Test Bank for Leading and Managing
in Nursing 7th Edition by Yoder Wise
(chapters 1-30) complete.
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Leading and Managing in Nursing 7th Edition Yoder-Wise Test Bank
Chapter 01: Leading, Managing, and Following
Yoder-Wise: Leading and Managing in Nursing, 7th 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?
Arrange another meeting in a week’s time so as to allow a cooling-off period.
Elevate the next negation session to the next manager, one level above.
Insist that participants continue to talk until a resolution has been reached.
Back the unit manager’s actions and end the dispute.
a.
b.
c.
d.
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. A charge nurse on a busy 40-bed medical/surgical unit is approached by a family member who
begins to complain loudly about the quality of care his mother is receiving. His behavior is so
disruptive that it is overheard by staff, physicians, and other visitors. The family member leaves
the unit abruptly, and the nurse is left feeling frustrated. Which behavior by the charge nurse best
illustrates refined leadership skills in an emotionally intelligent practitioner?
a. Reflect to gain insight into how the situation could be handled differently in
the future.
b. Try to catch up with the angry family member to resolve the concern.
c. Discuss the concern with the patient after the family member has left.
d. Notify nursing administration of the situation.
ANS: A
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Goleman suggests that emotional intelligence involves insight and being able to step outside
of the situation to envision the context of what is happening as well as being able to manage
emotions such as frustration effectively.
TOP: AONE competency: Leadership
9. The chief nursing officer has asked the staff development coordinator to facilitate the
development of a clinical competency program for the facility. While making rounds on
the units, the staff development coordinator overhears RN staff complaining that they feel
it is insulting to be required to participate in a competency program. What behavior by the
staff development coordinator is most appropriate in this situation?
a. Disregard staff concerns and continue with development of the program.
b. Inform the nurses that this program is a requirement for JCAHO accreditation.
c. Schedule a meeting with the chief nurse executive to apprise her of the situation.
d. Facilitate a meeting so nurses can articulate their values and concerns about
a competency program.
ANS: D
The manager role involves guiding others through a set of derived practices that are
evidence-based and known to satisfy preestablished outcomes such as participation in a
competency program. This involves engagement of staff through sharing of concerns and
ideas. A close analysis of the IOM report and the summary of the PPACA suggests that no
health reform can unfold without active nursing engagement. Each document emphasizes
that nurses must lead, manage, and behave as active collaborators with other members of the
health team and with those being served.
TOP: AONE competency: Communication and Relationship-Building
10. 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
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
11. 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.
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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 communitybased 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
12. 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
13. 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.
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TOP: AONE competency: Knowledge of the Health Care Environment
14. 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
15. 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
16. 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 patientfamily 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.
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TOP: AONE competency: Knowledge of the Health Care Environment
17. 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
18. 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
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
19. 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
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Transformational leadership involves attending to the needs and motives of followers,
which results in creativity, improvement, and employee development.
TOP: AONE competency: Professionalism
20. 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
21. 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.
TOP: AONE competency: Knowledge of the Health Care Environment
22. 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
23. 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?
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a.
b.
c.
d.
Empowering
A leadership tag
A symbol
A management task
ANS: B
According to complexity theory, leadership tags, 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
24. 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 involves 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
25. 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
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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
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Chapter 02: Clinical Safety: The Core of Leading, Managing, and Following
Yoder-Wise: Leading and Managing in Nursing, 7th 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
d. Fewer clinical leaders 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?
Asking the community what the safety issues are
Consulting with a management expert about staffing schedules
Ensuring that the senior nursing officer attends the board meetings
Instituting improved practices to reduce needlestick injuries
a.
b.
c.
d.
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
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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.
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 document
“Five Steps to Safer Health Care.” What does the manager include in the implementation?
a. Patients are actively encouraged to make decisions related to care.
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
The Agency for Healthcare Research and Quality (AHRQ) outlines “Five Steps to Safer
Health Care,” which suggests that safe, patient-centered care is facilitated by assisting patients
to become active partners in their own care.
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.
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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
8. What would be the primary emphasis in designing and implementing a quality, safe
healthcare environment?
Evidence-based practice
Informatics
Staffing
The patient
a.
b.
c.
d.
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
The Five Steps to Safer Health Care for patients include keeping a list of medications
that patients are taking.
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.
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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
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?
Evidence-based practice to reduce the prevalence of pressure sores
Implementation of informatics at the bedside
Staff-manager conferences to review reporting of adverse medical events
Patient councils to review food, recreation, and nurse-patient relations
a.
b.
c.
d.
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 how 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 Five Steps to Safer Health Care for Patients includes the step of asking questions if there
are doubts or concerns. The nurse can encourage patients to take a larger role in care by taking
these steps and by providing patients with coaching in the steps.
TOP: AONE competency: Communication and Relationship-Building
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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
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 settingspecific 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?
Appropriateness of charting terms and abbreviations
Nursing hours per patient
Acuity of patient admissions
Wait times for care
a.
b.
c.
d.
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
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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
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
Multidisciplinary approachesc.
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
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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
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
The Five Steps to Safer Patient Care identifies that 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.
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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.
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
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Chapter 03: Legal and Ethical Issues
Yoder-Wise: Leading and Managing in Nursing, 7th 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
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
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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, non-disabled 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
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.
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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:
employing additional staff to assist with orientation processes.
cross-educating staff members to other areas of the institution.
transferring patients to units where the staffing pattern is optimal.
orienting staff members to all patient care areas as part of their general
orientation to the institution.
a.
b.
c.
d.
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
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.
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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 has 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
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 respondeat superior
c. As a frivolous action
d. Under the element of causation
ANS: B
Known as vicarious liability, the doctrine of respondeat 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.
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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
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
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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?
Veracity
Autonomy
Fidelity
Honesty
a.
b.
c.
d.
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.
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:
notifying staff of changes to policies related to medication administration.
scheduling and staffing to ensure safe care.
delegating in accordance with practice acts.
supervising the practice of the physician.
a.
b.
c.
d.
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
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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
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
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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.
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
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Chapter 04: Cultural Diversity and Inclusion in Health Care
Yoder-Wise: Leading and Managing in Nursing, 7th 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 in this unit.”
ANS: B
The response of the nurse manager invites cultural awareness, which involves selfexamination and in-depth exploration of one’s own biases, prejudices, and assumptions.
TOP: AONE competency: Communication and Relationship-Building
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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
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
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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 dignityconserving 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
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
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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:
dominant versus nondominant behaviors.
the need to recognize diversity within groups.
the impact of cross-culturalism.
how language separates subgroups.
a.
b.
c.
d.
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:
lack of confidence.
professional behavior.
cultural sensitivity.
ethnicity.
a.
b.
c.
d.
ANS: D
Ethnicity refers to groups of people who are classified according to common racial,
tribal, religious, linguistic, or cultural backgrounds.
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:
acculturation.
cultural sensitivity.
ethnocentrism.
transculturalism.
a.
b.
c.
d.
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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?
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
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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.
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.
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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
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.
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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 HealthCare 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
c. Understanding the importance of language
d. Encouragement of potential in all staff
e. Age bias
f. 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
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Chapter 05: Gaining Personal Insight: The Beginning of Being a Leader
Yoder-Wise: Leading and Managing in Nursing, 7th 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
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
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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?
Person
Leader
Nurse
Position
a.
b.
c.
d.
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
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?
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a.
b.
c.
d.
Leadership
Reflection
Knowledge
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
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
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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
b. Personal growth
c. Improved self esteem
d. Management skills
ANS: A
By using 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
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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 request at an assigned to different patient for
today. What type of leadership is the charge nurse displaying?
a. Informal leadership
b. Formal leadership
c. Favoritism
d. No leadership displayed
ANS: B
The charge nurse is using formal leadership to assigning patients to the nurses were 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?
Position leadership
Informal leadership
Personal leadership
Formal leadership
a.
b.
c.
d.
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.
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TOP: AONE competency: Leadership
17. At the end of a shift, the charge nurse shares with the new nurse 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 feeling 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
19. A new nurse leader wants to be the best leader she can. The nurse takes classes, finds and
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.
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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
We can learn leadership through multiple avenues. For example, attending professional
association meetings, reading, and connecting with others at a local, state, or national
level allow us to learn from others about their development as a leader.
TOP: AONE competency: Leadership
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Chapter 06: Being an Effective Follower
Yoder-Wise: Leading and Managing in Nursing, 7th Edition
MULTIPLE CHOICE
1. As a new nurse manager, you are aware of leadership, management, and followership
principles. The concept of followership is rather new as relating to leadership. What is the
role of the follower in followership?
a. Leading the group in task
b. Submission position in organization
c. Person who may influence team
d. Negative meaning for worker
ANS: C
The principle of followership allows for the follower to have a role and say, and ability to
provide influence to the team. Based on new principles of leading and following, the leader
is a follower and needs those to further goals for the team at all levels.
TOP: AONE competency: Leadership
2. As a nurse manager, you are a leader and a follower 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 the primary role of the followers on the unit, as defined in nursing?
a. Direct care provider
b. Implements leader’s policy unquestioned
c. Passive role on unit
d. Devalued staff member
ANS: A
Often, the staff nurses are the followers and the role in nursing is the one of direct care
provider. The nurses are independent thinkers who implement policy with understanding
and question if needed, they are not possible and one of the most valued members of the
health care team.
TOP: AONE competency: Leadership
3. In nursing theory, one theorist developed the theory of self-care of patients. In the theory,
the nursing action of providing care and educating the patients can be interpreted in the form
of followership for the patient. Who was their theorist?
a. Dorothea Orem
b. Patricia Benner
c. Ida Jean Orlando
d. Robert E. Kelley
ANS: A
Dorothea Orem created the theory of self-care. In using the theory related to leadership and
followership, the nurse participates and provides quality care when the patient is unable
and educates the patient when needed. In this theory, the nurse is the follower in active,
participatory role with the patient.
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TOP: AONE competency: Communication and Relationship Management
4. In nursing theory, one theorist developed the idea of new nurses progressing to experienced
nurses and playing an important role in patient care in all stages. The new nurses follow
their role and progress through stages to advanced nurse. Who was this theorist?
a. Dorothea Orem
b. Patricia Benner
c. Ida Jean Orlando
d. Robert E. Kelley
ANS: B
Patricia Benner developed the theory of novice to expert. When using the theory in
application to leadership and followership, the nurse progressing following the role to
the advanced level.
TOP: AONE competency: Leadership
5. The definition of leader refers to a person who has ability to guide people. In nursing,
the leader does more. What is NOT a role of a leader in nursing?
a. Active listening
b. Open communication
c. Accountability in decisions
d. Tight control of decisions
ANS: D
In leadership and when defining a leader, one does not keep tight control of decisions. Leaders
incorporate the follower into decision making and adapt to changes during events and as
needed.
TOP: AONE competency: Leadership
6. The definition of follower has historically referred to a person who is subservient and
submissive. The new principles of followership offer a different perspective. What is
NOT considered an attribute of followership in nursing?
a. Independent decision making
b. Critical thinking
c. Patient advocate
d. No influence over leaders
ANS: D
A followership in nursing does have influence over the leaders in an organization. The
followers are an integral part of the healthcare team in nursing and provide support,
patient care, critical thinking, and decision-making skills.
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 keeps pushing the manager to make
changes. The manager decides to provide the new nurse with an opportunity to present an idea
to the staff at the next meeting. What is the manager providing the new nurse?
a. Leadership opportunity
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b. Working to improve patient care
c. Input to the unit
d. All of the above
ANS: D
The manager is offering the new nurse an opportunity for unit leadership. By presenting
ideas to the staff, the nurse will be working to develop input into the unit, and the idea if
patient related, will possibility influence and improve patient care.
TOP: AONE competency: Leadership
8. A staff nurse is taking leadership classes in an advanced degree program with a goal to
become a nurse manager. The nurse is studying the leader-follower relationship. What has
the nurse discovered as accurate part of the leader-follower relationship?
a. Leaders are also followers.
b. Followers need to linear structures.
c. Followers are submissive in nature.
d. Leaders should dictate to the group.
ANS: A
In the leader-follower relationship, it is important to be aware the leaders are also followers.
In reality, a core part of leadership is being an effective follower as well. There is no linear
structure any longer and followers have as much input in decision making as is needed based
on the topic. The older days of dictatorship as leadership are antiquated and no longer valid
in true leader-follower relationships.
TOP: AONE competency: Leadership
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 the
desire to have engaged staff nurses who participate in a team environment. What is the
manager describing?
a. Effective follower
b. Effective leader
c. Ineffective follower
d. Ineffective leader
ANS: A
The manger has described the role of an effective follower on the unit. The effective
follower identifies and engages and participates as member of the team to work to achieve
the team goals.
TOP: AONE competency: Leadership
MULTIPLE RESPONSE
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1. A new graduate nurse is working in an outpatient surgical center with the circulating nurse.
The nurse is reviewing the patient’s chart and orders. The patient has been in pre-op
receiving eye drops in her right eye as preparation for cataract removal surgery. The preoperative orders indicate a marking has been made above the right eyebrow by the preoperative nurse for surgery. The pre-operative nurse has been instilling the medicated eye
drops to dilate the right eye for surgery. Upon further review of surgical consent, the consent
was for surgery on the left eye and the history and physical by the surgeon indicate the
patient is supposed to have surgery on her left eye. What action by the new nurse is
considered appropriate followership? (Select all that apply.)
a. Alert the pre-operative nurse to the chart discrepancy.
b. Ask the charge nurse to double check the chart together.
c. Notify the surgeon to the issue for further orders.
d. Complete a hospital incident report.
e. Do nothing; assume the nurse was correct.
ANS: A, B, C, D
The appropriate role of the follower is to be a patient advocate, role model patient care, be an
active part of the team and influence outcomes. The nurse needs to notify the pre-operative
nurse, double check the chart, and notify the surgeon for further orders or possible
cancelation of surgery. In addition, this is an error and requires reporting and completion of a
hospital incident report.
TOP: AONE competency: Leadership
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Chapter 09: Power, Politics, and Influence
Yoder-Wise: Leading and Managing in Nursing, 7th Edition
MULTIPLE CHOICE
1. A nurse manager is experiencing poor staff morale on her unit. While participating in a
baccalaureate course, the nurse manager had learned that one of the reasons nurses lack
power today is related to the past. In the early decades of the profession, nurses lacked power
because:
a. nurses freely chose to defer to physicians and administrators with more education.
b. women lacked legal, social, and political power because of legal and
cultural barriers.
c. the first nursing licensure laws prohibited nurses from making most decisions.
d. nurses astutely recognized the risks of grabbing too much power too soon.
ANS: B
Nursing mirrored the lack of legal, social, and political power that was prevalent in the
early decades of the profession.
TOP: AONE competency: Leadership
2. Nurses who engage in infighting, seek physician support against nursing colleagues,
and avoid political advocacy through membership in nursing organizations:
a. refuse to believe that they are acting like members of groups that suffer
socioeconomic oppression.
b. do not understand how their failure to exercise power can limit the power of the
whole profession.
c. purposefully choose to exercise their power in the workplace through
indirect means.
d. suffer from learned helplessness as a result of abuse by powerful nurse executives.
ANS: B
Becoming an active, productive, collegial member of groups and teams within the workplace
and in professional associations and community groups ensures that the nursing voice is heard
on healthcare issues and problems and is an appropriate exercise of power.
TOP: AONE competency: Professionalism
3. 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
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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
4. 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
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
5. 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
b.
those who participate.
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
6. 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 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,
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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
7. 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
8. 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 jobsearching 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
Leading and Managing in Nursing 7th Edition Yoder-Wise Test Bank
9. A staff nurse asks the nurse manager for a few days off for personal reasons. The nurse manager
turns in the request to the human resources office with a note indicating that the staff nurse has
demonstrated excellent working skills and is a valued employee. The nurse manager has used the
influence of her position to help this staff member. Influence is the process of:
a. using power.
b. empowering others.
c. understanding power.
d. moving past apathy.
ANS: A
Influence involves the use of power to effect certain outcomes—in this situation, to
arrange days off for a valued employee.
TOP: AONE competency: Communication and Relationship-Building
10. A nurse is participating in a baccalaureate course. For the class, she has to attend the
legislative session regarding the new role of medication assistants. Why is it important
for nurses to be involved in shaping public policy?
a. Involvement will enable nurses to take over the healthcare system at some point
in the future.
b. Other healthcare professions are less concerned about the essential needs
of clients.
c. Such activities are important career builders for nurses who seek toplevel executive positions.
d. They are closest to the front line of health care and see how it affects clients and
families.
ANS: D
Nurses can no longer be passive observers of the political world. Political involvement is
a professional responsibility. Nurses’ perspectives of the critical issues for improving
the healthcare system can shape the policy agenda of the nation’s political leadership.
TOP: AONE competency: Knowledge of the Health Care Environment
11. Sondra, a new graduate, recently began a position as a registered nurse in a rural hospital,
where she is the youngest and newest staff member. Although she has limited experience, she
has a strong knowledge base, is confident, and was considered to have strong entry-level
skills on graduation. Sondra meets with her former instructor and confides that she is very
frustrated that others do not seem to accept her leadership. What might you suggest that
would help Sondra to understand what is happening in terms of power and influence?
a. As a new graduate, it is unlikely that she has acquired the experience
and knowledge of other staff, including aides and practical nurses.
b. Rural settings tend to be closed systems and therefore are, not welcoming of
those who are not from their community.
c. Morale on her unit can be improved by engaging in shared decision making.
d. Identify the informal leaders on her unit and how they affect care decisions.
ANS: D
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Developing organizational savvy includes identifying the real decision makers and those
persons who have a high level of influence with the decision makers. Recognize the informal
leaders within any organization may have more power than the formal leader because of
more knowledge of the organization, more informational power, or more expertise.
TOP: AONE competency: Knowledge of the Health Care Environment
12. What has the literature on oppression in nursing demonstrated?
a. Verified the presence of behaviors associated with oppression within nursing.
b. Suggested that oppression leads to bullying but has little or no effect on
patient outcomes.
c. Failed to establish that oppression is present in nursing groups.
d. Indicated that nurses use oppression negatively.
ANS: A
Oppressed group behavior is apparent when a population is dominated by another group and
begins to take on the characteristics of the dominant group (Roberts, 1983), often bullying
and abusing their peers. In the twenty-first century, bullying and incivility have become
epidemic in both nursing education and clinical settings.
TOP: AONE competency: Knowledge of the Health Care Environment
13. Politics is identified in what areas?
a. Confined to legislatures
b. Seen in dysfunctional workplaces
c. Found in all social organizations
d. A representation of self-interest
ANS: C
Politics involves social interaction among organizations and as such, politics permeates in
all organizations, workplaces, legislatures, professions, and even families.
TOP: AONE competency: Knowledge of the Health Care Environment
14. Your colleague Mary, a recent graduate, announces that she intends to leave nursing in 3 to 4
months to pursue a position in marketing. While at your agency, she plans to give patients
excellent care and to learn as much as she can, because “Who knows? Nursing is a
great job with a great pay and I may return someday.” Mary’s statements most
accurately exemplify which orientation to the concept of nursing? Nursing as a(n):
a. profession.
b. occupation.
c. flexible discipline.
d. career with off and on ramps.
ANS: B
Concern with nursing as potentially one in a series of possibly well-paid jobs reflects a
view of nursing as an occupation.
TOP: AONE competency: Professionalism
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15. Lucy, head nurse on the surgical unit, works with her staff to find ways in which they can
work together with other disciplines to provide more effective care for patients on the unit.
Lucy likely knows her power is:
a. limited, thereby necessitating involvement of others in implementing ideas.
b. restricted, which necessitates finding alternative means to achieve strong
patient outcomes.
c. directed primarily toward those who are subordinate to her.
d. of unlimited capacity when shared with others.
ANS: D
Those like Lucy, who share power, tend to be the strong collaborators and see power as an
unlimited quantity when shared. Empowered nurses make professional practice possible,
creating a culture that satisfies all nurses.
TOP: AONE competency: Leadership
16. 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
17. The work group on Nursing Unit 23 is marked by apathy toward the ward’s patients,
high absenteeism, open conflict among team members, and high turnover of personnel,
including managers. The underlying behavior in this situation may be characterized as:
a. powerlessness.
b. anger.
c. apathy.
d. oppression.
ANS: A
Emotions such as anger and apathy result from a workplace in which powerlessness
is exhibited.
TOP: AONE competency: Leadership
18. 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.
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ANS: D
Collegial behavior requires respect, not friendship.
TOP: AONE competency: Communication and Relationship-Building
19. 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.
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
20. 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
21. What is the best example of skilled negotiation?
a. Linda, the manager on pediatrics, takes a proposal to her supervisor, outlining
the benefits of a walk-in preoperative area for children.
b. Kim, RN, asks for leave to pursue a semester of full-time study in her graduate
program. She proposes to accept less popular rotations during peak vacation
time, in return.
c. George, the head nurse in ER, asks for additional staff for his department
and points out the benefits of being able to keep patients for longer periods.
d. Jerry speaks with his supervisor about his supervisor’s concerns related to
bedside reporting before presenting a proposal to change this process.
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ANS: D
Successful negotiators are well informed about not only their own positions but also those of the
opposing side. Negotiators must be able to discuss the pros and cons of both positions. They can
assist the other party in recognizing the costs versus the benefits of each position.
TOP: AONE competency: Leadership
22. Amy has worked in the dialysis unit on staff for about 12 years. She is frequently consulted
by other nursing staff regarding protocols and policies on the unit. What type of power is
Amy using?
a. Position power
b. Expert power
c. Personal power
d. Competency power
ANS: B
According to the types of power outlined in the text, Amy is most likely evidencing expert
power in that she is being consulted regarding areas of knowledge and competency on the
unit and is at the same level, potentially, in the hierarchy as her colleagues.
TOP: AONE competency: Leadership
23. Despite repeated invitations by his colleagues to become involved in regional and state
nursing practice committees, Tom refuses. His reason is that “nursing committees
rarely get anything worthwhile done because of politics and conflicts.” According to
the text, Tom’s view of involvement:
a.
is rare in nursing today.
b. reflects a fear of power.
c. reflects the essential process of power.
d. reflects empowerment and capacity to make his own decisions.
ANS: C
Tom’s response reflects a distancing from other nurses related to discomfort with conflict
associated with human interactions. The text defines human interactions within
organizations as politics, a component of which is the essential process of power.
TOP: AONE competency: Professionalism
24.
A unit manager watches a new RN graduate interacting with a patient. When the RN comes out of
the room, the unit manager says, “I don’t know what they taught you in your nursing program,
but if I see you do that again, I will write you up.” This example demonstrates:
a. coercive use of power.
b. appropriate application of control.
c. use of informatory power.
d. use of power to provide coaching.
ANS: A
Influence is the process of using power. Influence can involve the punitive power of
coercion, as is used in this example.
TOP: AONE competency: Communication and Relationship-Building
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MULTIPLE RESPONSE
1. As a new manager in the ED, you meet with each of the staff to ask about their priorities and
what they think is going well in the department or what is of concern to them. Almost all of
the staff express frustration and distress at being treated rudely or disrespectfully by patients,
staff from other departments, and physicians and complain that they feel that nurses in the
ED are not valued. With the staff, you brainstorm to raise the profile of nurses. Which of the
following strategies would be most effective? (Select all that apply.)
a. Requesting increased compensation
b. Speaking positively about one’s work
c. Dressing and grooming in a clean and neat manner
d. Using titles (e.g., Mr., Mrs., Ms.) and last names
e. Submitting a written complaint to senior administration regarding rude behaviors
f. Developing a code of conduct for the ED staff.
ANS: B, C, D, F
Demonstrating a positive and professional attitude about being a nurse to nursing colleagues,
patients and their families, other colleagues in the workplace, and the public facilitates the
exercise of power among colleagues while educating others about nurses and nursing. A
powerful image is an important aspect of demonstrating this positive professional attitude and
includes how we identify ourselves, how we dress, whether we are punctual for
commitments, and whether we speak positively about our work. Bullying and incivility are
negative expressions of power that can affect patient outcomes. The Joint Commission
standard demands that leaders ensure that a code of conduct is implemented to ensure patient
safety and a culture of quality.
TOP: AONE competency: Communication and Relationship-Building
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Chapter 10: Healthcare Organizations
Yoder-Wise: Leading and Managing in Nursing, 7th 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.
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:
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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.
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
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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.
only outpatient services.
ANS: C
d.
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 longterm 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:
pay dividends to stockholders.
can refuse clients who are unable to pay.
have no paid employees.
pay no taxes.
a.
b.
c.
d.
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
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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.
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.
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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
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
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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 HealthCare 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 the 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 the government and thus to taxpayers, who support the hospitals.
TOP: AONE competency: Knowledge of the Health Care Environment
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.
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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:
managing physician-led research.
monitoring physician documentation of the need for medical care.
determining which services are designated fee-for-service.
identifying errors in physician diagnoses.
a.
b.
c.
d.
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
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, you would expect what to be the major contributor
to funding and revenues in your organization?
The federal government
Medicare
Medicaid
Blue Cross/Blue Shield
a.
b.
c.
d.
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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
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
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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
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Chapter 11: Organizational Structures
Yoder-Wise: Leading and Managing in Nursing, 7th Edition
MULTIPLE CHOICE
1. Because of rapid turnover and the ongoing hiring of new graduates, the skill levels of staff in
a busy CCU are varied. Senior staff are becoming burned out with the need to provide
mentorship and guidance to new staff. As the manager, you propose the addition of a nurse
in advanced practice to provide consultation and education for staff. What is this position
considered?
a. Hierarchical position
b. Ancillary
c. Line position
d. Staff position
ANS: D
Line personnel have authority for decision making, whereas personnel in staff positions
provide education, support, advice, and counsel. The nurse in the advanced practice is
providing advice and support through education as well as consultation.
TOP: AONE competency: Business Skills
®
2. A hospital is working toward becoming a Magnet hospital. The chief nursing officer is aware
®
that professional nursing departments in Magnet hospitals will:
a. not be directed by nurses.
b. be virtual organizations.
c. be designed to maintain nursing standards of practice.
d. be entitled to have client care departments.
ANS: C
Hospitals that are successful in recruiting and retaining nurses have found that the major
contributing characteristic to success is a nursing department that is structured to provide
nurses the opportunity to be accountable for their own practice. Accountability is guided
by nursing standards of practice and thus, successful nursing departments emphasize
maintenance of these standards.
TOP: AONE competency: Knowledge of the Health Care Environment
3. The chief nursing officer and the dean of the School of Nursing create a partnership based
on belief that by establishing rules and regulations and controlling the environment, this
partnership will:
a. promote professional medical authority, autonomy, and responsibility.
b. need a degree of flexibility to engender success.
c. be essential for self-governance.
d. provide for the establishment of medical committees.
ANS: B
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Bureaucratic structures have a centralized command structure (chain of command) with
a clear division of labor and well-articulated and commonly accepted expectations for
performance. Rules, standards, and protocols ensure uniform actions and limit
individualization of services and variance in workers’ performance. Although bureaucracy
enhances consistency, by nature, it limits employees’ autonomy and thus the potential for
innovations.
TOP: AONE competency: Leadership
4. In matrix organizational structures, a nurse manager understands that this type of structure:
a. is a simplified organizational structure.
b. has both a functional manager and a service or product-line manager.
c. arranges departments strictly according to function.
d. promotes harmony in organizational decision making.
ANS: B
Matrix structures are complex, integrated organizational structures that involve both
functional and service or product-line managers. In this structure, team members or teams
from various functional departments may combine to complete a project or program,
thereby becoming responsible to both their functional department manager and their
product-line manager.
TOP: AONE competency: Business Skills
5. Collaborative partnerships between hospitals and schools of nursing are examples of
hybrid organizational structures. A hybrid organizational structure:
a. best fits long-term care units.
b.
has a mixture of the characteristics of various organizational types.
c. places the authority for decision making closest to the places where
workers perform.
ANS: b
Hybrid structures include characteristics of various organizational types and reflect the
needs of the situation and the environment.
TOP: AONE competency: Knowledge of the Health Care Environment
6. In opening a new dialysis unit, the nurse manager has to develop a philosophy for the
unit. This philosophy needs to:
reflect the culture of the unit and its values.
be developed by the nursing manager on the unit.
identify the clients that will be served on the unit.
replicate the organization’s philosophy.
a.
b.
c.
d.
ANS: A
A philosophy expresses the values and beliefs that members of the organization hold about
the nature of their work, about the people to whom they provide service, and about
themselves and others providing the services.
TOP: AONE competency: Knowledge of the Health Care Environment
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7. The hospital administration gives approval to the chief nursing officer to hire clinical nurse
specialists in staff positions rather than in administrative positions. A clinical specialist who
has staff authority but no line authority typically is able to:
a. function through influence.
b. take complete responsibility for the care of clients.
c. interview and hire staff nurses for designated nursing units.
d. be granted functional authority to determine standards of nursing care and
enforce them.
ANS: A
Staff positions provide support to line positions but have no direct accountability for staff
or patient outcomes and therefore function through influence.
TOP: AONE competency: Knowledge of the Health Care Environment
8. A new director of nursing in a small rural hospital wants to make changes from the traditional
model of governance to a shared-governance model. Select the characteristic below that best
describes the traditional organizational structure in which a staff nurse is assigned to carry out
nursing tasks for clients but is not given the chance to provide input into forming the policies and
procedures by which care is delivered or the standards by which care is evaluated:
a. bureaucratic.
b. decentralized.
c. delegated authority and responsibility.
d. delegated responsibility but no authority.
ANS: D
In traditional structures, decision-making authority (right to act) is held by a centralized
decision-making body, so that staff members have responsibility for certain functions but
do not participate in decisions related to those functions.
TOP: AONE competency: Knowledge of the Health Care Environment
9. The chief nursing officer is given the task of reviewing and proposing revision of the
organization’s mission, philosophy, and technology. In reviewing them, the chief
nursing officer understands that they should be reflected in:
a. the organizational structure.
b. line and staff responsibilities.
c. the policies and procedures.
d. government regulations.
ANS: A
The mission statement is an important foundation for the organizational structure and
defines technology and human resources required for the organization.
TOP: AONE competency: Knowledge of the Health Care Environment
10. The facilities department is experiencing some challenges and is undergoing
reorganization. Because of your familiarity with systems theory, you:
a. know that this challenge is their issue and that it has nothing to do with your unit.
b. understand that such events are localized and do not have an impact on
the organizational culture.
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c. know that the nature of challenges and reorganization in facilities will have
an impact on other areas.
d. anticipate that your prior experiences with facilities have no effect on the
current situation.
ANS: C
By nature, a system such as an organization is an interacting collection of parts that together
make up the whole. Changes to one part will affect other parts and the system as a whole.
TOP: AONE competency: Leadership
11. “Georgia Hospital will provide care that is a national example of consumer service” is a:
a. vision statement.
b. statement of philosophy.
c. mission statement.
d. rationale for care.
ANS: A
A vision statement is an articulated goal that provides an inspirational target to which the
organization aspires at some future time. A statement of philosophy expresses values and
beliefs, and a mission statement provides the reason for the existence of the organization.
TOP: AONE competency: Knowledge of the Health Care Environment
12. “At Thoroughcare, we provide health care for women and children in
transition” is an example of a:
a. vision statement.
b. mission statement.
c. goal statement.
statement of
d. philosophy.
ANS: B
Mission statements provide a reason or rationale for the existence of the organization and are
indicative of the structure of the organization and of who consumes the services provided.
TOP: AONE competency: Knowledge of the Health Care Environment
13. What would be the most appropriate mission statement for a nursing center?
a. “At Plentyville, we provide rehabilitative services for addicted adolescents.”
b. “Georgiatown provides treatment and prevention services for county residents.”
c. “At Heart, our aim is to provide services that lead the nation in health
education and research.”
d. “At Coeur, we strive to achieve optimal pain management with patients
who are experiencing chronic pain.”
ANS: D
The mission statements of nursing centers are oriented toward achieving optimal health
status for a defined group of patients or consumers rather than being treatment or
maintenance or social-support oriented.
TOP: AONE competency: Knowledge of the Health Care Environment
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14. A primary care clinic is established in Pleasantville to provide comprehensive services
to infants, children, and families within the community. The executive director of the
clinic oversees physician and nursing services for infants, children, and families; a
neurodevelopmental clinic; psychology, family counseling, and social work services;
nutritional counseling; speech and hearing services; and physiotherapy. This type of
organizational structure is known as:
a. hierarchical.
b. bureaucratic.
c. service-line.
d. matrix
ANS: C
In service-line structures (sometimes called product lines), the functions necessary to produce
a specific service or product are brought together into an integrated organizational unit under
the control of a single manager or executive.
TOP: AONE competency: Knowledge of the Health Care Environment
15. In what situations would you expect low morale and frustration?
a. Statement of philosophy indicates “We value our staff.” When staff members
leave, careful evaluation is done to determine whether staff should be replaced
by full- or part-time employees.
b. Practices include annual staff recognition celebrations. During times of change,
staff members are actively included in issue identification and solution finding.
c. Recruitment ads promise opportunities for advancement for everyone. Promotions
are given only to individuals with long-standing service and entrenched
relationships.
d. The vision indicates that there is strong commitment to lead in research. The
organization has tried to implement a strong campaign to attract leading
nurse researchers but has experienced difficulty in doing so.
ANS: C
Although frustration may occur with external factors that affect ability to act on values and
aspirations, lack of congruence between what is espoused as a value within the organization
(such as promising advancement as an incentive to join the organization) and what is
actually done (such as restricting advancement to internal candidates with much
organizational history) can cause low morale and confusion.
TOP: AONE competency: Communication and Relationship-Building
16. At Orangetown Hospital, the nursing department is developing a mission statement
for nursing. What would be a suitable mission statement?
“Nursing provides services for patients admitted to Orangetown Hospital.”
“To participate fully in the professional services offered by Orangetown Hospital.”
“To lead by the lamp; services for seniors.”
“At Orangetown, the nursing department provides caring services that
recognize the diversity of clients and promote optimal health with clients
through partnership, education, and interprofessional collaboration.”
a.
b.
c.
d.
ANS: D
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A nursing mission statement within an organization needs to establish the reason for
nursing within the organization and lays out relationships with clients, the community, and
other disciplines.
TOP: AONE competency: Knowledge of the Health Care Environment
17. At Hospital XYZ, staff members on Y3 Unit have dealt with the third charge nurse in 3
years. Donna, the current charge nurse, lacks confidence in patient-nurse relationships, and
scheduling and other processes are routinely left to the last minute. Staff members approached
Donna first and then administration with their concerns about Donna’s effectiveness as a
leader. The staff was told that the problem is likely staff related, that it is simply an unhappy
group, and that there is nothing that will be done further about their concerns. The
philosophy of the organization indicates that “open, transparent communication
between staff and management is desired and supported,” and that “innovation and
creative thinking are the foundation of the organization’s progress.” In assessing this
situation as a newly hired senior executive, you anticipate that:
a. staff members will resolve the conflict on their own.
b. the situation will lead to ongoing disgruntlement and attrition.
c. no further discussion or concerns will come out of the situation.
d. the head nurse will be able to resolve the conflict on her own.
ANS: B
Lack of congruence between the stated philosophy of the hospital and the experienced
organizational culture does not support either the staff or the charge nurse and likely will result
in ongoing frustration, confusion, and morale, which could result in increased attrition.
TOP: AONE competency: Communication and Relationship-Building
18. A new CEO has been hired at Valley Hospital who proposes to change the centralized
organizational structure that was put in place 10 years ago, based on widespread
consultation with staff. The proposed structure involves substantial flattening of the
organizational structure, with significant decision making being made at the point-of-care
and an emphasis on interprofessional collaboration. There is a great deal of discussion about
the balance between hospital-wide budget decision making and unit-based decision making.
This discussion represents:
a. Chaos theory.
b. organizational redesign.
c. organizational reengineering.
d. restructuring.
ANS: C
Reengineering involves a total overhaul of an organizational structure. It is a radical
reorganization of the totality of an organization’s structure and work processes. In
reengineering, fundamentally new organizational expectations and relationships are
created. Redesign is a technique to analyze tasks to improve efficiency, and restructuring is
a technique to enhance organizational productivity.
TOP: AONE competency: Knowledge of the Health Care Environment
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19. With revenue reductions and cost-saving measures, the number of managers has been
reduced, this has increased the number of team leaders supervised by managers by as many as
three. This change may result in:
a. decreased patient satisfaction.
b. increased efficiency in costs.
c. a more positive perception of managers.
d. little change to manager-staff relationships.
ANS: A
When a span of control becomes too large, supervision can become less effective, which can have
a negative effect on staff-manager relationships and on the overall quality of patient care.
TOP: AONE competency: Knowledge of the Health Care Environment
20. Taylor Hospital has well-defined organizational units that provide maintenance, financial
services, care for cardiac patients, care for surgical patients, and so on. The organizational
chart indicates that surgical units report to a surgical manager and all nursing units report to a
vice president of nursing; financial services to an accountant and then to a business
executive; and so on. The primary disadvantage of this organizational structure is:
a. breakdown in function and communication across specialties.
b. lack of congruence in culture and organizational values.
c. highly centralized decision making and authority.
d. wide span of control.
ANS: A
In a functional organizational structure, departments and services function according to
specialty. This model supports professional expertise but can lead to silos in
communication and decision making and discontinuity in patient services.
TOP: AONE competency: Knowledge of the Health Care Environment
21. In the Unity Healthcare organization, decisions, including those at the unit level, are made by
a group of senior executives. Rules for employees are clear, and nursing care is delineated by
procedures and protocols. This exemplifies:
a. transformational leadership.
b. transactional leadership.
c. bureaucratic organization.
d. Chaos theory.
ANS: C
Organizational structure refers to the organization of a work group, rather than to its
leadership, and includes where decisions are made and what the relationships are between
groups. In the example given, power is centrally located, with all decisions regarding
policies and procedures flowing from this central location, which is characteristic of
bureaucratic organizations.
TOP: AONE competency: Knowledge of the Health Care Environment
22. In the Unity Healthcare organization, communication flows:
a. laterally.
b. bottom to top.
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c. top to bottom.
d. intermittently.
ANS: C
In a bureaucratic organization, communication flows vertically top to bottom.
TOP: AONE competency: Knowledge of the Health Care Environment
23. Sarah is a clinical nurse educator in the dialysis unit at Pines Health Center and
provides education, consultation, and training support. Sarah has:
direct responsibility for patient care.
direct accountability for patient outcomes.
an authority relationship to staff.
an influence over patient outcomes.
a.
b.
c.
d.
ANS: D
In a staff position, Sarah supports line positions in accomplishing the primary goals and
objectives of the unit and provides support, counsel, and advice, but she has limited or no
authority for decision making.
TOP: AONE competency: Knowledge of the Health Care Environment
24. A statement such as “We believe in the right of patients to make choices and to have
care that is sensitive to their preferences and needs” is a _____ statement.
mission
goal
vision
philosophy
a.
b.
c.
d.
ANS: D
Philosophy statements capture significant beliefs and values of the organization.
TOP: AONE competency: Knowledge of the Health Care Environment
MULTIPLE RESPONSE
1. Organizational culture includes: (Select all that apply.)
a. norms.
b. traditions.
c. behaviors.
d. values.
ANS: A, B, C, D
Organizational culture, the reflection of the norms or traditions of the organization,
is exemplified in behaviors that illustrate values and beliefs.
TOP: AONE competency: Knowledge of the HealthCare Environment
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Chapter 15: Making Decisions and Solving Problems
Yoder-Wise: Leading and Managing in Nursing, 7th Edition
MULTIPLE CHOICE
1. 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
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 HealthCare Environment
2. 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
3. Several nurses on an adolescent psychiatric unit complain that the teens are becoming
unmanageable on the 0700-1900 shift. To resolve this problem, the nurse manager decides
that the staff should have a brainstorming session. The goal of brainstorming is to:
a. evaluate problem solutions.
b. critique the ideas of others.
c. generate as many solutions as possible.
d. identify only practical and realistic ideas.
ANS: C
Brainstorming encourages creativity when one is beginning to problem-solve and avoids
premature shutting down of ideas through early evaluation. The goal is to generate ideas,
no matter how seemingly unrealistic or absurd.
TOP: AONE competency: Communication and Relationship-Building
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4. During a fire drill, several psychiatric patients become agitated. The nurse manager quickly
assigns a staff member to each patient. This autocratic decision style is most appropriate for:
a. routine problems.
b. crisis situations.
c. managers who prefer a “telling” style.
d. followers who cannot agree on a solution.
ANS: B
An autocratic style is appropriate when rapid decision making is required, such as in a
crisis situation.
TOP: AONE competency: Leadership
5. After the nurses who work on an adolescent psychiatric unit have had a brainstorming session,
they are ready to resolve the problem of unmanageable teenage patients. To maximize group
effectiveness in decision making and problem solving, the nurse manager has:
a. prevented conflict.
b. formed highly cohesive groups.
c. used majority rule to arrive at decisions.
d. encouraged equal participation among members.
ANS: D
Groups are more likely to be effective if members are involved, the group is cohesive,
communication is encouraged, and members demonstrate some understanding of the
group process. The nurse leader or manager should provide a nonthreatening and positive
environment in which group members are encouraged to participate actively.
TOP: AONE competency: Communication and Relationship-Building
6. To solve a problem, the nurse manager understands that the most important problem-
solving step is:
the implementation phase.
identification of numerous solutions.
accurate identification of the problem.
evaluation of the effectiveness of problem resolution.
a.
b.
c.
d.
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
7. 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
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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
8. In a rural hospital, the unit for which you are charge nurse has a particularly busy morning. A 52-
year-old patient is complaining of left-sided chest pain and a multiparous patient is about to
deliver. A child with asthma is experiencing early signs of an attack. The other RN on the unit is
a recent graduate who has not yet been orientated to the labor room and has limited
cardiac nursing experience. An unlicensed assistant is available to assist. You must decide which
patient situation you will take and where the new graduate RN’s skills can best be used.
Given the limitations in skills and experience, number of staff available, and time
constraints, you must make a decision that involves:
a. a higher order thinking process.
b. selecting the best option for reaching a predefined goal.
c. optimizing.
d. satisficing.
ANS: D
With this approach, the decision maker selects an acceptable solution, one that may
minimally meet the objective or standard for a decision. This approach allows for quick
decisions and may be the most appropriate when lack of time is an issue.
TOP: AONE competency: Knowledge of the Health Care Environment
9. 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
10. An outpatient surgery manager is evaluating new infusion pumps for purchase to use in
the operating room. The manager should:
select the least expensive brand.
use a decision-making tool to evaluate brands.
ask the nursing staff which brand they prefer.
select the vendor the institution usually buys from.
a.
b.
c.
d.
ANS: B
Decision-making tools such as decision grids and SWOT analyses are most appropriate
when information is available and options are known.
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TOP: AONE competency: Knowledge of the Health Care Environment
11. 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
12. Sue, a nurse manager, has a staff nurse that has been absent a great deal for the past 3
months. A whistleblower gives some information to Sue indicating that the staff nurse will be
resigning and returning to school. Because of this, Sue decides to do which of the following?
a. Immediately fire the staff nurse.
b. Speak to the whistleblower and elicit more information.
c. Speak to the staff nurse and ask her to resign.
d. Do nothing.
ANS: D
Doing nothing is often warranted because of lack of energy, time, or resources to solve
the
real problem adequately, and because the benefits are not seen as sufficiently compelling to
commit to an action. Do nothing may also be utilized when the individual is not able to do
anything for the particular situation or issue.
TOP: AONE competency: Leadership
13. 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
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
14. A good nursing decision maker is one who:
a. uses various models to guide the process based on the circumstances of the
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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
15. From the information supplied in this chapter, which statement best defines critical
thinking? Critical thinking is a:
a. high-level cognitive process.
b. process that helps to develop reflective criticism for the purpose of reaching
a conclusion.
c. high-level cognitive process that includes creativity, problem solving, and
decision making.
d. discussion that guides the nursing process.
ANS: C
It is generally accepted by many authors and researchers that this statement best
defines critical thinking.
16.
TOP: AONE competency: Business Skills
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
17. 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 highquality care and who will fit well with the team. Which of the following decision-making
models did Justin use in making his decision?
a. Subjective model
b. Objective model
c. Optimizing model
d. Satisficing model
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ANS: C
Optimizing is a decision style in which the decision maker selects the option that is best,
based on an analysis of the pros and cons associated with each option. A better decision is
more likely when using this approach, although it takes longer to arrive at a decision.
TOP: AONE competency: Business Skills
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 highquality 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.
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.
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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.
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. Knowing when to have the entire team participate in the decision-making process or when
to have only the team leader make the decisions depends on the situation and the desired
outcomes. The autocratic process is used in which of the following situations?
a. The task and the outcome are relatively simple and defined.
b. It is unlikely that the group will reach a consensus.
c. A decision has to be discussed thoroughly.
d. A number of options need to be considered.
ANS: A
An autocratic style is appropriate when rapid decision making is required and in
situations where the task and the potential outcome are well-defined.
TOP: AONE competency: Leadership
23. Jane, an experienced head nurse, is given the task of completing the summer vacation
schedule for the pediatric unit. She is fully aware of the hospital’s restrictions on time
off and the number of staff on vacation at any given time, as well as its issues regarding
seniority. She weighs the options of allowing staff choice, such as it takes more time but
gives employees options. However, if choice is allowed, this could cause arguments. Which
of the following is the best alternative?
a. Ask for requests for vacation time in advance, and post the times.
b. Post the completed vacation schedule.
c. Post a tentative schedule, and request feedback.
d. Post a blank schedule, and ask staff members to fill in their times by a given date.
ANS: D
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This is based on a decision-making model that allows experience and knowledge to predict
whether a decision will or will not work. The experience of the head nurse suggests that it is
important to involve staff in decisions that affect them the most.
TOP: AONE competency: Knowledge of the Health Care Environment
24. The agency in which you are a nursing leader makes a decision to reduce the number of RN
positions in favor of PN positions because agency data suggest that the clients in the agency
can receive appropriate care from PN staff. Furthermore, the agency is facing a decline in
funding and without restructuring, some clients might not receive services at all. You
provide this information on this decision to the staff and ask them to advise you if they have
any feedback, concerns, or alternative solutions. This decision-making style is known as:
a. paternalistic.
b. shared.
c. reasoned
d. informative.
ANS: D
The informative model offers the staff the ability to make a decision after the information
has been shared and without the active involvement of the manager.
TOP: AONE competency: Leadership
MULTIPLE RESPONSE
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
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Chapter 17: Delegating: Authority, Accountability, Responsibility in Delegation
Decisions
Yoder-Wise: Leading and Managing in Nursing, 7th Edition
MULTIPLE CHOICE
1. 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
2. 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.
TOP: AONE competency: Knowledge of the Health Care Environment
3. 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.
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TOP: AONE competency: Knowledge of the Health Care Environment
4. 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. Thus, “ accountability rests within the decision
to delegate while responsibility rests within the performance of the task” (Anthony
and Vidal, 2010, p. 3).
TOP: AONE competency: Professionalism
5. 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 delegate.
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
6. 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
7. 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:
acknowledging the arrival of the second UNP on the unit.
providing clear directions to both UNPs.
matching tasks with qualified persons.
receiving reports from the prior shift.
a.
b.
c.
d.
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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.
TOP: AONE competency: Knowledge of the HealthCare Environment
8. 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 HealthCare Environment
9. 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
Assigning
c. Sharing
d. Authorizing
b.
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 HealthCare Environment
10. 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.
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ANS: D
When ability and willingness are strong, the involvement of the delegator is needed less.
TOP: AONE competency: Knowledge of the HealthCare Environment
11. With delegation, responsibility and accountability remain with the:
a. physicien.
b. professional who delegates.
c. individual who receives the delegation.
d. individual who previously performed the task.
ANS: B
Even though the delegate (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 delegate
has responsibility (obligation to engage in the task) and authority for the task.
TOP: AONE competency: Professionalism
12. Which of the following exemplifies accountability? Karen, the nurse manager on 5E:
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
13. 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
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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.
TOP: AONE competency: Knowledge of the Health Care Environment
14. 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
15. 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.”
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
16. 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?”
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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
17. 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.
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
18. 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. 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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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 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
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. Determination of Evelyn’s educational
preparation and certification is related to the concept of:
a. accountability.
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
21. 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’s activity in the example
described is termed:
a. passive delegation.
b. passive accountability.
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c. active delegation.
d. active responsibility.
ANS: C
When a position description contains functions that are considered to be the normal practice
of the person in that role, then it is considered a passive delegation act. When Sarah decides
what is best for the patients in her care in terms of who should perform the care and then
holds the person accountable, she is engaging in active delegation.
TOP: AONE competency: Knowledge of the Health Care Environment
22. Functions such as “delegates tasks to assistive personnel” that are outlined in a
position description for an RN Team Leader would be considered:
a. active delegation.
b. passive delegation.
c. passive accountability.
d. active responsibility.
ANS: B
Delegation of functions that are normally considered part of or an essential part of the
practice of a licensed person through a position description is considered passive delegation.
TOP: AONE competency: Knowledge of the HealthCare 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.
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.
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TOP: AONE competency: Knowledge of the HealthCare 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.)
teaching self-catheterization to a patient with paraplegia who has limited English.
basic care for a patient with a head injury who is rapidly deteriorating.
one-to-one observation with a suicidal patient.
assessment of patients being admitted through the Emergency Department.
basic hygienic care for a patient who is post MI and stable.
a.
b.
c.
d.
e.
ANS: A, B, D
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 HealthCare Environment
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Chapter 28: Developing the Role of Leader
Yoder-Wise: Leading and Managing in Nursing, 7th Edition
MULTIPLE CHOICE
1. 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
2. After a newly hired director of nursing has reviewed the hospital’s strategic plans, she
develops a timeline for achieving those plans. The new leader is:
a. not expecting that novice leaders will have a vision.
b. demonstrating mistrust of the abilities of her staff to implement the plans.
c. instituting deadlines against which the performance of staff will be evaluated.
d. translating a global document into realistic plans for nursing.
ANS: D
Followers need three things from leaders: direction, trust, and hope. Developing timelines for
the strategic plan involves translating a vision into reality and being able to communicate
a vision meaningfully, which is an example of a leader’s influencing behavior.
TOP: AONE competency: Communication and Relationship-Building
3. A nurse executive is hired to restore a unit’s productivity, which has decreased as the result
of low staff morale. The nurse executive utilizes which of the following leadership principles?
a. The leader declares the intent and goals to enhance productivity and assumes that
the unit also wishes to increase productivity, which allows nurses to feel in
control of the environment.
b. If staff members increase productivity, then they are given the opportunity to engage
in learning events such as workshops and conferences. If the staff members are not
satisfied, they will insist on a different leader, who will get them what they want.
c. Leaders at the national level who are seeking relief for nurses in the workplace
are seen as the solution to the nursing shortage.
d. Workplace satisfaction depends on staffing ratios, adequate pay, and tuition
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reimbursement, and these are things the leader can control.
ANS: A
Stephen M.R. Covey suggests that Smart Trust is a method for restoring trust in organizations.
Smart Trust Actions include declaration of the leader’s intent and assumption by the
leader that others also have positive intentions. Building trust involves signaling goals and
intended actions in advance. Actions such as promising external rewards such as additional
learning opportunities, workload relief, and compensation are consistent with transactional
leadership, which leads to low to stable commitment and limited satisfaction.
TOP: AONE competency: Communication and Relationship-Building
4. 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
5. After being interviewed for the unit manager position, the staff nurse reflects on the interview
process. The staff nurse is aware that leadership begins:
a. within.
b. through a relationship with a mentor.
c. with the job description.
d. with the chief nursing officer of the organization.
ANS: A
People notice differences in workplaces and tend to choose those that evidence a high
degree of trust between leaders and followers. Stephen M.R. Covey suggests that trust
begins with self and that leaders must focus first on developing character and confidence,
which is their credibility. Credibility enables leaders to trust themselves and gives others
someone or something that they can trust.
TOP: AONE competency: Leadership
6. The nurse manager in the Emergency Department needs to implement new staffing
patterns. As a transformational leader, the nurse manager would:
a. explain in detail how well the new idea will work.
b. reinforce how this change will respond to the ideas and solutions generated by
staff members.
c. reason with staff members that the new idea will save money and allow more
free time.
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d. imply that raises will be smaller than anticipated if the new idea is not accepted.
ANS: B
Transformational leadership inspires and motivates others through influence and persuasion
rather than through rewards (e.g., free time) and punishment (e.g., smaller raises). This type
of leader listens to the views of others (such as those of the staff members), empowers others
to lead (such as in generating solutions for staffing problems), finds ways to remove barriers,
and serves as an advocate for those who care for patients.
TOP: AONE competency: Leadership
7. To retain supervisory staff members, the director of nursing develops a mentoring program.
The best person to be a mentor for a new supervisor in a leadership position is someone who
has:
a. been in the same position and can relate to the new supervisor’s problems.
b. had vast leadership opportunities and likes to talk about his or her
past experiences.
c. leadership experience and time to spend communicating with the new
supervisor about his or her experiences.
d. people who can help the new supervisor get what he or she needs to make
the organization grow quickly and prosper in the process.
ANS: C
Mentors need to have experience and some success in the leadership area of interest, as well
as interest in the future development of the novice. The mentor can be geographically distant
or close and able to provide advice and feedback.
TOP: AONE competency: Leadership
8. 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
9. A nurse executive who considers herself a Baby Boomer will have the challenge of
convincing the emerging work force of the necessity of committee meetings. One of the
primary reasons that the Baby Boom generation appears to have so many meetings in
the work environment is that:
a. they feel more comfortable in a group.
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b. they find that the journey to the solution is as important as the solution itself.
c. they were deprived of collective action opportunities in the past and now feel
that solutions are better when many people have input.
d. Baby Boomers are aging and need the respite from work that meetings offer,
so they can recuperate from the physical demands of the work environment.
ANS: B
Baby Boomers mistrust authority and trust in collective action, based on successes with
social movements in their formative years.
TOP: AONE competency: Leadership
10. The hospital administration is discussing the possibility of closing hospital beds in your
unit because of a nursing shortage and the increased amount of overtime required to care
for patients. As the leader of the unit, which of the following examples best demonstrates
your transformational leadership style?
a. Your entire staff walks out on strike.
b. Your staff sends an ultimatum to the clinic director demanding higher pay.
c. A group of your staff members goes to the administration to propose closing of
a different unit.
d. A group of your staff members goes to the administration to request that they
be allowed to work the overtime hours.
ANS: C
Commitment to the vision that has been created is seen in the ability of the leader to influence,
motivate, and persuade others. The transformational leader can motivate employees by
encouragement of novel, innovative thinking. True transformational leadership as occurring when
the leader is able to motivate followers to create new ways to problem solve and manage the
changes together.
TOP: AONE competency: Leadership
11. 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
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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
12. Becky graduated 5 years ago and is keenly interested in pursuing leadership opportunities.
She has been active in learning about leadership through workshops and Internet research and
recently began a graduate degree program with a focus on nursing administration. She has
excellent clinical skills and eagerly accepts responsibility for various projects on the unit. Her
sarcastic and sometimes aggressive behavior tends to alienate other staff members on the
unit. In coaching Becky, you:
a. suggest that she reflect on situations in which she has had a positive influence
and consider how her interactions contributed to the situation.
b. suggest that she not consider leadership roles because her interaction skills are more
suited to roles in which she has limited opportunities to work with others.
c. ask staff members on the unit with whom she works to provide her feedback
about ways in which her behavior irritates or turns them away.
d. encourage her to continue her graduate courses, as information about strategies
and technical aspects of the role will compensate for negative interactions.
ANS: A
Leadership involves radiating positive energy and the ability to inspire and motivate
others. Management can be taught through formal instruction, but leadership is attained
through reflection on rich personal experience.
TOP: AONE competency: Leadership
13. The Sunny long-term care facility has experienced numerous difficulties with staff
relationships, despite its success in maintaining financial viability and judicious use of
resources. Staff members complain that the primary concerns of the facility include
applying policy, saving money, and ensuring that lawsuits are avoided. There is little trust
in, and involvement of, staff members. This facility may be:
a. well managed and well led.
b. overly managed and not well led.
c. poorly managed and well led.
d. overly led and overly managed.
ANS: B
This organization is concerned primarily with coordination of resources, application of
current policy, and economic issues connected to the present. These behaviors are consistent
with the management role. There is little evidence that the organization displays leadership,
which involves trust, belief, hope, and vision.
TOP: AONE competency: Leadership
14. While explaining the importance of developing leadership skills among nurses to a group
of first-year nursing students, Natalie, a nursing unit manager, emphasizes that:
a. most nurses are not expected to assume leadership roles.
b. the role of nurse leadership is only at the bedside, ensuring that patient care
is performed according to established standards.
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c. Only individuals in formal leadership roles are expected to be leaders.
d. The public depends on nurses to assume leadership in moving consumer
advocacy concerns forward.
ANS: D
The complexity of nursing and the healthcare environment demands that all nurses assume
roles of manager, leader, and follower, depending on the situation. Nurses are involved in
providing leadership in direct patient care, in leading others at a unit or organizational level,
in moving the profession forward, and in participating in legislative and policy arenas.
Consumers depend on nursing leadership to carry the healthcare agenda forward.
TOP: AONE competency: Knowledge of the HealthCare Environment
15. Which of the following nurses is MOST likely to inspire others to do their best?
a. Nancy, RN, is an individual who enjoys details and organization. She regularly
leaves notes for the next shift about what has been done incorrectly or omitted.
b. Jim, RN, has been involved in nursing for several years and is well liked by
patients and families. He continually searches for new knowledge and skills,
and his sense of humor and optimism are infectious.
c. Clara has been the head nurse on Unit 3Y for years. She is quiet but enjoys patients
and their families. She has not been to a conference in years because the unit is her
entire life.
d. Karen is a team leader. She is extraordinarily vigilant about ensuring that everyone is
treated fairly in assignments. She is also very conscientious about care and regularly
checks up on what everyone is doing to ensure that it is done correctly.
ANS: B
To be inspired, people must have a positive leader who radiates energy, a zest for learning,
and an interest in the common good, and is engaged in self-renewal. This leader is hopeful
and optimistic. Leaders, not managers, inspire others to work to their highest level.
TOP: AONE competency: Leadership
16. 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
Leaders who come out of the Baby Boomer generation may be more comfortable with collective
action than followers who come out of the Emerging Workforce generation, who are more
comfortable with interactions if they are seen as having value for them and with activities if they
are seen as having benefit. A group that is highly weighted toward the Emerging 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
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17. The adage “leaders are born and not made” reflects which of the following ideas
around leadership?
a. Management can be taught; leadership depends on abilities.
b. Mentorship is important in developing the innate skills of leaders.
c. Leadership is a natural skill that cannot be refined or developed.
d. Succession planning and formal education related to leadership are ineffective.
ANS: A
Leadership is an abilities role that is reflective of rich personal experience. It can be developed
and refined through such strategies as coaching, mentorship, and reflection. Management can
be taught and learned.
TOP: AONE competency: Leadership
18. 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
19. Susan, a new graduate on the dialysis unit, appears to take Kari’s remarks very seriously
and works even harder, often volunteering for extra assignments. She also is often in
Kari’s office, advising of successes with her patients and of the extra effort that she is
committing. This behavior suggests that Susan:
a. is fearful of losing her job.
b. lacks understanding of Kari’s leadership style.
c. is not intimidated by Kari’s leadership style.
d. knows how to “play the game.”
ANS: D
Followers under transactional leadership feel secure about what will happen next or what
is needed to be rewarded; therefore, they learn to “play the game.”
TOP: AONE competency: Leadership
20. The style of leadership that Kari is exhibiting is likely to:
a. ensure that the organization is financially stable.
b. stifle innovative thinking about ways to move out of financial jeopardy.
c. lead to apathy and disinterest in the organizational goals.
d. lead to decreased attrition of staff on her unit.
ANS: B
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Whether or not the organization achieves financial stability is a function of financial
envisioning and planning, but the style of leadership (transactional) that Kari is
demonstrating is likely maintaining the status quo within the organization, without generating
creative and innovative ideas to address the financial issues. Staff commitment is low to
stable, and conformity to organizational goals is motivated by external rewards.
TOP: AONE competency: Leadership
21. A group of managers is meeting to discuss ideas related to the successful implementation of
evidence-based practice on their units. Susan has been asked by the director of care to assume
leadership of these discussion groups. After two such sessions, Susan expresses
disappointment to her mentor that the group seems disinterested in her ideas and that they are
listening to Ken, who has much less experience with leadership. In discussing this with
Susan, the mentor understands that leadership:
a. is a designated role.
b. must be earned.
c. is more likely to be taken by someone who is more talkative.
d. rarely is taken over by someone with less experience.
ANS: B
A person can have an impressive title, but title or designation does not make the person
a leader. A leader must have the ability to inspire others to follow.
TOP: AONE competency: Leadership
22. 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
23. During a discussion of concern about approaches used with aggressive patients in the
Emergency Department, several staff members express concern for their safety. As a
leader, the nurse manager should:
a. look directly at speakers and acknowledge their comments.
b. promise to implement each suggestion that is made.
c. implement the idea that receives the most discussion.
d. listen but implement the plan that she had in mind before the discussion began.
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ANS: A
One of the five rules for leaders is to listen to the constituents—in this instance, the staff
members who have safety concerns. Active listening in the United States means establishing
direct eye contact and asking probing questions. Listening does not obligate the leader to
any one course of action. Action will be based on what is best for the group.
TOP: AONE competency: Leadership
24. In working with Cheryl, her mentor suggests that it is really important for Cheryl to engage in
self-appraisal and to know her strengths. This observation is based on an understanding that:
a. self-confidence comes automatically out of leading.
b. self-confidence requires constant self-affirmation of strengths.
c. There is little external motivation and affirmation in leadership.
d. supervisors of leaders rarely provide feedback.
ANS: C
Followers usually hold opinions about decisions that are made; these opinions can be favorable
or not, which means that external motivation and affirmation are rare. Leaders have to be
confident in their own abilities and enthused about the vision that they have created.
TOP: AONE competency: Leadership
MULTIPLE RESPONSE
1. As a senior executive, you are keen to develop your hospital as a learning organization. Part
Your purpose in translating this vision into practice is to: (Select all that apply.)
a.
retain funding fro m thir dN -partyURS payers INGT .B.COM b.
develop leaders.
c. maintain and/or improve quality of care.
d. stay abreast of new knowledge and evidence.
ANS: B, C, D
Learning organizations are concerned with providing opportunities and incentives for
individuals and groups to engage in lifelong learning, in recognition of the positive
impact that learning has on patient outcomes and staying abreast of new knowledge.
Lifelong learning and reflection are also characteristics of leaders.
TOP: AONE competency: Leadership
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Chapter 29: Developing the Role of Manager
Yoder-Wise: Leading and Managing in Nursing, 7th Edition
MULTIPLE CHOICE
1. Role theory has its underpinnings in management theory. Management theories influence
managers’ leadership styles. Which of the following styles would a nurse manager be
most likely to follow when redesigning the staffing schedule?
a. Humanistic
b. Authoritarian
c. Flexibility
d. Participative
ANS: D
Participative style of leadership allows for the input by the participants involved to have
input to the decision process. This assists in making change easier and is one way a manager
uses this leadership to lead the unit.
TOP: AONE competency: Leadership
2. A nurse manager has worked to bring the staff to participate in and then accept changes in the
unit’s mission, so that downsizing can be avoided. How is the nurse manager using change
theory for this situation?
a. Focusing on past concerns related to the mission
b. Teaching staff members how to self-manage themselves
c. Determining accurately the direction of change in the institution
.
d. Requiring all staff members to review and reinforce their technological skills
ANS: C
The manager is using change theory to have the staff develop and therefore buy into the
changes. Determining the direction of change for the institution allows the manager to
work using change theory to guide staff for changes.
TOP: AONE competency: Leadership
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
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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:
a. demonstrate interdependence.
b. depict flexibility and broadmindedness.
c. focus all energies of staff members on the best possible strategy.
d. 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 workforce.
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 decisios 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 HealthCare 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:
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a.
b.
c.
d.
managing of care by nurse managers.
coordination of resources for effective outcomes.
rapid discharge of clients to decrease costs.
managing 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 HealthCare Environment
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 HealthCare 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:
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a.
b.
c.
d.
measurable.
unrealistic.
attainable.
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 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 HealthCare 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 HealthCare Environment
13. Which of the following is not important in a positive work environment, as defined by
the AONE?
Clear, open, trustful communication
Accountability and clarity of roles and responsibilities
Participatory decision making
Challenge and striving for excellence
a.
b.
c.
d.
ANS: D
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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.
TOP: AONE competency: Knowledge of the HealthCare 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 doesn't 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
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16. As a nurse manager, you identify that a shift in nursing care models might increase patient
and staff satisfaction and avoid downsizing. Administration is reluctant to adopt this approach
because downsizing is seen as critical to reduction of costs. To leverage your ideas, you:
a. ask staff to send e-mails to the administration encouraging consideration of
your option.
b. invite a senior member of administration to your staff meeting, so you can tell
him what you are planning.
c. write a letter of complaint to a member of the institutional board about the lack
of openness of the administration.
d. identify influential members of your nurse manager group with similar ideas
and request an opportunity to meet with administration to discuss options.
ANS: D
Staff members often look to nurse managers to lead them in addressing workplace issues
with higher levels of administration. To do this, nurse managers must possess the ability to
address power sources in the work environment and to define power-based strategies, such as
in organizing a following of other nurse managers with similar concerns.
TOP: AONE competency: Leadership
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.
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. The successful integration of informatics into healthcare settings is key to:
a. quality decision making related to management of resources and patient care.
b. accessing current information about business practices.
c. meeting the modern-day expectations of staff regarding technology use.
d. speeding up calculations and decisions in budget development.
ANS: A
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The use of informatics to research evidence and alternative models of delivery, to compare
data and solutions with those of other managers, and to enhance the coordination and
delivery of patient care can assist managers in making solid decisions about resource
utilization. The use of informatics is embraced by Generation X-ers and Millennials who
grew up with technology, but may be more difficult for older staff.
TOP: AONE competency: Business Skills
19. As a nurse manager, you embrace the usefulness of resources such as Smart Bed.
This behavior is important to:
budget development.
a manager’s role.
succession planning.
encouragement of staff utilization of technology.
a.
b.
c.
d.
ANS: D
Informatics such as Smart Bed facilitates effectiveness and efficiency in care. By becoming
an early adopter of technology, staff members, particularly older staff, who may be less
comfortable with technology, are encouraged to value its use in care delivery and
management.
TOP: AONE competency: Business Skills
20. A manager who is concerned with ensuring that patients on her surgical unit have the
necessary information to make informed choices is:
a. practicing legal nursing care.
b. demonstrating respect for patient rights.
c. avoiding risks.
d. likely experiencing staff issues with informed consent.
ANS: B
In demonstrating respect for and advocacy for informed consent, the nurse manager is
reflecting a professional philosophy. Professional nurses are ethically and legally
accountable to the standards of practice and the accompanying nursing actions delegated to
others. Conveying high standards, holding others accountable, and shaping the future of
nursing are inherent behaviors in the role of a manager.
TOP: AONE competency: Professionalism
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.
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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 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
23. Nancy is a staff nurse who works in 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
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 communicate these findings to staff management.
f. allow clients to establish objectives and goals.
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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
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Chapter 07: Managing Self: Stress and Time
Yoder-Wise: Leading and Managing in Nursing, 7th 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.
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:
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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
7. The chief nursing officer listens to nurse managers verbalize their feelings of internal
stress. One common source of internal stress seems to be:
a. the death of a loved one.
b. perfectionnisme.
c. getting married.
d. Losing a job.
ANS: B
Losing a job, the death of a loved one, and getting married are examples of external stress.
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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 email 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 emails, 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:
a. maintain a perfectionistic attitude.
b. set up a complaint list.
c. have good negotiation skills.
d. 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:
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a.
b.
c.
d.
the comfortable gap between how we like our life to be and how it actually is.
everyday life, both the highs and the lows.
a consequence or response to an event or stimulus that can be positive or negative.
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.
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.
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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 workrelated 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:
a. both a positive stressor and a negative stressor.
b. occurring only because of age.
c. positive in both cases.
d. 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
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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?
High amounts of stress in the nursing home environment
Changes in the current healthcare system such as nursing strategies
Disruptive behavior coming from physicians and other healthcare workers
Stress triggers such as self-criticism and overanalyzing
a.
b.
c.
d.
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
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 b eing 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
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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 reframing 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
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.
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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
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Chapter 08: Communication and Conflict
Yoder-Wise: Leading and Managing in Nursing, 7th 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:
a. group decision-making options.
b. perceptions of incompatibility.
c. increases in group cohesiveness.
d. 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.
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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
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
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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 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
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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
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
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b. Competing
c. Compromising
d. Collaborating
ANS: D
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
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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
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?
Level of interdependence of the parties
Interprofessional collaboration
Expression of one’s own needs and ideas
Avoidance of the issue or concern
a.
b.
c.
d.
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.
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TOP: AONE competency: Communication and Relationship-Building
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
b.
after Tom leaves the unit.
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.
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d. competing and compromise strategies.
ANS: C
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
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1. Nurses entering the work force today are faced with which of the following relationships
that could create organizational conflict? (Select all that apply.)
a. Nurse-physician relationship
b. Nurse-nurse relationship
c. Nurse-patient relationship
d. Nurse-chief nursing officer relationship
e. 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
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Chapter 12: Care Delivery Strategies
Yoder-Wise: Leading and Managing in Nursing, 7th Edition
MULTIPLE CHOICE
1. 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.
TOP: AONE competency: Knowledge of the Health Care Environment
2. The relief charge nurse has assigned a newly licensed baccalaureate-prepared nurse to be one
of the team leaders for the 3-11 shift. In making this decision, the charge nurse has
overlooked this nurse’s:
a. clinical expertise.
b. leadership ability.
c. communication style.
d.
conflict-resolution skills.
ANS: A
Because the basic education of baccalaureate-prepared RNs emphasizes critical-thinking,
clinical reasoning, and leadership concepts, they are likely candidates for such roles. Benner
(2001), however, identified five stages of clinical competence for nurses: novice, advanced
beginner, competent, proficient, and expert. She suggests that competence is typified by a
nurse who has been on the job in the same or similar situation 2 to 3 years. Nurses who are
at the novice or advanced beginner stage would be less likely than their more experienced
counterparts to implement any type of delivery model effectively and thus, this
assignment overlooks the nurse’s level of clinical expertise and leadership experience.
TOP: AONE competency: Knowledge of the Health Care Environment
3. When interviewing an applicant for an RN position, the nurse manager describes the
unit’s care delivery system as one in which the nursing assistants are cross-trained to
perform specific tasks and the RNs complete all treatment, medication administration, and
discharge teaching. The nurse applicant knows this nursing care delivery strategy to be:
a. the case method.
b. functional nursing.
c. primary nursing.
d. nurse case management.
ANS: B
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The functional model of nursing is a method of providing patient care by which each
licensed and unlicensed staff member performs specific tasks for a large group of patients.
TOP: AONE competency: Knowledge of the Health Care Environment
4. You are the nurse manager of a nursing service organization that provides around-the-clock
care to clients in their homes. To achieve maximum reimbursement for a client who is
recovering from a hip replacement, the nursing staff most likely will follow the nursing
care guidelines presented in the:
a. nursing care plan.
b. physician’s orders.
c. critical pathway.
d. clinical practice guidelines.
ANS: C
A critical pathway outlines outcomes, clinical standards, and interventions for a patient in
each phase of treatment. The goal of critical pathways is effective coordination of care
across various staff and levels of care.
TOP: AONE competency: Knowledge of the Health Care Environment
5. The nurse case manager is working with a client admitted for end-stage renal disease.
The case manager’s major goal during this hospitalization for this patient is to:
implement the care pathway on admission.
provide direct nursing care throughout the hospitalization.
supervise the nursing staff members who implement the care map.
prevent additional hospitalizations resulting from complications of the client’s
disease.
a.
b.
c.
d.
ANS: D
The goals and outcomes established in a critical pathway are designed to support the aims of case
management, which are shortened hospital stays and prevention of hospital readmissions.
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?
Functional method
Case management method
Primary care method
Team method
a.
b.
c.
d.
ANS: B
Team nursing, functional nursing, and case management are all considered efficient, costeffective 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, highvolume, high-cost patient populations and seeks the active involvement of the patient, the
family, and diverse healthcare professionals.
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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:
department.
unit.
staff.
patient.
a.
b.
c.
d.
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. A patient is admitted to a medical unit with pulmonary edema. His primary nurse admits
him and then provides a written plan of care. What type of educational preparation best fits
the role of primary nurse?
a. Baccalaureate
b. Associate
c. Diploma
d. LPN/LVN
ANS: A
Because of the breadth of nursing knowledge required, baccalaureate education is
preferred for primary nurses.
TOP: AONE competency: Knowledge of the Health Care Environment
9. 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
10. 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
11. During times of nursing shortages and increased nursing costs in health care, which of
the following nursing care delivery models might come under greatest scrutiny?
a. Case method
b. Team nursing
c. Functional nursing
d. Nurse case management
ANS: A
The case method may involve total patient care provided by a registered nurse, which, in today’s
costly healthcare economy, is very expensive. In times of nursing shortages, there
may not be enough resources or nurses to use this model.
TOP: AONE competency: Knowledge of the Health Care Environment
12. 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.
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
13. For a nurse manager in the functional nursing model, an approach that will assist
in maintaining staff satisfaction in this specific model is:
rotation of task assignments.
frequent opportunities for in-service education.
orientation to job responsibilities and performance expectations.
team social events in off hours.
a.
b.
c.
d.
ANS: A
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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
14. In comparing team and functional models of care, a nurse manager favors the team model.
In particular, she finds that the team model:
can be effective in recognizing individual strengths and backgrounds of staff.
promotes autonomy and independence for the RN.
avoids conflict because of role clarity.
is efficient in delivering care to a large group of patients, utilizing a staffing mix.
a.
b.
c.
d.
ANS: A
Team nursing delivers care to a small group of patients, using a mix of licensed
and unlicensed personnel. Team nursing uses the strengths of each caregiver.
TOP: AONE competency: Knowledge of the Health Care Environment
15. To effectively delegate in a team nursing environment, the RN team leader must be
familiar with the legal and organizational roles of each group of personnel and must:
be able to effectively communicate with patients.
build relationships with physicians.
be able to adapt to daily changes in staffing.
adapt in communicating information to her supervisor.
a.
b.
c.
d.
ANS: C
A particular challenge in team nursing is that staff mixes and staff may change
daily because of individual schedules and shortages.
TOP: AONE competency: Leadership
16. 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
17. A conflict develops between an associate nurse and a primary nurse over the assessment of
a patient with pulmonary edema. Based on her assessment of the patient, the associate nurse
insists that it is her role to change the care plan because she is the one who has made the
assessment. As the nurse manager, you clarify that:
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a. it is the role of the primary nurse to make alterations based on assessment data
and input.
b. the associate nurse is accountable and responsible while the primary nurse is
off duty and therefore is able to alter the care plan.
c. neither the primary nor the associate should make changes without first
consulting you as the manager.
d. it really does not matter who alters the nursing care plan as it depends on
situation and time to do so.
ANS: A
The primary nursing model assumes that the primary nurse is accountable for patient care,
even while off duty. The primary nurse is responsible for establishing the patient plan of
care and therefore for altering it with the input of an associate. The associate is responsible
for implementation of the established care plan when the primary nurse is off duty.
TOP: AONE competency: Communication and Relationship-Building
18. The nurse manager is comparing functional nursing and primary nursing for potential
adoption. The nurse manager determines that patient and nurse satisfaction in primary
nursing are:
a. similar to those in functional nursing.
b. not of significance in either model.
c. low by comparison with functional nursing.
d. high when compared with functional nursing.
ANS: D
Although some studies suggest there is little difference between functional nursing and
primary nursing, primary nursing tends to be more satisfying for RNs, who enjoy a
high level
of accountability and autonomy in decision making. Patient satisfaction is also high, as
patients form close therapeutic relationships with the nurse because of the continuity of
the relationship. Functional nursing is criticized for low patient satisfaction and potential
staff dissatisfaction related to boredom and an autocratic approach to management.
TOP: AONE competency: Knowledge of the Health Care Environment
19. In transitioning to a primary nursing model, it is important for a nurse manager who enjoys
a high level of control over patient care to understand that his or her decision making at the
patient care level:
a. is increased.
b. is decreased.
c. is relinquished.
d. remains the same.
ANS: B
The nurse manager who is considering movement to primary nursing needs to consider how
the role of the manager changes, as well as the roles of the staff. The role of decision making
at the patient care level is relinquished to the primary nurse, and the role of manager becomes
that of facilitator, coach, mentor, role model, and clinical resource.
TOP: AONE competency: Knowledge of the Health Care Environment
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20. You are considering putting forward a proposal to move the model of care from team nursing to
a primary nursing hybrid: patient-focused care model. In considering this proposal, you
recognize that significant costs specific to operationalizing this model are related to:
a. implementation of an all-RN staff complement.
b. significant changes in the physical structure of units.
c. orientation of staff to new roles and responsibilities.
d. testing and piloting technology at the bedside.
ANS: B
This particular model includes a focus on patient care that includes multidisciplinary
teams and assistants at the bedside. Services, including laboratories and pharmacies, are
decentralized to bring them closer to where care is delivered.
TOP: AONE competency: Knowledge of the Health Care Environment
21. 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
22. Case managed care may enhance profit in a for-profit health organization by:
a. minimizing costs in high resource consumption areas.
b. combining licensed and non-licensed care providers in delivering patient care.
c. increasing reimbursement from third-party payers.
d. reducing the amount of technology used to support clinical decision making.
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
23. In hiring nurses during the transition from team nursing to a primary nursing model,
Benner’s work would suggest that you give priority to nurses who are at least at which level
of competency?
a. Advanced beginner
b. Competent
c. Proficient
d. Novice
ANS: B
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Nurses who have less than 2 or 3 years’ experience in primary nursing and/or less than
2 or 3 years of nursing experience will likely require more assistance than other nurses, which
will put a greater demand on the unit during a time of transition.
TOP: AONE competency: Business Skills
24. In considering whether or not to accept a job offer as a nurse manager at a Magnet
®
hospital, you look at an environment that you might encounter as a head nurse at the
hospital. You determine that you could expect to:
a. find it difficult to recruit new staff.
b. see rapid turnover of staff on your unit.
c. find nurses who exemplify interest in quality care.
d. find limited interest in excellence in the nursing environment.
ANS: C
Magnet® hospitals exemplify hospitals whose focus processes attract and retain nurses
who value and promote quality care and excellence in nursing environments.
TOP: AONE competency: Knowledge of the Health Care Environment
MULTIPLE RESPONSE
1. Your organization has made a decision to implement TCAB in your hospital. As a
manager, what strategies would you use to implement TCAB? (Select all that apply.)
a. Encourage recognition among staff of their knowledge of the patientcare environment.
b. With staff, select small changes for consideration.
c.
Select only projects that have widespread impact.
d. Secure external advisors to evaluate innovation.
e. Present ideas based on best practices and ask staff for advice on implementation.
ANS: A, B, E
Transforming care at the bedside (TCAB) relies on active involvement of staff in the
generation of innovative ideas to improve patient care. Staff are actively engaged in
selecting innovation, planning, and evaluation of the innovations. Critical to practice
changes, rapid cycle change is a process that encourages testing creative change on a small
scale while determining potential impact.
TOP: AONE competency: Leadership
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Chapter 13: Staffing and Scheduling
Yoder-Wise: Leading and Managing in Nursing, 7th 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:
a. 90%.
b. 85%.
c.
75%.
d. 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 non-productive
time. When calculating paid non-productive 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
Non-productive 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:
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a.
b.
c.
d.
assign staff on the unit on a daily basis.
ensure that days off are planned for the staff.
outline the number of individuals by classification on a per-shift basis.
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.
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.
b.
c.
d.
organizational staffing policies.
state licensing standards.
American Nurses Association.
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?
Hours of operation of the unit
Trends in acuity on the unit
Maximum work stretch for each employee
Weekend requirements
a.
b.
c.
d.
ANS: B
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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.
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:
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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
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
levels
national databases that measure staffing
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.
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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:
a. availability of diagnostic personnel.
b.
availability of physicians
c. communication with on-call providers.
d. 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.
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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
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?
“Will I be able to get overtime hours on your unit?”
“If there is an opportunity to work extra shifts, I would really like that.”
“Is there a strategy in place to reduce the number of overtime hours on the unit?”
“I see no reason why I wouldn’t be able to work overtime.”
a.
b.
c.
d.
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.
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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?
Maximum productive hours
Average non-productive hours
Minimum benefit hours
Maximum vacation time
a.
b.
c.
d.
ANS: B
To avoid understaffing, average non-productive 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.
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
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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
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Chapter 14: Work force Engagement through Collective Action and Governance
Yoder-Wise: Leading and Managing in Nursing, 7th Edition
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
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 interestbased 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.
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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
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:
client satisfaction with the healthcare organization.
organizations with a limited number of nurse managers.
private, specialty organizations in urban areas.
sophisticated academic health sciences universities.
a.
b.
c.
d.
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.
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TOP: AONE competency: Business Skills
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.
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.
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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
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.
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?
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a.
b.
c.
d.
Authority
Responsibility
Communication of conflict
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:
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.
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.
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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.
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 atwill 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
O
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.
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
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Chapter 16: The Impact of Technology
Yoder-Wise: Leading and Managing in Nursing, 7th 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
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.
d. contact the author for additional exercise and feedback.
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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
aclient’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?”
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.”
5. The clinic nurse has just accessed
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
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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
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
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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.
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:
participating in organizational information technology committees.
submitting written requests for needed information systems.
requesting budgetary funds needed for systems.
sending staff nurses to conferences that discuss cutting-edge technologies.
a.
b.
c.
d.
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:
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.
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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
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
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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
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
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
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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
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
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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
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
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.
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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
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.
b.
c.
d.
reduction in incidents of medication error.
immediate documentation of care.
comparison of patient data with previous data.
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
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Chapter 18: Leading Change
Yoder-Wise: Leading and Managing in Nursing, 7th Edition
MULTIPLE CHOICE
1. When goals/outcomes are somewhat unclear in early preparation for a complex change, the
manager and the change management team develop several acceptable goals/outcomes.
This change in management approach is termed:
a. unfreezing.
b. nonlinear.
c. cybernetic.
d. linear.
ANS: B
While Lewin theory was designed to describe planned or first-order changes, many scholars
think the theory is too simplistic to address how unplanned or second-order change occurs.
In complex situations with an uncertain change environment, a nonlinear approach that
involves flexibility improves overall outcomes. Linear change is appropriate to stable, less
complex, and more predictable situations.
TOP: AONE competency: Leadership
2. 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:
trusted,
quiet.
a.
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
3. 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
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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
4. 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
5. Complex change situations require that the change leader promote ongoing visioning among
staff members. One strategy is to:
a. consciously evaluate invisible mental models.
b. allow for individual outcomes.
encourage cooperative activities.
d. operate between order and disorder.
c.
ANS: A
Senge theory on change suggests that each individual or organization bases activities on a
set of assumptions, or a set of beliefs, or mental pictures about the way that the world should
work. When these invisible models are uncovered and consciously evaluated, it is possible
to determine their influences on work accomplishment.
TOP: AONE competency: Leadership
6. To effectively achieve a change goal/outcome in a change situation, the wound care
specialist will:
a. preserve the status quo.
b. diminish facilitators and reinforce barriers.
c. weigh the strength of forces.
d. strengthen facilitating forces.
ANS: D
For change to be effective, the facilitators must exceed the force of the barriers;
thus, strengthening the facilitating forces would achieve this aim.
TOP: AONE competency: Leadership
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7. The wound care nurse decided 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
8. 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
9. An example of one strategy to improve participation in the change process by staff fitting
the behavioral descriptions of laggards, early majority, late majority, and rejecters is to:
encourage teamwork.
transfer to a different unit.
require attendance at staff meetings.
delegate the roles and tasks of change.
a.
b.
c.
d.
ANS: D
According to Rogers’s work, the individual’s decision-making actions pass through five
sequential stages. The decision to not accept the new idea may occur at any stage. However,
peer change agents and formal change managers can facilitate movement through these
stages by encouraging the use of the idea and providing information about its benefits and
disadvantages.
TOP: AONE competency: Leadership
10. 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.
c. initiate frequent interactions among staff.
d. provide select information to the staff.
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ANS: B
Connecting innovators and early adopters to new ideas and with new peers keeps them at
the cutting edge.
TOP: AONE competency: Professionalism
11. 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 firstorder change and will involve listening to staff to see if they perceive a similar problem.
TOP: AONE competency: Leadership
12. To engage your staff in awareness of their current practice and how it is affirmed or not by
evidence, you plan a short series of learning presentations on evidence and use of heparin
and saline to maintain IV patency. You meet with the educator to plan out the goals for each
session with the overall purpose of increasing knowledge and awareness of staff in readiness
to consider questions related to the IV practice. This learning approach is an example of
which change management approach?
a.
b.
c.
d.
Linear
First-order
Facilitative
Integrative
ANS: A
In the second stage, the moving or changing stage of Lewin’s first-order, planned change
process, planned interventions and strategies are executed to support the implementation of the
change. One commonly used method is educating staff about the need for the change.
TOP: AONE competency: Leadership
13. To engage your staff in awareness of their current practice and how it is affirmed or not by
evidence, you plan a short series of learning presentations on evidence and use of heparin
and saline to maintain IV patency. You meet with the educator to plan out the goals for each
session with the overall purpose of increasing knowledge and awareness of staff in readiness
to consider questions related to the IV practice. Staff nurses who gain information on current
IV therapy practices are engaging in which phase of Rogers’ decision-making process?
a. Persuasion
b. Knowledge
c. Confirmation
d. Decision
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ANS: B
Rogers’ innovation—decision-making process involves five stages for change in
individuals, the first of which is knowledge.
TOP: AONE competency: Leadership
14. Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one
of the learning sessions on IV care and you overhear her telling a colleague that she thought
the session was a waste of time because “the unit has been using heparin for years and
there has never been any adverse effects.” According to Havelock (1973), this comment
may originate from failure in which phase of the six phases of planned change?
a. Generating self-renewal
b. Choosing the solution
c. Diagnosing the problem
d. Building a relationship
ANS: D
The first phase of this model of planned change involves building a relationship as a basis for
later phases, which include diagnosing the problem and choosing the solution. At this point, as
a new manager, the relationship may not have yet developed sufficiently with Elizabeth.
TOP: AONE competency: Leadership
15. Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one
of the learning sessions on IV care and you overhear her telling a colleague that she thought the
session was a waste of time because “the unit has been using heparin for years and there
has never been any adverse effects.” You follow up with Elizabeth and discover that she is
really quite angry about the information sessions because she feels that you are implying
that
“what she has been doing all these years means that she is incompetent and doesn’t care
about her patients.” Your response to her indicates that:
a. Elizabeth will never adopt the change.
b. Elizabeth is insecure in her practice.
c. Elizabeth requires more information about the practice.
d. change involves emotions.
ANS: D
Change, whether proactively initiated at the point of change or imposed from external sources,
affects people. Responses to all or part of the change process by individuals and groups may
vary from full acceptance and willing participation to outright rejection or even rebellion. It
is critical to be able to “read” people and to recognize that communication should
involve people’s emotions and feelings.
TOP: AONE competency: Communication and Relationship-Building
16. Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one
of the learning sessions on IV care and you overhear her telling a colleague that she thought the
session was a waste of time because “the unit has been using heparin for years and there
has never been any adverse effects.” You follow up with Elizabeth and discover that she is
really quite angry about the information sessions because she feels that you are implying that
“what she has been doing all these years means that she is incompetent and doesn’t care
about her patients.” Which of the following would be the most effective response to Elizabeth?
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a. “I understand how you feel, but you are going to have to change.”
b. “It is unfortunate that you feel this way. Others seem quite excited about
the new information.”
c. “It is difficult sometimes to change what we know very well. Sometimes it can
be frightening.”
d. “Perhaps I can arrange some more information sessions for you, so you
can see just how important this change is to patient safety.”
ANS: C
Dialogue can reveal areas where individuals feel inept or overwhelmed, providing the leader
with an understanding of what programs need to be developed to increase personal ability to
change and what educational initiatives need to be implemented to support change. To
promote dialogue, leaders must serve as facilitators, promoting the sharing of ideas, fears,
and honest reactions to the change proposal.
TOP: AONE competency: Communication and Relationship-Building
17. Elizabeth is an example of a(n):
a. early adopter.
b. late majority.
c. laggard.
d. resister.
ANS: C
Laggards prefer keeping traditions alive (“We have always done it this way”) and openly
express their resistance to ideas (speaking out against the change). Late majority individuals are
openly negative but will engage with new ideas when most others adopt the change.
TOP: AONE competency: Leadership
18. Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one
of the learning sessions on IV care and you overhear her telling a colleague that she thought the
session was a waste of time because “the unit has been using heparin for years and there has
never been any adverse effects.” You follow up with Elizabeth and discover that she is
really quite angry about the information sessions because she feels that you are implying that
“what she has been doing all these years means that she is incompetent and doesn’t care
about her patients.” After speaking with Elizabeth, a few days later you discover that
she is now fine with the change but is concerned that other areas of the organization might
resist the change because of perceptions related to patient safety and cost. She suggests that it
is important to bring pharmacy on board as they have had previous concerns about the use of
heparin. In relation to change theory, this is indicative of:
a. systems level thinking.
b. linear thinking.
c. interprofessional collaboration.
d. first-order change.
ANS: A
Senge complexity theory, Bevan Seven Change Factors, and general systems theory
all highlight connectivity and the idea that changes are not isolated events.
TOP: AONE competency: Leadership
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19. Based on Elizabeth’s insights and suggestions, you involve pharmacy, only to discover
that the change in practice involves practice committees, a medical practice committee,
and concerns from administration about potential costs and safety of the proposed change
to the IV protocols. The change process at this point is:
a. linear.
b. nonlinear.
c. sabotaged.
d. neutralized.
ANS: B
Complex change involves nonlinear processes and a variety of strategies to negotiate
influences on change. Complexity theories alter the traditional systems thinking approach
by asserting that system behavior is unpredictable. This theory views change as emergent,
nonlinear, and highly influenced by all individuals and subsystems in an organization.
TOP: AONE competency: Leadership
20. 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.
TOP: AONE competency: Leadership
21. As the unit manager on the unit that is leading changes to heparin locks, you find that
Elizabeth is very valuable in terms of her observations about other units and her knowledge
of organizational processes, and now in discussing the new procedure with others. Elizabeth
might be considered an:
a. engager.
b. innovator.
c. informal change agent.
d. informant.
ANS: C
Informal change agents are those who do not have formal, positional power but who
have credibility through expertise and can model the new way of thinking, or who offer
suggestions, ideas, and concerns.
TOP: AONE competency: Leadership
22. As the unit manager, you spend a day performing direct patient care and work with a new
system that is designed to capture patient documentation at the bedside. During discussions
with staff while giving care, you discover that the number of screens that need to be
opened during documentation makes charting more complex and time consuming than
traditional manual charting approaches. On the basis of this feedback, you:
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a. assume that the system is doing what it needs to do.
b. provide reassurance to staff that the unit has achieved its goals in
implementation of the system.
c. ask some of the staff if they have had similar experiences with the system.
d. consult chart audit data and end user consultation reports to determine if errors
and problems are occurring.
ANS: D
In Kotter eight-step change model, removing obstacles means keeping alert for barriers in
structure and processes that limit the ability to change and then removing those barriers
once they have been found.
TOP: AONE competency: Leadership
23. 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. Kotter (2012) characterizes this as establishing a sense of
urgency, and this involves overcoming complacency This is especially hard
when there doesn’t seem to be
any visible crisis, or the crisis seems irrelevant to the people being asked to change
(Kotter, 2012).
TOP: AONE competency: Leadership
24. 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.
TOP: AONE competency: Leadership
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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
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Chapter 19: Building Effective Teams
Yoder-Wise: Leading and Managing in Nursing, 7th Edition
MULTIPLE CHOICE
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 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
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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.
b.
c. fear that one can’t handle the consequences.
d. fear that the boss will not like one’s work.
lack of control of the environment.
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
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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.
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.
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
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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?”
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.
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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.
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
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
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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.
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
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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
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
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
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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.
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
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Chapter 20: Managing Costs and Budgets
Yoder-Wise: Leading and Managing in Nursing, 7th 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
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.
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TOP: AONE competency: Business Skills
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?
Cash budget
Capital budget
Operating budget
Supply and expense budget
a.
b.
c.
d.
ANS: C
The operating budget includes a personnel budget, which takes into account productive and
non-productive 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
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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
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
non-pharmacologic 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
ANS: D
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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
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.
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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.
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:
advocacy for patients with regard to services required and services utilized.
increasing the volume of services and decreasing the number of patients served.
accomplishing more with each visit and decreasing the volume of services used.
decreasing the volume of services used and the number of return visits.
a.
b.
c.
d.
ANS: A
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.
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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
12,480 paid
d. 10,800 patient care
ANS: C
c.
From the information given, it is not possible to determine how many non-productive 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 non-productive 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
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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 non-productive 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.
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?
Operating
Strategic
Unit of service
Capital
a.
b.
c.
d.
ANS: D
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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.
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
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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
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
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Chapter 21: Selecting, Developing, and Evaluating Staff
Yoder-Wise: Leading and Managing in Nursing, 7th 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.
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
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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.
TOP: AONE competency: Business Skills
5. As part of orientation to your unit, you decide to administer Kolb Learning Style Inventory
(LSI) to new staff. The most likely reason for your decision is that the use of Kolb LSI:
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. enables individualization of learning to the learner’s needs.
ANS: D
Administration of Kolb LSI enables identification of the learning styles of new
employees, which assists in focusing the implementation of orientation goals and in
individualizing learning to the needs and learning style of the employee.
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 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
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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.
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
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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
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
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
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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
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.
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b. management by objectives/learning goals.
c. a forced distribution scale.
d. a behaviorally anchored rating scale.
ANS: D
BARS contain both quantitative (rating scales) and qualitative data. They are specific
to situations and positions.
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
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
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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.
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:
role complexity.
role ambiguity.
role conflict.
time-dependent roles.
a.
b.
c.
d.
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.
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TOP: AONE competency: Business Skills
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
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Chapter 22: Person-Centered Care
Yoder-Wise: Leading and Managing in Nursing, 7th Edition
MULTIPLE CHOICE
1. 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.
TOP: AONE competency: Professionalism | AONE competency: Knowledge of the Health Care
Environment
2. As part of performance appraisal, the nurse manager designs strategies to acknowledge
staff members. What practices by the nurse manager best acknowledge staff accountability
and contribution?
a. Providing new and varied learning experiences for staff members
b. Fostering group cohesiveness through standardization of unit activities
c. Allowing professionals greater influence over their practices
d. Giving recognition for success and support for failure to staff members
ANS: C
Facilitating greater control over practices implies trust and acknowledges expertise
and performance.
TOP: AONE competency: Professionalism
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
Trend-setting organizations such as Magnet ® organizations need to demonstrate excellence in
outcome data such as patient satisfaction. 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
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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. In writing the patient satisfaction survey, the nurse manager is aware of the education
levels of the families. What is the most critical element in the concept of health literacy?
a. Providing instructional materials at appropriate reading levels
b. Facilitating access to translators for persons with language barriers
c. Obtaining, processing, and understanding basic health information so
appropriate decisions can be made
d. Knowing that most people have limited health literacy skills
ANS: C
The definition of health literacy used by the federal government is “the degree to which
individuals have the capacity to obtain, process, and understand basic health information and
services needed to make appropriate health decisions” (U.S. Department of Health and
Human Services, 2010).
TOP: AONE competency: Communication and Relationship-Building
6. The nurse manager analyzes the data from the patient satisfaction surveys. What can a
nurse manager do to strengthen service recovery and improve consumer relationships?
a. Post comparisons of patient satisfaction scores with those of other units monthly.
b. Involve the staff in resolving consumer issues quickly and effectively.
c. Ensure that staff members apologize to patients when they complain
about services.
d. Ask that patients with complaints about services place them in a written format.
ANS: B
Consumers need to be treated with fairness, given explanation, and provided with
information about how errors will be prevented in the future. Staff can be assisted to respond
to patient concerns through scripting, support, and an atmosphere that places an emphasis on
learning and solutions rather than on blaming.
TOP: AONE competency: Communication and Relationship-Building
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7. Based on data from the patient satisfaction survey, the nurse manager decides that a change
should be made in communication with family members. What would be important for a
nurse manager to consider when instituting a change to improve customer service?
a. Assess the perceptions of the nursing staff regarding the specific service problem.
b. Include community representatives on a planning committee to address the change.
c. Involve physicians, other healthcare professionals, and ancillary staff.
d. Review all patient complaints with the nursing staff.
ANS: A
Nurses are the healthcare providers who spend the most time with the consumer and are in an
opportune position to understand the issues, structures, and processes that affect patients. The
nurse acts as the primary person to be alert to circumstances that may prevent a successful
outcome for the patient and to intervene on the patient’s behalf. As a nurse manager, it is
important to support staff in their use of power to be in control and to make decisions at
the consumer-staff level of interaction.
TOP: AONE competency: Communication and Relationship-Building
8. The chief nursing officer is pleased with the nurse manager’s strategy of improving
patient satisfaction in the pediatric intensive care unit. She decides to implement these
changes throughout the hospital. What would be important to consider in implementing a new
program focused on improving relationships with consumers?
a. Recognition of the nursing staff for excellence in promoting
consumer relationships
b. Holding the staff accountable for resolving patient complaints
c. Selecting a staff nurse leader to implement the program
d.
Identifying key staff members who have already demonstrated excellence in consumer relationships
ANS: A
The nurse leader should allow professionals more influence over their practice; give staff
opportunities to learn new and varied skills; give recognition and reward for success and
support and consolation for lack of success; and foster motivation and belief in the
importance of each individual and the value of his or her contribution.
TOP: AONE competency: Communication and Relationship-Building
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?”
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
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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
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
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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. The complexity of the healthcare environment for consumers is increased by:
a. falling levels of education among the public.
b. increased levels of poverty.
c. complex compensatory systems and a variety of delivery systems.
d. increased numbers of uninsured or underinsured.
ANS: C
The complexity of options in health care and the processes and policies involved in funding
health services for patients, as well as fragmented relationships with a growing variety of
healthcare providers, contribute to the complexity of the system for patients, especially for
those who might need it most, such as the poor, uninsured or underinsured, and homeless.
TOP: AONE competency: Knowledge of the Health Care Environment
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.
ANS: B
*
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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. As a head nurse, you are concerned about the service orientation on your unit. Which of
the following findings and approaches might provide useful information for you?
a. Patients find nurses friendly and accessible; data are aggregated for the
institution as a whole.
b. Data indicate that nurses are responsive to requests for assistance; data
are available for the unit and the institution.
c. Specific questions related to management of comfort are included for
the institution as a whole.
d. The survey asks for a range of responses for the unit and the organization, with
a focus on facilities, such as cleanliness and responsiveness of administrative
services.
ANS: B
The National Database of Nursing Quality Indicators (NDNQI ®) is a national repository for
unit-based quality data that can be used by organizations to benchmark the outcomes of care
against those of other institutions (ANA, n.d.). Unit-based quality indicators, including
satisfaction with nursing care, are a key feature of the NDNQI ®. In addition to hospitals
being provided with their own and comparison data, researchers are able to access deidentified data in order to answer important questions about nursing care quality. Pain
management, the discharge process, and post-discharge patient callbacks are specific areas
where nurses can make significant improvement in patient satisfaction. Because patients and
nurses may differ in what they see as factors that produce satisfaction, total reliance on
nursing perceptions of patient satisfaction may not provide a complete picture.
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 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. Technology is integral to a cardiac ICU. Sue, the nurse manager, implements a patient-
centered approach that focuses on the meaning of the experience for the patient and
family, primary nursing, and a health literacy approach. Sue is:
a. using high-tech–low-touch approaches.
b. using high-tech–high-touch approaches.
c. providing products.
d. providing tangible products of satisfaction.
ANS: B
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The provision of humanistic care within a high-tech environment is characteristic of high
tech–high-touch approaches and reflects the idea that the more that high-tech is used, the
more patients also desire high-touch.
TOP: AONE competency: Knowledge of the Health Care Environment
21. 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
22. 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.
advocating for the patient
d. supporting the clinical pathway.
c.
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
23. A nurse makes a medication error that is not serious and does not cause harm to the
patient. As the charge nurse, your best action would be to:
a. call attention to it by posting the critical incidents report at the nursing station.
b. include the mistake on the nurse’s performance appraisal.
c. apologize to the patient for the error and indicate that discipline has occurred.
d. educate the nurse on how to provide an apology to the patient.
ANS: D
Service recovery ensures responsiveness to the patient, and as part of service recovery, it is
important to address an error in the most productive way, which also includes the nurse who
made the error offering an apology to the patient.
TOP: AONE competency: Communication and Relationship-Building
24. An example of a factor that would impede a patient’s
learning is: a. poverty.
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b. limited health insurance.
c. being an older adult.
d. heavy sedation.
ANS: D
Nurses need to be sensitive to the teaching needs of those at risk for disparities in health care:
persons of a different race or ethnic group, women, children, older adults, rural residents, and
those with limited or no health insurance, low health literacy, and/or low socioeconomic status.
It is important that lower expectations for persons who are disadvantaged, have a low literacy
level, or have limited English proficiency are not unintentionally communicated.
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
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Chapter 23: Managing Quality and Risk
Yoder-Wise: Leading and Managing in Nursing, 7th Edition
MULTIPLE CHOICE
1. A new graduate is asked to serve on the hospital’s quality improvement (QI)
committee. The nurse understands that the first step in quality improvement is to:
a. collect data to determine whether standards are being met.
b. implement a plan to correct the problem.
c. identify the standard.
d. determine whether the findings warrant correction.
ANS: C
Before further action (data collection, decision making related to correction, and
implementation of a plan) can occur, it is necessary to identify the standards against which
data collection and decision making will occur. Institutions may or may not adopt
standards that are already established by organizations such as the ANA.
TOP: AONE competency: Knowledge of the Health Care Environment
2. The chief executive officer asks the nurse manager of the telemetry unit to justify the
disproportionately high number of registered nurses on the telemetry unit. The nurse
manager explains that nursing research has validated which statement about a low nurse-topatient ratio? The low ratio:
a. promotes teamwork among healthcare providers.
b.
increases adverse events.
c. improves patient outcomes.
d. contributes to duplication of services.
ANS: C
Studies related to staffing and patient outcomes suggest that patient outcomes are improved with
a low nurse-to-patient ratio and especially with a low registered nurse-to-patient ratio.
TOP: AONE competency: Knowledge of the Health Care Environment
3. A nurse manager wants to decrease the number of medication errors that occur in her
department. The manager arranges a meeting with the staff to discuss the issue. The
manager conveys a total quality management philosophy by:
a. explaining to the staff that disciplinary action will be taken in cases of
additional errors.
b. recommending that a multidisciplinary team should assess the root cause of
errors in medication.
c. suggesting that the pharmacy department should explore its role in the problem.
d. changing the unit policy to allow a certain number of medication errors per
year without penalty.
ANS: B
Quality management stresses improving the system, and the detection of staff errors is not
stressed. If errors occur, reeducation of staff is emphasized rather than imposition of
punitive measures such as disciplinary action or blaming.
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TOP: AONE competency: Knowledge of the Health Care Environment
4. The nurse educator of the pediatric unit determines that vital signs are frequently not being
documented when children return from surgery. According to quality improvement (QI),
to correct the problem, the educator, in consultation with the patient care manager, would
initially do which of the following?
a. Talk to the staff individually to determine why this is occurring.
b. Call a meeting of all staff to discuss this issue.
c. Have a group of staff nurses review the established standards of care
for postoperative patients.
d. Document which staff members are not recording vital signs and write them up.
ANS: B
Leadership must identify safety shortcomings and must locate resources at patient care
levels to identify and reduce risks. One method of doing this is to invite all staff into a
discussion related to solutions to an identified concern. This approach encourages teamwork.
TOP: AONE competency: Knowledge of the Health Care Environment
5. A nurse is explaining the pediatric unit’s quality improvement (QI) program to a newly
employed nurse. Which of the following would the nurse include as the primary purpose of
QI programs?
a. Evaluation of staff members’ performances
b. Determination of the appropriateness of standards
c. Improvement in patient outcomes
d. Preparation for accreditation of the organization by the Joint Commission on
Accreditation of Healthcare Organizations (JCAHO)
ANS: C
The primary purpose of QI is improvement of patient outcomes, which relates to prevention
of error, quality patient care, and patient satisfaction.
TOP: AONE competency: Knowledge of the Health Care Environment
6. Before beginning a continuous quality improvement project, a nurse should determine
the minimal safety level of care by referring to the:
a. procedure manual.
b. nursing care standards.
c. litigation rate of unsafe practice.
d. job descriptions of the organization.
ANS: B
Standards establish the minimal safety level of care. Procedure manuals provide
information about how standards are to be achieved.
TOP: AONE competency: Knowledge of the Health Care Environment
7. The nurse gives an inaccurate dose of medication to a patient. After assessment of the patient,
the nurse completes an incident report. The nurse notifies the nursing supervisor of the
medication error and calls the physician to report the occurrence. The nurse who
administered the inaccurate medication understands that:
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a.
b.
c.
d.
the error will result in suspension.
an incident report is optional for an event that does not result in injury.
the error will be documented in her personnel file.
risk management programs are not designed to assign blame.
ANS: D
QM stresses improving the system, and the detection of staff errors is not stressed. If errors
occur, reeducation of staff is emphasized rather than imposition of punitive measures such
as disciplinary action or blaming.
TOP: AONE competency: Knowledge of the Health Care Environment
8. The nurse manager is concerned about the negative ratings her unit has received on patient
satisfaction surveys. The first step in addressing this issue from the point of view of quality
improvement is to:
a. assemble a team.
b. establish a benchmark.
c. identify a clinical activity for review.
d. establish outcomes.
ANS: C
In theory, all aspects of clinical activity could be improved through the QI process. However, QI
efforts should be concentrated on changes to patient care that will have the greatest effect.
TOP: AONE competency: Knowledge of the Health Care Environment
9.
With the rise of violence in the psychiatric department, the nurse manager decides that she
should work with the risk manager in violence prevention . The nurse manager should:
a. request all staff to accept new risk management practices.
b. hold staff accountable for safe practices.
c. document inappropriate behavior.
d. hire more police security.
ANS: B
Active involvement of staff in risk management activities is key to prevention of adverse
events. Nursing has a primary role in leadership in optimizing patient outcomes, preventing
patient care issues, and mitigating adverse events. Accountability for safety can be one
aspect of performance evaluations.
TOP: AONE competency: Knowledge of the Health Care Environment
10. A new RN staff member asks you about the difference between QA and QI. You explain
the difference by giving an example of QI.
a. “Last year, the management team established new outcomes that addressed
issues such as medication errors.”
b. “At a staff meeting last year, two of our staff commented on the number of
recent falls and asked, ‘What can we do about it?’”
c. “A process audit was done recently to determine how much time was being
spent on patient documentation.”
d. “Errors are reported on our new computerized forms, and I follow up with
staff to make sure that they understand the seriousness of their error.”
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ANS: B
In QI, followers invest in the process by continually asking “What makes this indicator
important to measure?” “What has been done to improve it?” “What can I do to improve it?”
TOP: AONE competency: Knowledge of the Health Care Environment
11. Healthcare organization X is committed to improving patient outcomes and, as part of the QI
process, examines its executive structure and organizational design. This approach recognizes:
a. the importance of decentralized structure in QA.
b. that structure influences nurse burnout and participation in quality
improvement initiatives.
c. the need to ensure sufficient supervisory staff to respond in a corrective
manner when mistakes occur.
d. that a narrow hierarchy ensures accountability for errors and outcomes.
ANS: B
Common organizational characteristics of Magnet ® hospitals include structure factors (e.g.,
decentralized organizational structure, participative management style, and influential nurse
executives) and process factors (e.g., professional autonomy and decision making, ongoing
professional development/education, active quality improvement initiatives). ANCC
Magnet® designated hospitals and other high-reliability organizations in the United States
and Europe generally have lower burnout rates, higher levels of job satisfaction, and provide
higher levels of quality care resulting in greater levels of patient satisfaction.
TOP: AONE competency: Knowledge of the Health Care Environment
12.
Hospital ABCD is a Magnet® hospital. One reason this designation has been applied to Hospital ABCD
because it:
a. facilitates active staff participation in decision making related to quality
nursing care.
b. has implemented a graduate nurse orientation program.
c. espouses commitment to excellence in patient care.
d. is establishing career ladders for nurses.
ANS: A
Magnet® hospitals are particularly successful in implementing excellence in patient care
through use of standards, evidence, and participatory decision making in quality
improvement. Organizations that cannot pursue Magnet ® status can implement strategies
such as career ladders.
TOP: AONE competency: Knowledge of the Health Care Environment
13. A nursing-led classification system that has led to greater reliability and standardization
in data utilized for QI processes is:
NANDA.
AHRQ.
NIOSH.
nursing process.
a.
b.
c.
d.
ANS: A
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NANDA has been developed by nurses and uses standardized terminology that enables
study of health problems across populations, settings, and caregivers.
TOP: AONE competency: Knowledge of the Health Care Environment
14. In determining the relationship between injury-producing falls and proposed
preventive measures as part of the QI process, a QI team might turn to which of the
following for confirmatory evidence?
a. NDNQI
b. NANDA
c. NIOSH
d. AHRQ
ANS: A
The National Database of Nursing Quality Indicators is a national, nursing quality
measurement program from the American Nurses Association that provides hospitals
with unit-level performance reports with comparisons to national averages and rankings.
TOP: AONE competency: Knowledge of the Health Care Environment
15. A method commonly used in quality assurance to monitor adherence to established
standards is:
a. a Pareto chart.
b. brainstorming.
c. patient interviews.
d. chart audit.
ANS: D
Chart audits are a common method of addressing process standards. Chart audits over
time yield trend charts.
TOP: AONE competency: Knowledge of the Health Care Environment
16. Hospital Magnet ® decides against creating a separate department to lead and monitor
quality activities because:
a. total organizational involvement is critical to QI.
b. data generated by a single, separate department are generally flawed.
c. monitoring and commitment to QI can come only from senior-level managers.
d. staff resent suggestions for improvement that originate outside of their unit.
ANS: A
Decentralized approaches are effective in developing unit-level solutions, as well
as commitment to strategies and implementation of changes.
TOP: AONE competency: Knowledge of the Health Care Environment
17. As a nurse manager, you know that the satisfaction of patients is critical in making QI
decisions. You propose to circulate a questionnaire to discharged patients, asking about their
experiences on your unit. Your supervisor cautions you to also consider other sources of
data for decisions because:
a. the return rate on patient questionnaires is frequently low.
b. patients are rarely reliable sources about their own hospital experiences.
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c. hospital experiences are frequently obscured by pain, analgesics, and other
factors affecting awareness.
d. patients are reliable sources about their own experiences but are limited in
their ability to gauge clinical competence of staff.
ANS: D
Patients are reliable and motivated sources of their own experience but often do not have
sufficient knowledge of clinical procedures to provide feedback about clinical competence.
TOP: AONE competency: Knowledge of the Health Care Environment
18. An example of an effective patient outcome statement is:
a. eighty percent of all patients admitted to the Emergency Department will be
seen by a nurse practitioner within 3 hours of presentation in the Emergency
Department.
b. patients with cardiac diagnoses will be referred to cardiac rehabilitation programs.
c. the hospital will reduce costs by 3% through the annual budget process.
d. quality is a desired element in patient transactions.
ANS: A
Patient outcome statements must be measurable, specific, and patient-centered.
TOP: AONE competency: Knowledge of the Health Care Environment
19. Patient perceptions are useful in:
a. determining disciplinary actions in QI.
b. establishing the competitive advantage of QI decisions.
c.
providing one source of data for QI initiatives
d. establishing blame for poor-quality care.
ANS: C
Customers define quality and patient dissatisfaction as useful indicators of which areas are of
greatest concern to patients and of what matters then to nurses and organizations. Patient
perceptions guide areas of inquiry; however, they do not establish what disciplinary
decisions will be made.
TOP: AONE competency: Knowledge of the Health Care Environment
20. Through the QI process, the need to transform and change the admissions process across
administrative and patient care units is identified. In this particular situation, what method
of data organization will be most effective?
a. Flowchart
b. Histogram
c. Narrative
d. Line graphs
ANS: A
Flowcharts are useful in identifying and visualizing sequential steps, such as the
admissions process.
TOP: AONE competency: Business Skills
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21. A nursing unit is interested in refining its self-medication processes. In beginning this
process, the team is interested in how frequently errors occur with different patients. To assist
with visualizing this question, which organizational tool is most appropriate?
a. Histogram
b. Flowchart
c. Fishbone diagram
d. Pareto chart
ANS: A
Histograms are bar graphs that are useful in outlining and identifying frequency.
TOP: AONE competency: Knowledge of the Health Care Environment
22. The outcome statement “Patients will experience a ten percent reduction in
urinary tract infections as a result of enhanced staff training related to catheterization
and prompted voiding” is:
a. physician-sensitive and nonmeasurable.
b. measurable and nursing-sensitive.
c. precise, measurable, and physician-sensitive.
d. patient care–centered and nonmeasurable.
ANS: B
Nursing-sensitive outcomes refer to outcomes that are affected by nursing activity and
are precise, measurable, and patient-centered.
TOP: AONE competency: Knowledge of the Health Care Environment
23. Your institution has identified a recent rise in postsurgical infection rates. As part of your
QI analysis, you are interested in determining how your infection rates compare with those of
institutions of equivalent size and patient demographics. This is known as:
a. quality assurance.
b. sentinel data.
c. benchmarking.
d. statistical analysis.
ANS: C
Benchmarking is a widespread search to identify the best performance against which
to measure practices and processes.
TOP: AONE competency: Knowledge of the Health Care Environment
24. At Hospital Alpha, there has been a 20% increase in instruments and sponges being left
in patients during surgery and surgeries on the wrong limbs. These are known as:
a. sentinel events.
b. medically sensitive events.
c. nurse-sensitive events.
d. Never Events.
ANS: D
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The NQF and CMS define Never Events as errors in medical care that are clearly
identifiable, preventable, and serious in their consequences for patients and that indicate a
real problem in the safety and credibility of a healthcare facility. Examples of Never Events
include surgery on the wrong body part, foreign body left in a patient after surgery,
mismatched blood transfusion, major medication error, severe pressure ulcer acquired in the
hospital, and preventable postoperative deaths.
TOP: AONE competency: Knowledge of the Health Care Environment
MULTIPLE RESPONSE
1. Examples of sentinel events include: (Select all that apply.)
a. forceps left in an abdominal cavity.
b. patient fall, with injury.
c. short staffing.
d. administration of morphine overdose.
e. death of patient related to postpartum hemorrhage.
ANS: A, B, D, E
Sentinel events are serious, unexpected occurrences involving death or physical
or psychological harm.
TOP: AONE competency: Knowledge of the Health Care Environment
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Chapter 24: Translating Research into Practice
Yoder-Wise: Leading and Managing in Nursing, 7th 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
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
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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
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
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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
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
Issuing reports on the adverse consequences of outdated practices
d.
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?
Hiring a nurse researcher
Partnering with nurse researchers at a local university
Subscribing to journals devoted to evidence-based nursing
Including research competencies in managers’ job descriptions
a.
b.
c.
d.
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
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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.
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
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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.
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.
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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
16. Which of the following would be most effective in implementing the findings of a new
clinical treatment for problems associated with bowel motility for the staff nurses?
a. Lecture by a nurse practitioner
b. Workshop for surgical nurses that involves discussion of case studies and
c.
application of evidence
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
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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 EDP 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 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
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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
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
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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
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
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Chapter 25: Managing Personal and Personnel Problems
Yoder-Wise: Leading and Managing in Nursing, 7th Edition
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:
include a plan to correct them and to prevent future occurrences.
state a detailed history of past problems that are related to the current one.
be written at the convenience of the manager.
not be discussed until the formal performance evaluation.
a.
b.
c.
d.
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.
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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.
c.
standardized clinical skills checklist
administration of personality tests and competency assessments at point of hire.
d. formalized competency program with established standards for practice.
ANS: D
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
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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.
should rehire the employee after a reasonable length of time.
d. should terminate the employee if the problem persists.
c.
ANS: D
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
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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
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?
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a.
b.
c.
d.
Personality and behavioral changes
Job performance changes
Changes in educational involvement and pursuit
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
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
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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.
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.
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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: D
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
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
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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
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 27: Managing Your Career
Yoder-Wise: Leading and Managing in Nursing, 7th Edition
MULTIPLE CHOICE
1. A new graduate is seeking a new position in nursing and wants to “sell” herself effectively.
The best strategy is to:
a. create a résumé.
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
2. A nurse manager has been employed in the same facility for 20 years and has held the
same position. This career style is known as:
a. linear.
b. spiral.
c. steady state.
d. entrepreneurial/transient.
ANS: C
Career styles that are marked by selecting and staying in a role throughout a career
are characterized as steady state.
TOP: AONE competency: Leadership
3. 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
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4. Before beginning her own nursing agency, a nurse worked with other temporary nursing
agencies in nine states and multiple agencies. She had set a personal goal to start her own
agency. What type of motivation does this exemplify in career success?
a. Linear
b. Spiral
c. External
d. Internal
ANS: D
This is an example of internally motivated career success for the nurse. She set a goal
and achieved the goal, meeting her own internal focus and resulting in her career
success.
TOP: AONE competency: Leadership
5. A young male nurse began in nursing as a staff nurse at a hospital. After 3 years, he moved
to a home healthcare agency for increase in pay and taking a position as a manager in the
agency. What type of motivation does this exemplify in career success?
a. Internal
b. External
c. Spiral
d. Entrepreneurial
ANS: B
This type of career success is exemplified by external focus or motivation. The motivation
in external focus is from tangible measures such as salary and promotions.
TOP: AONE competency: Leadership
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.
TOP: AONE competency: Leadership
7. Which of the following situations is most likely to result in a productive, whole
work situation?
a. Amy, RN, 5 years of experience in the Emergency Department. Amy accepts
a position working with older clients in a home health agency because she has
relocated, and this is the only full-time position available.
b. Adam, RN, 8 years of experience in various nursing positions, including that of
a nurse manager. Adam accepts a new nurse manager position because he has a
family and wants more regular hours. He is most comfortable working in direct
client care.
c. Louise, RN, 10 years of experience in an Emergency Department. She accepts a
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position as a case manager in home health care, working with older clients. She
especially enjoys working with older adults and wants to take on leadership and
management challenges.
d. Courtney, RN, a new graduate. Courtney is getting comfortable with delivering
nursing care as an RN. She is offered a position on surgery as a permanent
team leader. The unit has had a great deal of turnover recently, and only limited
mentorship is available.
ANS: C
The whole of any work situation is composed of two elements: person and position. A productive,
whole work situation results when a person’s talents and strengths are successfully
blended with expectations of the position. Of the situations described previously, the one
most likely to result in a productive, whole work situation is that of Louise, who, although her
experience has not been in home health, is interested in both the roles and the responsibilities
of the position, as well as the target group being served. She also considers the group being
served as an area in which she demonstrates strength.
TOP: AONE competency: Business Skills
8. 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
9. 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
10. 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?
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a.
b.
c.
d.
Résumé
Annual evaluations
Portfolio
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
11. During performance appraisal interviews, Joanne’s nurse manager notices Joanne’s
excitement when she talks about how she has helped patients on a rehab unit understand the
complexities of their regimens. When Joanne’s nurse manager asks her about her
career path plans, Joanne says that she wants to become a nurse administrator. The best
response to Joanne would be:
a. “Nursing administration is rewarding. What experiences would help you
along this path?”
b. “You do not appear excited about nursing administration. Unless you are
excited by that career path, I wouldn’t advise going in that direction.”
c. “You seem to find teaching others very rewarding. Have you considered
that as a possible career path?”
d. “You are too inexperienced to consider administration. Work for a few years,
and then consider administration.”
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
12. 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
13. 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
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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
14. Steady state styles would be most likely in which of the following situations?
a. Small hospital, in an isolated rural setting, with limited hierarchy
b. Large urban teaching hospital
c. Health network with several organizations
d. Travel nurse agency
ANS: A
Steady state career styles (career-long commitment to a particular position) are more likely
in rural settings, where commitment to the community is high and alternative career
opportunities are limited.
TOP: AONE competency: Professionalism
15. 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
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
16. Which of the following needs revision on a résumé or CV?
a. John Jones
87 Highway Drive
City, MI 79110
jjones@gmail.com
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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
17. 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
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
18. 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
19. A cover letter and a résumé together should be no longer than ________
page(s). a. two
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b. one
c. four
d. three
ANS: D
Two pages are recommended for a résumé and one for a cover letter.
TOP: AONE competency: Business Skills
20. 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
21. A well-written letter of resignation is critical to:
a.
b.
c.
d.
first announce your intent to resign.
formally signal discontent in your current position.
maintain a positive relationship with your former organization and colleagues.
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
22. 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.
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TOP: AONE competency: Business Skills
23. 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 Skills
24. 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
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 30: The Strategic Planning Process
Yoder-Wise: Leading and Managing in Nursing, 7th Edition
MULTIPLE CHOICE
1. 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
2. A community-based pain management program is being planned for your region. As a
coordinator of a home care agency, you have been requested to develop a conceptual
framework, mission statement, philosophy, and objectives for the program. In what order
will you pursue this endeavor?
a. Objectives, philosophy, and mission statement
b. Philosophy, objectives, and mission statement c.
Philosophy, mission statement, and objectives d.
Mission statement, philosophy, and objectives
ANS: D
The development of the mission statement is the first step in defining the purpose
and direction of the organization after an assessment has been completed.
TOP: AONE competency: Business Skills
3. Northwestern Hospital has decided to implement peer review. As a clinical leader in the
Emergency Department, you have overall responsibility for ensuring that this is in place
by next month. The most important step in this process is to:
a. provide an educational session for staff on peer review.
b. revise the mission statement, objectives, and performance standards.
c. develop objectives and performance standards with employees.
d. implement objectives and performance standards.
ANS: A
Once a strategic plan has been developed, the next step is open communication and
execution of the specific plan, which, in this instance, is peer review.
TOP: AONE competency: Leadership
4. 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.
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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
5. As a nursing leadership student, you have had the opportunity to develop a palliative care
manual that will be utilized by the palliative care network (PCN) in your region for teaching
healthcare professionals. The PCN has requested that you provide a prioritized plan of
action for marketing the manual on a regional and state basis. What is the first priority?
a. Motivate the target market.
b. Research the target market.
c. Communicate benefits to the target group.
d. Package the product.
ANS: B
To put a strategic plan into place for marketing, it is necessary to conduct an
external assessment.
TOP: AONE competency: Business Skills
6. 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
7. 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.
TOP: AONE competency: Knowledge of the Health Care Environment
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8. 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 HealthCare Environment
9. 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 be 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
10. To conduct assessment of the internal environment, the strategic planning team for
Pacific Hospital:
a. invites community members and staff of the hospital to an evening focus
group session.
b. discusses what it sees as the primary threats and opportunities in
demographic shifts affecting the hospital.
c. invites all levels of staff to focus groups on the effectiveness of the
hospital environment, including information systems and staffing.
d. asks the board to provide a summary of major opportunities for the future.
ANS: C
Assessment of the internal environment should include all levels of staff and facilitates
feedback on effectiveness of strengths and weaknesses of systems and processes within
the institution.
TOP: AONE competency: Business Skills
11. 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.
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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
12. 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
13. At the beginning of the strategic planning processes, Pacific Hospital learns that nursing
staff members are uncomfortable with utilizing evidence-based practice, and that staff
perceives that only limited resources are available to support translation of evidence into
their usual practice. Because this issue has been identified, the management team determines
that a plan of action is required to address the issue. Who should be involved at this point?
a. Nursing unit managers
b. Staff nurses
c. All staff
d. Administration
ANS: C
The first phase in planning is conducting an assessment of the external and internal
environments. Assessment of the internal environment should include all levels of staff
and facilitates feedback on effectiveness of strengths and weaknesses of systems and
processes within the institution.
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TOP: AONE competency: Business Skills
14. 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
15. 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
16. Assessment of the needs of the consumer or client (in developing a strategic marketing
plan) focuses on:
a. present needs only.
b. present and future needs.
c. the development of surveys.
d. secondary analysis of existing data.
ANS: B
Assessment of needs takes into account needs of the consumer now and for the future, using
a variety of data-gathering techniques. Future orientation aids in anticipating how marketing
and programs will need to shift to meet those needs.
TOP: AONE competency: Business Skills
17. After an extensive campaign to ensure that the community surrounding Pacific Hospital
has been exposed to the emphasis of excellence in clinical care that occurs through the use
of evidence, the marketing team finds that the public perception has changed little. This
determination is made possible through:
a. marketing surveys.
b. focus groups.
c. informal feedback.
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d. comparison of data against benchmarks.
ANS: D
Developing benchmark data at the beginning of a project enables comparison of later
data against the benchmark to determine if a marketing plan has met its objectives.
TOP: AONE competency: Business Skills
18. 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
19. Shifts such as changes in the percentage of seniors in the population, governmental initiatives in
health care, and the influence of income on health status are factors in the __________
environment.
a. public
b. macro
c. competitive
d. social
ANS: B
The external environment in strategic marketing planning includes the public, competitive,
and macro environments. Demographic, social, and political factors are included in the
macro environments.
TOP: AONE competency: Business Skills
20. A private ambulance clinic established a few streets away from Pacific Hospital markets its
services as quality-based within caring relationships. The clinic is part of the environment.
a. public
b. macro
c. competitive
d. social
ANS: C
The competitive environment includes factors and elements that compete for resources with
another organization. These elements may include those in public and macro environments.
TOP: AONE competency: Business Skills
21. Which of the following represents an effective goal statement?
a. Involve patients and families in planning health care.
b. To revise clinical guidelines for incontinence care from evidence within 6 months.
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c. Patients and families are partners first in care planning.
d. To acquire $4 million in additional funding within 12 months to support
clinical education programs for dementia.
ANS: A
Goal statements formalize targets for an organization. Objectives include the word to and an
action word, and specify dates for attainment. Mission statements convey values and beliefs
of the organization.
TOP: AONE competency: Business Skills
22. After a year, the staff at Pacific Hospital is frustrated, and implementation of evidence-based
practice has gone poorly. In responding to this situation, the strategic planning team at Pacific
Hospital:
a. recommends that the mission, objectives, and goals of the hospital be reassessed.
b. revises the goal statements in the strategic plan.
c. consults an external team on preparation of materials on evidence-based practice.
d. holds focus groups with staff to determine what kinds of issues, challenges,
and obstacles have occurred in implementation.
ANS: D
On a consistent basis, the strategic plan is reviewed at all levels to determine whether the
execution of goals, objectives, and activities is on target. As stated, a sense of flexibility
regarding the objectives is important to consider, and objectives may change as a result of
legislation, budget changes, and change in structure or other environmental factors. Involving
staff enables development of creative methods to ensure that necessary changes occur.
TOP: AONE competency: Business Skills
23. Benchmarks in the strategic marketing planning process are useful in:
a. establishing programs.
b. setting targets.
c. rewarding employees.
d. measuring progress.
ANS: D
Establishing benchmarks enables measurement of the interim and final achievements
of programs.
TOP: AONE competency: Business Skills
24. The executive team at Hospital XYZ develops a polished strategic plan that includes a
mission statement, goals, and objectives. The executive team involves the marketing team,
so that the plan can be communicated internally and externally. After 2 years, no significant
progress has been made toward any of the goals. What has been omitted in the plan?
a. Planning
b. Marketing
c. Integrated financial planning
d. Customer focus
ANS: C
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Without the inclusion of a business plan with the strategic plan and integration of financial
planning and allocation of resources execution of the strategic plan can become paralyzed,
even with the most effective communication of the strategic plan itself.
TOP: AONE competency: Business Skills
MULTIPLE RESPONSE
1. A clinic nurse developed objectives for a diabetic education program. The characteristics
of well-written objectives include that they should be what? (Select all that apply.)
a. Achievable
b. Understandable and specific
c. People-oriented
d. Manager-oriented
e. Means-oriented
f. Measurable
ANS: A, B, F
The S.M.A.R.T. acronym describes the attributes of objectives: specific,
measurable, agreed-upon, reasonable (achievable), and time-bound.
TOP: AONE competency: Business Skills
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