Avoidance of the issue or concern
ANS: D
Conflict involves a level of interdependence and is a condition for conflict but not necessarily
for continuance of the conflict. Expression of one‘s ideas and concerns is considered assertive
and effective in resolving conflict if the concerns and needs of the other are also considered.
Interprofessional collaboration has been shown to be effective in resolving conflict.
Avoidance tends to prolong and sometimes escalate conflict.
TOP: AONE competency: Communication and Relationship-Building
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20. The head nurse and a staff nurse are having a conflict over how to use and apply a new
procedure for dressings in the medical/surgical area. The staff nurse wishes to use the new
procedure based on newly released nursing research. The head nurse wishes to use a protocol
that has been used in the department for a number of years. The head nurse later makes
comments to other staff on her unit about the credibility of the staff nurse. This behavior is
associated with:
a. lateral violence.
b. horizontal violence.
c. confrontation.
d. bullying.
ANS: D
Bullying involves aggressive or destructive behavior or psychological harassment of a
recipient who is in a position of power differential with the perpetrator (the head nurse).
Bullying is closely related to lateral or horizontal violence and involves such behaviors as
incivility or intimidation.
TOP: AONE competency: Communication and Relationship-Building
21. Which of the following exemplifies the predominant conflict management style of nurse
managers?
a. Elizabeth, the head nurse on neurology, finds that Tom, the RN nurse on nights, is
irritable in relation to any suggestions or new ideas, and so she comes in to work
after Tom leaves the unit.
b. The technology committee has recommended a clinical system for implementation
on the nursing unit. Staff is anxious about the change. Tim, the head nurse, asks
staff for ideas on how to meet the technology goals and to meet staff needs.
c. During management meetings, George, the head nurse on nephrology, dominates
meetings and decisions. Lee, the head nurse on the cardiac step-down unit, begins
to miss the management meetings.
d. Ann, RN, asks her head nurse if she can go on the permanent evening shift. The
head nurse, Rajib, agrees, as long as Ann agrees to be involved in assisting to
mentor evening staff in the use of the new clinical information system.
ANS: D
Compromise involves trading and negotiation and is the predominant conflict management
style of managers.
TOP: AONE competency: Communication and Relationship-Building
22. Lee, the head nurse in ER, has attempted to meet Jillian, one of her staff RNs, for several days
to discuss concerns about Jillian‘s relationships with her team members. Lee hopes to offer
Jillian coaching so that Jillian‘s relationships can be more satisfying for Jillian and her team
members. Each time Lee and Jillian set a time to meet, Jillian phones in sick. In this situation,
Lee and Jillian are demonstrating:
a. similar conflict management strategies.
b. escalation of conflict.
c. avoidance and compromise strategies.
d. competing and compromise strategies.
ANS: C
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Jillian is demonstrating avoidance by staying away from meetings to discuss her team
relationships, and Lee is demonstrating compromise by offering coaching in return for
Jillian‘s being able to engage in more satisfying relationships.
TOP: AONE competency: Communication and Relationship-Building
23. What exemplifies the predominant style of conflict management for staff nurses?
a. Sarah and Jonas, two RNs, disagree about the best approach to assisting a family
that has complex needs. They decide that they will consult with family and
together will decide what is best.
b. Jennifer needs to switch a shift to attend a family function. She arranges to trade
with Nancy, who wants a day off next to a 3-day break.
c. Lindsay asks Melody to stay late for the third day in a row. Melody refuses, stating
that she has already helped out for 2 days by staying late for Lindsay.
d. Lara asks Stacey to switch shifts with her because Lara wants to attend a concert.
Stacey would prefer not to but does to enable Lara, who is new in town, to be with
her friends.
ANS: D
Avoidance and accommodation are the predominant conflict management styles of nurses.
Accommodating involves neglecting one‘s own needs while trying to satisfy the needs of
another.
TOP: AONE competency: Communication and Relationship-Building
24. In trying to achieve Magnet® status, the chief nursing officer establishes a shared governance
model to help nurses experience job satisfaction. However, some nurses who have enjoyed
working with less autonomy resist this change and begin to criticize and make rude comments
about managers who embrace this model, as well as colleagues who support it. The comments
are largely ignored because those who are making them are well established nurses who are
often vocal about their displeasure with the organization. Organizational conflict is arising
from which of the following?
a. Staffing practices
b. Increased participation in decision making
c. Allocation of resources
d. Tolerance of incivility
ANS: D
Organizational conflict arises from discord related to policies and procedures (such as staffing
policies and practices and allocation of resources), personnel codes or conduct or accepted
norms of behavior (such as incivility), and patterns of communication. A major source
conflict in organizations stems from strategies that promote more participation and autonomy
of staff nurses.
TOP: AONE competency: Leadership
MULTIPLE RESPONSE
1. Nurses entering the work force today are faced with which of the following relationships that
could create organizational conflict? (Select all that apply.)
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a.
b.
c.
d.
e.
Nurse-physician relationship
Nurse-nurse relationship
Nurse-patient relationship
Nurse-chief nursing officer relationship
Nurse-auxiliary personnel relationships
ANS: A, B, C, D, E
By nature, conflict is potentially present in all interpersonal situations. The nurse manager
should create an environment that recognizes and values differences in staff, physicians,
patients, and communities.
TOP: AONE competency: Communication and Relationship-Building
Chapter 09: Healthcare Organizations and Structures
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
MULTIPLE CHOICE
1. 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 serve large populations.
ANS: D
Healthcare networks are interconnected units. Their aim is serving large regional populations.
TOP: AONE competency: Knowledge of the Health Care Environment
2. 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. An 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.
ANS: B
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).
TOP: AONE competency: Knowledge of the Health Care Environment
3. 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.
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c. capable only of providing referrals for health problems to primary care providers.
d. funded exclusively by local authorities.
ANS: A
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.
TOP: AONE competency: Knowledge of the Health Care Environment
4. 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.
ANS: B
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.
TOP: AONE competency: Knowledge of the Health Care Environment
5. A nursing informatics specialist hired by Blue Cross/Blue Shield Insurance System (a form of
third-party payers benefit package for a prepaid fee that uses specific standards to approve a
period of time for the use of inpatient and community health services) is participating in:
a. critical pathways.
b. healthcare networks.
c. health maintenance organizations.
d. managed care.
ANS: D
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).
TOP: AONE competency: Knowledge of the Health Care Environment
6. 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.
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d. controlled by the insurance agency.
ANS: A
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.
TOP: AONE competency: Knowledge of the Health Care Environment
7. 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
ANS: D
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 example, the facilities are funded and
managed by a religious organization that provides care that is congruent with its particular
faith-based values.
TOP: AONE competency: Knowledge of the Health Care Environment
8. 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.
ANS: C
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.
TOP: AONE competency: Knowledge of the Health Care Environment
9. 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. can refuse clients who are unable to pay.
c. have no paid employees.
d. pay no taxes.
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ANS: D
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.
TOP: AONE competency: Knowledge of the Health Care Environment
10. In reviewing the current delivery model, the nurse manager is aware that a demographic
change that will have a significant effect on 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.
ANS: C
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.
TOP: AONE competency: Knowledge of the Health Care Environment
11. 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.
ANS: A
Healthcare networks embrace and provide wellness and illness services, including primary,
secondary, and tertiary care, through a network of providers.
TOP: AONE competency: Knowledge of the Health Care Environment
12. 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.
ANS: C
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.
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TOP: AONE competency: Knowledge of the Health Care Environment
13. 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.
ANS: D
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.
TOP: AONE competency: Business Skills
14. 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.
ANS: A
For-profit hospitals tend to have lower wage and salary costs that are most likely connected to
aggressive goals for profit.
TOP: AONE competency: Business Skills
15. What 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.
ANS: D
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.
TOP: AONE competency: Knowledge of the Health Care Environment
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16. 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,
what 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.
ANS: D
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.
TOP: AONE competency: Knowledge of the Health Care Environment
17. 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
ANS: C
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.
TOP: AONE competency: Knowledge of the Health Care Environment
18. 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.
ANS: B
Veterans Administration hospitals provide a range of services to Veterans and are responsible
to government and thus to taxpayers, who support the hospitals.
TOP: AONE competency: Knowledge of the Health Care Environment
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19. A group of patients with early Alzheimer disease and their spouses approach you regarding
help with the establishment of a local Alzheimer Society for the support and education of
affected individuals and their families. As a manager in an ambulatory care clinic, what
suggestion or advice would you offer this group?
a. Self-help groups are, by nature, directed, funded, and led by those requiring help,
and therefore, the patients and families should need no help from your clinic.
b. Your healthcare organization would 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 and
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.
ANS: C
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.
TOP: AONE competency: Knowledge of the Health Care Environment
20. Tracy is an RN case manager who interfaces between the Centers for Medicare & 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.
ANS: B
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.
TOP: AONE competency: Knowledge of the Health Care Environment
21. The Wellington Mental Health Institute is fully accredited by the AOA and not directly by the
CMS. This means that the Wellington facility:
a. cannot accept mental health patients who are Medicare beneficiaries.
b. can 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.
ANS: D
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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.
TOP: AONE competency: Knowledge of the Health Care Environment
22. As a nurse manager in a hospital, what you would expect 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
ANS: A
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.
TOP: AONE competency: Knowledge of the Health Care Environment
23. 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.
ANS: D
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.
TOP: AONE competency: Knowledge of the Health Care Environment
24. What patients would most likely 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
ANS: D
Medicare is a federal government program for individuals over 65 and with certain permanent
illnesses, such as end-stage renal disease. Medicaid provides financing of health care for the
medically indigent.
TOP: AONE competency: Knowledge of the Health Care Environment
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MULTIPLE RESPONSE
1. 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.
ANS: A, B, C
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.
TOP: AONE competency: Business Skills
Chapter 10: Person-Centered Care
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
MULTIPLE CHOICE
1. A nurse manager questions the true difference between primary nursing and 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.
ANS: C
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.
TOP: AONE competency: Knowledge of the Health Care Environment
2. The chief nursing officer decides to establish a client advocacy position in an oncology unit.
Advocacy is best represented by:
a. establishing private and professional networking systems.
b. asking social services to handle clients‘ concerns.
c. identifying community support groups.
d. empowering others by promoting self-determination.
ANS: D
Advocacy involves empowering and promoting self-determination in others.
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TOP: AONE competency: Professionalism| AONE competency: Knowledge of the Health Care
Environment
3. The nurse manager on a pediatric intensive care unit wants to evaluate patient satisfaction.
The nurse manager understands that ultimately, positive relationships with consumers of care
are evaluated by the:
a. cultural sensitivity of staff.
b. cost-effectiveness of care delivery.
c. economic value of service.
d. outcomes for clients and their perceptions of care.
ANS: D
Patient satisfaction and perception of the quality of care are affected by the quality of the
nurse-patient relationship. Valid measurement of patient satisfaction is an evolving science;
nurses do not always accurately gauge what factors are most important to patients.
Satisfaction measures are often skewed in a positive direction with scores clustered at the top
of the scale.
TOP: AONE competency: Professionalism
4. The nurse manager must develop a patient satisfaction survey. What is one of the critical
elements in selecting a patient satisfaction instrument?
a. Being able to use the same instrument for all clinical units
b. Including items that are important from the patient‘s perspective
c. Being able to administer the instrument before a patient‘s discharge from the
hospital
d. Being sure that the reading level is no higher than third grade
ANS: B
Because satisfaction is a measure of service and service is a measure of perception of what
matters to the patient, to measure satisfaction, surveys must include items that reflect the
perspective of the patient. The quality of human contacts becomes the measure by which the
consumer forms perceptions and judgments about nursing and the health agency. Consumers
may not be able to evaluate the quality of interventions, but they always can evaluate the
quality of the relationship with the person delivering the service.
TOP: AONE competency: Professionalism
5. Complex care of acutely ill patients 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 is based?
a. Licensure status
b. Experience in the agency
c. Leadership capabilities
d. Education and expertise
ANS: D
Differentiated nursing practice models are models of clinical nursing practice that are defined
or differentiated by level of education, expected clinical skills or competencies, job
descriptions, pay scales, and participation in decision making.
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TOP: AONE competency: Knowledge of the Health Care Environment
6. 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
ANS: B
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 care, 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.
TOP: AONE competency: Business Skills
7. 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.
ANS: D
In a functional nursing model, where other team members are focused on performing specific
tasks, the nurse manager assumes primary responsibility for patient outcomes.
TOP: AONE competency: Knowledge of the Health Care Environment
8. 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
ANS: C
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.
TOP: AONE competency: Knowledge of the Health Care Environment
9. In orienting new staff nurses to a pediatric intensive care unit, the nurse manager asks the staff
nurses to answer the following question: ―What is an important consideration in providing
information to parents of a critically ill child?‖
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a. Making sure that they receive complete information during each encounter with a
member of the nursing staff
b. Assessing parents‘ preferences regarding the amount of information provided
c. Allowing parents to observe key aspects of their child‘s nursing care
d. Making sure that patient education brochures explaining ICU protocols are readily
available
ANS: B
Consultation with the parents regarding the amount of information that they desire reflects a
service orientation, in which preferences and needs of the consumer are placed first. The other
answers reflect nurse-directed decisions in which the nurse decides what information and how
much information is needed and how it is to be delivered.
TOP: AONE competency: Knowledge of the Health Care Environment
10. In designing a program for young adults regarding safe sexual practices, which of the
following might reach the greatest number in the target group?
a. Web-based applications
b. Print-based media such as newspapers
c. Television advertisements
d. Brochures in kiosks in malls
ANS: A
Mobile technology is changing the digital divide, with young adults, minorities, those with no
college experience, and those with lower household incomes being more likely to indicate that
phones are their main source of Internet access.
TOP: AONE competency: Knowledge of the Health Care Environment
11. A nurse is admitted to a psychiatric unit. The staff expresses frustration with her because they
have explained her medication regimen several times, and yet, when she leaves the unit with a
pass, she fails to follow it. The staff believe that, as a nurse, she should be able to understand
what is expected. The nurse‘s failure to follow the regimen indicates:
a. early cognitive impairment.
b. lack of motivation.
c. lack of health literacy.
d. worsening health state.
ANS: C
What is evident from the response is that she lacks health literacy or the capacity to obtain,
process, and understand basic health information and services. Using a Health Literate Care
Model involves weaving health literacy strategies into care by assuming that patients do not
understand their health conditions or what to do about them, and then, subsequently assessing
patients‘ understanding. For example, a nurse who is an expert clinician in a specialty practice
area, when diagnosed with a serious chronic illness, may not have the appropriate background
to make informed healthcare decisions.
TOP: AONE competency: Knowledge of the Health Care Environment
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12. John is an older adult patient who comes regularly to the multigroup practice in which you are
a nurse practitioner. He says that he doesn‘t understand what he is supposed to be doing about
his medications, because every time he comes to the clinic, he sees a different provider.
John‘s experience represents what aspect of the current consumer experience?
a. Nurses are well-trusted members of the healthcare team.
b. Fragmentation of care results in lack of respect and trust.
c. Care providers often have conflicting ideas about care.
d. The public does not trust care providers other than nurses.
ANS: B
When consumers visit a multigroup practice, they do not have the option of selecting a
specific healthcare provider, and thus, there is less opportunity to build a trusting relationship
with a provider.
TOP: AONE competency: Knowledge of the Health Care Environment
13. 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 nonlicensed 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.
ANS: A
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.
TOP: AONE competency: Business Skills
14. Corrine, a student nurse, often hears that nurses are gatekeepers and wonders what that term
means. As a nurse leader, you explain that this is a reference to the:
a. assessment and admission of patients into care.
b. orientation of patients to services once they are admitted.
c. function of controlling which patients see the physician and which do not.
d. coordination of care, services, advocacy, and access for patients within the
healthcare system.
ANS: D
As gatekeepers to the system, nurses advocate for and coordinate care, services, and access for
patients across all providers, settings, and levels of care.
TOP: AONE competency: Professionalism
15. A 27-year-old woman is admitted to your ICU in a coma, following an accident. The family
of the patient, who is a Native American, places a medicine pouch in the bed with the young
woman. As the nurse in this situation, it is important to:
a. explain to the family that the medicine pouch may contain herbs that may bother
other patients.
b. ask the family about the significance of the medicine pouch for them.
c. remove the pouch when the family is not present.
d. put the medicine pouch on the shelf beside the bed.
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ANS: B
Diversity encompasses more than differences in nationality or ethnicity and may include a
variety of ways that patients are different from their healthcare providers. Nurses need to
recognize the culture of their work setting, realizing that it may differ markedly from the
culture of the consumer, and move beyond ethnocentrism to provide culturally competent
care. This competence includes cultural knowledge, which involves actively learning about a
community; cultural sensitivity, which entails valuing and respecting beliefs, norms, and
practices of the people being served; and collaboration within a community. In this instance, it
is important to understand the meaning of the pouch for the family; removal from the bed
without discussion does not demonstrate respect for the values and beliefs of this family.
TOP: AONE competency: Communication and Relationship-Building
16. You are involved in designing a clinic for women in an inner-city neighborhood. A goal of
this clinic might be:
a. development of services that are identified in various studies as important for this
target group.
b. partnership with area city councilors and health professionals to provide services
that are consistent with their vision and funding sources.
c. provision of immunization and addictions services and health screening services
for women in the area.
d. development of services that have been identified by the women and neighborhood
advocates as necessary for their health care.
ANS: D
Involvement of persons in their own health care is a cornerstone of healthcare reform and is
important for improving health outcomes and patient experiences. While studies and
partnership with key informants are important sources of information in the design of
services, engagement of the women through their neighborhood advocates may increase
activation and resulting behavior. Patient activation refers to patients‘ willingness and ability
to take independent actions to manage their health and care.
TOP: AONE competency: Knowledge of the Health Care Environment
17. Which of the following exemplifies a service orientation for a facility?
a. Staff members on the unit are encouraged to chart details about family support
networks.
b. Chart audit reveals that details related to assessment of family history are missing.
c. The palliative care unit organizes a ―tree of light‖ fundraiser each year to highlight
the importance of palliative care.
d. A children‘s preoperative holding area is implemented in response to requests from
families and staff nurses for development of an area.
ANS: D
A service orientation needs to translate caring into appropriate, timely action that meets the
needs of patients. Activities such as documentation of details or promotion of services may
remain at the technical or conceptual level without a commitment to caring interactions. The
institution of a holding area where families can be with children represents a caring action that
arises out of interactions and knowledge of patient needs and thus, is service oriented.
TOP: AONE competency: Communication and Relationship-Building
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18. 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.
ANS: D
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.
TOP: AONE competency: Knowledge of the Health Care Environment
19. As a nurse manager, you see an opportunity for patients to be well serviced through the
medical home concept. You recognize that the concept of medical homes:
a. currently does not include nurses in its vision of multifaceted primary care.
b. includes nurses as part of an interdisciplinary and multidisciplinary team.
c. restricts nurses to services related to direct care and procedures.
d. cannot encompass nurses within this framework.
ANS: A
The patient-centered medical home (PCMH) is a delivery model that facilitates care
integration across settings. The concept of medical homes encompasses the idea of
multifaceted medical homes that provide a usual source of health care. Current discussions
have focused on physician-directed care even though nurses in advanced practice are well
suited to lead teams in this model.
TOP: AONE competency: Knowledge of the Health Care Environment
20. 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.
ANS: A
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.
TOP: AONE competency: Knowledge of the Health Care Environment
21. A patient 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 and she says, ‗That‘s not my job.‘ I ask the pill nurse about
my lab tests and 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.
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d. case management.
ANS: C
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.
TOP: AONE competency: Knowledge of the Health Care Environment
22. Which of the following actions best exemplifies advocacy?
a. Developing a list of agencies that will provide free services for the homeless
b. Working in a needle exchange program for individuals in an inner-city
environment
c. Acting on behalf of a patient to promote end-of-life wishes to an ethics committee
d. Working in a free clinic for immigrant workers
ANS: C
Advocacy means making known and defending and protecting the rights and interests of
others, as well as ensuring the dignity and respect due to others. Simply being employed in an
environment where this might be a focus of practice does not necessarily ensure that advocacy
is occurring.
TOP: AONE competency: Professionalism
23. During review of a patient‘s progress, the healthcare team determines that a patient requires
treatment that is generally accepted at that time in the usual illness trajectory of a patient. The
patient is unable to pay. As the head nurse, you persist in ensuring that this patient receives
the treatment. You are:
a. empowering the patient.
b. avoiding litigation.
c. advocating for the patient.
d. supporting the clinical pathway.
ANS: C
Advocacy means defending the rights and interests of others and, in this situation, the right of
a patient to receive care, as determined by standards utilized in a critical pathway.
TOP: AONE competency: Professionalism
24. 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 postsurgical 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
ANS: C
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This model is especially useful in the care of complex patients who need active symptom
management provided by an RN, such as the care of the patient in a hospice setting or an
intensive care unit. This method would be justifiable delivery in the pediatric intensive care
unit, where the status of patients can change rapidly and where complex functions of care
involve both patients and families.
TOP: AONE competency: Knowledge of the Health Care Environment
MULTIPLE RESPONSE
1. Which of the following activities would represent a customer-friendly approach in a
healthcare setting? (Select all that apply.)
a. Using a local anesthetic before inserting a needle into a child‘s arm
b. Repeating patient history information to the admitting clerk, the admitting nurse,
and the ultrasound technician
c. Ensuring that birthing preferences are on file and available in a laboring mother‘s
chart
d. Providing support to families when a family member is brought into trauma
ANS: A, C, D
A service orientation means delivering services in a manner that is least disruptive. When
possible, services should come to the patient and should be as easy, comfortable, pleasant, and
effective as possible. Meeting the emotional, psychosocial, and spiritual needs of the patient is
important.
TOP: AONE competency: Communication and Relationship-Building
Chapter 11: Staffing and Scheduling
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
MULTIPLE CHOICE
1. The number of adverse events such as falls and pressure ulcers on the 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.
ANS: D
A number of studies have identified that adverse events such as falls and 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.
TOP: AONE competency: Knowledge of the Health Care Environment
2. A small rural hospital has been designated as a critical access hospital. It has 40 beds and an
average occupancy of 34 beds. To prepare the staffing, the chief nursing officer computes the
occupancy as being:
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a.
b.
c.
d.
90%.
85%.
75%.
60%.
ANS: B
A way to assess a unit‘s activity level is to calculate the percentage of occupancy. Formula:
daily patient census (rounded) divided by the number of beds in the unit
The occupancy level is calculated as 34/40, or 85%.
TOP: AONE competency: Business Skills
3. 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.
ANS: C
Nonproductive hours are hours of benefit time and include vacation, holiday, and personal or
sick time.
TOP: AONE competency: Business Skills
4. 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.
ANS: C
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.
TOP: AONE competency: Business Skills
5. A nurse manager must consider a number of external variables when preparing the personnel
budget and projecting the unit‘s staffing needs. An external variable to be considered is:
a. organizational staffing policies.
b. staffing models.
c. changes in services that will be offered.
d. department of Health licensing standards.
ANS: D
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.
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TOP: AONE competency: Business Skills
6. 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.
ANS: A
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.
TOP: AONE competency: Business Skills
7. 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
ANS: B
Acuity levels are determined through classification systems, which determine the nursing
resources required.
TOP: AONE competency: Knowledge of the Health Care Environment
8. 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.
ANS: C
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.
TOP: AONE competency: Business Skills
9. The difference between staffing and scheduling is that staffing:
a. puts the right person in the right position.
b. puts the right person in the right time and place.
c. refers to the number of nursing hours per patient per day.
d. looks after interpretation of benefits and compensation.
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ANS: A
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.
TOP: AONE competency: Business Skills
10. 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
ANS: A
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.
TOP: AONE competency: Business Skills
11. 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.
ANS: C
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.
TOP: AONE competency: Business Skills
12. Staff members on your unit raise concern that there is rising acuity on the unit and lack of
responsiveness in addressing these needs through appropriate staffing. They point to increased
incidences of adverse and sentinel events on the unit. To address this concern, your hospital
organization would do best to:
a. implement a patient-classification system immediately.
b. participate in databases that compare the outcomes and staffing levels versus those
of similar institutions.
c. provide increased numbers of staff to the unit.
d. ignore such concerns because acuity is variable.
ANS: B
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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.
TOP: AONE competency: Knowledge of the Health Care Environment
13. 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.
ANS: B
Validity of categories and implications for staffing levels are in question in this situation
because staffing levels are not reflective of the levels of activity required for patient care.
TOP: AONE competency: Business Skills
14. 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.
ANS: D
Lower fall rates are shown to be related to higher total nursing hours and a higher percentage
of nursing hours supplied by RNs.
TOP: AONE competency: Business Skills
15. 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.
ANS: D
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.
TOP: AONE competency: Business Skills
16. 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:
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a.
b.
c.
d.
availability of diagnostic personnel.
availability of physicians.
communication with on-call providers.
acuity level of patients.
ANS: C
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.
TOP: AONE competency: Knowledge of the Health Care Environment
17. 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.
ANS: B
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.
TOP: AONE competency: Knowledge of the Health Care Environment
18. As the unit manager, you post the staffing plan and 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.
ANS: A
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.
TOP: AONE competency: Knowledge of the Health Care Environment
19. To maintain patient safety, studies suggest that scheduling should avoid:
a. rotating shifts.
b. weekends.
c. 8-hour shifts.
d. mandatory overtime.
ANS: A
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Rotating shifts and overtime past 12 hours (mandatory or not) are being shown to increase
nurse error and jeopardize patient safety.
TOP: AONE competency: Knowledge of the Health Care Environment
20. In a job interview for a staff position, which of the following indicates your knowledge of
patient safety?
a. ―Will I be able to get overtime hours on your unit?‖
b. ―If there is an opportunity to work extra shifts, I would really like that.‖
c. ―Is there a strategy in place to reduce the number of overtime hours on the unit?‖
d. ―I see no reason why I wouldn‘t be able to work overtime.‖
ANS: C
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.
TOP: AONE competency: Knowledge of the Health Care Environment
21. To reduce reliance on overtime hours, an organization develops a strategy for floating nurses
during staff shortages. To maximize patient safety and reduce costs, the healthcare
organization:
a. develops a centralized pool of float nurses.
b. assigns nurses from less busy units to ones with increased acuity levels.
c. floats nurses only between units on which the nurses have been cross-trained.
d. assigns float nurses to basic care only.
ANS: A
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.
TOP: AONE competency: Knowledge of the Health Care Environment
22. To project staffing needs and to avoid understaffing, it is important that nurse managers
consider which of the following?
a. Maximum productive hours
b. Average nonproductive hours
c. Minimum benefit hours
d. Maximum vacation time
ANS: B
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.
TOP: AONE competency: Business Skills
23. 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.
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d. submit the schedule to a centralized staffing office for review.
ANS: D
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.
TOP: AONE competency: Knowledge of the Health Care Environment
24. 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
ANS: D
ANA has opted to support the nurse staffing committee as the approach to ensure safe
staffing. For the last decade, the ANA has advocated for a Registered Nurse Safe Staffing Act.
The legislation is based upon the ANA Safe Staffing Principles (Box 13-2) and considers the
following:
RN educational preparation, professional certification, and level of clinical experience
The number and capacity of available healthcare personnel
Geography of the unit
Available technology
Intensity, complexity, and stability of patients
TOP: AONE competency: Knowledge of the Health Care Environment
MULTIPLE RESPONSE
1. In reviewing the job description of a nurse manager, the staff becomes aware that a nurse
manager‘s role is complex. Which of the following duties are required of a nurse manager?
(Select all that apply.)
a. Ensure unit productivity reports.
b. Develop policy and legislation to protect nurses‘ well-being.
c. Plan staffing of UNPs only.
d. Prepare a unit budget that reflects unit staffing needs.
e. Monitor nurse-sensitive indicators such as falls and incidence of infections.
ANS: A, D, E
A nurse manager manages financial resources by developing business and staffing plans.
TOP: AONE competency: Business Skills
Chapter 12: Workforce Engagement Through Collective Action and Governance
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
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MULTIPLE CHOICE
1. 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.
ANS: D
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.
TOP: AONE competency: Business Skills
2. 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.
ANS: C
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. US 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.
TOP: AONE competency: Business Skills
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3. The Emergency Department 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.
ANS: A
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.
TOP: AONE competency: Business Skills
4. The chief nursing officer utilizes the hospital‘s workplace advocacy to help the overwhelmed
Emergency Department 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.
ANS: B
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.
TOP: AONE competency: Business Skills
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5. 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.
ANS: A
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.
TOP: AONE competency: Business Skills
6. A Magnet® hospital surveys the staff about job satisfaction. This type of environment, in
which nurses have authority and 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.
ANS: A
Autonomy and 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.
TOP: AONE competency: Business Skills
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7. 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.
ANS: D
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.
TOP: AONE competency: Business Skills
8. 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.
ANS: C
The night supervisor is acting in accordance with the National Labor Relations Act, which
would enable the supervisor to assign nurses to care.
TOP: AONE competency: Business Skills
9. The Emergency Department 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.
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d. refuses to bargain in good faith with the elected bargaining agent.
ANS: B
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.
TOP: AONE competency: Business Skills
10. As a new nurse manager who has ―inherited‖ a unit with high nurse turnover and complaints
of patient 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.
ANS: A
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.
TOP: AONE competency: Knowledge of the Health Care Environment
11. 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.
ANS: C
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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.
TOP: AONE competency: Communication and Relationship-Building
12. Awareness and use of power have been challenging for nurses in general because 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.
ANS: D
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.
TOP: AONE competency: Knowledge of the Health Care Environment
13. 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.
ANS: D
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.
TOP: AONE competency: Business Skills
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14. 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.
ANS: B
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.
TOP: AONE competency: Leadership
15. 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.
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d. important in clarifying the difference between his accountability and that of the
community in patient care.
ANS: B
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.
TOP: AONE competency: Professionalism
16. 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
ANS: A
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.
TOP: AONE competency: Professionalism
17. 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:
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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.
ANS: D
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.
TOP: AONE competency: Knowledge of the Health Care Environment
18. 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.
ANS: B
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.
TOP: AONE competency: Knowledge of the Health Care Environment
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19. 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.
ANS: C
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.
TOP: AONE competency: Knowledge of the Health Care Environment
20. 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.
ANS: B
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.
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TOP: AONE competency: Knowledge of the Health Care Environment
21. 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.
ANS: A
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.
TOP: AONE competency: Knowledge of the Health Care Environment
22. Nurses in an Emergency Department, 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.
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ANS: A
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.
TOP: AONE competency: Communication and Relationship-Building
23. 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.
ANS: A
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.
TOP: AONE competency: Business Skills
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24. Sandra, an RN on the surgery unit, is assisting with a procedure in the patient examination
room. The physician orders a medication to be given through IV. Sandra questions the order,
based on her knowledge of the patient‘s history and of other medications that the patient 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.
ANS: A
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.
TOP: AONE competency: Knowledge of the Health Care Environment
MULTIPLE RESPONSE
1. 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.
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ANS: A, B, C
When management accountability for activities is not accepted, then relationships suffer,
professional practice is diminished, and self-esteem suffers.
TOP: AONE competency: Professionalism
Chapter 13: Solving Problems and Influencing Positive Outcomes
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
MULTIPLE CHOICE
1. A nurse belongs to several professional organizations, serving on a state-level committee of
one group and on two task forces at work. The nurse is committed to a range of health issues
and knows the state senator from the nurse‘s district, as well as the name of the representative
in Washington, DC. This nurse exemplifies which level of political activism in nursing?
a. Gladiator
b. Buy-in
c. Self-interest
d. Political astuteness
ANS: D
Political involvement is a professional responsibility and nurses‘ perspectives of the critical
issues for improving the healthcare system can shape the policy agenda of the nation‘s
political leadership. This nurse exemplifies several of the skills associated with political
astuteness.
TOP: AONE competency: Professionalism
2. A manager relies on his director (immediate supervisor) for advice about enrolling in graduate
school to prepare for a career as a nurse executive. The director may exercise what kinds of
power in the relationship with the manager in this advisory situation?
a. Expert, coercive, and referent
b. Reward, connection, and information
c. Referent, expert, and information
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d. Reward, referent, and information
ANS: C
Because the director is in a leadership role, he comes with knowledge or expertise that is
required to assume a leadership role, and he has information that he is willing to share, which
gives him the power of information. The employee sees him as credible and seeks his advice,
which gives him referent power.
TOP: AONE competency: Business Skills
3. A nurse manager must implement a 2% budget cut on the nursing unit. What approach would
the manager use to most effectively empower the staff of the unit?
a. Discuss the guidelines for the budget cuts with the staff, making the decisions with
those who participate.
b. Inform the staff of the budget cuts in a series of small group meetings and accept
their ideas in writing only.
c. Provide the staff with handouts about the budget cuts and let them make
recommendations in writing.
d. Hold a series of mandatory meetings on the budget cuts, asking staff for ideas on
the cuts.
ANS: A
Empowerment is the process of exercising one‘s own power to facilitate the participation of
others in decision making and taking action so they are free to exercise power. It means
releasing authority and enabling others to have accountability, for participation and decisions.
TOP: AONE competency: Communication and Relationship-Building
4. During orientation of new nurse managers, the chief nursing officer stresses strategies that
help nurse managers to achieve a powerful image. What behaviors best contribute to a
powerful image for the nurse manager?
a. Greeting patients, families, and colleagues with a handshake and a smile; listening
carefully when problems arise
b. For men, no facial hair, always wearing a suit and tie; for women, always wearing
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a suit and high-heeled shoes
c. Maintaining a soft voice during times of conflict; making unbroken eye contact
during interactions
d. Smiling all the time; always wearing a suit, carrying a briefcase, and, if a woman,
wearing no jewelry
ANS: A
A powerful and positive approach is communicated through confident behaviors such as
greeting others, smiling, and showing respect for the opinions of others through listening.
Grooming and dress need to be clean, neat, and appropriate to the situation. Speech needs to
be firm and confident.
TOP: AONE competency: Leadership
5. Two nurses approach their manager about a conflict regarding the next month‘s schedule. The
nurses are talking loudly and at the same time. The manager most effectively uses
communication skills to resolve the conflict by:
a. taking both nurses aside, separately and then together, and charging them with
resolving the problem without her direct intervention.
b. listening to each nurse speak to the other without interruption and asking clarifying
questions to help them resolve the issue themselves.
c. separating the nurses, instructing each to decide how the problem can be resolved,
and meeting with them the next day.
d. calling an emergency scheduling committee meeting and asking volunteers to
resolve the conflict between the two nurses.
ANS: B
Negotiation involves the presentation of an opening position with each party, then moving on
until they achieve a mutually agreeable result or until one or both move away from a failed
negotiation. Negotiation occurs when one party has something that the other party values,
such as a desired schedule.
TOP: AONE competency: Communication and Relationship-Building
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6. A nurse manager recognizes the need to expand her professional network as she begins a job
search for a middle-management position. What action is least likely to expand her
job-searching network?
a. Reviewing her address book or card file for names and phone numbers of former
colleagues who are now in middle-management positions
b. Making an appointment to meet with a former instructor from her graduate
program in nursing administration
c. Making a long overdue return call to a former colleague who is now a chief nurse
executive
d. Attending a state-level conferences for nurse managers and executives and
volunteering to help with professional organizations‘ informal luncheons and
receptions
ANS: C
Networking is the result of identifying, valuing, and maintaining relationships with a system
of individuals who are sources of information, advice, and support. Many nurses have
relatively limited networks within the organizations where they are employed. Active
participation in nursing organizations is the most effective method of establishing a
professional network outside one‘s place of employment.
TOP: AONE competency: Professionalism
7. The risk manager informs the nurse manager of an orthopedic unit that her unit has had an
increase in incident reports related to patients falling during the 11-7 shift. The nurse manager
knows that the best way to resolve the problem is to:
a. use creativity.
b. obtain support from the 7-3 shift.
c. use institutional research.
d. identify the problem.
ANS: D
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Identification of a problem is the first step in problem solving and occurs before any other
step. The most common cause for failure to resolve problems is the improper identification of
the problem/issue; therefore, problem recognition and identification are considered the most
vital steps.
TOP: AONE competency: Knowledge of the Health Care Environment
8. The nurse manager of a rehab unit wants to purchase a new antiembolic stocking for use with
patients. To make a high-quality decision, the nurse manager would:
a. involve the rehab staff in the decision.
b. involve the sales representative.
c. make the decision alone.
d. involve administration in the decision.
ANS: A
In a shared decision model, the decisions are made through an interactive, deliberate process
and the staff may express and discuss options and preferences. The shared decision model has
been shown to increase work performance and productivity, decrease employee turnover, and
enhance employee satisfaction.
TOP: AONE competency: Communication and Relationship-Building
9. To solve a problem, the nurse manager understands that the most important problem-solving
step is:
a. the implementation phase.
b. identification of numerous solutions.
c. accurate identification of the problem.
d. evaluation of the effectiveness of problem resolution.
ANS: C
To proceed effectively, it is important to determine if a problem exists and to accurately
identify a problem. Failure to resolve problems is most often linked to improper identification
of the problem.
TOP: AONE competency: Knowledge of the Health Care Environment
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10. A clinic nurse has observed another nurse deviating from agency policy in performing wound
care. The best approach for the clinic nurse to take is to:
a. stay out of it.
b. inform the nursing supervisor.
c. fill out a notification form (incident report).
d. assess the risk to the client and the agency before proceeding.
ANS: D
If the situation is subjective, nonroutine, and unstructured or if outcomes are unknown or
unpredictable, the nurse leader and manager may need to take a descriptive or behavioral
approach. More information (such as degree of risk to the client and to the agency) needs to
be gathered to address this situation effectively.
TOP: AONE competency: Knowledge of the Health Care Environment
11. The risk manager wants to evaluate the reasons for an increased number of falls on the rehab
unit. The risk manager devises a fishbone diagram. A fishbone diagram is a useful tool to:
a. identify the root causes of problems.
b. list possible solutions to problems.
c. help leaders select the best options.
d. evaluate the outcomes of decisions made.
ANS: A
A fishbone diagram, also known as a cause-and-effect diagram, is useful for determining the
reasons (causes) for an effect (falls).
TOP: AONE competency: Knowledge of the Health Care Environment
12. An outpatient surgery manager is evaluating new infusion pumps for purchase to use in the
operating room. The manager should:
a. select the least expensive brand.
b. use a decision-making tool to evaluate brands.
c. ask the nursing staff which brand they prefer.
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d. select the vendor the institution usually buys from.
ANS: B
Decision-making tools such as decision grids and SWOT analyses are most appropriate when
information is available and options are known.
TOP: AONE competency: Knowledge of the Health Care Environment
13. Select the statement that best defines the difference between problem solving and decision
making:
a. decision-making skills require critical thinking; problem-solving skills do not.
b. problem-solving skills require critical thinking; decision-making skills do not.
c. decision making is a goal-directed effort; problem solving is focused on solving an
immediate problem.
d. problem solving is a goal-directed effort; decision making is focused on solving an
immediate problem.
ANS: C
Problem solving is focused on solving immediate problems, whereas decision making is a
goal-directed process that is aimed at selecting appropriate actions from among options. Not
all decisions begin with a problem.
TOP: AONE competency: Leadership
14. The maintenance department wishes to have the nursing lounge renovated, so the lounge will
be more ―user-friendly.‖ The department asks the nursing staff to make a wish list of
everything that they would like to see in the new lounge. This process is an example of which
part of the decision-making process?
a. Assessment/Data collection
b. Planning
c. Data interpretation
d. Generating hypotheses
ANS: A
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In this particular model (a model similar to the nursing model), data collection is the first step
toward identifying important alternatives or determining if there is a problem or problems.
TOP: AONE competency: Leadership
15. A good nursing decision maker is one who:
a. uses various models to guide the process based on the circumstances of the
situation.
b. adopts one model and uses it to guide all decision making.
c. decides not to use any models because they are all useless.
d. develops a new model each time a decision has to be made.
ANS: A
The decision model that a nurse uses depends on specific circumstances. Is the situation
routine and predictable or complex and uncertain? Is the goal to make a decision that is ―just
good enough‖ (conservative) or one that is optimal?
TOP: AONE competency: Leadership
16. Decision making is described by the nursing educator as the process one uses to:
a. solve a problem.
b. choose between alternatives.
c. reflect on a certain situation.
d. generate ideas.
ANS: B
The hallmark of decision making is choosing among options. Generating options is one phase
of decision making, and solving a problem refers to problem solving, which is problem
centered. Decision making does not always begin with problems, but rather is defined as a
purposeful, goal-directed effort that uses a systematic process to choose among options.
TOP: AONE competency: Leadership
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17. One day, at coffee, your co-worker suggests that you and she sit with unit members of the
hospital research committee. She suggests that this would be an excellent way to get to know
people who share her interest in research. Her actions are an example of:
a. mentorship.
b. politics.
c. networking.
d. empowerment.
ANS: C
Meeting individuals outside the normal work group to share ideas and gain support and
encouragement is an example of networking.
TOP: AONE competency: Leadership
18. Justin is a nurse manager in a rehabilitation unit in a small urban center. There is a high
turnover rate among rehab-assistants because of the heavy work assignments. Despite his need
for staff, Justin decides to review each application thoroughly and interview candidates
carefully because he recognizes that it is important to hire staff who can best provide
high-quality care and who will fit well with the team. Which of the following decision-making
solutions should Justin consider to have a more efficient department?
a. Replace staff only with qualified applicants.
b. Determine what the problem or problems are before hiring new staff.
c. Consult with the human resources department and develop a plan for hiring new
staff.
d. All listed are appropriate to consider.
ANS: D
Decision making involves a goal-oriented consideration of many options that are objectively
weighed according to their possible risks, consequences, and positive outcomes. The options
should be ranked in the order in which they are likely to result in the desired goals or
objectives. The solution selected should be the one that is most feasible and satisfactory and
has the fewest undesirable consequences. In this instance, all of the options listed might be
considered and weighed.
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TOP: AONE competency: Business Skills
19. When confronted with the controversy and the apparent poor morale of the evening staff, the
unit manager decided the staff needed to take some time off. He scheduled holidays for the
staff without consulting them. A couple of the staff nurses approached the manager and
indicated that the problem was not scheduling, but rather the team leader and her patient
assignments. What was the unit manager‘s first missed step in problem solving?
a. Not using a problem-solving model
b. Not considering a number of alternatives
c. Poor evaluation of outcomes
d. Incorrect problem identification
ANS: D
The unit manager did not begin with an accurate identification of the problem. Problem
solving needs to begin with ―why?.‖
TOP: AONE competency: Business Skills
20. John Smith, one of three managers at BSG Labs, drafted a policy that would allow his
department to do more testing in his lab. This policy included the times for regular collection
as well as a new process for emergency laboratory testing. The policy and procedures were
never followed. The reason was that:
a. the policy was too lengthy and inundated readers with too much detail.
b. the policy made decisions for other departments in the company.
c. the staff did not believe that the new policy would be effective.
d. testing should not be done in the lab.
ANS: B
Two primary criteria make for effective decisions. First, the decision must be of a high
quality; that is, it achieves the predefined goals, objectives, and outcomes. Second, those who
are responsible for its implementation must accept the decision. Higher quality decisions are
more likely to result if groups are involved in the decision-making and problem-solving
process. Taking ownership of the process and outcome provides a smoother transition in
changes.
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TOP: AONE competency: Leadership
21. High-quality decisions are most likely to be made in nursing situations when:
a. team leaders make the crucial decisions.
b. individuals are advised of the problems.
c. group size is neither too small nor too large.
d. members are passively involved.
ANS: C
Research has shown that group size is important. Too small a group means a limited number
of options generated. Too large a group can mean lack of structure or lack of meaningful
discussion.
TOP: AONE competency: Leadership
22. . During a unit meeting, you notice that Vivian listens attentively when Mary is speaking and
offers support and advice when Mary presents ideas to the group. You are surprised because
Vivian has often confided that she does not like Mary. Vivian‘s behavior is best described as:
a. insincere.
b. networking.
c. politically sophisticated.
d. collegial.
ANS: D
Collegial behavior requires respect, not friendship.
TOP: AONE competency: Communication and Relationship-Building
23. What interaction is MOST consistent with the idea of networking?
a. Meet with the same colleagues daily to have coffee and share concerns about the
workplace and stories about colleagues.
b. Join an online workplace forum to gain ideas about how to handle workplace
conflict.
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c. Suggest that you and a new team member meet after work for coffee to review unit
guidelines.
d. Join a nurse executive interest group to meet other executives for support and for
sharing ideas of expertise.
ANS: D
Networking is the result of identifying, valuing, and maintaining relationships with a system
of individuals who are sources of information, advice, and support. Many nurses have
relatively limited networks within the organizations where they are employed. Active
participation in nursing organizations is the most effective method of establishing a
professional network outside one‘s place of employment. Successful networking involves
sharing similar ideas and maintaining relationships within a system of individuals who serve
as sources of information, advice, and support.
TOP: AONE competency: Communication and Relationship-Building
24. The institution where you are a nurse manager has resisted the adoption of a new document
management software, citing cost as a concern. You meet with other nurse managers who are
in favor of the software and prepare a proposal to take to the senior executive with the goal of
persuading the executive to adopt the software. This is an example of:
a. collaboration.
b. a coalition.
c. networking.
d. policy building.
ANS: B
The formation of temporary groups to achieve particular goals involves the development of
coalitions.
TOP: AONE competency: Leadership
MULTIPLE RESPONSE
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1. In a busy rehabilitation unit, the team manager decided that the best way to reward the staff
was to give them a monetary bonus rather than time off. The staff was very concerned about
the decision and went to the administration with a number of complaints. Critical thinking is a
process that entails a number of steps. What steps did the manager omit? She should have:
(Select all that apply.)
a. identified what assumptions were underpinning the issues.
b. considered why it was important to make this change or the context for the change.
c. considered how this change might affect staff relationships.
d. attained a majority consensus of all staff.
ANS: A, B, C
Taking a majority consensus is not a step in the critical thinking process. Points A, B, and C
are ―what,‖ ―why,‖ and ―how‖ questions that are part of effective critical thinking processes.
TOP: AONE competency: Leadership
Chapter 14: Delegating: Authority, Accountability, and Responsibility in Delegation
Decisions
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
MULTIPLE CHOICE
1. The charge nurse on a rehabilitation unit recognizes that due to the COVID-19 pandemic, her
unit has been left with a shortage of nurses. She understands that delegating responsibilities
to competent delegates will be necessary. She also is aware that for positive outcomes it is
crucial to:
a. educate delegatees on how to implement a delegated responsibility.
b. allow UNP/AP‘s to have autonomy so the RN has less accountability.
c. never delegate to a UNP/AP.
d. delegate only the most critical patients.
ANS: A
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Educating delegatees on how to implement a delegated responsibility is crucial for positive
outcomes. The Research Perspective provides an exemplar of an innovative educational
approach to elevate the knowledge, skills, and attitudes of delegates.
TOP: AONE competency: Knowledge of the Health Care Environment
2. You are a member of a team assigned to care for 15 general medical/surgical clients. You
have all worked well together in the past in this same type of care. If you are assigned to
coordinate this team‘s work, your best strategy, based on the Hersey model, would be to:
a. have a list of tasks to be accomplished and tell each member of the team what he
or she must do.
b. encourage people to discuss their frustrations in providing this care.
c. ignore them—they‘ve done it before.
d. provide minimal direction and let them come to you with questions.
ANS: D
According to the Hersey model, when ability (skills, job knowledge) and willingness are
strong, the role of the delegator is less (―delegating behavior‖).
TOP: AONE competency: Knowledge of the Health Care Environment
3. The charge nurse is making patient assignments for the next shift on the unit. There is one
critical patient on the unit, who is going to require more care than the other patients. Before
delegating this patient in an assignment, what is the appropriate action by the charge nurse?
a. Delegate the admission assessment to the LPN.
b. Review the employee‘s performance assessment for the most recent period.
c. Assess the amount of guidance and support needed for the nursing care of the
patient.
d. Create a task analysis of critical behaviors for the individual.
ANS: C
To delegate effectively, the charge nurse must assess the abilities required in the situation and
the abilities that staff have to anticipate the amount of direction, monitoring, explanation, and
independence that can be assumed.
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TOP: AONE competency: Knowledge of the Health Care Environment
4. A key advantage that a charge nurse has in terms of delegating is that:
a. clients receive less attention because too many staff make it difficult to coordinate
care.
b. nurses report less pressure to perform necessary tasks themselves.
c. administration can predict overtime more accurately.
d. team skills can be used more effectively.
ANS: D
The use of multilevel healthcare providers enables healthcare organizations and nursing to
provide patient-centered care, with a focus on abilities and skills that can be employed to
perform ―what is needed now.‖ As tasks become more complicated, delegating skills to others
enables the nurse to effectively deliver a complex level of care.
TOP: AONE competency: Knowledge of the Health Care Environment
5. The nurse on the 7-7 shift is assigning a specific component of care to an unlicensed nursing
personnel (UNP) employee. The night nurse would remain:
a. accountable.
b. responsible.
c. authoritative and liable.
d. responsible and task-oriented.
ANS: A
When a registered nurse delegates care to a UNP, responsibility is transferred; however,
accountability for patient care is not transferred.
TOP: AONE competency: Professionalism
6. The night nurse understands that certain factors need to be considered before delegating tasks
to others. These factors include the:
a. complexity of the task and the age of the delegatee.
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b. potential for benefit and the complexity of the task.
c. potential for benefit and the number of staff.
d. complexity of the task and the potential for harm.
ANS: D
In delegating tasks to others, the nurse considers factors such as stability of the patient, safety
of the situation and of the patient, time and intensity involved, and level of critical thinking
required to achieve desired outcomes.
TOP: AONE competency: Knowledge of the Health Care Environment
7. During a fire drill, the nurse manager becomes very assertive and directive in her
communications with staff. This type of situational leadership depends on:
a. supportive behavior by the leader and immature followers.
b. the development level of the followers and the behavior based on the situation.
c. well-developed followers combined with a strong leader who acts quickly.
d. the leader‘s ability to evaluate personnel and communicate that evaluation.
ANS: B
When abilities, relationships, and/or time is limited (as in a crisis situation), the leader
assumes a bigger role in guiding and in making decisions, or ―telling‖ behavior. Leaders need
to behavior differently and use different leadership styles in different situations.
TOP: AONE competency: Leadership
8. The unit manager is working in a large metropolitan facility and is told that two UNPs are to
be assigned to work with her. Delegation begins with:
a. acknowledging the arrival of the second UNP on the unit.
b. providing clear directions to both UNPs.
c. matching tasks with qualified persons.
d. receiving reports from the prior shift.
ANS: C
In delegating to the UNPs, the nurse must consider what cannot be delegated, as well as the
factors of safety, time, critical thinking, and stability of patients.
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TOP: AONE competency: Knowledge of the Health Care Environment
9. During staff-development programs, staff nurses verbalize their frustration about their
workloads and having to delegate so many tasks to others. One of the main reasons that
delegation has emerged as an issue is because of:
a. the amount of paperwork required to complete care.
b. the complexity of care required by patients.
c. earlier discharge practices.
d. the numbers of other disciplines present on a given unit.
ANS: B
Complexity of client care, a multilevel nursing model (registered nurses, mixed with
LPNs/LVNs, and UNPs), and community-based care provide many challenges in determining
the care required and outcomes desired and/or mandated, and in matching needs with various
abilities and authority of regulated and unregulated healthcare providers. The nurse manager
should ensure that staff is clinically competent and trained in their roles in patient safety.
TOP: AONE competency: Knowledge of the Health Care Environment
10. The day shift nurse asks an LPN/LVN to complete a task for a patient. The day shift nurse is
engaging in what function?
a. Delegating
b. Assigning
c. Sharing
d. Authorizing
ANS: B
Delegation refers to transfer of responsibility for work; the day shift nurse retains
accountability for the outcomes of patient care therefore is using assigning of the task rather
than delegation.
TOP: AONE competency: Knowledge of the Health Care Environment
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11. You are working in a home health service and have three unlicensed nursing personnel
(UNPs) assigned to your team. You have worked with two of them for 2 years; the third is
new. The two experienced UNPs have patients with complex illnesses for whom they provide
basic care. The third member of the team has been assigned to patients with less complex
illnesses. Your best approach to supervising their care is to:
a. remain in the office and ask each UNP to check in with you upon arrival at their
first patient care site.
b. ask another RN to supervise the two experienced assistants so you can be with the
new person full time.
c. meet the new staff member at the first patient care site and ask the others to call if
anything is unusual.
d. meet the new staff member at the first patient care site and call the others with
questions to determine whether anything is unusual.
ANS: D
When ability and willingness are strong, the involvement of the delegator is needed less.
TOP: AONE competency: Knowledge of the Health Care Environment
12. With delegation, responsibility and accountability remain with the:
a. physician.
b. professional who delegates.
c. individual who receives the delegation.
d. individual who previously performed the task.
ANS: B
Even though the delegatee (the one who receives the delegation) receives direction from the
professional who delegates a task and must have the authority to complete it, the delegator
retains accountability for the overall outcome and completion of the activity. The delegatee
has responsibility (obligation to engage in the task) and authority for the task.
TOP: AONE competency: Professionalism
13. Which of the following exemplifies accountability? Karen, the nurse manager on 5E:
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a. consistently submits her budgets on time.
b. gets along well with her staff and with other managers.
c. outlines her rationale for reduction of RN coverage on nights to the Nursing
Practice Committee after serious patient injury.
d. actively solicits ideas regarding scheduling from her staff.
ANS: C
Reliability, dependability, and obligation to fulfill the roles and responsibilities of the nurse
manager are consistent with responsibility. Accountability refers to being answerable for
actions and results.
TOP: AONE competency: Professionalism
14. Which of the following indicates safe delegation?
a. The nurse supervisor for a large urban acute care department asks the unit manager
to accept two new acutely ill patients, which the manager does. The unit is short
two staff, and the replacement is inexperienced.
b. A unit manager agrees to release a staff from her unit to Unit B. The staff member
she agrees to release is experienced on Unit B and is agreeable to the change. The
unit manager‘s unit is fully staffed and patients are stable.
c. The nurse supervisor asks the head nurse for Unit A to make do without a
replacement for an ill staff member because Unit A was originally overstaffed
anyway. Patient acuity levels are very high on Unit A and two staff are orientating.
d. The nurse supervisor asks the charge nurse on Unit B to cover Unit F, which is two
floors up, because the charge nurse for Unit F is ill. The charge nurse for Unit B is
an experienced manager but has no experience with the nursing care required on
Unit F.
ANS: B
When span of control (number of individuals for whom a manager is responsible) is
compromised by geographic factors such as lack of proximity, instability in patients‘
conditions, or lack of experience, the span of control that is being delegated may lead to
unsafe care.
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TOP: AONE competency: Knowledge of the Health Care Environment
15. Which of the following would be most in line with Hersey model and concepts?
a. The team of caregivers on day shift are familiar with their roles and with the
patients. The nurse manager decides to work on the unit budget in her office.
b. After a year of working on the unit, Shari, an LPN, is still hesitant about many
policies and procedures. The charge nurse decides to challenge Shari with more
difficult patients.
c. The nursing supervisor asks one of her charge nurses to lead a technology
integration project. The supervisor continuously demands involvement in decisions
that the charge nurse is making in the project.
d. Team members complain that Alysha, an RN, is unmotivated, and that she refuses
assignments that are complex or difficult. The charge nurse suggests that Alysha is
relatively new and that she needs time to adjust.
ANS: A
The Hersey model/framework suggests that when ability (skills, job knowledge) and
willingness are strong, the involvement of the delegator is less.
TOP: AONE competency: Business Skills
16. In delegating to a UNP in a home health setting, which of the following represents the most
appropriate delegation communication?
a. ―You will be taking care of Mrs. S., who needs assistance with her bath.‖
b. ―You will need to help Mrs. S. get into and out of her shower. Ensure that you
check the condition of her feet, and let me know if you have any concerns when
you check in.‖
c. ―I am not sure that you know how to do this, but I am giving you Mrs. S. She is
quite obese and needs skin care.‖
d. ―Mrs. S. needs help to get into and out of her bathtub. Her bath will need to be
completed by 10:00. When you are helping her to dry, please check between her
toes and toenails, and phone me by 10:30 if you notice nail discoloration or
redness.‖
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ANS: D
Delegation communication includes what is being delegated (and what is not), outcomes,
specific deadlines (if applicable), specific reporting guidelines (what, when), and who may be
consulted. Communication also includes conveying recognition of the authority to do what is
expected.
TOP: AONE competency: Knowledge of the Health Care Environment
17. An RN colleague, who is a long-standing and collaborative member of your team, is
performing a complex dressing with new orders written for the first time for the assigned
patient. Which of the following would be the most appropriate communication with her?
a. ―How do you usually do this kind of dressing?‖
b. ―The dressing needs to be done today and tomorrow with the supplies on this cart.‖
c. ―Here is what you need for the dressing, and I will show you what needs to be
done.‖
d. ―I know you know what you are doing. Let me know if you have any problems.‖
ANS: C
If a situation involves a new task and the relationship is ongoing (two individuals who will
usually continue to work together), the delegator explains what to do and how to do it. Hersey
described the leader‘s behavior as explaining or persuading, which, is characterized as
―selling.‖ The RN who is assigned to the patient is an experienced nurse and team member,
but is new to this specific situation. In situations where the nurse is experienced but the task is
new, explain (and demonstrate) what needs to be done.
TOP: AONE competency: Knowledge of the Health Care Environment
18. Sally is an experienced nurse on the unit and is very experienced with ICP monitoring. She is
assigned David, a patient who has been admitted with a severe head injury. In communicating
with Sally, what is an appropriate action by the charge nurse?
a. Provide a detailed explanation of what she needs to do with ICP monitoring.
b. Tell her when she needs to provide an update about David‘s status.
c. Ask her to tell you what she knows about ICP monitoring and share expectations
about reporting.
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d. Advise her that you are available if she needs you.
ANS: D
The charge nurse and Sally have a well-established relationship and Sally has the expertise to
work effectively with David; therefore, the charge nurse would need to provide little guidance
but would need to communicate that they are available if needed. Hersey refers to this leader
behavior as ―delegating.‖
TOP: AONE competency: Knowledge of the Health Care Environment
19. You ask Evelyn, a new UNP, to check what is left in Mrs. N.‘s inhaler when Evelyn makes
visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the
medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is
plenty medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to
the hospital in severe respiratory distress. When she is admitted, she tells the physician that
she has not been using the inhaler for 4 weeks. This incident is an example of:
a. incompetence of the UNP.
b. failure to follow-through.
c. skills but no motivation.
d. lack of accountability.
ANS: B
The nurse should maintain open lines of communication and seek information, and the UNP
should know how, when, and what to report. Communication of delegation of tasks includes
specific information about what is being delegated, expected outcomes, and deviations (which
includes what immediate action needs to be taken). This 2-way communication and
follow-through allows patient care to be altered, if necessary, in a timely manner.
TOP: AONE competency: Knowledge of the Health Care Environment
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20. You ask Evelyn, a new UNP, to check what is left in Mrs. N.‘s inhaler when Evelyn makes
visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the
medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is
enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted
to the hospital in severe respiratory distress. When she is admitted, she tells the physician that
she has not been using the inhaler for 4 weeks. Before assigning Evelyn to Mrs. N.‘s care, the
most appropriate action of the care coordinator would have been to:
a. determine Evelyn‘s educational background and preparation for this role.
b. ask Evelyn if she has worked with inhalers before and to describe what she knows
about them.
c. advise that if Evelyn has any questions about what to do with the inhaler, she
should come to the coordinator.
d. advise Evelyn that working the inhaler is not really complicated and that she
should ask the patient how to check medication levels in the inhaler.
ANS: B
When delegating tasks, in addition to specifying the task to be completed, outcomes,
priorities, time lines, deviations, report time frames, monitoring, and resources, asking the
delegatee to give examples of each is helpful in ensuring that communication is clear and has
been understood. Preparation of UNPs lacks consistency; therefore, the safest practice is to
determine the knowledge and skill level of the UNP in relation to the skill and the patient
before delegating.
TOP: AONE competency: Knowledge of the Health Care Environment
21. You ask Evelyn, a new UNP, to check what is left in Mrs. N.‘s inhaler when Evelyn makes
visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the
medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is
enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted
to the hospital in severe respiratory distress. When she is admitted, she tells the physician that
she has not been using the inhaler for 4 weeks. Determination of Evelyn‘s educational
preparation and certification is related to the concept of:
a. accountability.
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b. authority.
c. role performance.
d. assignment.
ANS: B
Authority refers to the right to do and may be designated by law, educational preparation, or
job description.
TOP: AONE competency: Business Skills
22. Nurses can use four elements to determine the abilities of the UNP/AP to perform the task or
activity when delegating. These four elements are:
a. ability, attitude, acuity, and authority.
b. skill, diet, communication, and agility.
c. accountability, time management, organizational skills, and degree.
d. safety, critical thinking, stability, and time.
ANS: D
To assist with the challenges of delegating, nurses can use four elements to determine the
abilities of the UNP/AP to perform the task or activity. These four elements are safety, critical
thinking, stability, and time.
TOP: AONE competency: Knowledge of the Health Care Environment
23. County Hospital has position descriptions for all staff, including RN Team Leaders. Sarah, a
team leader on the rehab unit, assesses the needs of the patients in her area, assesses the skills
and backgrounds of each of the individuals on her team, and then assigns and delegates the
appropriate care provider to each patient and task. Sarah provides Colleen, her RN colleague
with details regarding the patients to whom Colleen has been assigned on the day shift. This is
an example of:
a. accountability.
b. responsibility.
c. assignment.
d. delegation.
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ANS: C
When an RN assigns care to another RN, it is termed an assignment and not delegation,
because both accountability and responsibility are transferred.
TOP: AONE competency: Knowledge of the Health Care Environment
24. Leslie, a UNP, transfers a patient while using improper technique. The patient is injured, and
as a result, a suit is launched in which both Sarah (the delegator) and Leslie (the delegatee) are
named. Sarah is named in the suit because she:
a. retains accountability for the care of the patient.
b. worked the same shift as Leslie.
c. has passive accountability for delegation.
d. retains accountability for the outcomes of care for the patient.
ANS: D
Whenever care is provided by someone other than a registered nurse, accountability for care
remains with the manager/delegator even though others provide aspects of care.
TOP: AONE competency: Knowledge of the Health Care Environment
MULTIPLE RESPONSE
1. An example of a nursing care activity that would not be delegated by an RN to a UNP is:
(Select all that apply.)
a. teaching self-catheterization to a patient with paraplegia who has limited English.
b. basic care for a patient with a head injury who is rapidly deteriorating.
c. one-to-one observation with a suicidal patient.
d. assessment of patients being admitted through the Emergency Department.
e. basic hygienic care for a patient who is post MI and stable.
ANS: A, B, D
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Functions such as assessment, diagnosis, planning, and evaluation cannot be delegated. In
addition, stability, critical thinking, time, and safety are factors that are considered in
assessing whether or not to delegate care to a UNP. Teaching self-catheterization to a patient
with limited English requires critical thinking; basic care for a patient who is rapidly
deteriorating exemplifies concern with stability; and assessment of patients through
Emergency is related to the factor of time. An exception to safety and stability in which
patients may be delegated to UNPs is when patients are placed on suicide precautions.
TOP: AONE competency: Knowledge of the Health Care Environment
Chapter 15: Effecting Change, Large and Small
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
MULTIPLE CHOICE
1. The home health agency hired an expert in financial management to evaluate and propose a
plan for reversing growing expenses and decreasing revenues. The expert is well respected,
both personally and professionally, by members living in this small community. To be
effective, staff will need to perceive this change agent as:
a. trusted, quiet.
b. flexible, informal.
c. credible, enthusiastic
d. communicative, personable.
ANS: C
To influence the decision, the expert must be seen as having knowledge of what matters to the
people that they lead and of the change area itself. The expert also must be enthusiastic and
communicative and have referent power.
TOP: AONE competency: Leadership
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2. The nurse manager frequently interacts with staff and other hospice facility employees.
Communication is purposeful because the manager assesses current issues, such as specific
satisfactions and dissatisfactions with the newly implemented computerized documentation
system. Informally, the manager gathers available staff members to address similar learning
needs. Many times, staff members are found coaching other staff about improving use of the
new system. According to Senge (1990), the activities demonstrated in this example are:
a. dialogue, team learning.
b. resilience, personal mastery.
c. shared vision, systems thinking.
d. mental models, teachable moments.
ANS: A
Building shared vision occurs when leaders involve all members in moving personal visions
of the future into a consolidated vision common to members and leaders.
TOP: AONE competency: Leadership
3. The clinical coordinator expects the position description of the new wound care specialist to
change nurses‘ responsibilities in caring for clients with skin integrity problems. The best
approach to address this need for change, yet to have the best outcomes for clients, staff
nurses, and the organization, is to:
a. select one of the change models.
b. use Lewin‘s model and principles of change.
c. apply both planned and complexity theory approaches.
d. form a task force of nursing staff and wound care specialists.
ANS: C
In the second stage, the moving or changing stage of Lewin theory, planned interventions and
strategies, such as education, vision building, and incremental steps towards the change, are
executed to support the implementation of the change. This situation potentially also involves
complexity theories that recognize that change involves engagement of individuals and
subsystems throughout the unit and organization.
TOP: AONE competency: Leadership
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4. The nurse decides to involve those to be affected by change early in the change management
process. This can positively result in:
a. coordination.
b. resistance.
c. anticipation.
d. participation.
ANS: D
Successful change means persistence and advancement of the change, which requires the
undivided focus of all team members. Early involvement and participation are critical to
capturing the undivided focus of team members.
TOP: AONE competency: Business Skills
5. The oncology clinical manager and the educational coordinator asked nursing staff to
complete a brief written survey to assess their attitudes and knowledge related to having used
the new infusion equipment for 6 weeks. The stage of change in this situation is:
a. developing awareness.
b. experiencing the change.
c. integrating the change.
d. perceiving awareness.
ANS: C
This particular initiative assesses the success with which the change has been integrated into
everyday practice after it has been experienced, or the degree to which staff members have
accepted using the new infusion equipment.
TOP: AONE competency: Leadership
6. An example of one strategy used to improve participation in the change process by staff fitting
the behavioral description of innovators and early adopters is to:
a. repeat the benefits of the change.
b. share change experiences early in the process.
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c. initiate frequent interactions among staff.
d. provide select information to the staff.
ANS: B
Connecting innovators and early adopters to new ideas and with new peers keeps them at the
cutting edge.
TOP: AONE competency: Professionalism
7. As a new manager, you are shocked to learn that your unit is still using heparin in heparin
locks. You are aware of evidence related to this practice and want to change this practice as
quickly as possible on your unit. You are in which stage of Lewin‘s stages of change?
a. Unfreezing
b. Experiencing the change
c. Moving
d. Refreezing
ANS: A
Although you may be at a higher level of change in relation to your individual practice and
knowledge of the use of change, in this situation, you are recognizing the need for change in
relation to practice on the unit that you are managing. This phase is the initial phase in
first-order change and will involve listening to staff to see if they perceive a similar problem.
TOP: AONE competency: Leadership
8. Resistance is most likely when change:
a. is not well understood.
b. involves many layers in an organization.
c. involves nonprofessional workers.
d. threatens personal security.
ANS: D
Resistance and reluctance commonly occur when personal security is threatened and may
involve loss of confidence in abilities or loss of job or financial security.
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TOP: AONE competency: Leadership
9. You anticipate that your region will soon move toward an e-health record system. You begin
to discuss this with your staff and are disappointed that you receive little positive response
from the staff about this possibility. One staff member, in particular, seems to sum it up by
saying ―e-health? Won‘t happen in my working life! There are too many problems with it, like
privacy issues.‖ This response is most likely motivated by:
a. lack of urgency regarding the need to change.
b. lack of evidence to support importance of technology.
c. deficits in education and experience.
d. lack of organizational support for change.
ANS: C
For leaders to inspire change, they must have intimate knowledge of what matters to the
people they manage.
TOP: AONE competency: Leadership
10. Sarah, RN, is one of your most enthusiastic staff members and has been to a workshop on
preparing educational materials for patients. On the basis of this workshop, she would like to
develop an information website for patients who are being admitted to the ward. An
appropriate response to Sarah‘s suggestion would be:
a. ―That is a great suggestion, but we have no resources for such an expensive
undertaking right now.‖
b. ―Perhaps you can keep that in mind as we redesign our charting system.‖
c. ―We have too many seniors as patients, and you know that they don‘t use
technology.‖
d. ―There is a great group here that meets to look at technology pilots. Let‘s see if
you can join them and discuss your idea further.‖
ANS: D
Involving Sarah with others who enjoy new ideas and who are able to try out new ideas in
pilot projects enables her to remain on the cutting edge and to try out innovative solutions
with the least amount of disruption.
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TOP: AONE competency: Leadership
11. 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.
TOP: AONE competency: Business Skills
12. 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.
TOP: AONE competency: Leadership
13. 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.
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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.
TOP: AONE competency: Business Skills
14. 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.
TOP: AONE competency: Business Skills
15. 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.
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TOP: AONE competency: Knowledge of the Health Care Environment
16. 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.
TOP: AONE competency: Knowledge of the Health Care Environment
17. 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).
TOP: AONE competency: Business Skills
18. To conduct assessment of the internal environment, the strategic planning team for Pacific
Hospital:
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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.
TOP: AONE competency: Business Skills
19. 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.
TOP: AONE competency: Business Skills
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20. 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.
TOP: AONE competency: Business Skills
21. 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
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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.
TOP: AONE competency: Business Skills
22. 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.
TOP: AONE competency: Business Skills
23. 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).
TOP: AONE competency: Business Skills
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24. 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.
TOP: AONE competency: Communication and Relationship-Building
MULTIPLE RESPONSE
1. Which of the following are examples of application of the Leadership Rounding Tool? (Select
all that apply.)
a. ―What is working well for you during bedside reporting?‖
b. ―What has not worked for you today?‖
c. ―Is there someone on your team who deserves special recognition for her efforts in
the implementation?‖
d. ―Did you have a good vacation?‖
ANS: A, B, C, D
The Leadership Rounding Tool suggests establishing and maintaining rapport and asking what
is working well, what was a barrier, and who should be recognized, as well as answering
tough questions.
TOP: AONE competency: Communication and Relationship-Building
Chapter 16: Building Effective Teams
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
MULTIPLE CHOICE
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1. A nurse manager is experiencing conflicts between herself and staff members. She had tried to
develop a team by using a shared leadership model to empower the staff. Staff members are
functioning:
a. as a team.
b. independently.
c. interdependently.
d. as a group.
ANS: D
A group is a collection of interconnected individuals working together, with a high degree of
interdependence, for the same purpose. A team is a unified group that is committed to a
common purpose, performance goals, and approach, for which they hold themselves mutually
accountable. The conflict indicates that the staff may not be united in a common purpose.
TOP: AONE competency: Communication and Relationship-Building
2. The nurse manager used a mediator to help resolve conflicts on the unit. During the mediation
process, the nurse manager saw signs of potential team building. One key concept of an
effective team is:
a. conflict.
b. task clarity.
c. commitment.
d. a designated leader.
ANS: C
Team building involves moving toward a common vision, which requires commitment.
Conflict and clarification of tasks are components in the development of this commitment.
TOP: AONE competency: Communication and Relationship-Building
3. A mediator suggested that the nurse manager and staff members decide on a method to
resolve conflicts. It is important to have agreements about how team members will work
together because:
a. if there are no agreements, each member will make up rules about how to handle
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disagreements and relationships.
b. people are naturally difficult and will not work well together without such
agreements.
c. people will naturally ask for agreements about how to be together.
d. a way to eliminate nonproductive team members must be available.
ANS: A
People must agree on the goals and mission with which they are involved. They have to reach
some understanding of how they will exist together. Tenets or agreements such as ―I will
respectfully speak promptly with any team member with whom I have a problem‖ go a long
way to avoid gossiping, backbiting, bickering, and misinterpreting others. Without agreement,
people have implicit permission to behave in any manner they choose toward one another,
including angry, hostile, hurtful, and acting-out behavior.
TOP: AONE competency: Communication and Relationship-Building
4. By following a shared leadership model, the nurse manager believes that staff members will
learn to function synergistically. Some teams function synergistically because members:
a. do not volunteer unwanted information.
b. actively listen to each other.
c. listen to the person who believes he or she is an expert.
d. do not speak unless they are absolutely sure they are correct in their views.
ANS: B
Active listening in a group creates synergy in that team members really hear one another‘s
ideas and share in decision making.
TOP: AONE competency: Professionalism
5. The chief nursing officer decided that the nurse managers need a series of staff-development
programs on team building through communication and partnerships. She understood that the
nurse managers needed to build confidence in ways of handling various situations. The
greatest deterrent to confidence is:
a. lack of clarity in the mission.
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b. lack of control of the environment.
c. fear that one can‘t handle the consequences.
d. fear that the boss will not like one‘s work.
ANS: C
Fear of not being able to manage consequences undermines confidence and a sense of
competency.
TOP: AONE competency: Professionalism
6. The mediator noticed that tension was still evident between the nurse manager and staff
members. He informed the chief nursing officer that to begin team building, it would be
important that everyone:
a. work together in a respectful, civil manner.
b. use avoidance techniques when confronted with a conflict.
c. develop a personal friendship with each other.
d. socialize frequently outside of work.
ANS: A
For team building to occur, team members need to be able to listen actively and respect one
another‘s opinions, while feeling comfortable in openly expressing their own.
TOP: AONE competency: Communication and Relationship-Building
7. The state of being emotionally impelled, demonstrated by a sense of passion and dedication to
a project or event, describes:
a. commitment.
b. control.
c. willingness to cooperate.
d. communication.
ANS: A
Commitment is described as having a sense of passion and commitment to a project without
necessarily having a need to control.
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TOP: AONE competency: Professionalism
8. The mediator suggested to the unit staff that a group agreement needed to be made so
meetings could become productive. For example, the group agreement, ―We will speak
supportively,‖ prevents:
a. expression of opposing ideas.
b. gossip and making negative comments about absent team members.
c. efforts to ensure that everyone thinks alike.
d. votes that oppose motions.
ANS: B
This is an example of a rule that a team can implement to prevent certain negative behaviors
such as gossip, backbiting, and bickering that undermine the productivity and functioning of a
group.
TOP: AONE competency: Professionalism
9. The mediator asked each staff member to reflect on his or her communication style. Which of
the following best describes communication? Communication:
a. is a reflection of self-analysis.
b. is a result of thoughtful consideration.
c. consists of thoughts, ideas, opinions, emotions, and feelings.
d. focuses on the sender of the message.
ANS: C
Communication involves both senders and receivers and may or may not be a reflection of
self-analysis and thoughtful consideration. It always, however, involves thoughts, ideas,
opinions, emotions, and feelings.
TOP: AONE competency: Communication and Relationship-Building
10. The staff development educator developed strategies to help nurse managers actively listen.
Guidelines for active listening include which of the following?
a. Speed up your internal processes so that you can process more data.
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b. Realize that the first words of the sender are the most important.
c. Be prepared to make an effective judgment of the communication sender.
d. Cultivate a desire to learn about the other person.
ANS: D
Active listening means suspending judgment about what is about to be said and listening to all
that is said (and not just the first or last words). It is motivated by a genuine desire to learn
about the other person.
TOP: AONE competency: Communication and Relationship-Building
11. The nurse manager was upset with the staff nurse and said, ―You did not understand what I
said.‖ Which element in the communication process was she referring to?
a. Feedback between receiver and sender
b. A message channel
c. A receiver who decodes the message
d. A set of barriers that may occur between sender and receiver
ANS: D
Problems can occur at any point in communication and result in miscommunication. In this
instance, it can be assumed that there was a sender, a receiver, a channel, and feedback. In this
scenario, barriers such as distractions, inadequate knowledge, differences in perceptions, and
emotions and personality may have resulted in misunderstanding between the manager and
the staff nurse.
TOP: AONE competency: Communication and Relationship-Building
12. As the nurse manager on a rehab unit, you are asked to come to the tub room immediately
because two nursing assistants are having a loud disagreement in front of a patient. You ask
the nursing assistants to meet you outside and after ensuring that a third nursing assistant is
able to care for the patient, you speak with the two nursing assistants. Which of the following
would you ask first?
a. ―How long have you two been working together?‖
b. ―Have you experienced disagreements like this before?‖
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c. ―How do you think this patient‘s perception of her care has been changed?‖
d. ―What happened to bring on this disagreement today?‖
ANS: D
Conflicts are usually based on attempts to protect a person‘s self-esteem or to alter perceived
inequities in power. When a nurse recognizes upset and reaction, the following steps can be
helpful (Sportsman, 2005):
Identify the triggering event (―What happened to bring on this disagreement today?‖).
Discover the historical context for each person.
Assess how interdependent each person is on the other.
Identify the issues, goals, and resources involved in the situation.
TOP: AONE competency: Communication and Relationship-Building
13. Sally (RN) and Melissa (RN) have shared an ongoing conflict since the first day that Melissa
worked on the unit. Sally has confided to another colleague that she doesn‘t even know why
the conflict started or what it was about. This is an example of:
a. how expectations and objectives need to be made clear in team situations.
b. the need to encourage open discussion of disagreements in opinions.
c. the importance of involving all staff in discussions in group settings.
d. the enduring nature of first impressions.
ANS: D
First impressions are lasting and, as Sally indicates to her colleagues, are often an unconscious
response.
TOP: AONE competency: Communication and Relationship-Building
14. After staff meetings lately, Sharon, the head nurse, observes her staff in small groups, having
animated discussions that end abruptly when she approaches. Sharon reflects on this
observation and realizes that:
a. two very outspoken members tend to dominate discussions in meetings.
b. this behavior is indicative of a high level of communication among her staff.
c. staff members are very committed to the team and have strong opinions.
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d. ongoing discussion outside of meetings is conducive to creativity.
ANS: C
When team communication is dominated by a few members, leaving others uninvolved or
bored, disagreement is not expressed openly. As a result, team members ―stuff‖ their feelings
and wait until after meetings to voice their opinions.
TOP: AONE competency: Communication and Relationship-Building
15. You are charged with developing a new nursing curriculum and are committed to developing
a curriculum that reflects the needs of the profession and of the workplace. To address deficits
that may already be present in nursing curricula related to the workplace, you include more
content and skills development related to:
a. therapeutic communication with patients.
b. effective communication in the workplace.
c. increased emphasis on sender-receiver dyads.
d. generational differences in communication.
ANS: B
Nursing programs teach therapeutic communications with patients and their families. Little
focus, however, is placed on effective communication in the workplace, although
communication is essential to building and maintaining smoothly functioning teams.
TOP: AONE competency: Communication and Relationship-Building
16. The SBAR system of communications is one of the most used communication systems in
health care because:
a. it deals with all aspects of communications in patient care except communication
with the physician.
b. the nurse is on the same communication level as administration.
c. it honors a familiar, structured transfer of information among health professionals.
d. it honors an unstructured transfer of information.
ANS: C
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The SBAR system was developed by professionals in the California Kaiser Permanente
System and involves direct, respectful communication skills among professionals with the aim
of quality patient care.
TOP: AONE competency: Communication and Relationship-Building
17. In the cardiac intensive care unit, there has been simmering discontent about the new nurse
manager, who avoids any discussion about her scheduling and practice decisions. The staff
have begun to sort into ―different camps‖ depending on how they feel about the manager or
the decisions. Which of the following statements MOST accurately describes this situation?
a. The tension that has been generated will result in creative solutions.
b. Staff will become a cohesive group that takes a stand against the manager.
c. The conflict will result in increased dialogue about practice and scheduling
options.
d. Patient care may suffer because attention and energy is being diverted toward the
unit relationships.
ANS: D
Destructive conflict polarizes groups, saps group morale, deepens differences in values, and
diverts energy from more important activities, such as patient care. Constructive conflict
opens up issues of importance, results in solutions to problems, and enables authentic
communication.
TOP: AONE competency: Communication and Relationship-Building
18. From the information presented in this chapter, which of the following statements best defines
an accomplished team? Effective teams:
a. can create a form of synergism in which the outcome is greater than the sum of the
individual performances.
b. do not necessarily need goals, objectives, vision, and a clearly stated purpose.
c. do not always have effective communication patterns.
d. may or may not have a clear plan that is followed and revisited and has an ongoing
evaluation scheme.
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ANS: A
Research on team building over many years has established that high-functioning teams are
characterized by synergy that takes the team from a collection of individuals to an outcome
that is greater than the sum of the parts.
TOP: AONE competency: Communication and Relationship-Building
19. ―I really wish that my supervisor would realize and acknowledge all the things I do well.‖ In
nursing, this has been identified as a problem. Which statement is part of the solution? Focus
on:
a. new staff.
b. care assignments with which the individual is not familiar.
c. making corrections.
d. the strengths of the individual rather than the weaknesses.
ANS: D
The research of Rath (2007) included many recommendations, one of which was that focusing
on mediocre behaviors and on a person‘s weaknesses will not lead to excellence. Focusing on
weaknesses tends to decrease the appreciation, and thus the acknowledgements.
TOP: AONE competency: Communication and Relationship-Building
20. Trust is an important aspect of helping relationships, therapeutic communications, and the
positive communications model. Which statement does not involve or define trust? Trust:
a. involves decisions to manipulate situations to gain advantage over another.
b. is the basis by which leaders facilitate the activities and progress of a team.
c. is low among members and leaders in poorly performing teams.
d. involves what we say and not necessarily what we do.
ANS: A
Trust is high in high-performing teams and involves not consciously taking advantage of
others and behaving in a way that inspires trust. It is the basis by which leaders facilitate the
activities and progress of a team.
TOP: AONE competency: Communication and Relationship-Building
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21. Team Member A and Team Member B engage in heated disagreements on a frequent basis in
team meetings. Their behavior is characterized by insistence on their points of view and
refusal to back down or to negotiate alternative solutions once their ideas have been
expressed. This behavior is characteristic of:
a. autocratic leadership.
b. constructive conflict.
c. dualism.
d. creativity.
ANS: C
Our society tends to be dualistic in nature. Dualism means that most situations are viewed as
right or wrong, black or white. Answers to questions are often reduced to ―yes‖ or ―no.‖ As a
result, we sometimes forget a broad spectrum of possibilities actually exists. Exercising
creativity and exploring numerous possibilities are important. This allows the team to operate
at its optimal level.
TOP: AONE competency: Communication and Relationship-Building
22. The unit manager was addressing nursing students in the lounge area and was discussing team
leadership and team effectiveness. She stated, ―One can agree to disagree with another team
member‘s perspective even when one doesn‘t necessarily see that perspective as being the
correct one.‖ In being creative, what did she mean?
a. Championing one‘s own opinion
b. Being compassionate
c. Being flexible
d. Committing to resolution
ANS: D
Caregivers must listen to the other person‘s perspective, listen to the message accurately,
identify differences, and creatively seek resolutions.
TOP: AONE competency: Leadership
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23. Which of the following would not be a characteristic of an effective team nurse leader?
a. An autocratic perspective
b. Excellent communication skills
c. Awareness of everyone‘s abilities
d. A genuine interest in team members
ANS: A
In ineffective teams, leadership tends to be autocratic and rigid, and the team‘s
communication style may be overly stiff and formal. Members tend to be uncomfortable with
conflict or disagreement, avoiding and suppressing it rather than using it as a catalyst for
change. When criticism is offered, it may be destructive, personal, and hurtful rather than
constructive and problem-centered. Team members may begin to hide their feelings of
resentment or disagreement, sensing that they are ―dangerous.‖ This creates the potential for
later eruptions and discord.
TOP: AONE competency: Communication and Relationship-Building
24. As a nurse manager, you notice that one of your new nurses has provided exceptional care for
a patient with especially complex needs. What would be the MOST effective way of
recognizing the nurse‘s performance?
a. At the next performance review, note specifically what the nurse did to make the
patient comfortable.
b. To avoid embarrassing the nurse in front of others, find a way to compliment the
nurse in private.
c. When the nurse comes out of the room, tell the nurse specifically what you
appreciated about the care that was provided.
d. Encourage the patient to note the care on the patient feedback form so that the
institution can recognize the nurse‘s efforts.
ANS: C
Acknowledgement is most effective when it is specific, timely, given in public, sincere, and
on an eye-to-eye basis. The more time that elapses between the event and acknowledgement,
the less effective it becomes.
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TOP: AONE competency: Communication and Relationship-Building
MULTIPLE RESPONSE
1. Mobilizing others to accomplish extraordinary things requires what leadership behaviors?
(Select all that apply.)
a. Celebrating the successes of others
b. Demonstrating exceptional technical skills
c. Imagining possibilities
d. Establishing a sense of ―being in this together‖
ANS: A, C, D
Leaders who inspire teams to accomplish extraordinary things or to display synergy model the
way, inspire shared vision, challenge the status quo, and encourage the heart by celebration of
success.
TOP: AONE competency: Leadership
Chapter 17: The Impact of Technology
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
MULTIPLE CHOICE
1. A nurse manager was orienting new staff members to computerized charting. To understand
computerized charting, staff members must understand informatics. The three core concepts in
informatics are:
a. hardware, software, and printers.
b. data, information, and knowledge.
c. decision making, data gathering, and reporting.
d. wireless technology, voice recognition, and handheld devices.
ANS: B
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Informatics is the application of technology to all fields of nursing to facilitate and extend
nurses‘ decision-making abilities and to support nurses in the use, storage, and linkage of
clinical information to provide effective and efficient patient care.
TOP: AONE competency: Business Skills
2. The nursing manager of a surgical unit has been asked by administration to evaluate client
outcomes post cardiac catheterization. Using data about client outcomes post cardiac
catheterization for the past 6 months in order to modify practice is an example of:
a. information.
b. cost-effective care.
c. meeting standards.
d. evidence-based practice.
ANS: D
Technology enables evidence-based practice by collecting good clinical knowledge,
translating nursing knowledge into reference materials that can be accessed at the
point-of-care, and, potentially, assisting nurses to take action based on best evidence for
practice.
TOP: AONE competency: Knowledge of the Health Care Environment
3. Mr. Cruiser has been surfing the Web. He is looking for healthcare information on low back
pain. He shows the clinic nurse a webpage he thinks is great and tells her that he has been
following the exercises recommended by the author. He wants to know what she thinks about
the site. When the clinic nurse evaluates this site, she discovers that its author is a personal
trainer. No credentials are listed. In several testimonials on the page, people (their pictures are
included) say how wonderful they feel after having done these exercises. The exercises all
have animated demos when you click on the pertinent highlighted text or icon. They seem
easy to follow. The site was posted 5 years earlier and was last updated 3 years before. The
clinic nurse advises Mr. Cruiser to:
a. avoid this site.
b. check with his primary healthcare provider.
c. continue with the exercises.
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d. contact the author for additional exercise and feedback.
ANS: A
Patients need coaching as to how to use and decipher information that is available through the
Internet. In this situation, the provider on the site lacks credibility because no credentials are
listed, and the information is not current.
TOP: AONE competency: Business Skills
4. A primary care clinic in a small urban center sees a high volume of cardiology patients.
Patients who attend the clinic have smart cards that they use at hospitals, clinics, and
Emergency Departments within that region of the state. A primary benefit of the smart card
for these patients would be:
a. rapid and accurate treatment in emergency situations.
b. reduced wait times to see specialists.
c. e-mail notification of test results.
d. readily available information regarding medications.
ANS: B
Credit card–like devices called smart cards store a limited number of pages of data on a
computer chip and serve as a bridge between the clinician terminal and the central repository
of the electronic health record (EHR), making patient information available to the caregiver
quickly and cheaply at the point-of-service. Smart cards provide information to healthcare
providers regarding the patient‘s demographic and contact information, allergies,
immunizations, lab results, and past patient care encounters and are presented at the
point-of-service.
TOP: AONE competency: Business Skills
5. The clinic nurse has just accessed a client‘s chart on the computer. The resident comes over
and asks her to stay logged on because he needs to add a note to that client‘s chart. She should
say:
a. ―No problem. Just log me off when you‘re done.‖
b. ―I‘ll put the note in for you. What do you want to say?‖
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c. ―Just make sure that you sign your note because it‘s under my password.‖
d. ―I‘m sorry, but you will have to enter the information using your own password.‖
ANS: D
System users must never share the passwords that allow them access to information in
computerized clinical information systems. Each password uniquely identifies a user to the
system by name and title, gives approval to carry out certain functions, and provides access to
data appropriate to the user. All users must be aware of their responsibilities for the
confidentiality and security of the data they gather and for the security of their passwords.
TOP: AONE competency: Business Skills
6. A home health nurse has been assigned to cover a 300-square-mile area of remote Montana.
Mrs. Baker has just been discharged home following bowel surgery and has a new colostomy.
She will need daily contacts for at least 2 weeks and then regular weekly contact following
that week. Because it is not possible to visit Mrs. Baker in person every day and see all of the
other clients, the nurse gives her a laptop computer with net meeting software installed. Each
morning, both dial in at an agreed-upon time and discuss her progress. The home health nurse
assesses whether or not the client needs to be seen that day and is able to view the colostomy
site. This type of technology is called:
a. distance learning.
b. knowledge software.
c. telecommunications.
d. biomedical technology.
ANS: C
Telecommunications and systems technology facilitate clinical oversight of health care via
telephone or cable lines, remote monitoring, information links, and the Internet. Patients
sitting in front of the teleconferencing camera can be diagnosed, treated, monitored, and
educated by nurses and physicians. EKGs and radiographs can be viewed and transmitted.
TOP: AONE competency: Business Skills
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7. At a newly built outpatient surgical center, an integrated information system has been
purchased. The chief nursing officer creates a series of staff development classes to orient the
staff to this new system. One of the advantages of an integrated information system is that
client-care data from all sites can be stored in and retrieved from a:
a. nursing information system.
b. central data repository.
c. nurse expert system.
d. handheld device.
ANS: B
Computer information systems manage large volumes of data, examine data patterns and
trends, solve problems, and answer questions. In other words, computers can help translate
data into information from both within and among organizations. Data from all patient
encounters with the healthcare system are stored in a central data repository, where they are
accessible to authorized users. Patient information in a centralized database is organized,
legible, and easily retrievable from a variety of sources and reflects a variety of data.
TOP: AONE competency: Business Skills
8. Nurses need to know how to operate a computer, compare data across time, and look for
patterns in client responses to treatments. These are examples of:
a. JCAHO standards.
b. information systems.
c. informatics competencies.
d. requirements for nursing licensure.
ANS: C
The Quality and Safety Education for Nurses (QSEN) project identified informatics
competency as a necessary component of the knowledge, skills, and attitudes for quality
patient care. Nurses are anticipated to be able to use information and technology to
communicate, manage knowledge, mitigate error, and support decision making. Nurses must
utilize hospital database management, decision support, and expert system programs to access
information and analyze data from disparate sources for use in planning for patient care
processes and systems.
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TOP: AONE competency: Business Skills
9. Leaders in nursing must advocate for information and knowledge systems that support nursing
practice. This is best accomplished by:
a. participating in organizational information technology committees.
b. submitting written requests for needed information systems.
c. requesting budgetary funds needed for systems.
d. sending staff nurses to conferences that discuss cutting-edge technologies.
ANS: A
Nurse leaders and direct care nurses must be members of the selection team, participate
actively, and have a voice in the selection decision. The information system must make sense
to the people who use it and fit effectively with the processes for providing patient care.
TOP: AONE competency: Business Skills
10. You are in the process of designing a patient education program that will provide education
and monitoring for patients with hypertension. To support your planning, you draw out and
present patient data from:
a. a clinical database.
b. biomedical technologies.
c. e-mail.
d. Internet sources.
ANS: A
Clinical databases are collections of elements organized and structured for the processing,
organization, and presentation of data for interpretation as information, which, in this
particular instance, includes outpatient data.
TOP: AONE competency: Business Skills
11. You document your patient‘s vital signs into a bedside documentation device and are able to
compare your patient‘s vital signs with patients who have similar diagnoses and similar
medications, and who are of a similar age. You are accessing:
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a. e-mail.
b. telecommunications.
c. a database.
d. technology.
ANS: C
A database is a collection of data elements stored and organized together for the purposes of
interpreting information such as vital signs.
TOP: AONE competency: Business Skills
12. In an ICU, you order new devices to measure heart rhythm and rate, respiratory rate, oxygen
levels, and intracranial pressure. These devices involve:
a. biomedical technology.
b. telecommunications.
c. retrieval of patient history information.
d. Internet.
ANS: A
Physiologic monitoring devices and patient surveillance systems involve biomedical
technology.
TOP: AONE competency: Knowledge of the Health Care Environment
13. As the head nurse involved in leading determination of which patient surveillance systems to
acquire for your unit, one of your aims is to avoid adverse events through the implementation
of appropriate technology. This particular aim recognizes that:
a. human error is significant in contributing to adverse events.
b. documentation of patient data is often illegible and therefore, misinterpreted.
c. data systems provide backup documentation with adverse events that staff cannot
provide.
d. physiologic monitoring systems enable detection of early changes before an
adverse event occurs.
ANS: D
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Data about adverse events suggests that a majority of physiologic abnormalities are not
detected early enough and may be present hours before the event actually occurs. Physiologic
monitoring aids in early detection of changes.
TOP: AONE competency: Knowledge of the Health Care Environment
14. A 39-year-old patient awaits a kidney transplant. Because he must immediately arrange to get
to the hospital when a donor kidney is available, it is important that he can be reached
anywhere and at any time. To ensure that he receives the message, what type of technology is
most effective?
a. Internet
b. Telecommunications
c. WL pager
d. CDS
ANS: C
Wireless (WL) communication is an extension of an existing wired network environment and
uses radio-based systems to transmit data signals through the air without any physical
connections. Patients awaiting organ transplants are provided with WL pagers so that they can
be notified if a donor is found.
TOP: AONE competency: Business Skills
15. A recent nursing graduate in a busy Emergency Department triages a patient who has
sustained a large, deep puncture wound in his foot while working at a construction site. He is
bleeding and is in pain. The nurse enters the triage data that she has obtained from the patient
into a computerized, standard emergency patient-classification system. After she enters the
assessment data, she notices an alert on the computer screen that prompts her to ask the
patient about the status of his tetanus immunization. What system of technology is involved in
generating the alert?
a. Clinical decision support
b. WL technology
c. Computerized provider order
d. Electronic health record
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ANS: A
Clinical decision support (CDS) is a clinical computer system, computer application, or
process that helps health professionals make clinical decisions to enhance patient care. The
clinical knowledge embedded in computer applications or work processes can range from
simple facts and relationships to best practices for managing patients with specific disease
states, new medical knowledge from clinical research, and other types of information.
TOP: AONE competency: Business Skills
16. Despite the implementation of bar-code medication administration (BCMA) on your busy
medical unit, you notice that the number of medication errors has not significantly decreased.
Which of the following reasons might explain the lack of change in errors?
a. A number of new medications have been introduced into the hospital pharmacy
that are not yet recognized in the CDS.
b. There have been an unusually high number of patients on the unit who have been
unable to confirm their identity at the time of medication administration.
c. Lack of staff understanding and support for BCMA has led to overrides or failures
to scan bar codes during busy times.
d. Clinical data that have been entered into the system to guide administration of the
medications are outdated.
ANS: C
Most errors related to technology involve mislabeled bar codes on medications, mistakes at
order entry because of confusing computer screens, or issues with management of
information. Errors also are related to dispensing devices and human factors, such as failure to
scan bar codes or overrides of bar-code warnings.
TOP: AONE competency: Business Skills
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17. A rural-urban health consortium enables physicians in a rural remote setting to consult with
specialists in care through electronic conferencing, which includes consultation using intranet
radiology images. This system may be in which phase of electronic medical technology
adoption, according to the Healthcare Information and Management Systems Society
(HIMSS)?
a. 0
b. 1
c. 3
d. 6
ANS: D
According to the HIMSS, this healthcare organization may be in phase 6, which includes the
capacity to transmit all radiology images through intranet or another secure source. Level 1
refers to the installation of major ancillary clinical systems (such as radiology) and level 3 to
the retrieval of radiology images from picture archives and communication systems.
TOP: AONE competency: Business Skills
18. As a nurse manager representative on a clinical information system selection team, you would
be particularly concerned if the favored system:
a. involves screen displays that are best configured for nonclinical users.
b. requires an upgrade to servers in the facility.
c. requires staff orientation and training during implementation of the software.
d. minimizes the amount of data entry necessary.
ANS: A
An ideal hospital information system should include as much instrumentation as possible to
minimize data entry. As a clinical end user, you would expect orientation and training on how
the screen display can be configured so as to suit the purposes and preferences of users in
clinical areas.
TOP: AONE competency: Business Skills
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19. When assessing the appropriateness of adopting WL COWs for a nursing unit, you need to
consider the advantages, which include:
a. mobility of the carts.
b. small display screen.
c. font size.
d. speed of operation.
ANS: A
Installing computers on mobile carts, also known as computers on wheels or COWs, may
increase work efficiency and save time. However, if the cart is cumbersome to move around
or if concern about infection risk is associated with moving the cart from one room to another,
some organizations favor keeping one cart stationed in each patient care room or installing
hardwired bedside computers.
TOP: AONE competency: Business Skills
20. A nurse manager is excited by the possible use of speech recognition (SR) systems for
documentation of patient care, especially during crisis situations when staff members need to
focus on performing rapid assessments and implementation of procedures. She learns,
however, that SR systems would be impractical at this point. What would lead to this
conclusion?
a. SR systems are not available outside pilot projects.
b. The type of speech required for voice recognition is unlikely to occur in a
pressured situation.
c. The hands-free function has not been perfected in SR technology.
d. Wireless communications are prone to unreliability in transmission.
ANS: B
Speech recognition systems rely on staccato-like speech, pauses between words, and
programming for each user, any and all of which would be unlikely in a pressured crisis
situation. SR is being used primarily for therapeutic purposes and in situations where data
entry is stable.
TOP: AONE competency: Business Skills
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21. As a nurse manager, one challenge is to orient new staff to your agency‘s policies and
procedures, as well as to provide training across various shifts. A cost-effective and effective
learning strategy would be:
a. development of new learning modules and software to support document retrieval.
b. e-mail distribution to staff home e-mail addresses regarding important policies.
c. preparation of DVDs that can be viewed on computers at the nursing station during
―down times.‖
d. linking policies and procedures to the network for access when required at the
point-of-care.
ANS: D
Knowledge technology consists of systems that generate or process knowledge and provide
clinical decision support (CDS). The clinical knowledge embedded in computer applications
can range from simple facts and relationships to best practices for managing patients with
specific disease states, new medical knowledge from clinical research, and other types of
information. The most accessible and cost-effective approach would be utilization of what is
already available in the work environment, such as the systems that provide CDS.
TOP: AONE competency: Business Skills
22. A necessary, basic condition for successful integration of clinical information systems is:
a. software.
b. standard medical nomenclature.
c. confirmatory evidence from nursing-led studies.
d. strong interdisciplinary cultures.
ANS: D
An integrated clinical information system draws on specific knowledge from many involved
disciplines that interface at the patient. Successful integration of clinical information systems
requires that the various disciplines work together collaboratively to transform the data into
meaningful knowledge.
TOP: AONE competency: Communication and Relationship-Building
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23. To improve outcomes on the stroke recovery unit, the unit manager leads an evidence-based
practice (EBP) project. The goal of this project is to:
a. enable detection of variations in clinical outcomes from well-researched standards
that are supported by confirmatory evidence.
b. gain quick access to literature based on studies of patients and families who have
experienced stroke.
c. develop a list of articles that could be accessed to address clinical issues and
problems with stroke patients.
d. advance the development of staff who are able to conduct independent nursing
research on stroke outcomes.
ANS: A
Several ―intelligent‖ clinical information systems are in place that collect good data and then
translate nursing knowledge, such as well-researched standards, into reference materials at
the point-of-care. In addition, computer applications assist nurses to take action and provide
patient care based on the best evidence for practice.
TOP: AONE competency: Business Skills
24. As part of an information technology implementation team, you are implementing a clinical
decision support system. Particular considerations for successful implementation of this
project include:
a. ensuring that the system is reliable.
b. ensuring that patient information is reliable.
c. developing unique identifiers for individuals.
d. developing rules that support inferences.
ANS: D
Clinical decision support systems provide support for novice nurses, in particular, as they
enable entry of real-time data from patient situations and inferences that apply the logic that
expert nurses would use. These inferences require rules to be developed for the system.
TOP: AONE competency: Knowledge of the Health Care Environment
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MULTIPLE RESPONSE
1. As a nurse manager, you want to institute point-of-care devices on your unit. The rationale
that you provide to support the point-of-care devices includes: (Select all that apply.)
a. reduction in incidents of medication error.
b. immediate documentation of care.
c. comparison of patient data with previous data.
d. immediate access to staffing schedules.
ANS: A, B, C
Point-of-care devices that allow documentation of assessment, care, and teaching at the
bedside reduce the gap in time between care and documentation, thereby reducing error,
increasing accuracy, and improving communication of care. Medication devices and patient
databases enable accurate clinical decision making.
TOP: AONE competency: Business Skills
Chapter 18: Artificial Intelligence
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
MULTIPLE CHOICE
1. Nurses need to prepare for the eventual infusion of systems that possess
knowledge-generating capabilities such:
a. artificial intelligence.
b. data, information, and knowledge.
c. contemporary digital health technologies.
d. wireless technology, voice recognition, and handheld devices.
ANS: A
Preliminary evidence generated in the academic literature suggest that the wider-scale
adoption of these kinds of intelligent systems is in the not-too-distant future.
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TOP: AONE competency: Knowledge of the Health Care Environment
2. As artificial intelligence devices emerge, it is important that at least a core of nurses engaged
in the work that leads to improvement of AI-related devices to ensure that:
a. if it doesn‘t work, they are not to blame.
b. the thinking of nurses is a part of the development process.
c. it meets their standards.
d. they can contact the manufacture about complaints.
ANS: D
Having at least a core of nurses engaged in the work that leads to improvement of AI-related
devices ensures that the thinking of nurses is a part of the developmental process.
TOP: AONE competency: Knowledge of the Health Care Environment
3. Medication errors which directly resulted from the redevelopment of processes and workflow
brought about by the implementation of BCMA are considered:
a. unintended consequences related to technology.
b. intended response to change.
c. reasons to return to paper-based medication administration processes.
d. an expected response to technology-based nursing.
ANS: A
Considerable research has been completed about unintended consequences related to health
technology (Ash et al., 2007; Gephart et al., 2015; Snowden & Kolb, 2016). Increasing
recognition of technology can and will influence the actions of humans in both intended and
unintended.
TOP: AONE competency: Knowledge of the Health Care Environment
4. Technology can influence human social systems and humans can reciprocally influence
technology. This relationship is known as:
a. knowledge.
b. informatics.
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c. wisdom.
d. sociotechnical.
ANS: B
Although we can conceptualize and view the nuanced relationship humans have with
technology in many ways, we suggest a sociotechnical systems lens to better understand this
relationship (Berg et al., 2003).
TOP: AONE competency: Knowledge of the Health Care Environment
5. The cascading continuum that is extremely important when exploring digital health
technology, especially with some of the modern technologies present today is:
a. data-information-knowledge-wisdom
b. tools-technology-intelligence-response
c. illness-symptoms-treatment-nursing care
d. automation-task-ability-hybridized
ANS: A
Data-information-knowledge-wisdom, while appearing logical, is extremely important when
exploring digital health technology, especially with some of the modern technologies present
today. Unfortunately, many of the digital health technologies used by nurses today lack
sensitivity to various elements of nursing knowledge and wisdom.
TOP: AONE competency: Knowledge of the Health Care Environment
6. The nurse can identify various apparatuses, processes, or systems that have experienced some
form of automation. Tasks and processes undertaken by nurses that introduce some level of
automation include :
a. electronic medical records (EMR).
b. point-of-care devices.
c. telecommunications.
d. barcode medication administration (BCMA).
ANS: C
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All contemporary digital health technologies—including EMR, BCMA, and point-of-care
devices—introduce some level of automation on tasks and processes undertaken by nurses..
TOP: AONE competency: Knowledge of the Health Care Environment
7. Nurses complete many tasks that requiring skill, judgment, fine motor control, and other types
of expertise that are difficult to replicate with AI. One such skill would be:
a. collection of materials and supplies.
b. wound care.
c. contacting members of the care team.
d. screening applicants for open positions.
ANS: B
Many of the tasks completed by nurses are extremely nuanced, requiring skill, judgment, fine
motor control, and other types of expertise that are difficult to replicate mechanically. Wound
care is an extremely knowledge-intense task due to the complexity of wound healing, patient
complexity, dressing products, treatment trajectory, and a host of other important clinical and
contextual factors.
TOP: AONE competency: Knowledge of the Health Care Environment
8. An AI-enabled care management system used in an American healthcare context
systematically underestimated the healthcare needs of predominantly Black patients. This is
an example of:
a. stereotyping.
b. situational awareness.
c. automation of inequities.
d. task automation.
ANS: C
Automation of inequities is a phrase that has become a term used by both researchers and the
media to denote the occurrence of when a self-learning technology unintentionally reinforces
systematic biases or other types of inequity during its insight generation (Bullock, 2019;
Eubanks, 2018).
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TOP: AONE competency: Knowledge of the Health Care Environment
9. The nurse in a large hospital working in the emergency room is caring for a patient having a
myocardial infarction. The hospital has recently implemented an order entry system that uses
artificial intelligence (AI). The nurse should be aware that AI should never take the place of:
a. knowledge and wisdom.
b. nurses notes.
c. nursing experience.
d. tasks and procedures.
ANS: A
The types of knowledge and wisdom brought by nurses is extremely difficult to functionally
replicate within technology.
TOP: AONE competency: Business Skills
10. The term data refers to the smallest unit of insight, commonly presented without background
context, and possesses little meaning in isolation:
a. data.
b. information.
c. knowledge.
d. wisdom.
ANS: A
Data is the smallest unit of insight, for example the number 150.
TOP: AONE competency: Knowledge of the Health Care Environment
11. Information that could be conceived as data that has been further contextualized to possess
meaning, ―data plus meaning‖, is:
a. data.
b. information.
c. knowledge.
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d. wisdom.
ANS: B
Information is described by Matney et al. (2011) as ―data plus meaning‖. Therefore,
information could be conceived as data that has been further contextualized to possess
meaning. For instance, the number 110 and 70 are both meaningless data. If the numbers of
110 and 70 are placed within the context and alignment of representing a blood pressure
reading measured in millimeters of mercury (mm Hg), then the 110 and 70 can become
evolved into information. W.
TOP: AONE competency: Knowledge of the Health Care Environment
12. ―Information that has been synthesized so that relationships are identified and formalized‖ is
referred to as:
a. data.
b. information.
c. knowledge.
d. wisdom.
ANS: C
It is knowledge that allows a practitioner to rationalize through the information and promote
the 110 and 70 in light of the correct context (i.e., systolic, diastolic measurements) and
reasoning into knowledge.
TOP: AONE competency: Knowledge of the Health Care Environment
13. Actualized knowledge that uses insight to ―manage and solve human problems‖ is:
a. data.
b. information.
c. knowledge.
d. wisdom.
ANS: D
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While knowledge is one of the higher levels of insight that a practitioner can possess, the
extension to wisdom takes actualized knowledge and uses this insight to ―manage and solve
human problems‖. Therefore, knowing a blood pressure of 110/70mm Hg was within a
normal range would allow a clinician to execute wisdom traits and actions to man_age the
care of a patient—including continuing clinical treatment and interventions for a patient
presentation in which a blood pressure of 110/70mmHg is deemed normal.
TOP: AONE competency: Knowledge of the Health Care Environment
14. The use of AI intelligence in healthcare is to help nurses:
a. see more patients in a shorter amount of time.
b. decrease the need for nurses to further their education
c. provide data to assist the nurses to make decisions.
d. make patient decisions
ANS: C
Nurses need to prepare for the eventual infusion of systems that possess
knowledge-generating capabilities such as those found with AI.
TOP: AONE competency: Business Skills
15. A recent nursing graduate in a busy Emergency Department triages a patient who has
sustained a large, deep puncture wound in his foot while working at a construction site. He is
bleeding and is in pain. The nurse enters the triage data that she has obtained from the patient
into a computerized, standard emergency patient-classification system. After she enters the
assessment data, she notices an alert on the computer screen that prompts her to ask the
patient about the status of his tetanus immunization. What system of technology is involved in
generating the alert?
a. Clinical decision support (CDS)
b. WL technology
c. Computerized provider order
d. Electronic health record
ANS: A
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Clinical decision support (CDS) is a clinical computer system, computer application, or
process that helps health professionals make clinical decisions to enhance patient care. The
clinical knowledge embedded in computer applications or work processes can range from
simple facts and relationships to best practices for managing patients with specific disease
states, new medical knowledge from clinical research, and other types of information.
TOP: AONE competency: Business Skills
16. Despite the implementation of bar-code medication administration (BCMA) on your busy
medical unit, you notice that the number of medication errors has not significantly decreased.
Which of the following reasons might explain the lack of change in errors?
a. A number of new medications have been introduced into the hospital pharmacy
that are not yet recognized in the CDS.
b. There have been an unusually high number of patients on the unit who have been
unable to confirm their identity at the time of medication administration.
c. Lack of staff understanding and support for BCMA has led to overrides or failures
to scan bar codes during busy times.
d. Clinical data that have been entered into the system to guide administration of the
medications are outdated.
ANS: C
Most errors related to technology involve mislabeled bar codes on medications, mistakes at
order entry because of confusing computer screens, or issues with management of
information. Errors also are related to dispensing devices and human factors, such as failure to
scan bar codes or overrides of bar-code warnings.
TOP: AONE competency: Business Skills
17. Robotics within healthcare environments can conceivably be described as task automating
systems. Using devices such as TUG or Moxi can improve nurses‘ efficiency by:
a. reducing the number of retrieval trips to various areas when supplies on a unit are
inadequate
b. making decisions about the care a patient is to receive.
c. entering physician‘s orders into the hospital data system.
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d. performing minor surgical procedures.
ANS: A
The Moxi robot that can assist nurses with a variety of lower-knowledge tasks, including the
collection of supplies, delivering lab samples, distribution of personal protective equipment,
and couriering of medications. TUG boast similar functionalities in terms of being able to
ferry equipment and supplies around a healthcare environment.
TOP: AONE competency: Business Skills
18. As a nurse manager, one challenge is to orient new staff to your agency‘s policies and
procedures, as well as to provide training across various shifts. A cost-effective and effective
learning strategy would be:
a. development of new learning modules and software to support document retrieval.
b. e-mail distribution to staff home e-mail addresses regarding important policies.
c. preparation of DVDs that can be viewed on computers at the nursing station during
―down times.‖
d. linking policies and procedures to the network for access when required at the
point-of-care.
ANS: D
Knowledge technology consists of systems that generate or process knowledge and provide
clinical decision support (CDS). The clinical knowledge embedded in computer applications
can range from simple facts and relationships to best practices for managing patients with
specific disease states, new medical knowledge from clinical research, and other types of
information. The most accessible and cost-effective approach would be utilization of what is
already available in the work environment, such as the systems that provide CDS.
TOP: AONE competency: Business Skills
19. To improve outcomes on the stroke recovery unit, the unit manager leads an evidence-based
practice (EBP) project. The goal of this project is to:
a. enable detection of variations in clinical outcomes from well-researched standards
that are supported by confirmatory evidence.
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b. gain quick access to literature based on studies of patients and families who have
experienced stroke.
c. develop a list of articles that could be accessed to address clinical issues and
problems with stroke patients.
d. advance the development of staff who are able to conduct independent nursing
research on stroke outcomes.
ANS: A
Several ―intelligent‖ clinical information systems are in place that collect good data and then
translate nursing knowledge, such as well-researched standards, into reference materials at
the point-of-care. In addition, computer applications assist nurses to take action and provide
patient care based on the best evidence for practice.
TOP: AONE competency: Business Skills
20. As part of an information technology implementation team, you are implementing a clinical
decision support system. Particular considerations for successful implementation of this
project include:
a. ensuring that the system is reliable.
b. ensuring that patient information is reliable.
c. developing unique identifiers for individuals.
d. developing rules that support inferences.
ANS: D
Clinical decision support systems provide support for novice nurses, in particular, as they
enable entry of real-time data from patient situations and inferences that apply the logic that
expert nurses would use. These inferences require rules to be developed for the system.
TOP: AONE competency: Knowledge of the Health Care Environment
MULTIPLE RESPONSE
1. Automation technologies such as Moxi and TUG speaks to an emergent reality that the
nursing profession must reflect on, including (Select all that apply.)
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a. tasks that should be allocated or provided to nonhuman service drones
b. deciding the tasks that nonhuman service drones will adopt.
c. nursing profession being eliminated due to robotics.
d. drone robots and other task automation technologies being factored into the
clinical processes, care models, and health system delivery attributes of the future.
ANS: A, B, D
The use of process automation technologies also presents a range of evolving existential
questions for the profession to consider, including (1) how much automation will be tolerated
by clinicians and patients?; (2) what types of activities, knowledge, and behaviors can or
should be automated?; and (3) what are the intended and unintended consequences of
amplifying automation of nursing-centric activities and knowledge?
TOP: AONE competency: Business Skills
Chapter 19: Managing Costs and Budgets
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
MULTIPLE CHOICE
1. The chief nursing office of a Magnet® hospital has conducted a study of ways to improve
healthcare services. Healthcare services that add value for clients:
a. accomplish healthcare goals.
b. minimize costs.
c. decrease the number of services used.
d. use high-technology treatments.
ANS: B
Models of reimbursement affect which services and approaches (e.g., decreasing the number
of services used) might be financially viable and add value for clients. It is critical to
determine and advertise the value of nursing care. Services that add value are of high quality,
affect health outcomes positively, and minimize costs.
TOP: AONE competency: Business Skills
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2. The difference between a nurse practitioner‘s charge of $45 for an office visit and the
insurance company‘s payment of $34 is:
a. a contractual allowance.
b. a profit.
c. a flat rate.
d. revenue.
ANS: A
Because the amount that is allowed for an office visit is less than the amount that the NP
charges, this is known as a contractual allowance or discount. If the amount allowed were
more than what the NP charges, then a profit would be realized. All of the answers represent
sources of revenue.
TOP: AONE competency: Business Skills
3. The chief nursing office continues to seek ways to improve healthcare services to clients and
to save the hospital money. However, with the federal guidelines of paying agencies based on
capitation, the chief nursing office faces a challenge. Capitation provides incentives for
healthcare providers to control costs by:
a. providing fewer services to fewer clients.
b. using fewer services per client.
c. using high-technology treatments.
d. requiring second opinions.
ANS: B
In a capitated environment, a single fee is paid for all services provided. To be financially
viable under this reimbursement model, organizations would be interested in decreasing the
volume of services used and increasing the volume of patients. High-technology treatments
and second opinions may increase the number of services used.
TOP: AONE competency: Business Skills
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4. In a nurse managers‘ meeting, the chief nursing officer encourages the managers to brainstorm
ways to reduce costs. Nurse managers have the greatest impact on reducing costs by
managing:
a. supplies.
b. staffing.
c. fixed costs.
d. medication costs.
ANS: B
Because staffing constitutes the largest portion of any healthcare budget, managing the mix
and numbers of staff required for patient care to meet identified outcomes will have the largest
impact on budgets.
TOP: AONE competency: Business Skills
5. The chief nursing officer works with her nurse managers by helping them understand how to
develop and implement a budget. A nurse manager can best describe a budget as a:
a. day-to-day plan for operations.
b. unit of service.
c. statement of revenues and services.
d. financial plan.
ANS: D
The budget is an overall financial plan that reflects organizational assumptions, objectives,
and standards, and various types of budget planning, including operational and capital
budgets, which, in turn, reflect revenues and costs.
TOP: AONE competency: Business Skills
6. A nurse manager approves two staff nurses to attend a national conference. When reviewing
the budget, the nurse manager looks at which line item?
a. Cash budget
b. Capital budget
c. Operating budget
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d. Supply and expense budget
ANS: C
The operating budget includes a personnel budget, which takes into account productive and
nonproductive paid work hours. Education hours are covered under nonproductive paid work
hours in the operating budget.
TOP: AONE competency: Business Skills
7. A staff nurse regularly works two 12-hour shifts each week and one 8-hour shift every other
week. How many FTEs is this position?
a. 0.6
b. 0.7
c. 0.8
d. 1
ANS: B
Assuming that a full-time RN works 2080 hours/year (40 hours  52 weeks), the nurse works
(24 hours  52 weeks + 8 hours  26 weeks)/2080, which is 0.7 FTE.
TOP: AONE competency: Business Skills
8. After reviewing her monthly budget report, the nurse manager sees that she has a negative
variance, which prompts her to change the staffing schedule. A negative or unfavorable
variance in a monthly expense report may result from:
a. overestimation of inflation.
b. higher than expected client acuity.
c. net revenue exceeding net expenses.
d. not replacing staff who called in sick.
ANS: B
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Variance reflects the difference between what was projected and the actual performance in a
budget. When the variance is negative or unfavorable, the amount spent is more than what
was budgeted (expenses exceed revenue); this may be a result of higher acuity. To help
managers interpret and use variance information better, some institutions use flexible budgets
that automatically account for census variances.
TOP: AONE competency: Business Skills
9. An example of an initiative that may reduce total healthcare costs would be:
a. offering nurse practitioner–led clinics that educate parents about
nonpharmacologic strategies for managing ear infections.
b. educating seniors about the comparative costs of medications that are prescribed to
them.
c. lowering copayments for prescription drugs for seniors.
d. advocating for more readily available MRI services to ensure early diagnosis.
ANS: A
Total healthcare costs are a function of prices that are established for various services and the
volume or quantity of services used. Utilization of high-tech diagnostic services and lowering
of copayments have been implicated in increasing total healthcare costs (thus C and D would
not be correct), as well as attitudes and behaviors of consumers of health care. In general,
consumers prefer to ―be fixed‖ when something goes wrong rather than to practice prevention.
Many consumers still believe that the physician knows best, so they do not seek much
information related to costs and effectiveness of different healthcare options. When
information is sought, it is not readily available or understandable. Also, consumers are not
accustomed to using other, less costly healthcare providers, such as nurse practitioners.
TOP: AONE competency: Business Skills
10. Which of the following factors is not implicated in rising healthcare costs?
a. Rising expectations of consumers for cure and care
b. Marketing of drugs to consumers
c. Large administrative staffs to process medical billings
d. Rising Medicare costs
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ANS: D
Unintentional injuries, socioeconomic conditions (e.g., poverty and violence), marketing of
pharmaceuticals, and the rising expectations of consumers with regard to what should be done
to manage health concerns all contribute to rising healthcare costs. The costs of Medicare are
not considered in relation to rising costs of health care.
TOP: AONE competency: Knowledge of the Health Care Environment
11. An older adult couple with limited means and on Medicare is considering options after the
hospitalization of Mrs. A. with a fractured hip. Mrs. A. is stable but requires assistance with
bathing, transfer, and mobility, and this will present stress for Mr. A., who was hospitalized
with a mild myocardial infarction last year. Considering their means and health concerns,
which of the following might be the best option?
a. Hospice care
b. Custodial nursing home care
c. Home care
d. Hospital care
ANS: C
Custodial nursing care is not covered under Medicare and therefore, the financial burden of
this option may cause further stress for the couple. Medicare Part A is an insurance plan for
hospital, hospice, home health, and skilled nursing care that is paid for through Social
Security. Because Mrs. A. is stable and not terminal, she does not require hospice care. The
assistance provided through home care is covered under Medicare and provides assistance for
needs such as those of Mrs. A.
TOP: AONE competency: Knowledge of the Health Care Environment
12. After a major flu vaccination campaign, an agency bills a private insurance company for
allowable costs for administration of each vaccination according to the schedule established
by the insurance company for reimbursement. This is an example of which major payment
method?
a. Cost-based reimbursement
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b. Charges
c. Contractual allowance
d. Prospective reimbursement
ANS: A
Because the agency is submitting costs after the campaign is completed and in accordance
with an established schedule of allowable costs, a retrospective, cost-based reimbursement
payment method is being utilized. If a desire for profit was indicated, then the answer would
be ―charges.‖
TOP: AONE competency: Business Skills
13. Physicians in a small urban hospital are reluctant to discharge older adult patients because
many of the patients lack private insurance and the resources to travel distances for follow-up
care. The hospital administration pressures the physicians to discharge patients sooner and to
be more consistent with the number of hospitalization days specified within the DRGs. Which
of the following would most likely prompt the action of administrators?
a. The hospital is incurring a deficit related to a gap between the PPS and the DRGs
and costs of care.
b. Local home care services are expressing concern about the increased acuity of
patients being discharged into their care.
c. The resource-based relative scale for physicians does not account for the increased
length of stay.
d. Acute care patients are being denied entry to the hospital because of the increased
stay of patients.
ANS: A
Length of stay (LOS) is the most important predictor of healthcare costs and extra days are a
cost to the organization in terms of both the extra days and decreased patient volume. The
situation, as outlined, does not indicate that there is a bed shortage and therefore, there is no
evidence that other patients are being denied access to services or that additional patient
volume is not being captured. The hospital would be concerned about the impact on its
income because of the additional, uncompensated care costs incurred for patients who exceed
the usual length of stay explicitly calculated under PPS and the DRGs.
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TOP: AONE competency: Business Skills
14. Within a healthcare environment, where the gap between revenues and costs can mean the
difference between sustainability of an organization and nonsustainability of an organization
or services, it is critical for nurse managers to:
a. maintain a clear vision of how to trim healthcare costs.
b. balance value-added services against costs and revenues.
c. consistently delete programs that are of high cost.
d. implement programs that bring in additional revenues.
ANS: B
To achieve and maintain financial viability, nurse managers must be able to think strategically
financially and in terms of nursing care. Cutting costs by deleting programs and bringing in
additional revenue through new programs and services are not in themselves strategic unless
the decisions made lead to quality care, have positive outcomes, and are efficient in terms of
cost.
TOP: AONE competency: Business Skills
15. Because of the complexity of reimbursement systems and its implications for the services
available to patients, the nurse has a key role in:
a. advocacy for patients with regard to services required and services utilized.
b. increasing the volume of services and decreasing the number of patients served.
c. accomplishing more with each visit and decreasing the volume of services used.
d. decreasing the volume of services used and the number of return visits.
ANS: A
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The specific strategies employed by organizations and nurses to contain costs and increase
revenues depend on the reimbursement system(s) within which the organization operates and
therefore on whether the volume of services is increased or whether the volume of services is
decreased by placing greater emphasis on efficacy in each visit and reducing the number of
return visits. Because of the complexity of the reimbursement environment, the nurse is
placed in a position of advocacy in terms of what the patient needs and how those needs can
be best met within the funding structures.
TOP: AONE competency: Knowledge of the Health Care Environment
16. Of the following, which is the most effective strategy that a nurse manager could employ to
reduce unnecessary costs in specific healthcare settings?
a. Training nurses on accurate documentation of supplies used for patient care
b. Reducing the number of overtime hours worked by staff
c. Reducing the number of staff on a unit
d. Making decisions for patients about which care is important to their health
ANS: A
Reducing overtime hours needs to be carefully assessed against the reasons for overtime (e.g.,
staff overload, recent illnesses, increased acuity) in terms of whether this reflects an ongoing
or temporary situation and therefore whether it is a necessary variance or not. Reducing staff
may or may not be effective, depending on the services being provided. Making decisions for
the patient misses an important opportunity to invite the patient into discussion about patient
priorities and needs and relative costs of options, which may lead to improved adherence with
regimens and less waste of resources. An effective approach to cost containment is ensuring
that supplies are accurately accounted for and charged in a timely manner.
TOP: AONE competency: Business Skills
17. In preparing her budget, a nurse manager determines that she needs to budget for six FTE RN
positions in the upcoming year. Based on a 40-hour week, this means that the nurse manager
has determined that the budget will provide for
hours.
a. 12,480 productive
b. 10,820 productive
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c. 12,480 paid
d. 10,800 patient care
ANS: C
From the information given, it is not possible to determine how many nonproductive hours
(vacation, holiday, sick time, education) the nurse manager has accounted for in her budget
calculations and therefore whether the total number of hours (40 hours  52 weeks  6 staff =
12,480 paid hours) is productive (paid time that is worked) or nonproductive hours. 12,480
accurately reflects the total number of hours of work paid per year.
TOP: AONE competency: Business Skills
18. In preparing her budget, a nurse manager determines that she needs to budget for six FTE RN
positions in the upcoming year. The nurse manager determines that RN 1 has 5 weeks of
vacation and 3 days of education and has averaged 3 sick days a year. RN 2 has 6 weeks of
vacation, has asked to attend a 3-day conference and a 2-day workshop, and has no history of
sick time. RN 3 is new, and you anticipate 3 weeks of orientation, as well as 4 weeks of
vacation. RN 4 has 6 weeks of vacation and has an ongoing health condition, so you anticipate
2 weeks of sick time, as well as 3 days for education. RN 5 has 5 weeks of vacation, has no
education planned, and averages 5 sick days per year. RN 6 has 6 weeks of vacation, has no
educational opportunities planned, and has been off ill for 4 weeks. How many hours of
productive paid time can be anticipated for the budget?
a. 12,480
b. 11,200
c. 10,848
d. 10,688
ANS: C
From the information given, there are 32 weeks of vacation (40 hours  32 weeks = 1280
hours), 11 days of education (11 days  8 hours = 88 hours), 15 days of orientation (15 days 
8 hours = 120 hours), and 18 days of sick time anticipated (18 days  8 hours = 144) or 1280
+ 88 + 120 + 144 = 1632 hours of nonproductive time. This will leave 10,848 hours of
productive time available, based on the information available and the fact that the manager is
not anticipating sick time for RN 6 in the upcoming budget year.
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TOP: AONE competency: Business Skills
19. The primary reason for calculating productive hours paid instead of simply calculating work
paid per year is that productive hours enable the manager to:
a. anticipate total costs for patient care.
b. know how much time staff will likely be unavailable because of illness.
c. determine when orientation needs to occur for new staff.
d. determine the number of hours available for patient care.
ANS: D
Total hours are critical for determining the total number of hours that need to be paid for the
year. Productive hours are needed to determine what hours are actually available for patient
care. The number of FTEs required is determined by dividing the total patient care hours
required by the number of productive hours.
TOP: AONE competency: Business Skills
20. In preparing a budget, the nurse manager needs to anticipate the cost of benefits (e.g., health,
life insurance, pension, and retirement plans). Based on the usual cost of benefits, how much
should a nurse manager include for a total full-time salary cost of $312,000?
a.
$78,000 to $93,600
b.
$62,400 to $78,000
c. $46,800 to -$93,600
d. $31,200 to $46,800
ANS: C
The average cost of benefits is approximately 25% to 30% of a full-time employee‘s salary. In
this example, the correct response is obtained by multiplying the total full-time salary cost by
0.25 and 0.30.
TOP: AONE competency: Business Skills
21. A nurse manager is planning to request three new infusion pumps at a cost of approximately
$1500 each. This item would typically be included in which budget?
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a. Operating
b. Strategic
c. Unit of service
d. Capital
ANS: D
Items that have a useful life of longer than a year, which is likely with the pumps, and that
have a cost that usually exceeds $300 to $1000 (specific amount is set by the organization) are
considered capital items. Operating budget items include what is used on a day-to-day basis,
such as staffing.
TOP: AONE competency: Business Skills
22. A nurse manager is planning to request three new infusion pumps at a cost of approximately
$1500 each. What would BEST support the capital request?
a. Number of patient care hours anticipated for the year
b. Cost comparisons; how much and how often infusion pumps are used; condition of
existing pumps
c. Outline of cost for each pump
d. Estimation of total cost; no further details
ANS: B
Complete well-documented justifications are needed because the competition for limited
resources is stiff. Justifications should be developed using the principle of any business case
and should include, at minimum, projected amount of use; services duplicated or replaced;
safety considerations; need for space, personnel, or building renovation; effect on operational
revenues and expenses; and contribution to the strategic plan.
TOP: AONE competency: Business Skills
23. As an experienced nurse manager who is new to an organization, it would be important to:
a. know the difference between operating and capital budgets.
b. understand the budget timetable and level of involvement expected of individual
managers in budget preparation.
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c. know why a budget is essential to the well-being of an organization.
d. understand what factors drive up healthcare costs in the healthcare system.
ANS: B
Although all of the answers reflect knowledge that is critical to budgeting for nurse managers,
an experienced nurse manager would likely be already familiar with general knowledge
related to budgeting. The nurse manager, however, would need to become familiar with
budget timetables and level of involvement expected in this specific organization because
these elements of budgeting vary from work environment to work environment.
TOP: AONE competency: Business Skills
24. A nurse manager discovers that the actual number of visits per patient in a home health
service is 3.8 visits per day when the standard is 5 visits per day. Based on this information,
the nurse manager:
a. concludes that the complexity of care in each visit has arisen.
b. concludes that patient volume has been decreased.
c. decides that more information is needed before a conclusion can be reached.
d. initiates a training session regarding the importance of ensuring that visits are
made.
ANS: C
Variance from measures of productivity or ratio of outputs to inputs does not necessarily offer
an explanation of whether or not care was delivered as needed. Before proceeding to any
further conclusion, the nurse manager will need to investigate reasons for the decreased
output.
TOP: AONE competency: Business Skills
MULTIPLE RESPONSE
1. Which of the following are considered variable costs? (Select all that apply.)
a. Salaries for the minimum number of staff
b. Utilities and rent
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c. Managed care
d. Supplies
e. Medication and treatment supplies
ANS: D, E
The total fixed costs in a unit are those costs that do not change as the volume of patients
changes. In other words, with either a high or a low patient census, expenses related to rent,
utilities, loan payments, administrative salaries, and salaries of the minimum number of staff
to keep a unit open must be paid. Variable costs are costs that vary in direct proportion to
patient volume or acuity. Examples include nursing personnel, supplies, and medications.
TOP: AONE competency: Business Skills
Chapter 20: Selecting, Developing, and Evaluating Staff
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
MULTIPLE CHOICE
1. The nurse manager schedules evaluations of staff members using a newly developed
performance appraisal tool. The development of a performance appraisal tool should include:
a. organizational mission, philosophy, and position requirements.
b. a generalized overview of the duties of a position.
c. a skills checklist and accreditation requirements.
d. an ordinal scale that ranks all employees.
ANS: A
Performance appraisal tools and processes should reflect the organizational mission and
philosophy, as well as position requirements.
TOP: AONE competency: Business Skills
2. John, a new graduate, reviews the employee evaluation for his new position. The first section
requires that he list his own specific objectives to be accomplished. This is an example of:
a. the traditional rating scale.
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b. learning goals, or management by objectives.
c. a forced distribution scale.
d. a behavior-anchored rating scale.
ANS: B
In management by objectives, the employer and the employee jointly establish clear and
measurable objectives for the next performance period.
TOP: AONE competency: Business Skills
3. John notes that the next section is specific to the organizational philosophy and has a 4-point
ordinal scale that describes performance from ―always meets expectations‖ to ―does not meet
expectations.‖ This type of evaluation is most commonly known as:
a. a behavior-anchored rating scale.
b. management by objectives/learning goals.
c. the forced distribution scale.
d. a graphic rating scale.
ANS: D
Graphic rating scales are commonly used in evaluation and reflect generalizations rather than
specific behaviors.
TOP: AONE competency: Business Skills
4. On your unit, despite efforts to build a strong sense of team, conflict between some of the staff
is ongoing. Nonetheless, you want to proceed with developing a systematic and effective
performance appraisal system. Which of the following approaches would be most appropriate
for you to implement?
a. Peer review
b. A combination of tools
c. Anecdotal notes
d. Rating scale
ANS: B
A combination of tools is likely superior to any one method in any situation.
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TOP: AONE competency: Business Skills
5. As part of orientation to your unit, you decide to assign the new nurse to a preceptor. The
most likely reason for your decision is that the use of preceptors:
a. reduces the cost of orientation.
b. determines if there is fit between learner and organizational values.
c. develops the strengths of the new staff member.
d. can impact the retention rate.
ANS: D
Bodine (2020) notes that the preceptor is an important integrating force for the new
employee‘s transition and can impact the organization‘s retention rate.
TOP: AONE competency: Business Skills
6. Which of the following might best conclude an interview?
a. ―Thank you for your interest. Someone will be in touch with you soon.‖
b. ―Before you go, we will make sure that we have your contact information. Thank
you for coming.‖
c. ―I will be in contact with all candidates by telephone by next Friday. It has been a
pleasure to meet you.‖
d. ―We have several excellent candidates so I am not sure about the outcome of the
interview, but I will let you know. Thank you for coming.‖
ANS: C
An employment interview should always conclude with information as to how and when
follow-up to the interview will occur.
TOP: AONE competency: Business Skills
7. In determining the fit of a candidate with the culture on your unit, which of the following
interview questions might be asked?
a. ―Could you review your résumé for us, highlighting your certifications and
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experience?‖
b. ―If we were to ask your references, what would they list as your strengths?
Weaknesses?‖
c. ―We have a number of older adult patients on this unit. If you noticed another staff
member addressing one of these patients impatiently, how would you respond?‖
d. ―Tell us about your work and academic experiences and qualifications.‖
ANS: C
The nurse manager wants the most qualified individual for the position who also fits the
culture of the organization. Asking behavioral questions in the interview allows you to assess
how a candidate may function in real-life situations and to assess if this behavior is
compatible with the culture on the unit.
TOP: AONE competency: Business Skills
8. The biggest challenge in the recruitment of staff is:
a. finding well-qualified candidates who can function well within your particular
work culture.
b. recruiting individuals with the appropriate qualifications and experience.
c. screening out candidates who are unable to function well within a team.
d. determining if candidates have had previous negative experiences in a work
environment.
ANS: A
Choosing the right individual is the challenge for managers and involves finding qualified
candidates who will work well within your culture.
TOP: AONE competency: Business Skills
9. Anecdotal notes:
a. should be completed only when there are performance concerns.
b. can be used to support and justify fairness in termination discussions.
c. are unnecessary if the evaluation instrument is thorough.
d. need to be completed at the end of a performance period.
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ANS: B
Anecdotal notes should be kept consistently throughout the evaluation period and should
reflect both negative and positive behaviors if they are to provide an accurate assessment of
performance. Anecdotal notes provide documentation to support rating scales and narrative
evaluation summaries.
TOP: AONE competency: Business Skills
10. An outpatient clinic advertised for RN positions. Before authorizing an open position, the
nurse manager should:
a. review the position description and performance expectations for the opening.
b. place an ad in the local newspaper and on the telephone job line.
c. review all current applications on file.
d. look for employees within the system who might best fill the position.
ANS: A
The position description provides the basis for this position within the organization and
communicates expectations for the role. When applying for a position, researching the facility
and position description will help an applicant gain insight into the organization; therefore, the
position description should be current and communicate expectations.
TOP: AONE competency: Business Skills
11. The turnover rate for RNs in the ICU is high. You discuss this situation with existing staff and
you find out that because of the rapid turnover, new staff are frequently required to assume
full responsibilities soon into the position and before training is completed. In considering
approaches that will reduce turnover rates, the staff and you decide to implement:
a. an employee recognition program.
b. coaching for new staff.
c. a new performance appraisal system.
d. a committed orientation and training program.
ANS: D
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Retention of new nursing personnel begins on the day of their hire. This includes an effective,
appropriate orientation and training program, which has a measurable impact on reducing
turnover.
TOP: AONE competency: Business Skills
12. The validity of comments and ratings related to performance is enhanced by:
a. maintenance of anecdotal notes over the entire evaluation period.
b. quantity of information gathered for appraisal purposes.
c. agreement of the employee with the ratings and comments.
d. whether or not other individuals have contributed to the observations.
ANS: A
Anecdotal notes compiled consistently over the entire rating period are a much more equitable
method of providing an accurate summary of the employee‘s performance.
TOP: AONE competency: Business Skills
13. A nurse manager in the ICU works with his staff to develop an appraisal instrument that
includes quantitative data and respects standards for an RN working on that unit. This type of
appraisal is a:
a. rating scale.
b. collaboratively based appraisal system.
c. narrative instrument.
d. behaviorally anchored rating scale.
ANS: D
Behaviorally anchored rating scales (BARSs) describe performance quantitatively and
qualitatively.
TOP: AONE competency: Business Skills
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14. You have hired a new RN to replace a well-respected and experienced nurse in your
outpatient department. The new RN recently graduated and is nervous about stepping into a
role that was previously filled by someone who was so competent. You recognize anxiety and
set up regular, frequent meetings during which you explore how she is dealing with her
anxiety, provide feedback, and discuss strategies/ideas that will enhance her performance.
What development approach are you using?
a. Performance appraisal
b. Counseling
c. Empowerment
d. Coaching
ANS: D
The overall evaluative process can be enhanced if the manager employs the technique of
coaching. Coaching is a process that involves the development of individuals within an
organization. This coaching process is a personal approach in which the manager and the
employee interact on a frequent and regular basis with the ultimate outcome that the employee
performs at an optimal level.
TOP: AONE competency: Business Skills
15. Sue, a nurse manager, discusses her concerns about the hospital‘s employee appraisal system
with her work group, noting that it includes only one rating scale and that it means nothing
unless the manager has effective relationship skills. Sue‘s concerns reflect which best
practices associated with performance appraisal?
a. Rating scales are too generalized to be considered valid or reliable.
b. The effectiveness of appraisal is enhanced by a combination of methods and
effective communication skills.
c. BARS is considered superior to simple rating scales in terms of performance
appraisal.
d. Rating scales need to be designed by users to be well accepted.
ANS: B
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A combination of several methods is probably superior to any one method. The primary
success of any performance appraisal lies in the skills and communication abilities of the
manager.
TOP: AONE competency: Business Skills
16. During a performance appraisal, Joanne, the nurse manager, indicates that Alysha has
difficulty mentoring students on the unit. Alysha responds that this is not her responsibility. In
responding to Alysha, Joanne needs to consider:
a. Alysha‘s level of confidence.
b. whether mentoring is included in the position description.
c. whether mentoring is an essential component of the position description.
d. whether mentoring can be accurately observed and measured.
ANS: B
Employees must have clear role expectations, clearly understand what is expected of their
performance, and understand the ramifications of not meeting those expectations. Position
descriptions provide written guidelines detailing the roles and responsibilities of a specific
position within the organizational context.
TOP: AONE competency: Business Skills
17. The final section of a performance appraisal is a rating scale. This scale is very detailed and
relates to competency standards specific to surgical clients. The scale is a summary of
performance directly observed or documentation reviewed and is specific to client care
situations in which the employee has been involved. This type of evaluation is most
commonly known as:
a. a traditional rating scale.
b. management by objectives/learning goals.
c. a forced distribution scale.
d. a behaviorally anchored rating scale.
ANS: D
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Performance appraisals may include self and peer evaluations as well as managerial
components.
TOP: AONE competency: Business Skills
18. John‘s performance was satisfactory during the first month, but after that time, he was found
to be very inconsistent in the provision of nursing care. One month before the end of the
rating period, he cared for a very wealthy and influential client, who is best friends with the
clinical manager. This client donated new furniture for the staff lounge in John‘s name to
show appreciation for his care. John‘s subsequent performance appraisal resulted in
outstanding ratings in all areas. This is an example of:
a. a performance rating based on justifiable evidence.
b. a bias related to recent events.
c. the impact of personality on the appraisal of performance.
d. the effective use of a behaviorally anchored rating scale.
ANS: B
To gain and to provide an accurate evaluation of performance over time, anecdotal notes need
to be maintained throughout the evaluation period. This process assists in avoiding bias
related to recent or sensational events that make a particularly strong impression.
TOP: AONE competency: Business Skills
19. As a manager, you are interested in developing behavioral questions for an interview.
Knowing that there is team conflict at times on your unit, which of the following questions
would satisfy your interest in behavioral questions?
a. ―Tell me about a time you were involved in a conflict related to a project. What
was your role in the conflict? In the resolution of the conflict?‖
b. ―If you were to employ one strategy for managing conflict, what would it be?‖
c. ―What is your preferred style of conflict resolution?‖
d. ―How effective are you in working in a group? In dealing with conflict?‖
ANS: A
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Behavioral questions seek demonstrated examples of behavior from the candidate‘s past
experiences; behavioral-based interviewing can be a strong predictor of a future employee.
TOP: AONE competency: Business Skills
20. Which of the following strategies might be effective in empowering staff?
a. Communication book in which new information on policies and processes is
communicated and mistakes are highlighted.
b. Monthly staff meetings during which a portion of the agenda is devoted to sharing
ideas and presentations on best practices for implementation on the unit.
c. Once-yearly summative evaluations based on what the manager best likes about
the individual.
d. Focus on discussion of errors in care with direction as to how errors are to be
prevented in the future.
ANS: B
Empowerment is a process that acknowledges the values and judgments of others and trusts
their decisions. It allows freedom for making decisions while retaining accountability and
provides an environment that is safe in which to explore.
TOP: AONE competency: Knowledge of the Health Care Environment
21. The chief nursing officer establishes a shared governance model to help empower the nursing
staff, thus empowering the organization. Common characteristics of empowered organizations
are:
a. shared values, high salaries, and a human focus.
b. shared values, flexibility, and a human-capital focus.
c. commitment to communication, high salaries, and flexibility for evaluations.
d. creation of community and of effective stress management in the midst of
divergent goals.
ANS: B
Shared governance involves valuing the contributions of each member of the team, releasing
the need to control, and understanding that accountability rests with members of the team.
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TOP: AONE competency: Leadership
22. Joanne, a new nurse manager, writes certain assumptions regarding the organization‘s
objectives into her budget. Her supervisor tells her that the objectives implied in her
assumptions are not entirely consistent with the organization, and that she needs to clarify
these objectives with her supervisor. Joanne apologizes and says she had more latitude with
the budget where she previously worked. This is an example of:
a. role complexity.
b. role ambiguity.
c. role conflict.
d. time-dependent roles.
ANS: B
Role ambiguity in the workplace creates an environment for misunderstanding and hinders
effective communication. Without clear expectations of performance, missteps in performance
can occur.
TOP: AONE competency: Business Skills
23. A survey of staff satisfaction is conducted. The survey indicates that staff members are
satisfied, are loyal to the organization, and feel that they have reasonable control in their
individual responsibilities. The findings best exemplify:
a. clarity in roles and valuing of contributions.
b. satisfaction but not empowerment.
c. effective coaching of new staff.
d. role attachment.
ANS: A
Commitment, a sense of control, and satisfaction are linked to clear role expectations and a
feeling that contributions are valued.
TOP: AONE competency: Business Skills
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24. You have hired Chelsea as a new staff member on your unit. Although she is an experienced
ICU nurse, this is her first educator role. A month into her new position, she confides that she
feels really incompetent in her new position and bursts into tears. Your response is based on
application of your understanding of:
a. role acquisition.
b. role conflict.
c. role complexity.
d. performance appraisal.
ANS: A
Acquisition of a role is time dependent and involves application of life experiences to each
role and interpretation of the role within one‘s own value system. As roles become more
complex, an individual may take longer to assimilate the components of each role.
TOP: AONE competency: Business Skills
MULTIPLE RESPONSE
1. During the performance appraisal session, the manager should: (Select all that apply.)
a. maintain a relaxed and professional manner.
b. inquire about the employee‘s personal life and how it is affecting performance.
c. allow the employee to express opinions orally and in writing.
d. plan to give specific examples only for poor performance.
ANS: A, C
During a performance appraisal, it is important to provide examples of both strong and
problematic performance and to provide opportunities to express opinions. The supervisor
needs to maintain a relaxed professional manner.
TOP: AONE competency: Business Skills
Chapter 21: Managing Personal and Personnel Problems
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
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MULTIPLE CHOICE
1. The most important approach that a nurse manager can take with an emotionally troubled
employee is to:
a. act as a therapist for the employee.
b. adjust the standard of care to assist the employee.
c. assist the employee in obtaining professional help.
d. adjust the employee‘s work schedule to decrease stress.
ANS: C
Emotional difficulties are usually beyond the scope of skills that a nurse manager would
normally employ. A referral needs to be made to a professional who is specifically prepared to
deal with this kind of difficulty.
TOP: AONE competency: Communication and Relationship-Building
2. The nurse manager knows that the most serious effect that absenteeism has on the nursing unit
is that:
a. using replacement personnel with new ideas may be beneficial.
b. salary costs are lower because personnel are fewer, and outcome is favorable.
c. absence on the part of the rest of the staff is decreased.
d. unacceptable patient care may result.
ANS: D
Reduced staffing adversely affects patient care. Employee morale suffers, care standards may
be lowered, and additional stress is placed on working staff.
TOP: AONE competency: Knowledge of the Health Care Environment
3. In keeping with guidelines of the organization, the nurse manager documents staff problems.
Documentation of disciplinary problems should:
a. include a plan to correct them and to prevent future occurrences.
b. state a detailed history of past problems that are related to the current one.
c. be written at the convenience of the manager.
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d. not be discussed until the formal performance evaluation.
ANS: A
In documenting staff problems, it is important to identify the incident with an objective
statement of facts and record actions taken to correct/prevent future problems.
TOP: AONE competency: Business Skills
4. Before terminating an employee, a nurse manager must:
a. be an expert in all legal aspects of termination and discipline practices.
b. follow the organization‘s specific policies for addressing disciplinary problems and
termination.
c. function as a counselor for problem employees.
d. do everything to assist and protect the employee by adjusting standards and
policies.
ANS: B
It is important to know the policies of the organization to address disciplinary issues fairly and
equitably, as well as to know the model that is employed to address employee problems.
Human resource departments and legal departments are important sources for consultation,
advice, and support.
TOP: AONE competency: Business Skills
5. A nurse manager understands that the typical first step in handling an employee with a
disciplinary problem is a:
a. verbal reprimand.
b. written reprimand.
c. reminder of employment standards.
d. day off without pay.
ANS: C
The progressive model of discipline advocates that the first step of the disciplinary process is
the informal reprimand or verbal admonishment. The nonpunitive discipline model advocates
reminding the employee of the employment policies and procedures of the agency.
TOP: AONE competency: Business Skills
6. The chief nursing officer understands that clinical incompetence is best prevented by a(n):
a. flexible protocol for evaluating competency skills.
b. standardized clinical skills checklist.
c. administration of personality tests and competency assessments at point of hire.
d. formalized competency program with established standards for practice.
ANS: D
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The competency program with established standards of practice outlines what the nurse must
do to achieve desired competencies in her current position. Competency assessment and
goal-setting should help the nurse identify how to excel and which competencies the nurse
wants to achieve in the future.
TOP: AONE competency: Business Skills
7. A nurse manager understands that the second step in handling an employee with a disciplinary
problem is to document the incident. Which of the following is best for documentation of
personnel problems?
a. Use of the performance appraisal on an annual basis
b. Notes made immediately after an incident that include a description of the incident,
actions taken, plans, and follow-up
c. A tally sheet of medication errors and other specific problems that will be used at
annual review
d. Copies of reports, placed in his or her file, of all unusual occurrences involving the
employee
ANS: B
In documenting staff problems, it is important to specifically indicate what rules were broken
or violated, consequences if behavior is not altered, employee‘s explanation of the incidents,
and the plan of action to achieve and to reach new goals.
TOP: AONE competency: Business Skills
8. The nurse manager places a staff member on probation because of reports of chemical
dependency. The nurse manager should be aware that which of the following statements is
true regarding chemical dependency?
a. The chemically dependent employee usually hides any changes in behavior.
b. When confronted with the issue, the affected employee is usually relieved to have
someone to talk to about the problem.
c. The chemically impaired nurse affects the entire healthcare organization.
d. Hospital policy, state laws, and nurse practice acts address procedures for the
chemically dependent employee in the most general terms.
ANS: C
A chemically impaired nurse jeopardizes patient care through impaired skills and judgment.
She or he also compromises teamwork and continuity as peers attempt to cover deficiencies in
work performance for their impaired team member.
TOP: AONE competency: Business Skills
9. The chief nursing officer reviews the policy about ―progressive discipline process.‖ The
progressive discipline process includes which of the following? The manager:
a. acts as a counselor and friend to the employee.
b. should reprimand and suspend the employee as a last resort.
c. should rehire the employee after a reasonable length of time.
d. should terminate the employee if the problem persists.
ANS: D
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Termination can be defined as the discharge of an employee who is performing at an
unsatisfactory level or who is not a good match for the organization. Termination is always
considered the last resort when dealing with poor performance.
TOP: AONE competency: Business Skills
10. A nurse manager must be familiar with the agency‘s policies regarding termination.
Termination procedures include which of the following?
a. Following specific procedures from other organizations
b. Having an attorney present at the termination meeting
c. Having adequate written documentation to support the action
d. Having a friend present during the termination meeting
ANS: C
All steps should be followed, including full appropriate detailed documentation and following
the procedures of the organization.
TOP: AONE competency: Business Skills
11. Nathan has been on the cardiac unit for 6 months and has found it difficult to adjust to the
expectations of his team. Which of the following behaviors would most likely signal that
Nathan is intending to resign from his position on the unit?
a. Increased absenteeism over the past month
b. Increased attempts to discuss his concerns with his colleagues
c. Testing of workplace guidelines
d. Frequent defensiveness
ANS: A
Many employees increase their absenteeism just before submitting their resignation. If the
healthcare worker is experiencing some form of role stress, it might be manifested through
absenteeism. Role strain may be reflected by (1) withdrawal from interaction; (2) reduced
involvement with colleagues and the organization; (3) decreased commitment to the mission
and the team; and (4) job dissatisfaction. Testing of workplace guidelines and defensiveness
are associated with immaturity.
TOP: AONE competency: Business Skills
12. All of the following are grounds for immediate dismissal except:
a. failing to pursue further medical help for a patient; patient dies.
b. selling narcotics obtained from the unit supply of narcotics.
c. restraining a patient in bed for 7 hours, unsupervised, as punishment for hitting a
staff member.
d. grabbing the unit manager and threatening further physical harm after a poor
performance appraisal.
ANS: A
Situations that may warrant immediate dismissal include theft, violence in the workplace,
willful abuse of the patient, harassment, and chemical abuse.
TOP: AONE competency: Business Skills
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13. The unit manager on 4E is concerned about the performance of Jean, a staff nurse. She is not
involved directly with Jean, so she has not been able to determine whether the problem is one
of motivation, ability, or both. If Jean lacks ability, which of the following strategies might the
head nurse use?
a. Dismiss or transfer Jean.
b. Document all problem areas and then discuss them with Jean.
c. Develop appropriate solutions and make recommendations to human resources.
d. Smooth over the problems if they are minor in nature.
ANS: B
For the employee to change and grow, specific corrective measures need to be taken.
Consultation with the employee is necessary, and documentation is key to determining the
issues.
TOP: AONE competency: Business Skills
14. Nurses generally experience difficulty in identifying behaviors and actions that could signal
chemical dependency in a co-worker. Which of the following is not a behavioral change that
occurs with chemical dependency?
a. Personality and behavioral changes
b. Job performance changes
c. Changes in educational involvement and pursuit
d. Absenteeism
ANS: C
A manager needs to be alerted when suspicions of chemical dependency are raised by
behavioral changes in the employee. These include mood swings, changes in hygiene and
appearance, heightened interest in the pain control of patients, frequent changes in shifts,
increases in absenteeism, and increases in tardiness.
TOP: AONE competency: Business Skills
15. Nurse Stacey is a self-admitted drug addict and has been a heavy abuser of codeine. Stacey
and the unit manager decide that changes have to occur. Stacey enrolls in an addiction
program, and the manager has her transferred to a drug-free area. What other strategies might
be appropriate?
a. The manager could refer Stacey to the human resources department.
b. The manager could assist in monitoring Stacey‘s progress.
c. The manager could counsel Stacey if Stacey has formed a trusting relationship
with her.
d. Stacey needs to be asked not to involve her family in the recovery program
because this is a work-related situation.
ANS: B
Effective management demands that the organization take an active role in helping employees
with special needs. Humanistic strategies that counsel and assist employees are cost-effective
and necessary.
TOP: AONE competency: Business Skills
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16. Incivility is a disruptive behavior or communication that creates a negative environment and
interferes with quality patient care and safety. The manager can implement steps that help to
alleviate uncivil behavior on a unit. Which of the following would not be an appropriate first
step?
a. Suspending the staff member from work
b. Providing written admonishment that is discussed and placed in the employee‘s
file
c. Providing verbal admonishment
d. Terminating the staff member
ANS: D
Dismissal does not enable the present organization to attempt remediation of the behavior and
is not consistent with first steps in progressive discipline.
TOP: AONE competency: Business Skills
17. Incivility is a disruptive behavior or communication that creates a negative environment and
interferes with quality patient care and safety. The manager can implement the following steps
that help to alleviate uncivil behavior on a unit. (A) Suspending the staff member from work,
(B) Providing written admonishment that is discussed and placed in the employee‘s file, (C)
Providing verbal admonishment, (D) Terminating the staff member
a. A, B, C, D
b. B, A, C, D
c. C, B, A, D
d. C, A, B, D
ANS: C
The steps in progressive discipline are followed from the least severe (counseling the
employee) to the most severe (termination). Studies have shown that following this sequence
provides a fair and effective plan for discipline and remediation.
TOP: AONE competency: Business Skills
18. When progressive discipline is used, the steps are followed progressively only for repeated
infractions of the same rule. On some occasions, rules that are broken are so serious that the
employee is:
a. transferred to another unit.
b. suspended indefinitely.
c. asked to attend a union grievance meeting.
d. terminated after the first infraction.
ANS: D
Behaviors that include violence, theft, and purposeful abuse of a client are sufficiently serious
to warrant immediate dismissal with the first incident.
TOP: AONE competency: Business Skills
19. During unit staff meetings, you observe that Marg rolls her eyes and snorts whenever Julia
makes a comment. Your first response as a unit manager is to:
a. discuss what you have observed with Marg.
b. file immediate documentation in Marg‘s personnel file.
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c. ask Julie to monitor Marg‘s behavior during meetings.
d. ignore the behavior, as Marg is one of your strongest nurses.
ANS: A
Incivility must be addressed. The initial step in addressing it is discussion with Marg, and if
the behavior continues, then written documentation should be filed in Marg‘s personnel file.
Monitoring and follow-up are your responsibility as the unit manager.
TOP: AONE competency: Business Skills
20. Ellen is a novice nurse on your unit. Even though she has come to you highly recommended,
as her supervisor, you have noticed some knowledge and skill deficiencies. These deficiencies
have been noticed by her peers as well, who cover for her because she is new and they like
her. Which of the following is likely to be the greatest asset to Ellen in improving her
performance?
a. Ignore Ellen‘s errors until she has more experience.
b. Instruct staff to avoid working with Ellen until she learns to how do things herself.
c. Ask Ellen to complete a self-assessment, using a standard skills checklist.
d. Encourage staff to report every behavior of Ellen‘s that is different from theirs.
ANS: C
When other employees are engaged in enabling behavior by covering for the mistakes of one
of their peers, the nurse leader may be surprised to discover that the employee does not know
or cannot do what is expected of him or her. The nurse leader must remind employees that
part of professional responsibility is to maintain quality care and thus they are obligated to
report instances of clinical incompetence, even when it means reporting a co-worker. Ignoring
violations of a safety rule or poor practice is unprofessional and cannot be tolerated. The
employee may be asked to do a self-assessment of the listed skills or competencies and then
have performance of the skills validated by a peer or co-worker. This is a very effective
method for the leader to assess the skill level of employees and to determine whether
additional education and training may be necessary.
TOP: AONE competency: Communication and Relationship-Building
21. Susan, a new graduate, is upset that so many staff have been absent lately from the unit. She
declares to you that all absenteeism could be eliminated with proper management. Your
response is based on understanding that:
a. not all absenteeism is voluntary.
b. high personal control contributes to absenteeism.
c. direct discussions with employees who have high levels of absenteeism are not
recommended.
d. all absenteeism is related to personal issues and needs.
ANS: A
Not all absenteeism is voluntary or preventable, which means that absenteeism can never be
fully eliminated. Absenteeism can result from personal issues and needs, work dissatisfaction,
and involuntary reasons such as jury duty.
TOP: AONE competency: Business Skills
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22. The nursing director calls a meeting with one of the new unit managers. She is very concerned
about a report of substance abuse on the manager‘s unit, and she reviews the procedures
involved in dealing with chemically dependent staff. Which of the following statements would
NOT be included in the discussion? ―As a manager, you:
a. need to be aware of ADA issues.‖
b. should check with human resources regarding chemically dependent employees
and employment practices.‖
c. check the nurse practice acts for the state in which the nurse resides.‖
d. should realize that the nurse is a professional embarrassment and should be kept
out of sight of other staff.‖
ANS: D
As a manager, you need to be familiar with state and professional regulatory and reporting
requirements regarding chemical use and abuse, as well with human resource practices and
guidelines.
TOP: AONE competency: Business Skills
23. The education consultant for the hospital is presenting a workshop titled ―Documentation: A
Manager‘s Responsibility.‖ Which of the following points would she not include in her
PowerPoint presentation? Documentation:
a. cannot be left to memory. A notation must be placed in the personnel file.
b. should avoid discussion of the problem.
c. should include what was done about the problem when it occurred.
d. needs to include date, time, and place.
ANS: B
Documentation of personnel problems is one of the most important aspects of the nursing
manager‘s role. Through carefully detailed and timely documentation of the problem and
plan, the manager decreases the burdensome problems that can ensue from improper or
inadequate documentation.
TOP: AONE competency: Business Skills
24. The unit manager discusses absenteeism with the unit clerk. She indicates that it is a serious
problem on the unit. Which of the following points would they have likely discussed?
a. Employee morale is at a high level.
b. Patient care will be jeopardized and possibility below standards.
c. Existing staff have experienced little effect from the absenteeism.
d. Cost for the unit remains the same when new staff are hired.
ANS: B
Absenteeism puts a strain on staff, produces morale problems, can jeopardize patient safety,
and increases unit costs.
TOP: AONE competency: Business Skills
MULTIPLE RESPONSE
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1. Clinical incompetence is one of the more serious problems facing a nurse manager. Joyce, the
nurse manager, is not aware of the problems of Sarah, a novice nurse. After she investigates, it
is obvious that Sarah‘s peers are covering for her. Which of the following might Joyce include
in her meeting with the nurses? (Select all that apply.)
a. ―It is a nurse‘s professional responsibility to maintain quality control.‖
b. ―All instances of clinical incompetence are to be reported.‖
c. ―It is not considered being disloyal when one nurse reports another for poor care.‖
d. ―Patient care is the number one concern. Meeting standards is mandatory and
necessary.‖
ANS: A, B, C, D
The nurse leader must remind employees that professional responsibility is to maintain quality
care, and thus they are obligated to report instances of clinical incompetence, even when it
means reporting a co-worker. Ignoring safety violations or poor practice is unprofessional and
jeopardizes patient care.
TOP: AONE competency: Professionalism
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Chapter 22: Role Transition
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
MULTIPLE CHOICE
1. 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.
ANS: C
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.
TOP: AONE competency: Leadership
2. 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.
ANS: D
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.
TOP: AONE competency: Knowledge of the Health Care Environment
3. 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.
ANS: D
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.
TOP: AONE competency: Business Skills
4. 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
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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.
ANS: D
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. It can take up to a year to understand the role, system, and boundaries in a new
job-role-position.
TOP: AONE competency: Communication and Relationship-Building
5. A nurse manager 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.
ANS: A
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.
TOP: AONE competency: Leadership
6. The new nurse manager feels pulled between the expectations of staff, the demands of
hospital administrators, and family obligations. According to the theory by 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.
ANS: C
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.
TOP: AONE competency: Leadership
7. 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.
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ANS: C
When an employment relationship ends or changes unexpectedly, grieving occurs. One of the
phases in grieving is anger.
TOP: AONE competency: Leadership
8. 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
ANS: C
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.
TOP: AONE competency: Business Skills
9. 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.
ANS: A
Mentoring has been identified as important to staff retention.
TOP: AONE competency: Business Skills
10. A nurse manager notices that Nathan, an RN who has been on the unit for approximately 3
years, has an interest in health 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.
ANS: A
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.
TOP: AONE competency: Business Skills
11. 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.
ANS: A
Clarification of implicit and explicit expectations regarding the role assists in avoiding role
ambiguity and role strain.
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TOP: AONE competency: Leadership
12. After beginning her new position as nurse manager, 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.
ANS: C
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.
TOP: AONE competency: Leadership
13. A strategy that may help to make transition to a new management role and to respond to
relationships and situations in the new position is:
a. avoiding discussion of personal beliefs with staff until ready to do so.
b. finding a network of clinicians with interests similar to their own.
c. researching clinical literature to maintain clinical assessment skills for the unit.
d. recognizing a strong commitment to care in the management process
ANS: D
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.
TOP: AONE competency: Leadership
14. A new nurse manager 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 her new role.
c. is justified if practices are deficient on the new unit.
d. reflects Sarah‘s astuteness as a clinician.
ANS: B
By focusing on the weaknesses of the unit, she may lack the energy to internalize the new
role—a step that is critical to being an effective leader. As a new manager, she must learn how
to access resources in the organization. Approaching the organization as a foreign culture, she
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.
TOP: AONE competency: Leadership
15. A staff member in a new management position, finds a mentor who has been in the role of
unit manager for 3 years and has a similar interest in clinical excellence. During their frequent
meetings, the mentor 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 the mentors coaching depends on:
a. clarity of the mentor‘s information.
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b. organizational support for the mentor relationship.
c. the congruence of the mentor‘s beliefs with the mentoree‘s beliefs.
d. willingness of the mentoree to receive feedback.
ANS: D
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.
TOP: AONE competency: Leadership
16. 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.
ANS: C
Counseling provides opportunity for the mentee to share personal concerns. For counseling to
be successful, confidentiality must be assured.
TOP: AONE competency: Leadership
17. A nurse manager can become a certified nurse executive with a minimum of:
a. a graduate degree.
b. at least a nursing diploma.
c. 24 months of experience.
d. 5 years of successful experience.
ANS: C
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.
TOP: AONE competency: Leadership
18. A new nurse manager finds that she is now 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, she has likely attained
this role:
a. development.
b. acceptance.
c. symmetry.
d. internalization.
ANS: D
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.
TOP: AONE competency: Leadership
19. 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?
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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 healthcare economics
d. Attendance at a workshop on survey tool development and statistical measurement
ANS: B
In a qualitative descriptive study that explored the professional development needs of nursing
leaders, 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.
TOP: AONE competency: Leadership
20. 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.
ANS: C
According to Hardy‘s role theory, 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.
TOP: AONE competency: Leadership
21. 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.
ANS: D
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.
TOP: AONE competency: Business Skills
22. 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
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b. Acceptance
c. Development
d. Discrepancy
ANS: D
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.
TOP: AONE competency: Leadership
23. 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
ANS: A
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.
TOP: AONE competency: Leadership
24. Who of the following might be the most appropriate 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.
ANS: C
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.
TOP: AONE competency: Leadership
MULTIPLE RESPONSE
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1. 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.
ANS: B, C, D
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.
TOP: AONE competency: Leadership
Chapter 23: Managing Your Career
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
MULTIPLE CHOICE
1. The department manager makes a list of interview questions for a new position. Which of the
following questions are inappropriate?
a. What are your short-term and long-term goals?
b. Do you have any disabilities we need to know about?
c. Will you be able to meet our attendance expectations?
d. Do you understand our philosophy and mission?
ANS: B
Only questions related to the position and its description are legitimate. Employers should not
ask unrelated questions, and applicants should decline to answer if asked inappropriate
questions, for example disabilities.
TOP: AONE competency: Communication and Relationship-Building
2. A cover letter should be included with your resume when applying for a position. A cover
letter is the key to:
a. getting your resume read and into the interview process
b. asking questions about the position.
c. listing all of the positions you have held in the past.
d. revealing information about your personal life..
ANS: A
The key to getting your résumé or curriculum vitae read and entry to the interview process is a
cover letter.
TOP: AONE competency: Communication and Relationship-Building
3. A new graduate is seeking a position in nursing and wants to ―sell‖ herself effectively. The
best strategy is to:
a. create a résumé.
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b. practice interviewing.
c. call the personnel offices.
d. create a curriculum vitae.
ANS: A
A résumé provides a customized overview of details of your professional background that
relates specifically to a position for which you are applying. Résumés advertise your skills to
a prospective employer.
TOP: AONE competency: Communication and Relationship-Building
4. According to the ANA, ―systematic professional learning experiences designed to augment
nurses‘ knowledge, skill, and attitudes, thereby enriching the nurses‘ contributions to quality
health care and their pursuit of professional career goals‖ is known as:
a. accreditation.
b. endorsement.
c. continuing education.
d. entrepreneurialship.
ANS: C
Lifelong learning is a professional attribute that also contributes to professional growth. As
you assess career construction benchmarks, additional education will be needed..
TOP: AONE competency: Leadership
5. 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.
ANS: D
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.
TOP: AONE competency: Business Skills
6. 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.
ANS: C
Certification is an expectation in some settings for career advancement in advanced practice
or in specialized areas and goes beyond basic preparation.
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TOP: AONE competency: Leadership
7. 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 must 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.
ANS: B
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.
TOP: AONE competency: Business Skills
8. 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.
ANS: B
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.
TOP: AONE competency: Business Skills
9. 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
ANS: C
A portfolio enables prospective employers to view evidence of significant achievements and
responsibilities that would be pertinent to the position.
TOP: AONE competency: Professionalism
10. 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
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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.‖
ANS: C
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.
TOP: AONE competency: Professionalism
11. Knowing your professional strengths is important to:
a. find 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.
ANS: A
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.
TOP: AONE competency: Professionalism
12. 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.
ANS: D
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.
TOP: AONE competency: Professionalism
13. On your curriculum vitae, which of the following is the recommended approach for listing
employment and educational history information?
a. 1979 RN Diploma
1985 BScN
2002 MN
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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
ANS: C
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.
TOP: AONE competency: Business Skills
14. Which of the following needs revision on a résumé or CV?
a. John Jones
87 Highway Drive
City, MI 79110
jjones@gmail.com
b. M. Howes
Anyway Highway
City, MO 77700
(H) 777-777-0000
e-mail: mh@gmail.com
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
beerhog@hotmail.com
ANS: D
When including Web or e-mail addresses, it is important to use addresses that are not overly
casual or that communicate personal information.
TOP: AONE competency: Business Skills
15. The primary difference between a résumé and 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.
ANS: A
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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.
TOP: AONE competency: Business Skills
16. A functional résumé 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.
ANS: A
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.
TOP: AONE competency: Business Skills
17. A cover letter and a résumé together should be no longer than
a. two
b. one
c. four
d. three
page(s).
ANS: D
Two pages are recommended for a résumé and one for a cover letter.
TOP: AONE competency: Business Skills
18. 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.
ANS: C
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.
TOP: AONE competency: Communication and Relationship-Building
19. A well-written letter of resignation is critical to:
a. first announce your intent to resign.
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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.
ANS: C
A well-written resignation letter outlines your intent to leave the organization and your
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.
TOP: AONE competency: Communication and Relationship-Building
20. 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.
ANS: D
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.
TOP: AONE competency: Business Skills
21. To enhance team leadership skills for your team leaders, you arrange opportunities for:
a. certification.
b. continuing education.
c. graduate courses.
d. volunteerism.
ANS: B
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.
TOP: AONE competency: Professionalism
22. 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.
ANS: C
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.
TOP: AONE competency: Professionalism
MULTIPLE RESPONSE
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1. 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.
ANS: C, D
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.
TOP: AONE competency: Professionalism
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Chapter 24: Developing Leaders, Managers, and Followers
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
MULTIPLE CHOICE
1. 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
ANS: D
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.
TOP: AONE competency: Communication and Relationship-Building
2. Recruiting among the emerging work force (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 work force?
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
ANS: B
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.
TOP: AONE competency: Communication and Relationship-Building
3. 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.
ANS: B
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.
TOP: AONE competency: Communication and Relationship-Building
4. 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:
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a.
b.
c.
d.
demonstrate interdependence.
depict flexibility and broadmindedness.
focus all energies of staff members on a best possible strategy.
defuse the possibility that staff members will escalate their discontent when
staffing the unit on weekends.
ANS: C
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 work force.
TOP: AONE competency: Communication and Relationship-Building
5. 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).
ANS: D
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.
TOP: AONE competency: Business Skills
6. 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.
ANS: A
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.
TOP: AONE competency: Knowledge of the Health Care Environment
7. 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.
ANS: B
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.
TOP: AONE competency: Knowledge of the Health Care Environment
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8. 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
ANS: C
Nurse managers have responsibility for both patient and staff safety. High-risk areas, such as
the Emergency Department, require special attention.
TOP: AONE competency: Knowledge of the Health Care Environment
9. 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.
ANS: D
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.
TOP: AONE competency: Leadership
10. 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.
ANS: B
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.
TOP: AONE competency: Leadership
11. 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 older adult 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
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interprets policies to facilitate quality care.
d. She organizes the team and delegates responsibilities effectively in providing
nursing care.
ANS: A
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.
TOP: AONE competency: Knowledge of the Health Care Environment
12. Budgeting and protection of revenues is a function of:
a. leadership.
b. management.
c. team leadership.
d. followers.
ANS: B
Managers address complex issues such as planning, budgeting, and allocating resources,
whereas leaders address change.
TOP: AONE competency: Knowledge of the Health Care Environment
13. 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
ANS: D
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.
TOP: AONE competency: Communication and Relationship-Building
14. 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.
ANS: D
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.
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TOP: AONE competency: Knowledge of the Health Care Environment
15. 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.
ANS: D
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.
TOP: AONE competency: Communication and Relationship-Building
16. 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.
ANS: C
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.
TOP: AONE competency: Communication and Relationship-Building
17. 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 and 18 reflect.
a. differences in the managers‘ expectations of their role.
b. shaping of the workplace behavior of employees.
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c. different approaches to cooperation and collaboration.
d. recognition of institutional priorities.
ANS: A
Management theory addresses how managers address employees‘ concerns and needs and the
interactions of managers with employees. Expectations of the managerial role affect
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.
TOP: AONE competency: Leadership
18. John is interested in leadership positions within his nursing organization. Although 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 work–life balance.
ANS: D
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.
TOP: AONE competency: Professionalism
19. 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.
ANS: B
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Leaders who come out of the Baby Boomer generation may be more comfortable with
collective action than followers who come out of the Emerging Work force 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 Work force 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.
TOP: AONE competency: Communication and Relationship-Building
20. 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
ANS: B
Transactional leaders tend to rely on position and power, and they tend to reward and punish
according to performance and conformity with expectations.
TOP: AONE competency: Leadership
21. 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.
ANS: B
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.
TOP: AONE competency: Professionalism
22. 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
ANS: D
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.
TOP: AONE competency: Business Skills
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23. 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.
ANS: D
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.
TOP: AONE competency: Professionalism
24. 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.
ANS: D
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.
TOP: AONE competency: Communication and Relationship-Building
MULTIPLE RESPONSE
1. 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 five 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
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f.
communicate these findings to staff management.
allow clients to establish objectives and goals.
ANS: A, B, D, E
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.
TOP: AONE competency: Knowledge of the Health Care Environment
Chapter 25: Thriving for the Future
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
MULTIPLE CHOICE
1. 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.
ANS: B
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.
TOP: AONE competency: Knowledge of the Health Care Environment
2. 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.
ANS: C
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.
TOP: AONE competency: Business Skills
3. 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 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.
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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.
ANS: A
Referral to a food bank addresses the needs of a specific population, while exemplifying an
important leadership strength: thinking long-term, acting short-term. The project that involves
mothers will teach mothers about nutrition and engage them in preparation of low-cost,
healthy meals while promoting longer term changes in healthy eating.
TOP: AONE competency: Leadership
4. 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
ANS: C
The second step in the Wise Forecast Model© is to think wildly. Step two is designed to create
connections among disparate thoughts. This thinking might be seen as the start of innovations.
TOP: AONE competency: Knowledge of the Health Care Environment
5. 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.
ANS: B
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.
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TOP: AONE competency: Leadership
6. 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
ANS: B
Future forecasts include evolutions in power, structure, and knowledge; rapid change in the
healthcare system; the demise of macromarketing; and increased evidence-based practice.
TOP: AONE competency: Leadership
7. 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
ANS: A
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.
TOP: AONE competency: Leadership
8. Nursing research has indicated that the foundation for becoming a nursing leader is the ability
to:
a.
b.
c.
d.
write effectively.
speak two or three languages.
focus on day-to-day priorities.
think futuristically.
ANS: D
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.
TOP: AONE competency: Leadership
9. The chief nursing officer has been developing her portfolio for years. What is the chief
nursing officer modeling?
a. Her clinical expertise
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b. Affection for tradition
c. Her employability
d. Her busy professional life
ANS: C
Being employed is no longer sufficient; we must be employable. A portfolio outlines
achievements and experiences that communicate employability.
TOP: AONE competency: Leadership
10. Your unit has several 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
several 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.
ANS: B
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.
TOP: AONE competency: Leadership
11. 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.
ANS: B
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.
TOP: AONE competency: Leadership
12. Which of the following will require greater attention in the future?
a. Chronic disorders
b. Obstetrical outcomes
c. Prevention of hospital-based errors
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d. Team conflict resolution strategies
ANS: A
Lifestyle choices, obesity, and an aging population will lead to an increased emphasis on
prevention, personal accountability, and innovations such as robotics in the management of
chronic illnesses.
TOP: AONE competency: Knowledge of the Health Care Environment
13. 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
ANS: D
Regardless of how we go about developing our vision (gathering evidence, testing ideas with
others), honesty and openness are foundational to a strong vision.
TOP: AONE competency: Leadership
14. 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?‖
ANS: D
Thinking wildly includes creating wild questions. Sometimes they are what lead to a wild
idea.
TOP: AONE competency: Leadership
15. Which aspect of our tradition and history in nursing may impede our movement toward
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
ANS: C
Because of our history of attention to details, we may need to challenge ourselves in
developing our ability for leadership. Moving from micromanaging to focusing on setting
expectations for those for whom we are accountable may feel uncomfortable. However, that
movement reinforces our ability to deal with longer term issues.
TOP: AONE competency: Knowledge of the Health Care Environment
16. 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:
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a.
b.
c.
d.
a poor relationship between leaders and staff.
lack of knowledge regarding the importance of changes.
striving to achieve stability during great disequilibrium.
the importance of chaos in promoting adherence with established practices.
ANS: C
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.
TOP: AONE competency: Leadership
17. 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.
ANS: D
Complexity compression refers to many changes occurring simultaneously before time is
sufficient to assimilate the change.
TOP: AONE competency: Leadership
18. 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.
ANS: C
It is suggested to ask 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.
TOP: AONE competency: Knowledge of the Health Care Environment
19. 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
ANS: B
Complexity compression is a term that means that many changes are happening almost
simultaneously and before one practice can be firmly implanted in our minds, we are already
addressing some other change
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TOP: AONE competency: Leadership
20. 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
ANS: C
The client base is aging, and more people will be living with chronic disorders. Persons will
travel more and there will be increased need to speak two or more languages to address the
needs of a mobile global population.
TOP: AONE competency: Leadership
21. 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 work force.
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.
ANS: D
Knowledge will change dramatically, requiring that we all be dedicated learners. With or
without state law, continuing education will be mandatory and essential. Knowledge will
evolve from the intensity of the current information evolution so that we will access content
with meaning and applicability for our work.
TOP: AONE competency: Professionalism
22. 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 work force.
ANS: A
Senge said that leadership is really about people working at their best to create the future.
Predictions of the future highlight the importance of interprofessional teams and of a shift
toward understanding the importance of health care.
TOP: AONE competency: Leadership
23. 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:
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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.‖
ANS: C
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.
TOP: AONE competency: Business Skills
MULTIPLE RESPONSE
1. 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.
ANS: A, B, C
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.
TOP: AONE competency: Knowledge of the Health Care Environment
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