What statement is true regarding decision making?
A) It is an analysis of a situation
B) It is closely related to evaluation
C) It involves choosing between courses of action
D) It is dependent upon finding the cause of a problem
Decision making is a complex cognitive process often defined as choosing a particular course of action. Problem solving is part of decision making and is a systematic process that focuses on analyzing a difficult situation. Critical thinking, sometimes referred to as reflective thinking, is related to evaluation and has a broader scope than decision making and problem solving.
What is a weakness of the traditional problem-solving model?
A) Its need for implementation time
B) Its lack of a step requiring evaluation of results
C) Its failure to gather sufficient data
D) Its failure to evaluate alternatives
The traditional problem-solving model is less effective when time constraints are a consideration. Decision making can occur without the full analysis required in problem solving. Because problem solving attempts to identify the root problem in situations, much time and energy are spent on identifying the real problem.
A) Scientific methods provide identical decisions by different individuals for the same problems
B) Decisions are greatly influenced by each person’s value system
C) Personal beliefs can be adjusted for when the scientific approach to problem solving is used.
D) Past expereince has little to do with the quality of the decision
Values, life experience, individual preference, and individual ways of thinking will influence a person’s decision making. No matter how objective the criteria will be, value judgments will always play a part in a person’s decision making, either consciously or subconsciously.
A) The decision maker’s immediate superior.
B) The type of decision that needs to be made
C) Questions asked and alternatives generated
D) The time of day the decision is made
The greater number of alternatives that can be generated by the decision maker, the better the final decision will be. The alternatives generated and the final choices are limited by each person’s value system.
A) Good decision makers are usually right-brain, intuitive thinkers
B) Effective decision makers are sensitive to the situation and to others
C) good decisions are usually made by left-brain, logical thinkers
D) good decision making requires analytical rather than creative processes
Good decision makers seem to have antennae that make them particularly sensitive to other people and situations. Left-brain thinkers are typically better at processing language, logic, numbers, and sequential ordering, whereas right-brain thinkers excel at nonverbal ideation and holistic synthesizing.
A) The planning process of management
B) The evaluation phase of the executive role
C) One step in the problem-solving process
D) Required to justify the need for scarce items
Decision making is a complex, cognitive process often defined as choosing a particular course of action. Decision making, one step in the problem-solving process, is an important task that relies heavily on critical thinking and clinical reasoning skills.
A) An alternative problem
B) A chosen course of action
C) An action that guarantees success
D) A restatement of the solution
A decision is made when a course of action has been chosen. Problem solving is part of decision making and is a systematic process that focuses on analyzing a difficult situation. Problem solving always includes a decision-making step.
A) Some values are not realistic or healthy
B) Not all values are of equal worth
C) Our values remain unchanged over time
D) Our values often collide with one another
Values, life experience, individual preference, and individual ways of thinking will influence a person’s decisio making. No matter how objective the criteria will be, value judgments will always play a part in a person’s decision making, either consciously or subconsciously.
A) It is a simple approach to decision making
B) It is narrower in scope than decision making
C) It requires reasoning and creative analysis
D) It is a synonym for the problem-solving process
Critical thinking has a broader scope than decision making and problem solving. It is sometimes referred to as reflective thinking. Critical thinking also involves reflectingupon the meaning of statements, examining the offered evidence and reasoning, and forming judgments about facts.
How do administrative man managers make the majority of their decisions?
A) After gathering all the facts
B) In a manner good enough to solve the problem
C) In a rational, logical manner
D) After generating all the alternatives possible
Many managers make decisions that are just “good enough” because of lack of time, energy, or creativity to generate a number of alternatives. This is also called “satisficing.” Most people make decisions too quickly and fail to systematically examine a problem or its alternatives for solution
What needs to be considered in evaluating the quality of one’s decisions?
A) Is evaluation necessary when using a good decision-making model?
B) Can evaluation be eliminated if the problem is resolved?
C) Will the effectiveness of the decision maker be supported?
D) Will the evaluation be helpful in increasing one’s decision-making skills?
The evaluation phase is necessary to find out more about one’s ability as a decision maker and to find out where the decision making was faulty.
A) They exert little influence on decisions that are made
B) They make decisions made that are in congruence with their own values
C) They allow others to make the decisions however they wish
D) They make all the important decisions with consideration to others
Not only does the preference of the powerful influence decisions of others in the organization, but the powerful are also able to inhibit the preferences of the less powerful. Powerful people in organizations are more likely to have decisions made that are congruent with their own preferences and values.
A) Affirming the consequences
B) Arguing from analogy
C) Deductive reasoning
This type of “crooked” thinking occurs when one believes that because A has a particular characteristic, every other A also has the same characteristic. This kind of thinking is exemplified when stereotypical statements are used to justify arguments and decisions
A) Making decisions independent of organizational values
B) Not trusting others to decide
C) Desiring personal power
D) Having private beliefs that are separate from corporate ones
The ability of the powerful to influence individual decision making in an organization often requires adopting a private personality and an organizational personality.
A) Examine alternatives visually and compare each against the same criteria
B) Quantify information
C) Plot a decision over time
D) Predict when events must take place to complete a project on time
A decision grid allows one to visually examine the alternatives and compare each against the same criteria. Although any criteria may be selected, the same criteria are used to analyze each alternative.
A) They are subject to human error
B) They ensure good decision making
C) They eliminate uncertainty and risk
D) They tend to save management time
Management decision-making aides are subject to human error. Some of these aides encourage analytical thinking, others are designed to increase intuitive reasoning, and a few encourage the use of both hemispheres of the brain. Despite the helpfulness of these tools, there is a strong tendency for managers to favor first impressions when making a decision, and a second tendency, called confirmation biases, often follows.
A) Discrete, unconscious process to allow individuals to solve problems quickly
B) Set of rules to encourage learners to discover solutions for themselves
C) Formal process and structure in the decision-making process
D) Trial-and-error method or rules-of-thumb approach
Most individuals rely on discrete, often unconscious processes known as heuristics, which allows them to solve problems more quickly and to build upon experiences they have gained in their lives. Thus, heuristics use trial-and-error methods or a rules-of-thumb approach, rather than set rules, and in doing so, encourages learners to discover solutions for themselves.
A) Lacks complete knowledge and generates few alternatives
B) Makes decisions that may not be ideal but result in solutions that have an adequate outcome
C) Makes most management decisions using the administrative man model of decision making
D) These managers gather as much information as possible and generate many alternatives
Economic managers gather as much information as possible and generate many alternatives. Most management decisions are made by using the administrative man model of decision making. The administrative man never has complete knowledge and generates fewer alternatives.
Analytical, linear, left-brain thinkers process information differently from creative, intuitive, right-brain thinkers. Left-brain thinkers are typically better at processing language, logic, numbers, and sequential ordering, whereas right-brain thinkers excel at nonverbal ideation and holistic synthesizing.
A) Upper left brain
B) Upper right brain
C) Lower left brain
D) Lower right brain
Individuals with lower-left-brain dominance are highly organized and detail oriented and individuals with upper-left-brain dominance truly are analytical thinkers who like working with factual data and numbers. These individuals deal with problems in a logical and rational way. Individuals with upper-right-brain dominance are big picture thinkers who look for hidden possibilities and are futuristic in their thinking. Individuals with lower-right-brain dominance experience facts and problem solve in a more emotional way than the other three types.
A) Case studies
C) Problem-based learning (PBL)
D) Grand rounds
Simulation provides learners opportunities for problem solving that have little or no risk to patients or to organizational performance while providing models, either mechanical or live, to provide experiences for the learner. While the other options provide learning opportunities that include problem solving, simulation is the most realistic while also being low risk.
A) “Since that didn’t work effectively, let’s try something different.”
B) “The solution has to be something the patient is willing to do.”
C) “I’ll talk to the patient’s primary care giver about the problem.”
D) “Maybe there is no new solution to this particular problem.”
A critical thinker displays persistence, empathy, and assertiveness. The remaining options reflect limited thinking and an inability to think outside the box.
A) Facilitates effective time management
B) Supports the acquisition of clinical reasoning
C) Supplements the orientation process
D) Encourages professional autonomy
A structured approach to problem solving and decision making increases clinical reasoning and is the best way to learn how to make quality decisions because it eliminates trial and error and focuses the learning on a proven process. This is particularly helpful to the novice nurse with limited clinical experience and intuition. The other options are outcomes of the possession of critical thinking skills and clinical reasoning.
A) The frequent absence of well-written patience-focused objectives
B) The confusion created by the existence of numerous nursing diagnoses
C) The ever-increasing need for effective assessment skills required of the nurse
D) The amount of nursing staff required to implement the patients’ plans of care
The weakness of the nursing process, like the traditional problem-solving model, is in not requiring clearly stated objectives. Goals should be clearly stated in the planning phase of the process, but this step is frequently omitted or obscured. While the remaining options relate to the nursing process, they are not directly a result of the process itself.
A) It assures the correct decision when dealing with financial situations
B) It is very helpful when quantitative information about the topic is available
C) It assists in the visualization of the available historic and current data
D) It is easy to construct even for the novice decision maker
Payoff tables do not guarantee that a correct decision will be made, but they assist in visualizing data. While it does lend itself to the use of quantitative data that are not its strength, the table may not be difficult to construct that is not its strength since it is dependent on the inclusion of accurate data and effective evaluation of that data.
A) Planning, directing, organizing, staffing, and evaluating
B) Planning, organizing, staffing, directing, and controlling
C) Organizing, planning, staffing, directing, and evaluating
D) Organizing, staffing, planning, implementing, and controlling
Management functions include planning, organizing, staffing, directing, and controlling. These are incorporated into what is known as the management process.
A) Meeting worker satisfaction
B) Delineating barriers to productivity
C) Using a laissez-faire approach
D) Encouraging employee participation
Classical, or traditional, management science focuses on production in the workplace and on delineating organizational barriers to productivity. Little attention was given to worker job satisfaction, and workers were assumed to be motivated solely by economic rewards.
A) Workers will naturally put forth effort
B) Workers need threats to be motivated
C) Workers are diligent and responsible
D) Workers are in tune with organizational needs
Theory X managers believe that their employees are basically lazy, need constant supervision and direction, and are indifferent to organizational needs.
A) Human beings under investigation will respond to the fact that they are being studied
B) Production will increase or decrease as light in a factory is increased or decreased
C) Membership in small groups forms social control
D) People are inherently good and will seek out work
Hawthorne effect indicated that people respond to the fact that they are being studied, attempting to increase whatever behavior they feel will continue to warrant the attention. The other statements do not reflect implied beliefs about people.
Directing sometimes includes several staffing functions. However, this phase’s functions usually entail human resource management responsibilities, such as motivating, managing conflict, delegating, communicating, and facilitating collaboration. Planning encompasses determining philosophy, goals, objectives, policies, procedures, and rules; carrying out long- and short-range projections; determining a fiscal course of action; and managing planned change. Organizing includes establishing the structure to carry out plans, determining the most appropriate type of patient care delivery, and grouping activities to meet unit goals.
A) Part of the management functions identified by Fayol
B) The result of the human relations studies
C) The outcome of studies done by Mayo at the Hawthorne Works
D) One of the four overriding principles of scientific management
Frederick Taylor, the “father of scientific management,” had the idea that workers should be hired, trained, and promoted based on their competence and abilities. This concept is not associated with any of the other options.
A)Workers had to have a say in management to work most effectively
B) Consistent rules and regulations for workers increased efficiency
C) Employees should feel appreciated and valued
D) Workers need frequent rest periods to increase overall production
Weber saw the need for legalized, formal authority and consistent rules and regulations for personnel in different positions. He thus proposed bureaucracy as an organizational design. None of the other options reflect his conclusions.
D) A contingency approach
Lewin identified three common leadership styles: authoritarian, democratic, and laissez-faire. Authoritarian leadership results in well-defined group actions that are usually predictable, reducing frustration in the work group and giving members a feeling of security. Productivity is usually high, but creativity, self-motivation, and autonomy are reduced. Authoritarian leadership is frequently found in very large bureaucracies such as the armed forces. Coercion to motivate is not associated with the other options.
A) High relationship behavior is much more essential to a good manager than high task behavior
B) This leadership model is effective in bureaucratic organizations because it is task focused
C) Management should be consistent in different situations so workers understand what is expected of them
D) The leadership style chosen by a manager should reflect the task/relationship behavior of those being managed
The idea that leadership style should vary according to the situation or the individuals involved was first suggested almost 100 years ago by Mary Parker Follett, one of the earliest management consultants and among the first to view an organization as a social system of contingencies. The other options present statements that are incorrect.
A) A leadership position is assigned
B) A leadership position carries a legitimate source of power
C) Members of a group will follow a person in a leadership position only by choice
D) Leadership requires meeting organizational goals
A leader is the person who guides direction, opinion, and course of action without having an assigned position within the formal organization and so people choose to follow them. The other options are not accurate descriptions of leadership.
A) They are politically astute
B) They look outward, toward the larger organization
C) They extend influence only to their own group
D) They emphasize vision, values, and motivation
Traditional managers influence those in their own groups while integrated leaders influence others beyond their own group. The remaining options represent traits that may be shared by both types.
A) Leadership is a process of influencing others within an organizational culture
B) The interactive relationship between the leader and the follower is significant
C) Some are born to lead, whereas others are born to be led
D) Vision and empowerment are two of the most critical leadership skills
Early leadership theorists focused on broad conceptualizations of leadership that assumed that people have certain characteristics or personality traits that make them better leaders than others. The remaining options do not describe a concept suggested by early leadership-theory development.
A) Non-consensus decision making
B) Fitting employees to their jobs
C) Rapid career promotions
D) Authoritative problem solving
Characteristics of Theory Z include fitting employees to their jobs, consensus decision making, job security, slower promotions, examining the long-term consequences of management decision making, quality circles, guarantee of lifetime employment, establishment of strong bonds of responsibility between superiors and subordinates, and a holistic concern for the workers.
Transformational leadership positively impacts the leader and the follower, who have a collective purpose. The traditional manager, concerned with the day-to-day operations, was termed a transactional leader. The remaining options are not associated with these characteristics.
Three primary leadership styles have been identified: authoritarian, democratic, and laissez-faire.
The human relations era of management science emphasized concepts of participatory and humanistic management. Three primary leadership styles have been identified: authoritarian, democratic, and laissez-faire.
A) Inward thinkers
B) Long-term thinkers
C) Concerned with employee motivation
D) Possess influence beyond their own group
Gardner asserted that integrated leader-managers possess six distinguishing traits: They influence others beyond their own group; they emphasize vision, values, and motivation; they think longer term; they look outward, toward the larger organization they are politically astute; they think in terms of change and renewal.
A) Leadership behavior is generally determined by the relationship between the leader’s personality and the specific situation
B) Manager behaviors are generally determined by the relationship between the manager’s personality and the specific situation.
C) Both managers and followers have the ability to raise each other to higher levels of motivation and morality.
D) Both leaders and followers have the ability to raise each other to higher levels of motivation and morality.
The basic premise of interactional theory is that leadership behavior is generally determined by the relationship between the leader’s personality and the specific situation. Transformational leadership is where both leaders and followers have the ability to raise each other to higher levels of motivation and morality.
There are nine factors impacting leadership style and its impact on followers; five are transformational, three are transactional, and one is a nonleadership or laissez-faire leadership factor.
The traditional manager, concerned with the day-to-day operations, is termed a transactional leader. This is not a characteristic of the other options.
A) Establishing a legitimate source of power
B) Delegating responsibilities to staff members
C) Formulate the budget to achieve the stated goals
D) Direct attention to the management of unwilling subordinates
The manager is typically involved in the delegation of responsibilities through the power of the legitimate power associated with the position. To manipulate people, the environment, money, time, and other resources to achieve organizational goals is also a manager’s focus. Attention to both willing and unwilling subordinates as well as established responsibilities is associated with the role of the manager.
A) Mentoring two new managers
B) Establishing goals for the coming year
C) Advocating for employee regarding personal policies
D) Providing a motivational speech at the new employee orientation
Leadership roles include mentoring, decision making, advocating, andenergizing. Risk taking is also considered a leadership role.
D) Staff development
Leadership is flawed and likely ineffective when the leader does not collaborate and communicate effectively with others in the organization. The improvement and development of both others and oneself is vital to the effectiveness of a leader. Clear forward thinking is associated with good leadership.
A) “Your plans for the changes will be difficult to implement.”
B) “I don’t think you heard what the rest of us had to say.”
C) “Do you have an idea what direction we need to go?”
D) “Can you tell me why my suggestion will not work?”
The statement is a clear indication that the subordinate feels the leader is not listening and collaborating; this is a fatal flaw. The other statements are more open to explanation by and with the subordinate and leader
Controlling is the function that includes performance appraisals, fiscal accountability, quality control, legal and ethical control, and professional and collegial control.
A) Trusting and valuing employees
B) Genuinely liking your colleagues
C) A laissez-faire style of leadership
D) A dynamic leadership charisma
These managers, termed servant leaders, put serving others, including employees, customers, and the community, as the number-one priority. In addition, servant leaders foster a service inclination in others that promotes collaboration, teamwork, and collective activism. The servant leader is not necessarily associated with the concepts identified in the other options.
A) Showing their true feelings
B) Empathizing with followers
C) Identifying existing emotions in themselvesand others
D) Manipulating the emotions of all involved to achieve stated goals
Theorists studying emotional intelligence posit that the ability to identify emotions in themselves and in others is a critical ingredient of leaders, enabling them to build a cooperative and effective team. While the other options may have value, they do not represent the critical skill related to team building
A) Support the followers’ right to disagree
B) Rely only on facts and discount intuition
C) Discourage acceptance until the facts are proved
D) Identify who to rely upon and who not to listen to
There is no guarantee that followers will not mislead leaders, but adhering to certain principles, such as making sure that followers are allowed to disagree, will guard against this happening. The remaining options are flawed in the principles they support.
A) They are totally trustworthy
B) They may have character flaws
C) They are by nature good intentioned
D) Charisma is their strongest attribute
Leaders may be deceitful and trustworthy, greedy and generous, and cowardly and brave. To assume that all good leaders are good people is foolhardy and makes us blind to the human condition. It is only when we recognize and manage our failings that leaders achieve greatness.
A) Bribing nurses
B) Quantum leadership
C) Principal agent theory
D) Servant leadership
Principal agent theory suggests that followers may have an informational (expertise or knowledge) advantage over the leader as well as their own preferences, which may deviate from that of the principal. This may lead to a misalignment of goals. To influence the agent, the principal offers an incentive that corrects excessive overtime. The remaining options do not represent the example offered.
A) The leadership role is most important in nursing today
B) Leadership is most important in managing health-care costs
C) The most important nursing leadership role is being charismatic
D) There is a need to integrate nursing management and nursing leadership
For managers and leaders to function at their greatest potential, the two roles must be integrated. The other statements are not true.
A) Leaders, followers, and the situation were all variables that interacted
B) The situation had the most profound effect on success in leadership
C) The situation has a greater effect on outcomes than followers do
D) Good results would occur if leaders led well
The successful leader will diagnose the situation before applying strategies from a large repertoire of skills that involve assessing the various variables presented by the leader, the followers and the situation. The remaining options are not related to interactional leadership theory.
A) Emotions are held in check
B) Emotions are used effectively
C) Expression of one’s emotions is expected
D) Expression of one’s emotions is encouraged
Emotional intelligence refers to the ability to use emotions effectively and is required by leader-managers in order to enhance their success. Holding one’s emotions in check can be unhealthy. The remaining options do not address the usefulness of emotions.
A) Using emotional intelligence
B) Transformational leadership
C) Building human capital
D) Using quantum leadership
By providing classes in leadership, the manager is investing in the potential of the head nurse staff to become better leaders and managers. Human capital refers to the attributes of a person that are productive in some economic context, although it is normally measured and conceived of as a private return to the individual as well as a social return. None of the remaining options relate to the example provided.
A) Explain to the new nurses the problem that their isolating is causing.
B) Arrange to send them to an English language course at the local adult school.
C) Ask the established RNs to make an effort to include the new nurses in after-work activities.
D) Begin a short sharing session before client report, so all RNs can share information about their cultures and differences in client care.
Providing an opportunity for both groups of nurses to share their cultural heritage and differences in nursing care is an opportunity to promote acceptance among all members of the staff. It has been established that speaking the language is not a problem since they do so while on duty. Including them in after-work activities may demonstrate willingness on the staff’s part but will not address work-related isolation. Merely presenting the problem to the new nurses does not show managing initiative.
A) Challenging the status quo
B) Learning new technology
C) Keeping up with current nursing knowledge
D) Being a transformational leader
Thought leadership applies to a person who is recognized among his or her peers for innovative ideas and who demonstrates the confidence to promote those ideas. Thus, thought leadership refers to any situation in which one individual convinces another to consider a new idea, product, or way of looking at things. None of the other options is a focus of thought leadership.
A) Ability to use emotions effectively that is required by leader-managers in order to enhance their success
B) In order to lead, leaders must be true to themselves and their values and act accordingly
C) One individual convinces another to consider a new idea, product, or way of looking at things
D) The environment and context in which people work is complex and dynamic and that this has a direct impact on organizational productivity
Quantum leadership suggests that the environment and context in which people work is complex and dynamic and that this has a direct impact on organizational productivity required by leader-managers in order to enhance their success. Authentic leadership suggests that in order to lead, leaders must be true to themselves and their values and act accordingly. Thought leadership refers to any situation whereby one individual convinces another to consider a new idea, product, or way of looking at things.
A) Relationship age
A transition has occurred in the twenty-first-century industrial age leadership to relationship age leadership. Quantum leadership suggests that the environment and context in which people work is complex and dynamic and that this has a direct impact on organizational productivity required by leader-managers in order to enhance their success. Authentic leadership suggests that in order to lead, leaders must be true to themselves and their values and act accordingly. Thought leadership refers to any situation whereby one individual convinces another to consider a new idea, product, or way of looking at things.
A) Active involvement in greatly needed health-care reform
B) Persistent and growing international nursing shortage
C) Shortage of qualified first-level nursing managers
D) High turnover rates by staff nurses
At the organizational and unit levels, nurse-leaders are being directed to address high turnover rates by staff, an emerging shortage of qualified top-level nursing administrators, growing trends toward unionization, and intensified efforts to legislate minimum staffing ratios and eliminate mandatory overtime, while maintaining cohesive and productive work environments. At the national level, nurse-leaders and nurse-managers are actively involved in greatly needed health-care reform and in addressing a persistent, and likely growing, international nursing shortage. The other options, while describing noteworthy issues, do not include the issue that affects needed skills.
Tabaka suggests that servant leadership is one of the top 10 characteristics of an agile organization today.
A) The ability to recognize and understand one’s moods, emotions, and drives as well as their effects on others
B) The ability to control or redirect disruptive impulses or moods as well as the propensity to suspend judgment
C) A passion to work for reasons that go beyond money or status; a propensity to pursue goals with energy and commitment
D) The ability to understand and accept the emotional makeup of other people
Self-awareness: The ability to recognize and understand one’s moods, emotions, and drives as well as their effects on others. Self-regulation: The ability to control or redirect disruptive impulses or moods as well as the propensity to suspend judgment. Motivation: A passion to work for reasons that go beyond money or status; a propensity to pursue goals with energy and commitment. Empathy: The ability to understand and accept the emotional makeup of other people.
D) Social skills
Social skills: Proficiency in handling relationships and building networks; an ability to find common ground. Self-regulation: The ability to control or redirect disruptive impulses or moods as well as the propensity to suspend judgment. Motivation: A passion to work for reasons that go beyond money or status; a propensity to pursue goals with energy and commitment. Empathy: The ability to understand and accept the emotional makeup of other people.
Values: Authentic leaders link between purpose and passion by having congruence in beliefs and actions. Purpose: Authentic leaders understand their own purposes and passions as a result of ongoing self-reflection and self-awareness. Heart: Authentic leaders care for themselves and the people they lead, and their compassion is genuine. Relationships: Authentic leaders value building relationships and establishing connections with others, not to receive rewards but rather to strengthen the human connection
A) Balanced processing
B) Internalized moral perspective
C) Relational transparency
Balanced processing refers to analyzing data rationally before making decisions. Internalized moral perspective suggests that the authentic leader is guided by internal moral standards, which then guide his/her behavior. Relational transparency refers to openly sharing feelings and information appropriate to a situation, and self-awareness alludes to a knowing of self so as to make sense of the world.
A) Balanced processing
B) Internalized moral perspective
C) Relational transparency
Balanced processing refers to analyzing data rationally before making decisions. Internalized moral perspective suggests that the authentic leader is guided by internal moral standards, which then guide his/her behavior. Relational transparency refers to openly sharing feelings and information appropriate to a situation, and self-awareness alludes to a knowing of self so as to make sense of the world.
A) Balanced processing
B) Internalized moral perspective
C) Relational transparency
Relational transparency refers to openly sharing feelings and information appropriate to a situation. Balanced processing refers to analyzing data rationally before making decisions. Internalized moral perspective suggests that the authentic leader is guided by internal moral standards, which then guide his/her behavior, and self-awareness alludes to a knowing of self so as to make sense of the world.
A) Communicates regularly with subordinates
B) Encourages teamwork to achieve problem solving
C) Includes committee representatives from all areas that will be affected by the change
D) Recognizes staff members who have contributed plausible problem-solving solutions
People skills, cooperation, and valuing staff knowledge are all characteristics of the relationship age leader. Focus on fact gathering rather than finding the meaning of the data is characteristic of an industrial age leader.
A) Effective communication skills
B) Financial planning for retirement
C) Advanced cardiopulmonary resuscitation
D) Meeting the needs of the patient’s family
Human capital can refer to a group’s collective knowledge, skills, and abilities. Human capital theory suggests that individuals and/or organizations will invest in education and professional development if they believe that such an investment will have a future payoff. Communication, meeting family needs, and cardiopulmonary resuscitation are all skills and abilities that will enhance the individual’s professional development and ultimately the services of the facility. The other options are related to the personal interests of the staff.
A) Tuition reimbursement for LPN to RN transition programs
B) Rehab services to staff diagnosed with abuse problems
C) Mental health counseling for depression and anxiety
D) Smoking cessation support classes
Strengths-based leadership, which grew out of the positive psychology movement (began in the late 1990s), focuses on the development or empowerment of workers’ strengths as opposed to identifying problems, improving underperformance, and addressing weaknesses and obstacles.
A) Possesses useful knowledge
B) Builds effective interdisciplinary teams
C) Galvanizes members to achieve goals
D) Demonstrates effective organization skills
Level 1: Highly capable individual makes high quality contributions with their work; possesses useful levels of knowledge; and has the talent and skills needed to do a good job. Team building is a Level 2 characteristic. Organizational skills are associated with Level 3 while galvanizing members to achieve goals is demonstrated by Level 4 leaders.
A) “I don’t think you have the skills necessary to be effective.”
B) “Let me think about that request for 24 hours.”
C) “Do whatever it takes to get it done fast.”
D) “I’ll personal handle this situation.”
A servant leader always thinks before reacting. This leader also chooses words carefully so as to not damage those being led, provides directions toward goal achievement, and finds asking for input more important than personally providing solutions.
A) The intensity and duration of relationships are similar in mentorship and preceptorship
B) Staff cannot be assigned to become mentors. It is a role voluntarily chosen by the mentor
C) “Mentees” must be willing to put aside their personal goals and beliefs in an effort to identify more closely with their mentor
D) Most nurses will have the opportunity for many mentor relationships during their careers
The mentor makes a conscious decision to assist the protégé in career development, with the relationship usually lasting several years. The remaining statements are not accurate regarding mentorships
A) Advise the new RN to avoid confrontations with doctors whenever possible
B) Advise the new RN that this is the real world not the textbook one
C) Be alert to signs and symptoms of the shock phase of role transition
D) Be alert to signs that the new RN has not shed nursing school values
Managers should be alert to signs and symptoms of the shock phase of role transition. Managers should also ensure that some of the new nurse’s values are supported and encouraged so that work and academic values can blend. The remaining options do not address the needs of the new RN appropriately.
A) Providing the employee with organizational rules and regulations
B) Providing the new employee with a good preceptor
C) Ensuring that there are sufficient numbers of good role models
D) Sharing organizational values, expected attitudes, and history
New group members must be socialized into the group, and these socialization efforts are led by the manager.
A) Behavior that supports positive sanctions
B) An application of a sanction regarding group norms
C) Constructive feedback about expected group norms
D) Role modeling desired behavior
Negative sanctions provide cues that enable people to evaluate their performance and modify behavior when needed. In this case, the experienced nurse is letting the new nurse know that the group’s weekly outing is important, and on that day the staff makes sure they finish their work on time. It may also suggest that detailed charting is not valued.
A) Stress the need to base practice on research findings during orientation of new graduates.
B) Include a statement of the need for evidence-based practice in the philosophy.
C) Reprimand nurses who do not use research during the annual evaluations.
D) Provide a computer program to nurses for access to the latest nursing research.
Providing available research for the staff is the most concrete action an organization could take to encourage nurses to incorporate research in practice. None of the remaining options provides the staff with the tools to implement or encourage evidence-based practice.
C) Encouraged by the role model
The relationship between an employee and a role model is passive in that the role model does not actively seek the emulation of the employee.
A) Take the RN out to lunch to congratulate the nurse on the promotion
B) Encourage the RN to meet with staff peers in the organization
C) Explain to the RN on the need for underling respect
D) Inform the RN of the past performance of new employees
There should be a management group in the organization with which the new manager can consult. The new manager should be encouraged to use the group as a resource. The remaining options are limited in their importance in successfully adjusting to a management role.
A) Identifying possible learning resources
B) Identifying any difference between current and needed skills
C) Identifying current level of knowledge
D) Identifying the knowledge or skill needed
Developing a training program starts with identifying the knowledge or skill needed. The other options are relevant but do not have the priority of the correct option.
A) Education generally has an immediate use
B) Managers have a responsibility to see that their staff is well educated
C) Recognizing and encouraging educational pursuits are a leadership role
D) Education always results in increased productivity
Although training has an immediate use, education is designed to develop the person in a broader sense. A leader will encourage continuous learning from all employees. Education is not a guarantee of productivity.
A) Andragogy techniques are usually ineffective for mature learners
B) Andragogy relies on structure and direction
C) Andragogy works well with people who have had life experiences
D) Andragogy works best with teacher-led activities
Andragogy works well with those who have had life experiences, because they are mature and can take part in their own learning experiences. In this type of learning the learner is self-directed rather than dependent. None of the remaining options accurately describes andragogy.
A) Have acquired the skills necessary for what is to be learned
B) Have the necessary motivation to learn
C) Are in an atmosphere that encourages learning
D) Are mature students with much experience
Readiness means that the individual has the prerequisites to move to the next stage of learning. The prerequisites could be behavior or prior learning. None of the other options accurately describe readiness to learn.
A) Schedule a long, uninterrupted session
B) Explain the most complicated part first
C) Use a dynamic lecture technique
D) Teach in short, frequent sessions
When learning motor skills, spaced practice is more effective than massed practice. The other options would be less effective
A) Mentors are not effective in social learning
B) Most behavior is learned by direct experience and observation
C) Individuals who make mistakes learn better than those who do not
D) Individuals learn best when left on their own
According to social learning theory, knowledge is frequently obtained through vicarious experiences, such as observing someone’s actions. None of the other options accurately describe a true statement regarding the social learning theory.
A) Solving problems for the employee
B) Showing employees how to work within the system
C) Helping employees reach an optimum level of performance
D) Redirecting employees to meet organizational goals
In coaching, the emphasis is on assisting the employee to recognize greater options, to clarify statements, and to grow. The other options are focused on doing for the learner rather than encouraging the learner to do for themselves.
A) Identifying the resources available to meet the needs
B) Identifying the desired skills or knowledge the staff should have
C) Explaining to the team that human resources should be doing this work
D) Assessing the staff’s willing to learn new skills
Identifying the desired skills or knowledge the staff should have is the first step in developing an educational program. While the other options are relevant, they lack the organizational priority of the correct option.
A) Having class participants evaluate the instructor and the class
B) Giving participants an examination or test at the conclusion of the course
C) Having a documented decrease in the unit’s IV site infections
D) Observing staff implement and document the changes recommended
Instructor evaluation supports effective teaching but not learning of the new skills. Testing someone at the end of educational training does not confirm that the learning changed behavior, which is the primary goal of staff development. There needs to be some method of follow-up to observe whether a behavior change occurred, showing that the education was effective. Observation of the staff will fulfill this need. Having a decrease in IV site infections may or may not be the result of the staff implementing the educational program.
A) A tolerance of mistakes
B) Hiring RNs with baccalaureate degrees
C) Encouraging a variety of visions
D) Stressing individual learning
Learning organizations have a shared vision and promote team learning. A common feature of learning organizations is their tolerance for mistakes. The mistakes should be learning opportunities. The remaining options do not support this aspect of a learning organization.
A) 1, 2
B) 1, 3
C) 2, 4
D) 3, 4
Socialization and re-socialization are often neglected areas of the indoctrination process. The other options are generally addressed in the indoctrination process.
A) Role ambiguity
B) Role overload
C) Inability to meet job demands
D) Past work experience
Difficulties with resocialization usually center on unclear role expectations (role ambiguity), an inability to meet job demands, or deficiencies in motivation. Role strain and role overload contribute to the problem. Past work experience is not a factor in creating a difficult resocialization.
B) Education department
C) Manager and preceptor
D) Manager and education department
Managers and education department staff have a shared responsibility for the education and training of staff. It is not the responsibility of the other options.
A) Discusses the value the unit places upon patient satisfaction
B) Addresses all questions regarding the responsibilities of the RN
C) Schedules orientation sessions at times when patient acuity is at its lowest
D) Plans for budget constraints so that educational needs are minimally impacted
Clarifying unit norms and values to all new employees is a leadership responsibility; the remaining options are appropriate management responsibilities.
A) Poor staff retention
B) Deficient nursing care
C) Increased role ambiguity
D) Decreased nursing autonomy
Some difficulties associated with decentralized staff development include the conflict created by role ambiguity whenever two people share responsibility. Role ambiguity is sometimes reduced when staff development personnel and managers delineate the difference between training and education. None of the other options are recognized as a result of decentralization of staff development.
A) Experiential factors
B) Transfer of learning
Experiential factors are skills previously acquired that are necessary for the next stage of learning. Transfer of learning refers to the goal of training to transfer new learning to the work setting. Once the behavior or skill is learned, it needs continual reinforcement until it becomes internalized. Chunking occurs when two independent items of information are presented and then grouped together into one unit.
A) “These are the goals for today’s lecture.”
B) “Today each of you demonstrated an understanding of patient focused care.”
C) “As RNs on this unit, you will need to be proficient in assessing for depression.”
D) “There will be a short quiz on today’s material to assure you understand the material.”
Research has demonstrated that people learn faster when they are informed of their progress. The knowledge of results must be automatic, immediate, and meaningful to the task at hand. People need to experience a feeling of progress, and they need to know how they are doing when measured against expected outcomes. The other options failed to demonstrate an understanding of that need.
C) Task learning
D) Transfer of learning
If learners are informed in advance about the benefits of learning specific content and adopting new behaviors, they are more likely to be motivated to attend the training sessions and learn. Telling employees why and how specific educational or training programs will benefit them personally is a vital management function in staff development. None of the other options demonstrates association with this concept of learning.
A) Promotes long-term retention of employees
B) Tends to increase the number of candidates
C) Provides well-motivated candidates
D) Attracts well-qualified candidates
Recruiting from outside the organization provides an opportunity to increase the pool of candidates for positions but is no guarantee that these candidates will be more qualified or motivated than those who come from within the organization.
The nurse is still in the entry stage and will be until necessary skills are learned. It generally takes an extended period of time to obtain the skills necessary for mastery. The remaining options are not relevant to this question.
A) Employee attrition can be reduced
B) Personnel can be used more effectively
C) Employees can increase earning power
D) Employment benefits are increased
Organizational justification for career development programs includes attrition reduction, improved productivity, and general improved quality of life. Although employees may earn more money and additional benefits as a result of career development, they are not the reason that organizations undertake career development programs.
A) It is the employer’s responsibility
B) It results in the spontaneous assessment of goals
C) It requires the development of a long-term plan
D) Functions best when the planning is episodic in nature
Effective career planning requires long-term planning; it is the responsibility of the individual and requires constant attention to function properly.
A) Emphasize strong and weak points equally
B) Be at least four to five pages in length
C) Reflect complex, scholarly language
D) Be concise and easy to read
The content of a resume should be able to be grasped quickly by the individual doing the hiring, so conciseness and readability are of key importance. The remaining options do not express correct information concerning resume construction.
A) Developing career ladders
B) Establishing career paths
C) Providing challenging assignments
D) Developing a career plan
Only the development of a career plan is the responsibility of the individual. The first three choices are management responsibilities.
A) It occurs annually at performance appraisal reviews
B) It focuses on employee performance deficits
C) It requires the same intensity as a mentoring relationship
D) It occurs over the entire employment tenure of an employee
Long-term coaching should occur over the entire employment of the employee. The remaining options are not true statements regarding career development.
Doing the same type of duties in another location is called a lateral transfer. The remaining terms do not infer this type of transfer.
A) They are not cost-effective, but increase worker satisfaction
B) They are necessary for advancement to management positions
C) They require the inclusion of social learning activities
D) They are a responsibility of middle-level management
The inclusion of social learning activities in management development increases the possibility for employee retention. Management development is cost-effective for the organization but may not be necessary for all managers. Top executives in the organization have a responsibility to support the management development program.
A) They do not feel that nursing is valued as a career
B) Boredom increases with time on the same job
C) Many nurses interrupt their careers for childrearing
D) Nursing is low paying compared with other careers
Research has shown that boredom and job indifference leading to disengagement increase with time on the same job. While the other options may be factors they are not research supported.
A) Doing so increases the chances of long-term career success
B) It allows for keeping a similar salary while decreasing energy expenditure
C) In times of downsizing, it allows a nurse to stay employed
D) It occurs when a nurse is physically impaired and productivity is affected
For individuals to gain experience in a new area and to enhance long-term career goals, a self-selected downward transfer may be used. None of the other options accurately describe the reason for a self-selected downward transfer.
A) An examination of patient records by a review team
B) Self-reporting on an administered skills checklist
C) Evidence of attendance in continuing education classes
D) Documentation of effectively meeting role demands
Competency relates to role and is determined by each role demand. None of the other options are able to determine competency as effectively as documentation of performance.
A) Skill development
B) Job esteem
C) Sense of purpose
During the entry phase of learning a job, an individual concentrates on skill development. None of the other options is the focus of this stage.
1. Introduce the applicant
2. Briefly highlight key points of career
3. Make a positive first impression
4. Always used when submitting a resume
A) 1, 2, 3
B) 1, 2, 4
C) 1, 3, 4
D) 2, 3, 4
Cover letters (whether by mail or e-mail) should always be used when submitting a resume. Their purpose is to introduce the applicant, briefly highlight key points of the resume, and make a positive first impression.
A) Lateral transfer
B) Professional specialty certification
C) Transfer to a new department
D) Professional registered nursing licensure
Professional specialty certification is one way that an employee can demonstrate advanced achievement of competencies. The transfer, when used appropriately, may be an effective way to provide career development but a lateral transfer does not demonstrate advancement. A transfer to a new department often requires the acquisition of new skills before advance can occur. A nursing license signifies entry-level skills.
1. Decreased collaboration with other health-care providers
3. Lack of recognition
4. Increased retention
A) 1, 2
B) 1, 4
C) 2, 3
D) 3, 4
Cost coupled with lack of institutional reward and support kept some nurses from pursuing certification. The impact of certification on absenteeism and retention was unclear.
1. Policies communicated to administrators
2. Appropriate use of transfers
3. How promotions are handled
4. Long-term coaching
A) 1, 2, 3
B) 1, 2, 4
C) 1, 3, 4
D) 2, 3, 4
The manager should have a well-developed, planned system for career development for all employees; this system should include the appropriate use of transfers, how promotions are to be handled, and long-term coaching. These policies should be fair and communicated effectively to all employees.
A) Is self-aware of personal values influencing career development
B) Encourages employees to take responsibility for their own career planning
C) Identifies, encourages, and develops future leaders
D) Works cooperatively to arrange intra-organizational transfers
Management function is to work cooperatively with other departments in arranging for the release of employees to take other positions within the organization. Leadership functions associated with career development are self-aware of personal values influencing career development; encourage employees to take responsibility for their own career planning; and identifies, encourages, and develops future leaders.
Promise is the earliest of the career phases and typically reflects the first 10 years of nursing employment.
Momentum is the middle career phase and typically reflects the nurse with 11 to 29 years of experience. Nurses in this phase are experienced clinicians with expert knowledge, skills, abilities, credentials, and education base.
A) Career goals
B) Salary expectations
C) Professional growth
D) Educational background
All nurses should maintain a professional portfolio (a collection of materials that document a nurse’s competencies and illustrate the expertise of the nurse) to reflect their professional growth over their career. The other options are not the focus of a professional portfolio.
A) Identifying ways to exceed minimal licensing requirements
B) Fulfilling state requirements for minimal nursing practice
C) Facilitating advancement up the facility’s career ladder
D) Satisfying institutional employment qualification
Competency assessment and goal setting in career planning should help the employee identify how to exceed the minimum levels of competency required by federal, state, or organizational standards. The remaining options do not describe the purpose of competency assessments.
A) Introduces evidence-based practice changes regarding wound dressings
B) Discussing the health needs of the homeless with local politicians
C) Earning a Bachelor’s degree (BSN) in nursing
D) Working with a seasoned mentor
Career planning should include, at minimum, a commitment to the use of evidence-based practice, learning new skills or bettering practice through the use of role models and mentors, staying aware of and being involved in professional issues, and furthering one’s education. Full-time employment is not a necessary commitment.
A) Supporting practice autonomy
B) Strengthening new clinical skills
C) Introducing time management skills
D) Integrating into the nursing unit environment
A well-designed transition-to-practice program strengthens new graduates skills and competencies and prepares the new nurse for the demands of caring for patients. Furthermore, a systematic approach to transition not only facilitates “on-boarding” (integration into staffing on the nursing unit to provide direct patient care), it reduces turnover by decreasing the toll associated with insufficient preparation for the work environment. Satisfying nursing position needs is not a focus of a transition program for new graduates.
A) Earning a professional nursing certification
B) Gaining expertise in a specific field of nursing
C) Being a member of a professional nursing association
D) Earning an advanced nursing degree within 5 years of initial licensure
New graduates also have responsibility during the crucial first few years of employment to gain the expertise they need to have more opportunities for career divergence in the future. This includes becoming an expert in one or more areas of practice, gaining professional certifications, and being well informed about professional nursing and health-care issues. This is also a time where participation in professional associations has great value as a result of the opportunities for mentoring and networking. Finally, all new graduates should consider at what point, continued formal education will be a part of their career ladder and professional journey.
A) Proactively plan to hire two RNs for each unit each year
B) Use knowledge of turnover rates on their units for planning and hiring
C) Look at staff-to-patient ratios at other health-care organizations in the area
D) Hire consultants to study national turnover rates to determine recruitment needs
Staffing needs are unique to each institution and should be determined by looking at patient census, patient health-care needs, the type of patient care management used, and budget. None of the remaining options are accurate statements concerning adequate staffing.
A) The more centralized nursing management is and the more complex the personnel department, the greater the involvement of the unit manager
B) Unit managers should always leave such decisions to a centralized personnel department so consistency can be maintained
C) Regardless of the extent of their involvement, all managers must be aware of recruitment and selection constraints within their organization
D) Unit managers should assume total responsibility for recruitment and selection of personnel on their units
Although some institutions have personnel departments and nurse recruiters to carry out most of the hiring responsibilities, the nurse-manager must understand how recruitment and selection are accomplished within the organization. None of the remaining options are accurate statements concerning recruiting.
A) When the economy is on an upswing, many unemployed nurses return to work and recruitment becomes easier
B) When a recession occurs it causes many part-time nurses to return to full-time employment and others to delay their retirement
C) Although the economy tends to affect the size of the blue-collar workforce, professions such as nursing remain fairly stable regardless of economic changes
D) When there is an economic downturn, many nurses reduce their work hours from full time to part time
Nursing shortages occur when the economy is on the upswing and decline when the economy recedes, because many unemployed nurses return to the workforce and part-time employees return to full-time employment. None of the other options identify that relationship.
A) Interviewer reliability is high if the interview is unstructured
B) Interviewer reliability improves if the interview is structured uniformly
C) Reliability increases when there is a team approach to the interview
D) Positive information is weighed more heavily than negative information
Reliability means that something is measured consistently time after time. Therefore, if more than one interviewer uses the same format to interview a candidate, the reliability of the interviews improves. None of the other options identify the research findings.
A) Conduct single, rather than multiple, interviews
B) Trust his or her first impressions of an applicant
C) Avoid taking notes during the interview
D) Develop a structured interview format
The same structured interview should be used for all employees applying for the same job classification. None of the other options identify an appropriate technique.
A) When an applicant clearly does not have the proper qualifications for a position, the interviewer should be tactful, but advise the applicant as soon as possible that there is a lack of appropriate qualifications for the job
B) Personal questions should be asked early during the interview process so a rapport can be established between the interviewer and the applicant
C) The interviewer should develop questions that can be answered with a yes or no answer
D) The interviewer should assess an applicant’s perceptive skills by sending nonverbal cues to the applicant during his or her responses
In situations in which the interviewee is not qualified for the position, the interviewer must inform the interviewee of this early and tactfully. After the interview is completed, the interviewer should take notes for the file of the exact reason for rejection in case of later discrimination charges. None of the other options identify an appropriate strategy.
A) Questions about the applicant’s marital status
B) The languages the applicant speaks or writes
C) Inquiries about educational experiences
D) Place of residence
Asking applicants about their marital status or whether they have children is unlawful. None of the other options are considered illegal areas of questioning.
A) Accept the resume as an honest and objective source of data regarding the applicant
B) Require a physical examination before making a hiring decision
C) Always follow up on references and verify employment history
D) Use unsolicited personal information about an applicant as a valid reason for job disqualification
Some managers prefer to verify credentials and references before the interview; others do it after the interview. Either way, doing a comprehensive check of credentials and references is of absolute importance. None of the other options identify the selector’s processing role.
A) It occurs when an attempt is made to place employees in units where they have the greatest chance of success
B) It is overrated as a retention strategy because most employees readily adapt to whatever unit on which they are placed
C) It refers to placing employees on units that have the greatest need for new staff
D) It occurs when employees are able to modify their own personal values and beliefs to coincide with that of the unit on which they are placed
If employees are placed where they have the greatest chance of success, employee morale and retention will be positively affected. None of the other options are accurate statements.
A) It occurs after hiring but before performing the role
B) It includes the activities performed by the personnel department
C) It relates to the information included in the employee’s handbook
D) It is the responsibility of the staff development department
Induction, the first phase of indoctrination, includes all activities that educate the new employee about the organization and personnel policies and procedures before actually assuming nursing responsibilities. None of the other options identify that phase accurately.
A) Are you married?
B) Have you ever been arrested?
C) What is your religious preference?
D) What professional organizations do you belong to?
It is lawful for an interviewer to ask about professional organizations, but the interviewer cannot ask the interviewee to produce a list of all memberships. None of the other options identify an acceptable question.
A) Academic credentials
B) References of former employers
C) References of recent teachers
D) Verification of work history
Academic credentials are the least frequently checked background information. All of the other options are frequently checked.
A) When the economy is beginning an upswing
B) When the economy is receding
C) When nursing salaries decline
D) When patient acuity increases
Historically, nursing shortages occur when the economy is on the upswing and decline when the economy recedes. Historically, salaries were not a factor in existing nursing shortages. Currently, as the nursing pool ages, there is a nursing shortage projected.
1. Hospital downsizing
2. National businesses downsizing
3. Shortsightedness regarding recruitment
4. Shortsightedness regarding retention
A) 1, 2, 3
B) 1, 2, 4
C) 1, 3, 4
D) 2, 3, 4
Hospital downsizing and shortsightedness regarding recruitment and retention contributed to the beginning of an acute shortage of RNs in many health-care settings by the late 1990s. Retention was not considered a factor.
A) Supply side of the supply/demand equation
B) Demand side of the supply/demand equation
C) Both the supply and demand sides of the supply/demand equation
D) Short-term rise in demand in nursing services
From an economic perspective, the current nursing shortage is being driven more by the supply side of the supply/demand equation than the demand side. None of the other options identify that connection.
1. Size of the institution
2. Existence of a separate personnel department
3. Presence of a nurse recruiter within the organization
4. Use of decentralized nursing management system only
A) 1, 3, 4
B) 1, 2, 3
C) 1, 2, 4
D) 2, 3, 4
The manager may be greatly or minimally involved with recruiting, interviewing, and selecting personnel depending on (a) the size of the institution, (b) the existence of a separate personnel department, (c) the presence of a nurse recruiter within the organization, and (d) the use of centralized or decentralized nursing management.
As a predictor of job performance and overall effectiveness, the structured interview is much more reliable than the unstructured, semistructured, or informal interviews.
1. Personal philosophy of nursing
2. Professional organizations membership
3. Individual strengths and weaknesses
4. Career goals
A) 1, 3, 4
B) 1, 2, 3
C) 1, 2, 4
D) 2, 3, 4
It is difficult to spontaneously answer interview questions about your personal philosophy of nursing, your individual strengths and weaknesses, and your career goals if you have not given them advance thought.
A) Physical examination
B) Preemployment testing
C) Reference check
D) Personal interview
Positions should never be offered until information on the application has been verified and references have been checked.
4. Continuing education
A) 1, 3, 4
B) 1, 2, 3
C) 1, 2, 4
D) 2, 3, 4
Indoctrination consists of induction, orientation, and socialization of employees.
The workforce should also reflect the gender, culture, ethnicity, age, and language diversity of the communities that the organization serves. The lack of ethnic, gender, and generational diversity in the workforce has been linked to health disparities in the populations served. The importance of this goal cannot be overstated. The remaining options do not have the impact that the correct options have on this situation.
A) When staff resignations historically occur
B) How long new hires usually stay employed
C) Education of current nursing staff members
D) Third-party insurer reimbursement levels
Accurately predicting staffing needs is a crucial management skill because it enables the manager to avoid staffing crises. Managers should know the usual length of employment of newly hired staff and peak staff resignation periods. In addition, managers must consider the education and knowledge level of needed staff and have a fairly sophisticated understanding of third-party insurer reimbursement since this has a significant impact on staffing in contemporary health-care organizations.
A) Closing of nursing programs
B) Lack of interest in nursing
C) Hospital downsizing
D) Poor nursing salaries
Hospital downsizing and shortsightedness regarding recruitment and retention contributed to the beginning of an acute shortage of RNs in many health-care settings by the late 1990s. None of the other options were significant contributors to the nursing shortage that began in the late 1990s.
A) Lack of nursing faculty
B) Expense of nursing education
C) Lack of interest in nursing as a career
D) Poor social respect of the nursing profession
The nursing faculty shortage will likely be the greatest obstacle to solving the projected nursing shortage. None of the other options have the impact on the nursing shortage that the lack of nursing faculty has on the projected nursing shortage.
A) Fresh ideas
B) Younger staff
C) Cost containment
D) Increased groupthink
Some turnover is normal and, in fact, desirable. Turnover infuses the organization with fresh ideas. It also reduces the probability of groupthink, in which everyone shares similar thought processes, values, and goals. However, excessive or unnecessary turnover reduces the ability of the organization to produce its end product and is expensive.
A) Maximum patient load capacity of the unit
B) Numbers of patients present for an upcoming shift
C) An agreed-upon staffing formula currently in use
D) Total beds on the unit
A staffing formula is the best way to determine staffing needs, provided it is based on an accurate patient classification system (PCS). The remaining options are not as fiscally responsible since they involve uncontrollable factors.
A) Classification systems are able to solve staffing problems
B) Nursing care hours assigned to a classification system should remain constant
C) A good classification system is without fault
D) Internal and external forces may affect classification systems
Examples of internal and external forces that may affect a PCS are a sudden increase in nursing or medical students using the unit, a lower skill level of new graduates, or cultural or language difficulties of recently hired foreign nurses. None of the remaining options is totally accurate because of uncontrollable factors.
A) Self-scheduling requires greater worker accountability
B) The manager has little responsibility in self-scheduling
C) Self-scheduling has few or no shortcomings
D) Self-scheduling works in most organizations
Self-scheduling requires greater worker participation in decision making and shared responsibility for adequate staffing. None of the remaining options is accurate.
A) Increased fairness to employees through consistent, objective, and impartial application
B) Cost-effectiveness through better use of resources
C) Greater manager autonomy to control the staffing on the units, resulting in an increase in self-esteem and teamwork
D) Increased availability of data for monitoring the effect of staffing size and composition, quality of care, and costs
In an institution that has no human resources department and no nurse recruiters, the unit manager does the hiring and has greater autonomy in personnel matters. The other options are not associated with decentralized staffing.
Category I, 4 patients @ 2.0 hours
Category II, 2 patients @ 2.3 hours
Category III, 10 patients @ 2.8 hours
Category IV, 6 patients @ 3.4 hours
What are the needed hours of nursing care?
A) 61 hours
B) 52.6 hours
C) 68.4 hours
D) 48.4 hours
Four category I patients require 8 hours of care; two category II patients require 4.6 hours of care; 10 category III patients require 28 hours; six category IV patients require 20.4 hours; total nursing care hours equal 61.
A) Schedule staff so there is no overtime
B) Ensure that there is adequate staff to meet the needs of each patient
C) Develop trust in staff by seeing that staffing is carried out in a fair manner
D) Ensure that staff members usually have days off and special requests granted
The manager is tasked with seeing that patient care needs are met first and foremost. While the other options are relevant, they are not the priority goal of the manager.
A) It is more important to communicate policies verbally than in writing
B) It is necessary that policies are written in a manner that allows some flexibility
C) Policies should focus on the process
D) Managers should have autocratic control over scheduling and staffing policies
To retain employees, the staffing policies must allow some flexibility, which could include job sharing, flextime, a part-time staffing pool for weekends, or allowing employees to exchange hours of work among themselves.
A) It carries risks that employees may be treated unequally or inconsistently
B) It uses one individual or a computer to do the staffing
C) The manager’s role is that of making minor adjustments or providing input
D) It provides good control for the organization
A manager being perceived as granting special treatment to some employees is a risk of decentralized staffing. None of the other options identifies an associated concern.
A) It eliminates most staffing problems
B) It decreases the amount of overtime
C) It provides an understanding of staffing problems
D) It eliminates the need for adjustment or review
The main strength of the PCS is that it provides data with which to make staffing decisions. It will not solve all staffing problems, and it will not replace a manager’s judgment.
A) Automatically cancel the PCS
B) Will result in fiscal savings
C) Require no changes in scheduling policies
D) Impact patient care assignment methods
As new practice models are introduced, there must be a simultaneous examination of the existing staff mix and patient care assessments to ensure that appropriate changes are made to the staffing and scheduling policies. They are not associated with the impact suggested by the other options.
C) Decentralized staffing
D) Cyclical staffing
When a hospital uses flextime, employees arrive at the unit and leave at many different times. The other options are not associated with the system described.
A) It is incompatible with ethical accountability
B) It is only the responsibility of the centralized staffing office
C) It is inappropriate with new practice models
D) It is a critical responsibility of managers
Accountability for a prenegotiated budget is a management function. The other options are incorrect regarding this function.
A) They are mandated by federal law
B) They are required by 28 states
C) They are proposed to improve patient care
D) They are necessary to reduce costs
Several states have proposed or passed mandatory staffing ratios for the purpose of improving patient care, although there is no guarantee improved care will result from such legislation. None of the other options are associated with minimum staffing ratios.
1. Requires overtime pay
2. Increases nurse satisfaction
3. Decreases cost
4. Increases judgment errors
A) 1, 2, 3
B) 1, 2, 4
C) 1, 3, 4
D) 2, 3, 4
There are advantages and disadvantages to each type of scheduling. Twelve-hour shifts have become commonplace in acute care hospitals even though there continues to be debate about whether extending the length of shifts results in increased judgment errors related to fatigue. Because extending the workday with 10- or 12-hour shifts may require overtime pay, the resultant nurse satisfaction must be weighed against the increased costs.
A) Adverse patient outcomes generally increase
B) Decreased errors
C) Decreased patient falls
D) Decreased patient satisfaction
A review of current literature suggests that as RN hours decrease in NCH/PPD, adverse patient outcomes generally increase, including increased errors and patient falls as well as decreased patient satisfaction.
A) 1925 to 1942
B) 1943 to early 1960s
C) Early 1960s to 1980
D) Late 1970s to 1986
The veteran generation is typically recognized as those nurses born between 1925 and 1942.
A) Veteran generation
B) Baby boomer
C) Generation X
D) Generation Y
“Generation Xers” (born between 1961 and 1981), a much smaller cohort than the baby boomers who preceded them, or the Generation Yers who follow them, may lack the interest in lifetime employment at one place that prior generations have valued, instead valuing greater work hour flexibility and opportunities for time off.
1. Local laws
2. Labor laws
3. State or national laws
4. Union contracts
A) 1, 2, 3
B) 1, 2, 4
C) 1, 3, 4
D) 2, 3, 4
Staffing and scheduling policies must not violate labor laws, state or national laws, or union contracts.
A) Unit manager understands the needs of the unit and staff intimately
B) Employees will be treated equally and consistently
C) Manager role is limited to making minor adjustments and providing input
D) It allows the most efficient use of resources
Advantages of decentralized staffing are that the unit manager understands the needs of the unit and staff intimately, which leads to the increased likelihood that sound staffing decisions will be made. In addition, the staff feels more in control of their work environment because they are able to take personal scheduling requests directly to their immediate supervisor. Decentralized scheduling and staffing also lead to increased autonomy and flexibility, thus decreasing nurse attrition.
A) Work for premium pay
B) Employed directly by the health-care agency
C) Result in increased continuity of nursing care
D) They receive the standard facility benefits
These nurses are usually directly employed by an external nursing broker and work for premium pay (often two to three times that of a regularly employed staff nurse), without benefits. While such staff provide scheduling relief, especially in response to unanticipated increases in census or patient acuity, their continuous use is expensive and can result in poor continuity of nursing care.
A) Role models the use of evidence in making appropriate staffing and scheduling decisions
B) Uses organizational goals and patient classification tools to minimize understaffing
C) Periodically examines the unit standard of productivity to determine if changes are needed
D) Evaluates scheduling and staffing procedures and policies on a regular basis
Role modeling is a leadership responsibility. The other options are recognized management responsibilities associated with staffing and scheduling.
A) It is flexible
B) It is staff focused
C) It is cost-effective
D) It is consistent and impartial
Centralized staffing is generally fairer to all employees because policies tend to be employed more consistently and impartially. In addition, centralized staffing frees the middle-level manager to complete other management functions. Centralized staffing also allows for the most efficient (cost-effective) use of resources because the more units that can be considered together, the easier it is to deal with variations in patient census and staffing needs. Centralized staffing, however, does not provide as much flexibility for the worker, nor can it account as well for a worker’s desires or special needs. In addition, managers may be less responsive to personnel budget control if they have limited responsibility in scheduling and staffing matters.
The expected legal ratio is 1:5.
A) They are classified as per-diem staff
B) The nurse trades increased personal flexibility for less pay
C) Float pool nurses do not receive usual staff benefits
D) They are crossed trained on multiple units
Some hospitals have created their own internal supplemental staff by hiring per-diem employees and creating float pools. Per-diem staff generally have the flexibility to choose if and when they want to work. In exchange for this flexibility, they receive a higher rate of pay but usually no benefits. Float pools are generally composed of employees who agree to cross-train on multiple units so that they can work additional hours during periods of high census or worker shortages. Float pools are adequate for filling intermittent staffing holes but, like agency or registry staff, they are not an answer to the ongoing need to alter staffing according to census since they result in a lack of staff continuity.
A) Presence of nursing students on the unit
B) The hiring of two graduates as staff
C) The increase of scheduled medical students
D) Language barriers presented by nursing staff
Regarding PCS, the middle-level manager must be alert to internal or external forces affecting unit needs that may not be reflected in the organization’s patient care classification system. Examples of such forces could be a sudden increase in nursing or medical students using the unit, a lower skill level of new graduates, or cultural and language difficulties of recently hired foreign nurses. The organization’s classification system may prove to be inaccurate, or the hours allotted for each category or classification of patient may be inaccurate (too high or too low). An anxious patient is not a force that should affect the staffing process.
A) Most stakeholders accepting the need for change
B) Finding solutions to resistance to change
C) Changing attitudes more than increasing knowledge
D) Finding underlying order in random data
Chaos theory requires finding underlying order in apparent random data.
A) To solve an existing problem
B) To increase staff efficiency
C) To reduce unnecessary workload
D) To improve staff productivity
Change should be implemented only for good reasons such as the solution of an existing problem, increasing staff efficiency, eliminating unnecessary workload and improving productivity. Boredom alone is not a sufficient reason to institute change.
A) Retired staff is replaced with new graduate nurses
B) State-of-the-art cardiac monitoring equipment is placed in the ICU
C) The unit functions with strict adheres to institutional rules and policies
D) A suggestion committee composed of staff and management meets monthly
The young organization is characterized by high energy, movement, and virtually constant change and adaptation. Aged organizations have established “turf boundaries,” function in an orderly and predictable fashion, and are focused on rules and regulations. Change is limited.
Unfreezing occurs when the change agent coerces members of the group to change, or when guilt, anxiety, or concern can be elicited. This is not observed in the other options.
The power-coercive strategy assumes that people are often set in their ways and will change only when faced by negative sanctions or some other method that demonstrates power and/or coercion. This is not the principle guiding any of the other options.
A) Inspiring group members to be involved in planned change
B) Visionary forecasting
C) Role modeling high-level interpersonal communication skills in providing support for individuals undergoing rapid or difficult change
D) Recognizing the need for planned change and identifying the options and resources available to implement change
Recognizing the need for planned change and identifying the options and resources available to implement change are management functions; the other choices are leadership functions.
B) Withdrawal and acceptance
C) Open acceptance
D) Active collaboration
During the unfreezing stage, people become discontented, and even angry, with the status quo. Ironically, they may also become angry that change is needed, because of the resistance that is a normal and expected part of the change process. The other options are not usually associated with the unfreezing phase of change.
A) Both formulate and implement the change
B) Have representation from all key stakeholders
C) Are made up of quality circles
D) Are teams of resistance breakers
In some large organizations today, multidisciplinary teams of individuals, representing all key stakeholders in the organization, are assigned the responsibility for managing the change process. In such organizations, this team manages the communication between the people leading the change effort and those who are expected to implement the new strategies.
A) The suggested change is brought forward after the plan has been formalized
B) Individuals affected by the change are involved in planning for the change
C) The change agent is aware of the organization’s internal and external environment
D) An assessment of resources to carry out the plan is completed before unfreezing
Employees should be involved in the change process. When information and decision making are shared, subordinates will be more accepting of the change. The other options support the change.
A) Helping followers arrive at total consensus regarding the change
B) Encouraging subgroup opposition to change so many viewpoints can be heard
C) Using change by drift if the resistance to change is too strong
D) Being available to support those affected by a change until the change is complete
The change agent needs to offer support to others so that the change occurs. The other options are not as impactful on a successful transition to change.
A) It occurs in organized steps
B) It must have a logical sequence
C) It results in equilibrium
D) It has unpredictable outcomes
Nonlinear change states that the dynamics and outcomes of change are always unpredictable. Nonlinear change does not involve the other statements.
A) Developing a program for recruitment of young talent
B) Rewarding employees by promoting from within
C) Having set pay increases mandated annually
D) Using longevity to determine committee selection
The constant influx of young talent brings new ideas to the organization. The other options are not as relevant to the prevention of stagnation and promotion of renewal.
A) Change occurs in sequential steps
B) Change is predictable
C) Change success relies on policies and hierarchies
D) Change is necessary because organizational stability is brief
Most twenty-first-century organizations experience fairly brief periods of stability followed by intense transformation.
A) Resistance to change should be expected as a natural part of the change process
B) Change should be viewed as a chance to do something innovative
C) Technical changes are more resisted by staff than social changes are
D) Change affects the homeostasis of a group
Change should not be viewed as a threat but as a challenge and a chance to do something new and innovative. Change should be implemented only for good reason. Because change disrupts the homeostasis or balance of the group, resistance should be expected as a natural part of the change process. The level of resistance to change generally depends on the type of change proposed not the age of the staff affected by the change. Technological changes encounter less resistance than changes that are perceived as social or that are contrary to established customs or norms.
A) Gather data
B) Accurately diagnose the problem
C) Decide if change is needed
D) Develop a plan
A responsibility of the movement stage is to develop a plan. Responsibilities of the change agent in the unfreezing stage are as follows: Gather data, accurately diagnose the problem, and decide if change is needed.
A) Information supports change
B) Peer influence brings about change
C) Reward-based incentives influence change
D) Punishment supports the acceptance of change
The change agent using this set of strategies assumes that resistance to change comes from a lack of knowledge and that humans are rational beings who will change when given factual information documenting the need for change. Normative-reeducative strategies use group norms and peer pressure to socialize and influence people so that change will occur. Power-coercive strategies, features the application of power by legitimate authority, economic sanctions or rewards, or political clout of the change agent.
A) Personal behavior
B) Group behavior
C) Group knowledge
D) Personal attitudes
It is much easier to change a person’s behavior than it is to change an entire group’s behavior. It is easier to change knowledge levels than attitudes.
A) Change should be implemented suddenly
B) Change should be implemented gradually
C) Change should be implemented arbitrarily
D) Change should be implemented sporadically
Change should be planned and thus implemented gradually, not sporadically or suddenly and certainly not arbitrarily.
A) They are planned
B) They are accidental
C) They are unplanned
D) They are a result of a threat
Change by drift is unplanned or accidental. The other options are not characteristics of changes that are a result of change by drift.
B) Change by drift
Historically, many of the changes that have occurred in nursing or have affected the profession are the result of change by drift. While other types of changes have occurred, change by drift accounts for most of them.
A) Increased cost of health-care services
B) Decrease in health-care professionals and providers
C) Decreased third-party reimburse of health-care services
D) Increased need to update health-care-related technologies
Many forces are driving change in contemporary health care, including rising health-care costs, declining reimbursement, workforce shortages, increasing technology, the dynamic nature of knowledge, and a growing elderly population. Contemporary health-care agencies then must continually institute change to upgrade their structure, promote greater quality, and keep their workers. Wages for health-care professions and providers have not contributed significantly to the changes in today’s health-care environment.
A) Demonstrates flexibility in goal setting
B) Recognizing the need for a planned change
C) Identifying the resources that are available to support a change
D) Support the staff during the implementation of a planned change
Leaders demonstrate flexibility in goal setting in a rapidly changing health-care system. The other options are associated with management functions associated with change.
A) The focus of this phase is to integrate the change into the status quo
B) Stabilization of change requires a 6- to 9-month period of time
C) If refreezing is incomplete, prechange behavior will be resumed
D) The change agent must remain involved until the refreeze stage is complete
During the refreezing phase, the change agent assists in stabilizing the system change so that it becomes integrated into the status quo. If refreezing is incomplete, the change will be ineffective and the prechange behaviors will be resumed. For refreezing to occur, the change agent must be supportive and reinforce the individual adaptive efforts of those affected by the change. Because change needs at least 3 to 6 months before it will be accepted as part of the system, the change agent must be sure that he or she will remain involved until the change is completed. The successfulness of the refreezing stage is dependent about the acceptance of change by all staff.
A) Accurate identification of the problem requiring change
B) Effective information gathering concerning the problem
C) Key personnel voicing their opinions regarding the need for change
D) The need for change is perceived by all those affected by the problem
The change agent should not proceed to the movement stage until the status quo has been disrupted and the need for change is perceived by the others. While the other options will affect the process, perception of the need to change by all affected by the change is the most impactful of the options provided.
A) Poor organizational leadership
B) Presence of employee mistrust
C) Ineffective organizational management
D) Insufficient staff involvement in the process
Perhaps the greatest factor contributing to the resistance encountered with change is a lack of trust between the employee and the manager or the employee and the organization. While the other options may increase resistance, employee distrust is the primary barrier to change.
A) Completing the highest priority task
B) Allowing enough time for sufficient daily planning
C) Reprioritizing based on new information received
D) Delegating work that cannot be accomplished in a day
Daily planning is essential if the manager is to manage by efficiency rather than by crisis. The remaining options are steps that occur after planning.
A) They generally interact directly with a greater number of subordinates in daily planning
B) They seldom have the clerical and secretarial help assigned to higher-level managers
C) They are more social in nature and personal interactions
D) They are busier than higher-level managers
Frequent interruptions are common for first- and middle-level managers, who have a larger number of direct reports than do higher-level managers. The other options are not generally true statements.
A) Failure to set objectives
B) Inability to say no
D) Paperwork overload
Excessive paperwork is an external time waster; the others are time wasters created by the manager (internal).
A) It should remain changed once initial planning is completed
B) It is a planning tool, and thus must have flexibility in its implementation
C) It should include all the planner’s short-term, intermediate, and long-term goals
D) It should be highly structured, thus decreasing the possibility of procrastination
The daily list should be flexible, changeable, leave some time for the unexpected, and include appropriate short-term goals.
A) An open-door policy
B) Scheduled appointments
C) Informal, impromptu meetings
D) Maintaining strict professional boundaries
Appointments will discourage unproductive socialization since time will be allotted and a schedule maintained. Open-door policies and impromptu meetings encourage socialization while strict professional boundaries may actually interfere with communications.
A) Plan to finish the task with few breaks
B) Delegate portions of the task to qualified staff
C) Break the task into smaller, less intimidating units
D) Delay beginning the task until it has your undivided attention
Breaking down a task, or chunking, prevents the person from becoming overwhelmed by the size of the task. It may not be possible or advisable to finish the task without breaks or delegating it to staff.
A) Most people have an accurate perception of the time they spend on a particular task or the total amount of time they are productive during the day
B) Nurses who are self-aware and have clearly identified personal goals and priorities have greater control over how they spend their time
C) Writing goals down is not necessary if the goals are limited to fewer than five in number
D) A time inventory for 2 or 3 days is sufficient to identify a time management pattern
Nurses who are self-aware and have clearly identified personal goals and priorities have greater control over how they spend their time. The other options are not true statements regarding time management.
A) Plan so that each patient on the team receives equal amounts of nursing care
B) Prioritize the amount and type of nursing care each patient requires
C) Identify the staff who will comprise the individual care teams
D) Assign patients to the specific nursing teams
Prioritizing the care each patient will require is the initial step in care planning. The other options are considered but implementation will happen after the prioritizing.
A) Support face-to-face communication between staff members
B) Encourage paper clutter to be thrown away at the end of each shift
C) Deal with paper correspondence as soon as possible after it arrives.
D) Place additional recycling and trash receptacles throughout the unit
Whenever possible, incoming correspondence should be handled the day it arrives. It should either be thrown away or filed according to the date to be completed. The other options do not have the same amount of impact on controlling clutter.
A) Doing “trivial” items first to get them out of the way
B) Putting some items in the “don’t do” category
C) “Breaking of” overwhelming tasks
D) “Delegating” the most important things to someone else
The “don’t do” list contains items that will take care of themselves, are already outdated, or are best accomplished by someone else. In the case of items that are best done by someone else, the manager should pass these along in a timely fashion. None of the remaining options address prioritization.
A) Short-term planning
B) Strategic planning
C) Immediate attention to care needs
D) Adhering to a daily plan
The foundational principle of time management is short-term planning. Strategic planning is a long-term activity while the other options lack the flexibility needed by time management.
A) Assisting followers in working cooperatively to maximize time use
B) Prioritizing day-to-day planning to meet short-term and long-term unit goals
C) Building time for time management planning into the work schedule
D) Utilizing technology to facilitate timely communication and documentation
A leadership role is to assist followers in working cooperatively to maximize time use. Management functions include the following: Appropriately prioritizes day-to-day planning to meet short-term and long-term unit goals; builds time for planning into the work schedule; utilizes technology to facilitate timely communication and documentation.
1. Being accessible in the nursing station
2. Instituting an open-door policy
3. Have limited office seating available
4. Refocus conversations as needed
A) 1, 2
B) 1, 3
C) 2, 4
D) 3, 4
Do not make yourself overly accessible. Make it easy for people to ignore you. Try not to “work” at the nursing station, if this is possible. Interrupt. When someone is rambling on without getting to the point, break in and say gently, “Excuse me. Somehow I’m not getting your message. What exactly are you saying?” Avoid promoting socialization. Having several comfortable chairs in your office, a full candy dish, and posters on your walls that invite comments encourage socializing in your office. Be brief. Watch your own long-winded comments, and stand up when you are finished.
A) “We’ll need to make it brief since my schedule is tight today.”
B) “I can’t speak with you now, but I’m going to have free time at 11 am.”
C) “Stop by and we can talk during your lunch break.”
D) “I am sorry but I do not have anytime today to talk with you.”
If someone has a pattern of lengthy chatter and manages to corner you on rounds or at the nurse’s station, say, “I can’t speak with you now, but I’m going to have some free time at 11 AM. Why don’t you see me then?” Unless the meeting is important, the person who just wishes to chat will not bother to make a formal appointment. If you would like to chat and have the time to do so, use coffee breaks and lunch hours for socializing.
1. Allow time for planning and establish priorities.
2. Complete the quickest priority tasks first.
3. Complete the highest priority task, and whenever possible, finish one task before beginning another.
4. Reprioritize based on remaining tasks and new information that may have been received.
A) 1, 2, 3
B) 1, 2, 4
C) 1, 3, 4
D) 2, 3, 4
Time management can be reduced to three cyclic steps: (a) allow time for planning and establish priorities; (b) complete the highest priority task, and whenever possible, finish one task before beginning another; and (c) reprioritize based on remaining tasks and new information that may have been received.
A) Whenever a block of time is available
B) Beginning of the day
C) Middle of the day
D) End of the day
Setting aside time at the beginning of each day to plan the day allows the manager to spend appropriate time on high-priority tasks.
A) Allow adequate time for planning
B) Recognizing the need for daily planning
C) Priority setting
D) Handling situations as they arise
Priority setting is perhaps the most critical skill in time management because all actions taken are some type of relative importance.
A) Squeaky wheel
B) Don’t do
C) Do later
D) Do now
One simple means of prioritizing what needs to be accomplished is to divide all requests into three categories: “don’t do,” “do later,” and “do now.” The “don’t do” items probably reflect problems that will take care of themselves, are already outdated, or are better accomplished by someone else.
A) A unit’s day-to-day operational needs
B) Issues related to short-term goals
C) Large, time-consuming tasks
D) Problems that cannot be delegated
The “do now” requests most commonly reflect a unit’s day-to-day operational needs. These “do now” requests are not necessarily related to short-term goals or time-consuming. Nor are they also non-delegatable.
1. It is a plan
2. It is a product
3. It is a planning tool
4. It is the final goal to be accomplished
A) 1, 2
B) 1, 3
C) 2, 3
D) 3, 4
In prioritizing all the “do now” items, the manager may find preparing a written list helpful. The list is a planning tool. Remember, however, that a list is a plan, not a product, and that the creation of the list is not the final goal.
A) “Crises always come up so my plan is always changing.”
B) “I have always handled my patients’ needs as they arise.”
C) “Sometimes it’s difficult to reserve time for daily planning.”
D) “Patient care requires a lot of reassessment by nursing.”
Two mistakes common in planning are underestimating the importance of a daily plan and not allowing adequate time for planning. The remaining options reflect an understanding of the importance of planning.
A) Evaluating the management skills of the nursing team leaders
B) Providing time management classes for staff members
C) Frequently reassessing personally established priorities
D) Encouraging staff to engage in daily planning
Setting new priorities or adjusting priorities to reflect ever-changing work situations is an ongoing reality for the unit manager. While the other options are appropriate, they are not directed to the management role in dealing with the ever-changing nature of the environment of nursing.
A) “It’s important to me to be professional.”
B) “I can depend on the members of my team.”
C) “I’ve learned that I’m most energetic in the morning.”
D) “I’ll adjust my sleep schedule now that I’m on night shift.”
Habit 1: Strive to be authentic. Be honest with yourself about what you want and why you do what you do. Habit 2: Favor trusting relationships. Build relationships with people you can trust and count on, and make sure those same people can trust and count on you. Habit 3: Maintain a lifestyle that will give you maximum energy. Exercise, eat well, and get enough sleep. Habit 4: Listen to your biorhythms and organize your day accordingly. Pay attention to regular fluctuations in your physical and mental energy levels throughout the day and schedule tasks accordingly. Habit 5: Set very few priorities and stick to them. Select a maximum of two things that are your highest priority, and work on them.
A) Decreasing the risk of inaccurate documentation
B) Implementing effective time management skills
C) Demonstrating professional nursing behavior
D) Observing an established nursing principle
Document your nursing interventions as soon as possible after an activity is completed. Waiting until the end of the workday to complete necessary documentation increases the risk of inaccuracies and incomplete documentation. The remaining options are accurate but lack the primary focus of patient safety.
A) The manager is overworked with too many responsibilities
B) The manager needs additional management training
C) The manager does not value other people’s time
D) The manager lacks time management skills
A lack of punctuality suggests that one does not value other people’s time. The other options may be true but the perception is the more emotional perception.
A)A learned skill that improves with practice
B) A job role of the facility business manager
C) Part of the organizing phase of the management process
D) Reactive based on political, social, and economic forces
Fiscal planning is a learned skill and must include nursing management input. It should never be reactive, and it is part of the planning process of management.
A) An organization’s revenues, expenses, assets, and liabilities are someone’s concern.
B) Managers have a responsibility to submit their budgets on time.
C) The organization’s financial officer works with department heads regarding budget approval.
D) Fiscal accounting should be honest and accurate.
Responsibility accounting requires that someone must be responsible for all revenue, expenses, assets, and liabilities. While true, the other options are not the basic principle of responsibility accounting.
A) To assume responsibility for achieving budgetary planning goals
B) To monitor and evaluate all aspects of the unit’s budget control
C) To streamline the number of subordinates involved in the budgetary process
D) To control unpredictable census variations that may undermine the personnel budget
The manager’s responsibility is to monitor all aspects of the unit’s budget. The other options fail to identify a manager’s responsibility.
A) Coordinating the monitoring aspects of budget control
B) Accurately assessing personnel needs using agreed-on standards or an established patient classification system
C) Assessing the internal and external environment of the organization in forecasting to identify driving forces and barriers to fiscal planning
D) Being visionary in identifying short- and long-term unit fiscal needs
Leaders are visionary; the other roles are management related.
A) Incremental budgeting
D) Managed care
Zero-based budgeting begins each year with zero and requires rejustification. This is not true of the other options.
C) Capital budget
The items mentioned are noncontrollable as these cannot be controlled or fixed and are not parts of capital costs.
A) It is the least expensive product available
B) It is worth the cost
C) It is reimbursable
D)Its cost was anticipated
Cost-effective does not necessarily imply the cheapest, but it requires that the expenditure be worth the cost. The other options are not characteristic of the term “cost effective.”
A) The personnel budget
B) Short-term capital acquisitions
C) The operating budget
D) Supplies and equipment
Health care is labor intensive; therefore, the personnel budget makes up the largest expense. The other options represent less expensive expenditures.
12 midnight to 12 noon, 1 registered nurse, 1 licensed vocational nurse
12 noon to 12 midnight, 1 registered nurse, 1 licensed vocational nurse, 1 unit clerk (8 hours only)
A) 5.6 NCH/PPD
B) 4.8 NCH/PPD
C) 5.0 NCH/PPD
D) 6.2 NCH/PPD
A total of 56 hours of nursing was worked in 24 hours (unit clerks are counted in NCH/PPD) and the census was 10 patients. Dividing the total number of nursing care hours by the census (56 divided by 10) yields an NCH/PPD calculation of 5.6 NCH/PPD.
A) The acuity level of the patients on a particular unit in a 24-hour time span
B) The total number of hours worked by nursing personnel on a particular unit in a 24-hour time span divided by the patient census
C) The specific amount of money spent on staffing during a 24-hour period
D) The quality of nursing care that was provided on a particular unit in a 24-hour time span
The Personnel Budget NCH/PPD refers to number of nursing care hours worked in 24 hours divided by the patient census.
A) Preferred provider organizations (PPOs)
B) A traditional third-party payer indemnity plan
C) A health maintenance organization (HMO)
D) Diagnostic-related groupings (DRGs)
HMOs provide health care in an organized system to subscribing members in a geographical area with an agreed-on set of basic and preventive supplemental health maintenance and treatment services for a fixed, prepaid charge. That definition does not apply to the other options.
A) Skyrocketing health-care costs following the advent of Medicare and Medicaid
B) The passage of the Health Maintenance Act of 1973
C) The introduction of the Health Security Act to Congress
D) A coalition held by the three largest private insurers in 1975
Prospective payment systems were the result of skyrocketing medical costs in the United States. That is not true of the other options.
A) A reimbursement schema whereby health-care organizations receive a predetermined amount (based on a patient’s diagnosis for services provided)
B) The limited availability of services to patients in managed care organizations
C) The use of a “gatekeeper” to ensure appropriate utilization of services
D) A predetermined, negotiated payment to providers, per patient, regardless of whether services are used
Capitation is a predetermined, negotiated payment to providers, per patient, regardless of whether services are used. None of the other options correctly describe capitation.
A) Education on appropriate documentation on patient care records
B) Number of clinical nurse specialists
C) Educational paid days for licensed staff
D) Mix and number of clinical staff
Although options B, C, and D have the potential to improve patient care, education on documentation would most likely increase revenues.
A) They determine justifiable differences among clients
B) They decrease the amount of paperwork required for reimbursement
C) They reduce administrative costs
D) They provide a means of standardizing care for clients with similar diagnoses
Critical pathways are one means of standardizing care for clients with similar diagnoses. The other options are not true statements regarding critical pathways.
A) Personnel workforce
D) Zero based
Managers must rejustify their program or needs every budgeting cycle in zero-based budgeting. Among the options available using a decision package to set funding priorities is a key feature of only zero-based budgeting.
1. Nurses as gatekeepers
2. Focus on prevention
3. Decreased emphasis on inpatient hospital care
A) 1, 2, 3
B) 1, 2, 4
C)1, 3, 4
D) 2, 3, 4
Key principles of managed care include the use of primary care providers as gatekeepers, a focus on prevention, a decreased emphasis on inpatient hospital care, the use of clinical practice guidelines for providers, selective contracting, capitation, utilization review, the use of formularies to manage pharmacy care, and continuous quality monitoring and improvement.
1. It guarantees reimbursement
2. Proof is required for need for services
3. Reimbursement is based on services provided
4. The social worker is the gatekeeper
A) 1, 2
B) 1, 4
C) 2, 3
D) 3, 4
Provision of service no longer guarantees reimbursement. Clear and comprehensive documentation of the need for services and actual services provided is needed for reimbursement.
1. Delay of payment for services provided
2. Denial of requests for additional treatment
3. Increased premiums to consumers
4. Lower co-pays and deductibles
A) 1, 2
B) 1, 3
C) 2, 4
D) 3, 4
Providers have grown increasingly frustrated with limited and delayed reimbursement for services provided as well as the need to justify need for services ordered. This phenomenon, referred to as managed care backlash, resulted in some managed care programs beginning to say “yes” to more treatments although they have passed the cost along with customers in the form of higher premiums, co-pays, and deductibles.
A) Zero-based budgets
B) Diagnostic-related groupings
C) Prospective payment system
D) Incremental budgets
The impetus of diagnosis-related groupings changed the structure of Medicare payments from a retrospectively adjusted cost reimbursement system to a prospective, risk-based one. None of the other options were involved in the change.
A) A budget’s reliability is related to how far in advance it was created
B) Budgets should be created as far in advance is possible
C) A budget is revised every 3 months during a fiscal year
D) Budgets are reliable only when expenses are fixed
A budget that is predicted too far in advance has greater probability for error. The other options are incorrect statements regarding a budget.
A) Social influences affect fiscal planning
B) The successful fiscal planner is creative
C) An understanding of economic forces is necessary
D) Practical experience is a key to being a good fiscal planner
Fiscal planning is not intuitive; it is a learned skill that improves with practice. Fiscal planning also requires vision, creativity, and a thorough knowledge of the political, social, and economic forces that shape health care.
A) A large health-care budget equals quality health-care outcomes
B) America spends less than any other industrialized country on health care
C) The outcomes related to low-birth-weight infants have not been successfully met
D) The scarcity of resources is the biggest factor in the failure to reach outcomes
Spending more does not always equate to higher-quality health outcomes. The United States spends more per capita on health care than does any other industrialized country, and yet our outcomes in terms of teenage pregnancy rates, low-birth-weight infants, and access to care are worse than many countries that spend significantly less. The problem then is not a scarcity of resources. The problem is that we do not use the resources we have available, in a cost-effective manner.
A) Services provided
B) Budget time frame
C) Size of organization
D) Acuity of patients being served
Selecting the optimal time frame for budgeting is important. Errors are more likely if the budget is projected too far in advance. The other options are considered but not of primary importance.
A) A budget contains an estimate of both expenses and income for a year.
B) It allows for an institution to plan for the effective use of its resources
C) The cost of supplies is an example of a variable expense
D) A mortgage is an example of a fixed expense
A budget is a financial plan that includes estimated expenses as well as income for a period of time. Accuracy dictates the worth of a budget; the more accurate the budget blueprint, the better the institution can plan the most efficient use of its resources. Because a budget is at best a prediction, a plan, and not a rule, fiscal planning requires flexibility, ongoing evaluation, and revision. In the budget, expenses are classified as fixed or variable and either controllable or noncontrollable. Fixed expenses do not vary with volume, whereas variable expenses do. Examples of fixed expenses might be a building’s mortgage payment or a manager’s salary; variable expenses might include the payroll of hourly wage employees and the cost of supplies.
A) How our lives and relationships are led in our reality
B) How people make decisions they see as legally and morally appropriate
C) The conflict, power, and interdependency associated with the way we live
D) What our conduct and actions should be regarding what is right and good
Ethics is the systematic study of what a person’s conduct and actions should be with regard to self, other human beings, and the environment; it is the justification of what is right or good and the study of what a person’s life and relationships should be, not necessarily what they are.
A) A problem that can be solved using empirical data
B) A situation that has clearly delineated facts for decision making
C) A problem that when handled effectively has a mutually agreed-upon solution
D) A situation that requires choosing between two or more undesirable alternatives
The most difficult of all moral issues is termed a moral or ethical dilemma, which may be described as being forced to choose between two or more undesirable alternatives. The problem is not generally solved with a solution that is mutually satisfying nor does it lend itself to empirical or delineated facts.
Justice: Seek fairness, treat “equals” equally, and treat “unequals” according to their differences. Autonomy: Promotes self-determination and freedom of choice. Beneficence: Actions are taken in an effort to promote good. Utility: The good of the many outweighs the wants or needs of the individual.
A) Unethical conduct
The principle of utility states that what is best for the common good outweighs what is best for the individual. There is no indication of unethical or maleficence behavior on the part of the insurance company. Paternalism would be characterized by the insurance company making treatment decision without the patient having input.
A) It is a problem-solving model
B) It does not include an evaluation step
C) The identification and analysis of multiple alternatives for action is required
D) The decision is arrived upon with only the involvement of the decision maker
MORAL is a decision-making model that is useful in clarifying ethical problems, and it requires the identification and analysis of multiple alternatives for action. The other options are not true statements regarding this decision-making model.
C) Rights based
The duty framework says that some things should be done just because there is a duty to do them or refrain from doing them. Utilitarianism states that the good of the many outweighs the wants or needs of the individual. The remaining options are not relevant to the situation.
A) Outlines minimum levels of ethical behavior that nurses must maintain
B) Functions as a guide to the highest standards of ethical practice for nurses
C) Is a legally binding document that directs a nurse’s ethical and moral behavior
D)Mandates the ethical behavior prerequisite for maintaining a nursing licensure
The ANA Code of Ethics outlines the important general values, duties, and responsibilities that flow from the specific role of being a nurse in order to achieve and maintain the highest standards. The document is not legally binding nor is it a mandate of behavior.
A) Outcomes are the basic criterion for evaluating ethical decision making
B) Only desirable alternatives are identified when solving ethical dilemmas
C) Critical ethical decisions are made quickly so the situation does not worsen
D) Accepting some ambiguity and uncertainty are a part of ethical decision making
Ethical decision makers choose between two or more undesirable alternatives, and because they can use only the information and resources available at the time, they must live with some ambiguity and uncertainty. The remaining options are not true statements regarding the ethical decision-making process.
A) Duty based
B) Rights based
Intuitionist states that each case weighed on a case-by-case basis to determine relative goals, duties, and rights. Utilitarian provides the greatest good for the greatest number of people. Duty based is a duty to do something to refrain from doing something. Rights-based individuals have basic inherent rights that should not be interfered with.
A) A person’s right to make his or her own decision
B) The obligation to do good and prevent harm
C) Doing what is right and fair
D) Truth telling
Autonomy, or self-determination, is also referred to as freedom of choice and accepting the responsibility for one’s choice. None of the other options addresses this concept.
Confidentiality is a foundation of both medical and nursing ethics, and it respects the client’s right to self-determination. While the other options are worthy of respect, they are not associated with confidentiality.
Research done at the University of Pennsylvania found that nearly 25% of the nurses and social workers reported having received no ethics training.
B) Decision-making process
C) Multiple alternatives
D) Data gathering
Outcomes should never be used as the sole criterion for assessing the quality of ethical problem solving, because many variables affect outcomes that have no reflection on whether the problem solving was appropriate. Quality, instead, should be evaluated both by the outcome and the process used to make the decision. If a structured approach to problem solving is used, multiple alternatives are analyzed, and data gathering is adequate, then, regardless of the outcome, the manager should feel comfortable that the best possible decision was made at that time with the information and resources available. The satisfaction of the involved parties is not a reliable factor.
A) Massage the dilemma
B) Outline options
C) Review criteria and resolve
D) Affirm position and act
Massage the dilemma: Collect data about the ethical problem and who should be involved in the decision-making process. Outline options: Identify alternatives, and analyze the causes and consequences of each. Review criteria and resolve: Weigh the options against the values of those involved in the decision. This may be done through a weighting or grid. Affirm position and act: Develop the implementation strategy.
A) Ethical controls are clearer and philosophically impartial
B) Ethical controls are much clearer and individualized
C) Legal controls are clearer and philosophically impartial
D) Legal controls are much less clear and individualized
In general, legal controls are clearer and philosophically impartial; ethical controls are much less clear and individualized.
C) Nurse practitioners
D) Social workers
Nurses are often placed in situations where they are expected to be agents for patients, physicians, and the organization simultaneously, all of which may have conflicting needs, wants, and goals. The nature of the patient contact of a nurse is more direct and involves more time than the other members of the health-care team.
A) Organizational processes
B) Proven decision-making models
C) Professional approach that eliminates trial and error
D) Ethical principles and frameworks
To make appropriate ethical decisions then, the manager must have knowledge of ethical principles and frameworks, use a professional approach that eliminates trial and error and focuses on proven decision-making models, and use available organizational processes to assist in making such decisions. Knowledge of the involved parties’ wishes is not a focus of the decision-making process.
A) Uses a systematic approach to problem solving and decision making when faced with management problems with ethical ramifications
B) Identifies outcomes in ethical decision making that should always be sought or avoided
C) Uses established ethical frameworks to clarify values and beliefs
D) Role models ethical decision making, which is congruent with the American Nurses Association Code of Ethics and Interpretive Statements and Professional standard
A leadership role is role models ethical decision making, which is congruent with the American Nurses Association Code of Ethics and Interpretive Statements and Professional standard. Uses a systematic approach to problem solving and decision making when faced with management problems with ethical ramification, identifies outcomes in ethical decision making that should always be sought or avoided, and uses established ethical frameworks to clarify values and beliefs are examples of management functions.
A) Is self-aware regarding own values and basic beliefs about the rights, duties, and goals of human beings
B) Accepts that some ambiguity and uncertainty must be a part of all ethical decision making
C) Accepts that negative outcomes occur in ethical decision making despite high-quality problem solving and decision making
D) Identifies outcomes in ethical decision making that should always be sought or avoided
Management function identifies outcomes in ethical decision making that should always be sought or avoided. Leadership roles include the following: Is self-aware regarding own values and basic beliefs about the rights, duties, and goals of human beings; accepts that some ambiguity and uncertainty must be a part of all ethical decision making; accepts that negative outcomes occur in ethical decision making despite high-quality problem solving and decision making.
A) Occurs when an individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is
B) Occurs when the individual knows the right thing to do but organizational constraints make it difficult to take the right course of action
C) Occurs when an individual witnesses the immoral act of another but feels powerless to stop it
D) Occurs when being forced to choose between two or more undesirable alternatives
Moral uncertainty occurs when an individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is. Moral distress occurs when the individual knows the right thing to do but organizational constraints make it difficult to take the right course of action. Moral outrage occurs when an individual witnesses the immoral act of another but feels powerless to stop it. Ethical dilemma is being forced to choose between two or more undesirable alternatives.
B) Societal role
C) Societal constraints
The manager’s ethical obligation is tied to the organization’s purpose, and the purpose of the organization is linked to the function that it fills in society and the constraints society places on it. So, the responsibilities of the nurse-manager emerge from a complex set of interactions. Society helps to define the purposes of various institutions, and the purposes, in turn, help to ensure that the institution fulfills specific functions. However, the specific values and norms in any particular institution determine the focus of its resources and shape its organizational life. The values of people within institutions influence actual management practice. The organization’s societal status should not be considered when making ethical decisions.
Paternalism is when one individual assumes the right to make decisions for another. Justice requires that a person seek fairness, treat “equals” equally, and treat “unequals” according to their differences. Fidelity involves the need to keep promises. Beneficence involves actions that are taken in an effort to promote good.
A) Moral conflict
B) Moral outrage
C) Ethical relativism
D) Ethical universalism
Moral outrage occurs when an individual witnesses the immoral act of another but feels powerless to stop it. Moral uncertainty or moral conflict occurs when an individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is. Ethical relativism suggests that individuals make decisions based only on what seems right or reasonable according to their value system or culture. Ethical universalism holds that ethical principles are universal and constant and that ethical decision making should not vary as a result of individual circumstances or cultural differences.
A) It is a form of personal liberty
B) Its legal equivalent is self determination
C) It is based on a person’s right to make a choice
D) It is supported by the process of progressive employee discipline
A form of personal liberty, autonomy is also called freedom of choice or accepting the responsibility for one’s choice. The legal right of self-determination supports this moral principle. The use of progressive discipline recognizes the autonomy of the employee. The employee, in essence, has the choice to meet organizational expectations or to be disciplined further. If the employee’s continued behavior warrants termination, the principle of autonomy says that the employee has made the choice to be terminated by virtue of his or her actions, not by that of the manager. Therefore, nurse-managers must be cognizant of the ethical component present whenever an individual’s decisional capacity is in question. To take away a person’s right to self-determination is a serious but sometimes necessary action.
A) Membership on the institution’s ethic board
B) Terminates a staff member for absenteeism
C) Assures staff and patients that unit decisions are ethically sound
D) Holds membership in the local and state American Nurses Association (ANA)
ANA standards for ethics related to nurse administrators identifies participants on multidisciplinary and interdisciplinary teams that address ethical risks, benefits, and outcomes as a criteria measurement. The remaining options while addressing ethical behaviors on the administrator’s part are not as directly identified by the ANA.
A) The state’s Attorney General
B) The Nurse Practice Act
C) The ANA standards of practice
D) The ANA Code for Nurses
The 51 Nurse Practice Acts representing the 50 states and the District of Columbia are examples of statutes. These Nurse Practice Acts define and limit the practice of nursing, stating what constitutes authorized practice as well as what exceeds the scope of authority. Although Nurse Practice Acts may vary among states, all must be consistent with provisions or statutes established at the federal level. The other options lack the comprehensiveness and focus of a state’s Nurse Practice Act.
A) The expert testimony of nursing witnesses
B) The defendant’s explanation of what the nurse did
C) The trial judge, after checking the outcome of prior similar court cases
D) The testimony of expert medical witnesses
The testimony of other nurses in the same specialty as the defendant may be used to prove breach of duty. The other options are not considered qualified to testify to this matter.
A) The staff nurse cannot be held legally liable for any harm to the patient if the procedure is carried out with due care
B) The nurse may lose his or her license by refusing to carry out the procedure
C) The nurse can be held legally liable for any harm if the procedure is carried out without question
D) The nurse can be held accountable for practicing medicine without a license
All nurses have personal liability, which means that every person is liable for his or her own conduct. None of the remaining options describes that liability or its outcomes accurately.
A) Observed the client sign the consent form
B) Is certain the client understands the proposed procedure
C) Believe the client is capable of understanding the proposed procedure
D) Assumes the client has had an adequate evaluation to agree to the procedure
Informed consent is obtained by a physician; therefore, a nurse is not legally responsible for informed consent but is confirming that the client signed the consent form. The other options are the responsibilities of the professional performing the procedure.
A) The expansion of job descriptions in an agency
B) Written contracts between the nurse and the client
C) A written agreement between the nurse and the physician
D) Revision of the Nurse Practice Act
RN scope of practice is always determined by the Nurse Practice Act and any expansion of roles must occur through legislated changes in that statute. None of the remaining options are sufficient to expand nursing roles legally.
A) Share that information with the charge nurse on the previous shift
B) Document the incident as per hospital policy
C) Write a memo to the nurse who made the error requesting incident report be written
D) Write a note in the client’s chart that an incident report will be completed
It is the responsibility as manager to immediately document the error according to hospital policy. Since policies concerning such situations vary, it is vital to know and follow established policies. It is not generally appropriate to make such a note on the client’s chart.
A) This will prevent them from getting sued
B) Laws are fluid and subject to change
C) It will protect the agency from a lawsuit
D) It will ensure that correct procedure is carried out
When using doctrines as a guide for nursing practice, the nurse must remember that all laws are fluid and subject to change. Laws are not static. It is the responsibility of each manager to keep abreast of legislation and laws affecting both nursing practice and management practice. While the other options are correct, they do not describe the most encompassing reason that nurse-managers need to keep aware of current legislature affecting nursing practice.
A) Years of clinically focused nursing experience
B) Specialized nursing skills
C) Average nursing judgment and skills
D) Earned advanced nursing degree
Reasonable and prudent generally means the average judgment, foresight, intelligence, and skill that would be expected of a person with similar training and experience. The other options describe qualifications not required of a reasonable and prudent nurse.
Statutes are the only laws made by official enactment by the legislative body.
A verdict of suspension or loss of licensure represents administrative law. This type of law is not based on any of the other options.
A) Breach of duty
B) Presence of injury
C) Ability to foresee harm
D) Causal relationship
A lawsuit pertaining to professional negligence must include duty, breach of duty, injury, a causal relationship between breach of duty and injury, and the ability to foresee harm. Intent to cause injury is not a requirement.
A) Duty to use due care
B) Failure to meet standard of care
C) Foreseeability of harm
D) A causal relationship
A direct causal relationship between failure to meet the standard of care (breach) and injury can be proved when a patient is harmed because proper care is not given. None of the remaining options are relevant to this criterion.
A) Duty to use due care
B) Failure to meet standard of care
C) Foreseeability of harm
D) A direct relationship between failure to meet the standard of care (breach) and injury can be proved
The nurse must have reasonable access to information about whether the possibility of harm exists not fulfilling this responsibility may result in a foreseeable harm to the client. None of the remaining options are relevant to this criterion.
A) Duty to use due care
B) Failure to meet standard of care
C) Foreseeability of harm
D) A direct relationship between failure to meet the standard of care (breach) and injury can be proved
The nurse must have reasonable access to information about whether the possibility of harm exists not fulfilling this responsibility may result in a foreseeable harm to the client. None of the remaining options are relevant to this criterion.
A) A timeline of when the treatment is expected to occur
B) Written information on what the post procedure outcomes will be
C) Information regarding the risks involved in the proposed procedure
D) An explanation of the nature of all associated treatment provided by the nurse
Informed consent can be given only after the patient has received a complete explanation of the surgery, procedure, or treatment and indicates that he or she understands the risks and benefits related to it. Timeline and nursing responsibilities are not components that are included. Outcomes are identified as expected or desired; no guarantees are given.
A) Suspected incidents of elder abuse
B) Examples of substandard medical care
C) Client-reported incidents of child abuse
D) Confirmed case of a communicable disease
In addition, the manager, like all professional nurses, is responsible for reporting improper or substandard medical care, child and elder abuse, and communicable diseases, as specified by the Centers for Disease Control and Prevention. Disagreements are not mandated reportable situations.
A) Involving health-care consumers as active members of the health-care team
B) Promoting the creation of cultures of patient safety in health-care organizations
C) Establishing a federal leadership locus for advocacy of patient safety and health-care quality
D) Building an evidence-based information and technology system that impacts patient safety and pursue proposals to offset implementation costs
One way to promote open communication between patients and practitioners is involving health-care consumers as active members of the health-care team. Pursing patient safety initiatives prevent medical injury by promoting the creation of cultures of patient safety in health-care organizations; establishing a federal leadership locus for advocacy of patient safety and health-care quality; and building an evidence-based information and technology system that impacts patient safety and pursue proposals to offset implementation costs.
A) A state nursing license
B) Institutional licensure
C) ANA certificate
D)ANA practice standards
In general, a license is a legal document that permits a person to offer special skills and knowledge to the public in a particular jurisdiction when such practice would otherwise be unlawful. A state nursing license allows for the practice of nursing in a specific state. Some professionals have advocated shifting the burden of licensure, and thus accountability, from individual practitioners to an institution or agency. Proponents for this move believe that institutional licensure would provide more effective use of personnel and greater flexibility. The ANA is not capable of permitting a person to practice nursing.
A) Higher than those required by law
B) The same as those required by law
C)Are established after those required by law
D) Are established prior to those required by law
Professional organizations generally espouse standards of care that are higher than those required by law. These voluntary controls often are forerunners of legal controls. The standards are written by health-care professionals while laws are written by legislatures.
A) Professional negligence
D) False imprisonment
While professional negligence is considered to be an unintentional tort, assault, battery, false imprisonment, invasion of privacy, defamation, and slander are intentional torts.
Five components must be present for a professional to be held liable for malpractice: duty to use care, failure to meet standard of care, foreseeability of harm, direct relationship between failure to meet the standard of care and injury can be proved, and injury.
A) Incarceration is a likely consequence of being found guilty of a criminal offense
B) Intentionally giving an overdose of a potent narcotic is a criminal offense
C)A guilty verdict requires evidence beyond a reasonable doubt
D) Most malpractice cases are tried in criminal court
In criminal cases, the individual faces charges generally filed by the state or federal attorney general for crimes committed against an individual or society. In criminal cases, the individual is always presumed to be innocent unless the state can prove his or her guilt beyond a reasonable doubt. Incarceration and even death are possible consequences for being found guilty in criminal matters. Nurses found guilty of intentionally administering fatal doses of drugs to patients would be charged in a criminal court. Most malpractice cases are tried in civil court.
A) Always carry a personal liability insurance policy
B) Always function with the state’s nursing practice act
C)Ask for assistance when engaged in complicated procedures
D) Devote time to establishing an effective nurse-patient relationship
Nurses can reduce the risk of malpractice claims by practicing within the scope of the Nurse Practice Act. Nurses should purchase their own liability insurance and understand the limits of their policies. Although this will not prevent a malpractice suit, it should help to protect a nurse from financial ruin should there be a malpractice claim. While the other options present reasonable advice, they will not necessarily help in the avoidance of a malpractice claim.
A) A nurse has a legal responsibility to provide emergency services
B) Such laws are universally worded so as to minimize state-to-state differences
C) In order for protection to apply, the nursing care cannot be considered negligent
D) A nurse who provided out-of-scope care is not protected by the Good Samaritan law
Nurses are not required to stop and provide emergency services as a matter of law, although most health-care workers feel ethically compelled to stop if they believe they can help. Good Samaritan laws suggest that health-care providers are typically protected from potential liability if they volunteer their nursing skills away from the workplace (generally limited to emergencies), provided that actions taken are not grossly negligent and if the health-care worker does not exceed his or her training or scope of practice in performing the emergency services. However, not being paid for your services alone will not provide Good Samaritan law protection. Good Samaritan laws apply only if the health-care worker does not exceed his or her training or scope of practice in performing the emergency services. Protection under Good Samaritan laws varies tremendously from state to state. In some states, the law grants immunity to RNs but does not protect LVNs or LPNs. Other states offer protection to anyone who offers assistance, even if they do not have a health-care background. Nurses should be familiar with the Good Samaritan laws in their state.
A) Remains current on all institutional policies and procedures
B) Delegates with consideration to appropriate scopes of practice
C) Requires physical proof of appropriate professional licensure each year
D) Provides yearly in-services on the operation of newly acquired equipment
Sound management functions regarding legal issues include understanding and adhering to institutional policies and procedures delegating to subordinates wisely, looking at the manager’s scope of practice and that of the individuals he or she supervises, and monitoring subordinates to ensure they have a valid, current, and appropriate license to practice nursing. In-services should be held frequently especially when related to issues that affect care delivery. The reliance on peers for advice in such matters is not prudent; the institution’s legal advisor is much better prepared for this task.
A) It allows for joint liability among physicians, nurses, and health-care organizations
B) It supports the sharing of blame among all involved sources of health-care services
C) It encourages legal intervention when health care is thought to be substandard
D) It implies that the institution is responsible for the acts of its employees
Nurses must remember that the purpose of respondeat superior is not to shift the burden of blame from the employee to the organization but rather to share the blame, increasing the possibility of larger financial compensation to the injured party. While the other options may be true statements, the correct option describes the more nurse-related implication of the concept.
A) Advocacy is a management function and not a leadership role
B) Managers advocate only as needed to meet organizational goals
C) Managers should advocate for patients as well as subordinates
D) Professional advocacy is not a primary concern for most managers
Advocacy is helping others to grow and self-actualize. The manager must be an advocate for patients, subordinates, and the nursing profession. The remaining statements are not accurate descriptions of the manager’s role as advocate.
A) Informing others of their rights and making certain they have sufficient information to make decisions
B) Learning about the need for a decision and then making a good decision for other people
C)Supporting an individual’s right to make a decision even when they do not have accurate information
D) Protecting the rights of patients in accordance with the law
The advocate informs others of their rights and makes certain they have sufficient information to make decisions. The remaining options are incorrect when describing the action associated with advocacy.
A) Encourage the patient to wait until morning to leave the hospital
B) Ask family members to help talk the patient out of the decision
C)Call the security guard to escort the patient off hospital property
D) Make sure the patient has appropriate follow-up appointments
As advocate for this patient, you have made sure he is informed of the ramifications of leaving AMA; however, it is a patient’s right to refuse treatment. The other options fail to recognize the patient’s right to make autonomous choices.
A) Not yet been enacted by the federal government
B) Became the law of the land
C) Became legally binding in every state
D) Has not been beneficial to patients
Although there has been significant progress in the field of patient rights since 1960, there is still no comprehensive federal legislation directed at the granting and protection of patient rights.
B) Top administrators
D) Federal government
In workplace advocacy, the manager works to see that the work environment is both safe and conducive to professional and personal growth for subordinates. The other options play a role in such situations but the manager has the primary responsibility.
Which situation is a reality for whistle-blowers?
A) Retaliation against them is illegal
B) Fellow workers are supportive of them
C) Federal and State law protects them
D) They are often afraid to speak out
Although whistle-blower protection has been advocated for at the federal level and has been passed in some states, many employees are reluctant to report unsafe conditions for fear of retaliation. Nurses should check with their state association to assess the status of whistle-blower protection in their state. Retaliation and resentment still exist against these individuals in many situations.
A) They attempt to persuade legislators to vote in a particular way
B) They are comprised of volunteers who are interested in politics
C) Their focus is the passage of specific pieces of legislature
D) They appear to have little influence with law makers
PACs of the Congress of Industrial Organizations attempt to persuade legislators to vote in a particular way. Lobbyists of the PAC may be members of a group interested in a particular law or paid agents of the group that wants a specific bill passed or defeated. Currently, PACs appear to have a significant amount of influence on law makers and the legislative process.
A) Form letters from group members
B) Individual phone calls from constituents
C) Meeting with a strong collective political group
D) A personal visit by an individual constituent
Legislators and policy makers generally are more willing to deal with a group rather than individuals; thus, joining and supporting professional organizations allow nurses to become active in lobbying for a stronger nurse practice act or for the creation or expansion of advanced nursing roles.
A) Be focused on key points.
B) Introduce statistics that support the key points
C) Repeat key points several times during the interview
D) Provide background material related to the key points
The best strategies for a television interview are to be prepared and to stick to three or four key points that will drive home your message, and repeat them during the interview. Concentrating on popular points is not necessarily where the focus should be directed.
A) They are very committed to both their profession and the political process
B) Many are active members of the American Nurses Association (ANA)
C) Their primary focus is to speak out on consumer health-related issues
D) They have not yet recognized the full potential of political activity
As a whole, the nursing profession has not yet recognized the full potential of collective political activity. Nurses must exert their collective influence and make their concerns known to policy makers before they can have a major impact on political and legislative outcomes. The remaining options are not true of nurses in general.
A) Create a climate where advocacy and its associated risk-taking are valued
B) Give subordinates and patients adequate information to make informed decisions
C) Ensure that rights and values of patients supersede those of the health-care providers
D) Seek appropriate consultation when advocacy results in intrapersonal or interpersonal conflict
A leadership role associated with advocacy is to create a climate where advocacy and its associated risk-taking are valued. Management functions include the following: give subordinates and patients adequate information to make informed decisions; ensure that rights and values of patients supersede those of the health-care providers; and seek appropriate consultation when advocacy results in intrapersonal or interpersonal conflict.
A) Awareness of current legislative efforts affecting nursing practice and organizational and unit management
B) Role modeling proactive involvement in health-care policy through both formal and informal interactions with the media and legislative representatives
C) Participation in professional nursing organizations and other groups that seek to advance the profession of nursing
D) Assertively advocating on behalf of patients and subordinates when an intermediary is necessary
A management function associated with advocacy is awareness of current legislative efforts affecting nursing practice and organizational and unit management. Leadership roles include the following: role models’ proactive involvement in health-care policy through both formal and informal interactions with the media and legislative representatives; participates in professional nursing organizations and other groups that seek to advance the profession of nursing; assertively advocate on behalf of patients and subordinates when an intermediary is necessary.
A) Helping others make informed decisions
B) Directly intervening on behalf of others
C) Providing consent to treat for the cognitively impaired patients
D)Making health-care decisions for those who are not able to do so
Nurses may act as advocates by either helping others make informed decisions, by acting as intermediary in the environment, or by directly intervening on behalf of others. Advocates do not make decisions or provide consent but rather educate patients so they can be informed.
A) Loss of physical freedom as a result of extended hospitalizations
B) Decreased independence due to physical or psychosocial limitations
C) Physical or psychosocial limitations negatively impacted autonomy
D) Illness tends to make an individual more vulnerable to unethical activities
Patient advocacy is necessary because disease almost always results in decreased independence, loss of freedom, and interference with the ability to make choices autonomously. In addition, aging, as well as physical, mental, or social disability may make individuals more vulnerable and in need of advocacy. It is not true that cognitive function is impaired as a result of chronic and/or acute illness.
A) Securing patient consents
B)Preventing medication errors
C)Facilitating access to health-care services
D) Respect for patient dignity and cultural values
Common areas requiring nurse-patient advocacy include inadequate patient consents; medical errors; access to health care; and respect for patient dignity and cultural values. While hospitalization is expensive, education on this subject is not considered a nursing advocacy role.
A)Staffing a unit with sufficient care providers
B) Orienting staff to safely use a new patient lift
C) Providing an in-service on culturally meeting end-of-life needs
D) Arranging for patient consultations with members of the financial office
Common areas for managers to advocate for patients include distribution of resources; use of technology; end-of-life decisions; and health-care reimbursement. While aesthetics is an important consideration, it is not a common area for managers to act as advocators
The legislative controls of nursing practice primarily protect the rights of patients. Protection of those identified by the other options while important is the primary focus of the nursing practice legislative bodies.
Until the 1960s patients had few rights; in fact, patients before then often were denied basic human rights. Conditions improved by the 1970s.
A) A health-care organization
B)A professional medical organization
C) A regulation professional nursing organization
D) A specific state
A bill of rights that has become law or state regulation has the most legal authority because it provides the patient with legal recourse. A bill of rights issued by health-care organization and professional associations is not legally binding but may influence federal or state funding and certainly should be considered professionally binding.
Standard V of the ANA Scope and Standards for Nurse Administrators suggests that nurse administrators should advocate for subordinates as well as patients. This issue is not addressed in the other options.
A) Assuring the patient that their wishes will be respected regarding the care they receive
B) Identifying the patient’s religious dietary practices when discussing a prescribed diet
C) Answering the patient’s questions regarding the alternatives to a proposed procedure
D) Suggesting to a patient that a social services consult would help with discharge needs
The nursing values central to advocacy emphasize caring, autonomy, respect, and empowerment. While appropriate, comforting a patient is not an act of advocacy in this situation.
A) Staff representatives on all unit committees
B) Monthly “brown bag lunches” with the staff
C) Requests revising criteria for granting a “leave of absence”
D) Working with primary care providers to expand standing nursing orders
The following are suggestions for creating an environment that promotes subordinate advocacy: Invite collaborative decision making; get to know staff personally; “go to bat” for staff when needed; and promote nurse autonomy. Rather than anticipating educational needs, the manager advocates by asking for and then respecting their suggestions by planning accordingly.
A) Ethical code
B) Legal recognition
C)Nurse Practice Acts
Managers must be advocates for the nursing profession. It was nurses who pushed for accountability through state nurse practice acts and state licensing. Nurse-leaders collaborated on defining the profession, achieving legal recognition of the profession and establishing a culture for professional nursing which has continued to the present time. Advocating for professional nursing is a leadership role. Professional issues are always ethical issues. When nurses find a discrepancy between their perceived role and society’s expectations, they have a responsibility to advocate for the profession. This includes speaking out on consumer issues, continuing and expanding attempts to influence legislation, and increasing membership on governmental health policy-making boards and councils. Only then will nurses be able to influence the tremendous problems facing society today.
A) Identify yourself as a constituent in the first paragraph
B) State your reason for writing in the second paragraph
C) Sign the letter and include your contact information
D)Address the legislator by title
Personal letters are more influential than formal letters, and the tone should be formal but polite. The letter should also be concise (not more than one page). Be sure to address the legislator properly by title. Establish your credibility early in the letter as both a constituent and a health-care expert. State your reason for writing the letter in the first paragraph, and refer to the specific bill that you are writing about. Then, state your position on the issue and give personal examples as necessary to support your position. Offer your assistance as a resource person for additional information. Sign the letter, including your name and contact information. Remember to be persistent, and write legislators repeatedly who are undecided on an issue. Display 6.5 displays a format common to letters written to legislators.
A)”I’ll include the latest data on the subject.”
B) “When will you need to have the final draft of my article?”
C) “Are you comfortable with me focusing on 3 key points related to this topic?”
D) “That isn’t my field of expertise but I will contact a peer with that knowledge.”
Tips of effective interaction with the media include respecting and meeting their deadlines, having key facts ready to include, limiting key points to two or three, and not being afraid to say you lack that specific expertise. One should assume, until proven otherwise, that the reporter will be fair and accurate in his/her reporting.
The combination that best characterizes the communication process is sender-message-receiver. The other options would result in the likelihood of miscommunication.
A) More than one mode is used
B) Face-to-face communication is used
C) Written communication is used
D) The sender repeats the message using the same mode
Using various communication methods in combination increases the likelihood that everyone in the organization who needs to hear the message actually will hear it. The other options are single methods.
A) It is consistent across cultures
B) It is given more credence than verbal communication when the two are incongruent
C) It should be minimized because it confuses the receiver regarding the true intent of the message
D) It is a significant part of the communication exchange only when it is not congruent with the verbal exchange
Because nonverbal communication indicates the emotional component of the message, it is generally considered more reliable than verbal communication. None of the remaining options present true statements regarding nonverbal communication.
A) Ask the informant to be quiet
B) Include the information in report for the next shift
C) Ask the team member what the purpose was in sharing the information
D)Ignore the comment
The role of the leader is to encourage communication that is appropriate and discourage communication that is inappropriate among staff. The other options fail to convey that responsibility.
A) Tell an informal leader on the evening shift the truth and let the leader spread the news informally
B) Hold a meeting for all staff members and tell them that the rumor is not true
C) Ignore the rumor because it will soon pass
D) Find out who started the rumor and correct the information
Nurse-leaders should intervene appropriately when communication problems (in this case, rumors) arise. The remaining options fail to fulfill that responsibility as effectively as the correct option does.
A) Group members actively attempt to impress each other with their credentials
B) Group members establish short- and long-term goals for the group to accomplish
C) Group members achieve stated goals
D) The group terminates and celebrates its accomplishments
In the norming stage, consensus evolves as group cohesion develops. This is the only option that describes a behavior associated with a group’s norming stage.
A) It makes you respect yourself and allows you to get what you want
B) Although it is unfeminine, it is a necessary communication skill for female managers
C) It involves rights and responsibilities for all parties in the communication
D) Assertive communication will never offend anyone
Assertive communication allows people to express themselves in direct, honest, and appropriate ways that do not infringe on another’s rights. The remaining statements do not correctly describe assertive communication.
A) “Tell me in your own words what you intend your charting to convey.”
B) “Your charting is non-descriptive.”
C) “Do you think a refresher course in charting would help you?”
D) “Are you having difficulty assessing your patient?”
Assertive communication is not rude or insensitive, nor is it passive-aggressive.
A) “You must remember to watch your tone of voice with patients. Someone might overhear.”
B) “Do you think it would be a good idea to have an in-service on dealing with Alzheimer’s patients?”
C) “I am concerned about your conversation with Mrs. Smith. It seemed short and impatient.”
D) “I have decided to reassign Mrs. Smith to another aide.”
Assertive communication effectively identifies and addresses an issue without being rude, insensitive, or passive-aggressive. None of the remaining options actually identifies the communication problem.
A)Most personnel engaging in the unofficial exchange of information.
B) Information exchange is initiated by subordinates and directed upward
C) Information is conveyed unofficially by administration through department heads
D) The exchange of information initiated by someone in a staff position to someone in a line position
Informal communication through the “grapevine” occurs when most personnel are involved in the unofficial exchange of information. This process is not accurately described by any of the other options.
A) A memo makes it main point at least twice
B) A memo is written using an authoritative format
C) Headings are not used in a memo to avoid confusing the reader
D) Only essential information is included in a memo
Only essential information is included in a memo since extraneous information will detract from the message. None of the other options presents correct information concerning a memo.
A) Mediating, harmonizing, and resolving conflict
B) Accepting and praising the contributions and viewpoints of group members
C) Facilitating and promoting open communication of all group members
D) Recording the group’s process and providing feedback to the group
The gatekeeper makes sure all voices in the group are heard in order to facilitate and promote open communication. The role of gatekeeper is not accurately described by any of the other options.
A) It must never be breached
B) It is made easier with electronic technology
C) It is primarily the duty of the medical records staff
D)It can be breached when necessary for legitimate professional need
Confidentiality of patients must be upheld, unless there is a legitimate professional need to know, such as when a provider must share information about a patient with another provider so that the other provider can assume care. None of the other options is an accurate statement regarding confidentiality.
A) Men are more collaborative communicators
B) It rarely impacts nursing care
C) It affects the quality of organization communication
D)Women are more competitive communicators
Men are usually more competitive and less collaborative than women in their communication patterns, and differences often impact the quality of organization communication.
Assessment is where the nurse states the patient’s problem. The problem is not documented in any of the other SBAR locations.
In downward communication, the manager relays information to subordinates. This is a traditional form of communication in organizations and helps to coordinate activities in various levels of the hierarchy. The other forms are not as effective as the various levels of an organization’s hierarchy.
B) Respectful listening
D) Recommend or request more information
Review occurs when the speaker summarizes the information he/she has conveyed to make sure the message was understood correctly. Once the speaker is finished conveying this summary and the other party has validated or clarified it, the listener has enough information to recommend or request more information. This does not occur in any of the other portions of the model.
Nonverbal communication is considered more reliable because it conveys the emotional part of the message. The other modes are not as effective with conveying emotion.
A) Incongruence between verbal and nonverbal messages
B) Incongruence between telephone and written messages
C) Incongruence between verbal and written messages
D) Incongruence between telephone and nonverbal messages
The incongruence between verbal and nonverbal messages is the most significant barrier to effective interpersonal communication.
A) GRRRR listening model
B) SBAR tool
C) Hospital information system
D) Wireless, local area networking
SBAR provides a structured, orderly approach to provide accurate, relevant information, in emergent patient situations as well as routine handoffs. The other options are not as focused on providing information in all the described situations.
A) Accessing the latest research and best practice information
B) Communicating with other health-care team members
C) Minimizing the need for paper documentation
D) Securing patient information for confidentially
As an information source, the Internet allows nurses to access the latest research and best practice information so that their care can be evidence based. The remaining options are not focused on personal nursing practice.
D) Recognition seeker
The playboy remains uninvolved and demonstrates cynicism, nonchalance, or horseplay. The blocker persists in expressing negative points of view and resurrecting dead issues. The dominator attempts to control and manipulate the group while the recognition seeker works to focus positive attention on himself.
A) Strictly avoiding the use of social networking in a professional setting
B) Participating in the development of institutional policies governing online conduct
C) Ignoring any information that appears to have the potential to harm a patient’s welfare
D) Realizing that social networking is not related to a nurse’s professional boundaries
The ANA has developed principles for social networking that include participation in policy development, nurse-patient boundaries, separating personal and professional online information, and reporting to authorities when patient welfare has been potentially harmed.
B) Slurred words
D) Rapid delivery
Vocal clues such as tone, volume, and inflection add to the message being transmitted. Tentative statements sound more like questions than statements, leading listeners to think that you are unsure of yourself, and speaking quickly may be interpreted as being nervous. Loud and slurred speech can be barriers to communication.
A) Intimate relationships
B) Personal interactions
C) Social exchange
D) Public distance
The study of how space and territory affect communication is called proxemics. In the United States, between 0 and 18 inches of space is typically considered appropriate only for intimate relationships; between 18 inches and 4 feet is appropriate for personal interactions; between 4 and 12 feet is common for social exchanges; and more than 12 feet is a public distance (Loo). Most Americans claim a territorial personal space of about 4 feet.
A) empower subordinates by “stretching” them in their work assignment
B) To free the manager to address more complex, higher-level unit needs
C) When the task is not a challenge for the manager
D) Because someone else is better qualified to do the task that needs to be done
That the manager is not challenged by a task is not a valid reason for delegating that task to another. The other options are all appropriate reasons to delegate tasks to qualified staff.
A) Whose turn it is to delegate a task
B) The qualifications of the person regarding the task
C) The fiscal cost of delegating the task
D) Whether the person has experience with similar tasks
Managers should ask the individuals to whom they are delegating if they are capable of completing the delegated task.
A) Temporary authority is given to support completion of a delegated task
B) The person to whom a task is delegated considers it a challenge
C) The employee is given exact instructions on completing the task
D) Regular updates on the task are exchanged with the manager and the employee
If an employee has the skills necessary to complete a task, that employee should be able to carry out the task with autonomy and be provided with the authority and resources necessary. Depending on the complexity of the project, the manager should meet with the employee for updates. One of the goals of delegation is to challenge employees into learning new skills.
A) Take over the task so the employee will not become demoralized
B) Be available to the employee as a role model and resource for the task
C) Assign another more experienced employee to help with the task
D) Re-assign the employee a different, less complex task
A manager should be available to the employee to help identify solutions to problems encountered with a delegated task and should encourage the employee to persevere. Taking back a task that was originally delegated is an absolute last resort. Reassigning and co-assigning the task are options that are not initially considered.
A)One can safely assume that the NAP has at least a high school diploma as a minimum hiring criterion
B) All unlicensed assistive personnel have achieved at least minimum standardized training pursuant to the Omnibus Budget Reconciliation Act of 1987
C) No federal or community standards have been established for training the broad classification of NAP
D) The nurse is protected from liability when allowing the NAP to perform only those tasks the employee includes in the job description
No federal or community standards have been established for the training of the NAP. The Omnibus Budget Reconciliation Act relates to certified nursing assistants only. The hiring policies of institutions vary regarding the employment qualifications of the NAP and many institutions do not have distinct job descriptions for NAP that define their scope of practice.
A) Creating job descriptions for all personnel
B) Providing formal recognition or reward for completion of delegated tasks
C) Demonstrating sensitivity to how cultural phenomena affect transcultural delegation
D) Reprimanding employees who demonstrate overt resistance to the tasks they are delegated
Factors such as communication, space, social organization, timing, environmental control, and biologic variations affect delegation to a culturally diverse staff and should be modeled as a leadership role. The other choices are all management functions.
A) It is minimal because subordinates alone are held accountable for practicing within the accepted scope of practice for their job classification
B) It is great because the RN is automatically held liable for the tasks delegated to all recognized subordinates
C) It is reduced when the RN appropriately assesses what and to whom delegation is appropriate and supervises the completion of the tasks
D) It is avoided entirely by delegating tasks to only other licensed personnel
Proper delegation practices that include assessment and evaluation help protect the RN from liability. The other statements are not true.
A) Always requiring a maximizing quality outcome
B) Frequently reassuring the employee that if they are incapable of completing a delegated task, it will be reassigned
C) Drafting a preliminary plan of how the task will be redone if the outcome does not meet stated expectations
D) Occasionally providing learning or “stretching” opportunities for employees
“Stretching” provides growth opportunities for employees, builds employee self-esteem, and helps prevent boredom and de-motivation. The other options are not actions that are supportive of the staff and the delegation process.
A) Skills evaluation
B) Patient safety
C) Effective delegation
This manager provided the team with the autonomy to complete the work and was available should any need arise. This describes effective delegation. This action is not related to any of the other options.
A) Assign the work to another team member
B) Take on the responsibility of the tasks
C) Have the team member perform only the necessary tasks
D) Examine the workload and assist the individual in reprioritizing
The manager should help the overwhelmed employee reprioritize the workload with the goal of making it manageable for that employee. None of the other options realistically assist the team member in managing time and prioritizing effectively.
A) Evaluating the NAP’s skills and knowledge level
B) Assessing which tasks the NAP is interested in assuming
C) Evaluating how patients rate the NAP’s performance
D) Assessing how team members like working with the NAP
The manager must be knowledgeable about the skills and knowledge of all members of the health-care team. While the other options are factors regarding general NAP utilization, initially skills and knowledge levels take priority.
A) Assigning home health aides to specific patient care
B) Serving on a diabetic study committee of community resources
C) Meeting with the agency’s administration regarding budget cuts
D) Reviewing staff time cards for completion and accuracy
Management responsibilities associated with budgeting would not be delegated to another RN on the staff. The other options could be appropriately delegated to another RN.
A) American Hospital Association (AMA)
B) The federal government
C) National League for Nursing (NLN)
D) State Boards of Nursing Licensure
State Boards of Nursing Licensure is responsible for clarifying the delegation parameters for RNs. None of the other options are involved in this process.
A) Time and space
B) Leadership and creativity
C) Authority and responsibility
D) Personnel and knowledge
Managers must delegate the authority and the responsibility necessary to complete the task. Nothing is more frustrating to a creative and productive employee than not having the resources or authority to carry out a well-developed plan. Qualities like leadership, knowledge, and creativity are not transferable. The remaining option choices are resources that are provided rather than delegated.
A) Nurse aide (NA)
C) Licensed practical nurse (LPN)
Although the Omnibus Budget Reconciliation Act of 1987 established regulations for the education and certification of “nurse’s aides” (minimum of 75 hours of theory and practice and successful completion of an examination in both areas), no federal or community standards have been established for training the more broadly defined NAP. LPNs and RNs are not addressed by this act.
A) The patient’s primary healthcare provider
B) The facility’s Director of Nursing
C) The unit’s nursing manager
D) The team’s RN
The team’s RN always bears the ultimate responsibility for ensuring that the nursing care provided by his or her team members meets or exceeds minimum safety standards. This is not the role of any of the other positions mentioned.
C) Improper delegating
D) Inappropriate delegating
Underdelegating occurs when a manager has a false assumption that delegation may be interpreted as a lack of ability on his or her part to do the job correctly or completely.
B) Social organization
C) Environmental control
D) Biologic variations
The phenomenon Biologic variations refers to the biopsychosocial differences between racial and ethnic groups, such as susceptibility to disease and physiologic differences. None of the other options are associated with managing these differences.
A)Failure of delegator to see subordinate perspective
B) Subordinate incapable of completing the task
C) Subordinate inherent resistance to authority
D) Overdelegation of specificity of the task
One cause of subordinate resistance to delegation is an inherent resistance to authority. Some subordinates simply need to “test the water” and determine what the consequences are of not completing delegated tasks. The remaining options do not represent the behaviors described.
A) Increase in patient acuity levels
B) Decrease in patient hospitalization time
C) Increase in the use of NAP
D) Decrease in nurse-to-patient ratios
With the increased use of NAP in patient care, the need for nurses to have highly developed delegation skills has never been greater. The impact of acuity levels, nurse-patient ratios, and hospitalization stays does not have as great an impact as does the correct option.
A) Years of experience
B) Willingness to grow professionally
C) Aversion to risk taking
D) Pervious experience with similar tasks
Identify which individuals can complete the job in terms of capability and time to do so. Remember that it is a leadership role to stretch new and capable employees who want opportunities to learn and grow. Also look for employees who are innovative and willing to take risks. It is also important that the person to whom the task is being delegated considers the task to be important. Years of experience and exposure to similar tasks are not as important as interest in professional growth.
A) Acknowledging the accomplishment of staff members at the unit’s staff meeting
B) Providing onsite in-services on new equipment for the staff
C) Including funds in the unit’s budget of staff development
D) Stressing the importance of patient safety to all new employees
The mark of a great leader is when he or she can recognize the excellent performance of someone else and allow others to shine for their accomplishments. While the other options are appropriate, they are not identified as being the mark of a great leader but rather an efficient manager.
A) “Don’t be afraid to let me know if you feel the project is overwhelming you.”
B) “What do you suggest we do to address the problems that exist with the project?”
C) “I can give you a few solutions for the issues you have been having with the project.”
D) “Do you want more time to complete the project?”
If the worker is having difficulty carrying out the delegated task, the leader-manager should be available as a role model and resource in identifying alternative solutions. Leaders should encourage employees, however, to attempt to solve problems themselves first, although they should always be willing to answer questions about the task or to clarify desired outcomes as necessary. Suggesting solutions or removing the person from the task prematurely does not demonstrate an understanding of effective guidance.
A) Less involvement in uncomplicated tasks
B) A staff that is familiar with team-related delegated tasks
C) Professional recognition as a leader
D) Staff that is growing as professional caregivers
Leaders are often measured by the successes of those on their teams. Therefore, the more recognition team members receive, the more recognition will be given to their leader. Spending less time on uncomplicated tasks is not the primary gain for the nurse-manager. It is the staff that benefit from the exposure to team work and professional growth.
A) Being willing to win at any cost
B) Communicating only when asked direct questions
C) Compromising only as a last resort
D) Beginning with a high but realistic expectation
The selected starting point in negotiations should be at the upper limits of the negotiator’s expectations, within reason. However, negotiators must realize they may have to come down to a lesser goal. The other options are not reflective of accepted tactics used in successful negotiations.
A) Smoothing of conflict by the leader
B) Facilitating collaboration among personnel
C) A majority rule approach
D) A good lesson in compromising
In collaboration, all parties set aside their original goals and work together to establish a common goal. None of the other options are examples of the described outcome.
A) Ridicule often takes the form of ambiguous or inappropriate questioning and is a diversionary tactic
B) Most managers successfully resist the illness/wellness tactic because of their nursing preparation.
C) Negotiation tactics can be manipulative; thus, managers should know how to identify and counter destructive tactics
D) The tactic of paternalism allows both parties in the negotiation to reach a consensus of opinion
Destructive negotiation tactics are never a part of a successful collaborative conflict resolution. A good manager will be alert for such tactics. None of the other options are true statements regarding negotiation tactics.
A) It should be dealt with immediately
B) It should be encouraged
C) It was an indication of poor management
D) It should be avoided
The interactionist movement encouraged organizations to promote conflict as a means of producing growth. The remaining options were not necessarily supported by the interactionist theorists.
A) It can lead to new ideas
B) It leads to decreased motivation
C)It should be avoided whenever possible
D) It is neither qualitative nor quantitative
Some level of conflict in an organization appears to be desirable since it appears to prevent organizational stagnation. None of the other options reflect contemporary thinking about conflict.
A) Intergroup conflict
B) Common control
C) Intrapersonal conflict
Interpersonal conflict happens between two or more people with differing values, goals, and beliefs. No other option is used to describe this situation.
A) It develops during the first stage of the conflict process
B) It is sometimes referred to as antecedent conflict
C) It occurs if the conflict is intellectualized
D) It occurs when the conflict is emotionalized
Perceived or substantive conflict is intellectualized and often involves issues and roles. The person recognizes it logically and impersonally as occurring. None of the other options are true statements concerning perceived conflict.
A) When fair play is important to all involved parties
B) When one party wins at the expense of the others
C) When managers need to control a volatile situation
D) When an appropriate political strategy is necessary
The competing approach is used when one party pursues what it wants at the expense of the others. Because only one party typically wins, the competing party seeks to win regardless of the cost to others. Neither manager control nor political strategy is necessarily associated with the competing approach to resolving conflict.
A) Having mutual respect for one another’s knowledge and expertise
B) Having the skills to negotiate successfully
C) Liking each other enough to want to collaborate
D) Being willing to cooperate with each other
In collaboration, problem solving is a joint effort with no superior/subordinate relationships. Mutual respect is required for its success. While the other options identify factors that add to the collaborative process, its foundation is mutual respect.
A) Conflict avoidance
B) Conflict smoothing
C) Encouraging competitive conflict
D) Facilitating conflict resolution
Managers should not intervene in every conflict, but should urge subordinates to handle their own problems. This is an example of supporting conflict resolution. The action of the manager is not reflective of any of the other options.
A) It involves an internal struggle resulting from value-related discord
B) Its basis is the violation of personal rights or values
C) It centers on either internal or external discord between individuals
D)It is the outcome of a visible struggle between individuals
Conflict is generally defined as the internal or external discord that results from differences in ideas, values, or feelings between two or more people. The remaining options describe only limited aspects of conflict.
A) That gains for each party are different but equal
B) That the hidden agendas of all parties be exposed
C) That each party willingly reveals their negotiated limits
D)That both parties perceive that they have won something they value
A successful negotiation leaves both parties feeling like they have gained something they want and/or value. None of the other options are considered a goal of negotiation.
A) One party wins at the expense of another
B) The willingness by all parties to accept agreed-on conditions
C) The most rapid conflict resolution strategies
D) An unanimous decision has been reached
In a consensus, an agreement is found that all parties can support, or at least not oppose. The term is not used to describe any of the other options.
A) Assuring the RNs that their suggestion will be taking under consideration
B)Asking the RNs to circulate a partition to be signed by employees who support the change
C) Arranging for the RNs to air their views at the next staff meeting.
D) Sharing with the RNs that they need to address the issue with upper management
This manager should plan to let employees air their views at the next staff meeting. Nursing managers can no longer afford to respond to conflict traditionally (to avoid or suppress conflict), because this is nonproductive. In an era of shrinking health-care dollars, it has become increasingly important for managers to confront and manage conflict appropriately. The ability to understand and deal with conflict appropriately is a critical leadership skill.
A) Responsibility charting
B) Smoothing conflict
C) Alternate dispute resolution
D) Mediation counseling
When a supervisor delineates job duties to persons in conflict, it is called responsibility charting. The other options are not related to job description conflict.
A) Communication problems
B) Organizational structure
C)Individual behavior within the organization
Self-scheduling is not generally associated with common causes of organizational conflict. The most common sources of organizational conflict are communication problems, organizational structure, and individual behavior within the organization.
B) Increased productivity
C) Decreased effectiveness
D) Employee immobilization
Too little conflict results in organizational stasis and decreased productivity, whereas too much conflict reduces the organization’s effectiveness and eventually immobilizes its employees.
The first stage in the conflict process is called latent conflict, which implies the existence of antecedent conditions. Latent conflict may proceed to perceived conflict or to felt conflict. Manifest conflict may also ensue. The last stage in the process is conflict aftermath.
A) It uses a neutral third party; is a confidential, legally nonbinding process designed to help bring the parties together to devise a solution to the conflict
B)It asks questions to clarify the issues
C) It makes a final decision for the parties in conflict
D)It involves presentation of evidence including that of expert witnesses
Mediation uses a neutral third party; is a confidential, legally nonbinding process designed to help bring the parties together to devise a solution to the conflict. None of the other options accurately describes the process of mediation.
A) All involved parties agree to support the way a conflict has been resolved
B) A conflict is resolved by meeting the goals of all involved parties
C) It resolves a conflict by an initial unanimous decision
D) Conflict is resolved through the mediation process
Consensus means that negotiating parties reach an agreement that all parties can support, even if it does not represent everyone’s first priorities. Consensus decision making does not provide complete satisfaction for everyone involved in the negotiation as an initially unanimous decision would, but it does indicate willingness by all parties to accept the agreed-upon conditions. Mediation is not a required factor in arriving at a consensus.
A) Providing expert testimony in conflict cases
B) Mediating disputes between an organization and its employees
C) Educating individuals involved in a grievance situation of their rights
D) Monitoring the implementation of the terms of a conflict’s compromise
A function of an ombudsperson is to assure that those involved in a conflict understand their rights as well as the process that should be used to report and resolve the conflict. This role is not appropriately described by any of the other options.
A) Clearly restating the compromise’s specific outcomes to all involved
B) Thanking all involved for their cooperation on reaching the compromise
C) Evaluating the compromise’s outcomes for fairness to all involved parties
D) Assuring all involved that the compromise will not cause a change in goals
Once a compromise has been reached, restate it so that everyone is clear about what has been agreed upon. A compromise by its natural requires a change in original goals. The evaluation for fairness needs to have been done prior to the compromise being agreed upon. Thanking all involved is appropriate but would not be the initial action.
A) Asks that the aggressive individual recognize the rights of all the other members
B) States, “I need to have time to think over all that we have discussed.”
C) Halts any discussion until new representatives can be appointed
D) Shares with the members that aggressiveness negatively impacts the negotiations
Some people win in negotiation simply by rapidly and aggressively taking over and controlling the negotiation before other members realize what is happening. If managers believe that this may be happening, they should call a halt to the negotiations before decisions are made. Saying simply, “I need to have time to think this over” is a good method of stopping an aggressive takeover. The other options are much less effective and may even lead to increased aggressiveness among team members.
A) Perseverance and assertiveness
B) Calmness and self-assuredness
C) Compassion and reflectiveness
D) Organization and preparedness
Negotiation is psychological and verbal. The effective negotiator always appears calm and self-assured. The other options are not as impactful when considering the psychological aspects of the negotiation process.
A) To take corrective action when standards have not been met
B) To collect data to determine whether standards have been met
C) To determine criteria and standards
D) To determine who will measure the standard
The first step in quality control is to determine criteria and standards. Measuring performance or making corrections is impossible if standards have not been clearly established.
A) Encouraging employees to think of a unit slogan
B) Developing a quota system for number of patients cared for
C) Explaining to the staff that “if it’s not broke, don’t fix it”
D) Promoting teamwork rather than individual accomplishments
In TQM, team efforts are favored over individual accomplishments. Slogans, quota systems, and maintaining the status quo work against quality in this philosophy.
A)Periodic evaluation of unit mission and philosophy
B) Making out the daily patient care assignments
C) Creating a yearly budget
D) Distributing holiday staffing policies
Unit mission, philosophy, goals, and objectives are the blocks on which policies and standards rest. All these must be in place to measure whether quality is being achieved on the unit. The other options are not related to quality control
A) Two organizations become financially integrated under a capitated model
B) Organizations compete for a “best practices” label from the National Committee for Quality Assurance (NCQA)
C)An organization compares its performance with that of “best-performing institutions”
D) Minimum practice guidelines are established for each health-care organization
In benchmarking, an organization compares its performance with that of “best-performing institutions.” Benchmarking is not associated with the other options.
An outcome audit determines what outcomes resulted from specific nursing interventions for clients. That is the function of the remaining options.
A process audit assumes that a relationship exists between the process used and the quality of the result. This is the only option that fulfills that function.
A) Compares the quality of nursing care and medical care
B) Identifies minimal levels of quality necessary for nurses to maintain licensure
C) Standardizes the collection of nursing data for use by multiple data users
D) Identifies only “nursing-sensitive” patient outcome measures
The nursing minimum data set standardizes the collection of nursing data for use by multiple data users. None of the remaining options accurately describes the function of such a data set.
A) Establishing clinical practice guidelines
B) Reducing diagnosis-related group reimbursement levels
C) Standardizing clinical outcome data collection
D) Assessing monetary fines for hospitals that fail to meet standards
The Joint Commission ensures quality at the organizational level by requiring participating organizations to choose from among 60 acceptable performance measurement systems. The Joint Commission is not actively involved in any of the other options.
A) Facility staff
C) All levels management
D) Health-care professionals
Consumers, health professionals, staff, and all levels of management should be involved in quality control measurement. Community members become involved when they become health-care consumers.
A) It is based on the premise that the organization knows what is best for the consumer
B) Its guiding purpose is to save the organization money
C) It is based on the premise that the customer is the focal element on which production and service depend
D) It assumes that inspection and removal of errors lead to the delivery of quality
TQM is based on the premise that the customer is the focal element on which production and service depend. The other options are false statements.
A) The primary purpose of the program is to satisfy various federal and state standards
B) Developed standards should reflect minimally acceptable levels so the organization will score well on self-assessment audits
C) A belief in the importance of quality control must be integrated through all levels of the organizational hierarchy
D) The process should be reactive; in other words, quality improvement efforts should be initiated after problems are identified
For any quality control program to be effective, a belief in the importance of quality control must be integrated through all levels of the organizational hierarchy. The remaining statements are false.
A) Findings are not released to the public
B) Only about half of managed care organizations have chosen to participate
C) Performance indicators are process focused rather than outcome focused
D) There are only 15 performance measures
The NCQA, a private nonprofit organization that accredits managed care organizations, has developed HEDIS. One of the most significant weaknesses of NCQA accreditation is that such accreditation is voluntary and only about half of managed care organizations currently undergo such review. The remaining options do not relate to the HEDIS
A) Morbidity and mortality rates
B) Nursing care hours per patient day
C)Average length of stay
D) Patient surveys of general satisfaction
In determining quality control for marketing, the best qualitative measurement would be patient surveys. The other options are not necessarily qualitative measurements.
A) Hire a well-qualified researcher to help staff design studies
B) Create a joint medical/nursing staff research committee
C) Provide staff with paid release time for research activities
D)Ensure that research designs are well grounded and scientific
Staff should be involved in determining criteria or standards, reviewing standards, and collecting data. To stimulate staff nurses’ involvement in quality control research, the best course of action would be to provide staff with paid release time for research activities. The other options fail to actually stimulate the nurse’s involvement in the process.
A) They occur infrequently in accredited hospitals
B) They are responsible for about 20% of hospitalized disabilities
C) They usually involve either prescribing or pharmacy errors
D) They occur because of individual recklessness
ADEs occur in all hospitals, are to blame for 20% of injury disabilities, and involve more than prescribing or pharmacy errors, but are rarely due to individual recklessness. They occur in both accredited and unaccredited facilities.
A) A predetermined baseline condition or level of excellence that constitutes a model to be followed and practiced
B) Diagnosis-based, step-by-step interventions for nurses to follow in an effort to promote evidence-based, high-quality care
C) Process of measuring products, practices, and services against those of best-performing organizations
D) Identify not only what and how an event happens but why it happens, with the end goal being to ensure that a preventable negative outcome does not recur
A standard is a predetermined baseline condition or level of excellence that constitutes a model to be followed and practiced. The remaining options all fail to accurately define a standard.
A) A predetermined baseline condition or level of excellence that constitutes a model to be followed and practiced
B) Diagnosis-based, step-by-step interventions for nurses to follow in an effort to promote evidence-based, high-quality care
C) Process of measuring products, practices, and services against those of best-performing organizations
D) Identify not only what and how an event happens but why it happens, with the end goal being to ensure that a preventable negative outcome does not recur
Clinical practice guidelines provide diagnosis-based, step-by-step interventions for nurses to follow in an effort to promote evidence-based, high-quality care and yet control resource utilization and costs. The remaining options all fail to accurately identify what a clinical practice guideline provides.
A) Diagnosis-related groups have not helped to contain rising health care costs
B) The system has increased the length of hospital stay
C) Services provided under this system have only slightly increased
D) On the whole quality of care has declines since its implementation
Critics of the prospective payment system argue that although DRGs may have helped to contain rising health-care costs, the associated rapid declines in length of hospital stay and services provided have resulted in declines in the quality of care.
A) Computerized physician-provider order entry, evidence-based hospital referral, ICU physician staffing, and the use of Leapfrog Safe Practices scores
B) Computerized physician-provider order entry, evidence-based visiting nurse referral, ED physician staffing, and the use of Leapfrog Safe Practices scores
C) Computerized primary care provider order entry, evidence-based hospital referral, ICU physician staffing, and the use of Leapfrog Safe Medication scores
D) Computerized nurse practitioner-provider order entry, evidence-based outpatient referral, ED physician staffing, and the use of Leapfrog Safe Medication scores
The Leapfrog Group identified four evidence-based standards that they believe will provide the greatest impact on reducing medical errors: computerized physician-provider order entry, evidence-based hospital referral, ICU physician staffing, and the use of Leapfrog Safe Practices scores.
A) Computerized order entry with a drug bar code system
B) Medications automatically dispensed to patients at predetermined times
C) Use of medication nurses to administer all ordered medications
D)Have patients’ medications kept at the bedside for self-administration
The U.S. Food and Drug Administration has suggested that a drug bar code system coupled with a computerized order entry system would greatly decrease the risk of medication errors.
A) Assessing the medical psychiatric staff for practice suggestions
B) Implementing a search of the literature for current related research results
C) Reviewing patient satisfaction data to identify the unit’s strengths and weaknesses
D) In-servicing all unit nursing staff on the need to adhere to established guidelines
Clinical practice guidelines reflect evidence-based practice; that is, they should be based on cutting edge research and best practices. The other options may be helpful but should occur after the review of the research literature.
A)The quality of care delivered is the primary factor related to
B) The patient’s understanding of his/her condition influences satisfaction
C) The length of the hospital stay is the deciding influence on satisfaction
D) The patient’s satisfaction has little to do with actual health improvement
Patient satisfaction often has little to do with whether a patient’s health improved during a hospital stay. It is important to remember that quality care, length of stay, and patient perception do not always equate with patient satisfaction.
A) Reporting of errors must be both mandatory and voluntary
B) Errors are a result of faulty organizational processes
C) People are the root cause of health delivery errors
D) Errors are either unavoidable or result from reckless behavior
A just organizational culture emphasizes the finding of the middle ground between the two extremes of error cause (people or system). It seeks to separate unavoidable error from reckless behavior and unjustifiable risk. Reporting of errors can be both mandatory and voluntary but this factor has less importance than the organization attitude regarding the cause of errors.
A) Sentinel event
B) Root cause analysis
C) Quality assessment (QA) program
D) Failure mode and effects analysis (FMEA)
Another Joint Commission priority is the development of root cause analysis with a plan of correction for the errors that do occur. A sentinel event is likely the trigger of the root cause analysis. FMEA examines all possible failures in a design—including sequencing of events, actual and potential risk, points of vulnerability, and areas for improvement. QA is an ongoing process that focuses on continued delivery improvement.
A) Inspiring staff to establish and maintain high standards regarding patient care
B) Being aware of the changes in quality control regulations
C) Reviewing research results upon which to base changes
D) Identifying outcomes that support quality nursing care
Inspiring subordinates to establish and achieve high standards of care is a leadership skill. The remaining options are management roles.
A) The manager is friendlier to the employee in constructive discipline than in destructive discipline, so that the employee likes the manager as a person
B) Constructive discipline includes verbal and written reprimands, whereas destructive discipline includes suspension without pay and termination
C) The person who has received constructive discipline always appreciates and believes the feedback given, whereas it is resented and disbelieved in destructive discipline
D) Constructive discipline helps the person to grow and to behave in a manner that allows him or her to be self-directive in meeting organizational goals. Destructive discipline focuses more on punishment
Constructive discipline uses discipline as a means of helping the employee grow. It is not used as a punitive measure. Destructive discipline focuses more on punishment. The remaining options are not necessarily true statements
A) It is one of the least effective forms of discipline
B) It decreases as an awareness of the rules and regulations that govern behavior increases
C)It increases when employees identify with the goals of the organization
D) It is internalized, and thus the leader can do little to create an environment that promotes self-discipline in employees
The highest level and most effective form of discipline is self-discipline. When employees feel secure, validated, and affirmed in their essential worth, identity, and integrity, self-discipline is enhanced.
A) If a rule or regulation is worth having, it should be enforced
B) Most rule breaking is a result of the actions of a few employees
C) Organizations should have as many rules and regulations as possible so employees are clear about what they are to do
D) Managers should increase monitoring efforts if a particular rule is constantly broken by many staff members
If a rule or regulation is worth having, it should be enforced. When rule breaking is allowed to go unpunished, other people tend to replicate the behavior of the rule breaker. An organization can have too many rules making enforcement very difficult. Evaluation of a rule that is being constantly broken is more effective than simple increased monitoring.
A) A written warning precedes verbal warnings
B) Formal warnings are followed up with informal warnings
C) Written warnings are advocated only in the most serious of offenses
D) The initial step is the delivery of a verbal warning by the manager
The first step of the progressive disciplinary process is an informal reprimand or verbal warning. This reprimand is followed by a formal reprimand or written warning when the behavior has not been changed.
A) Suspension with pay
B) Suspension without pay
D) Written admonishment
For a first infraction of gross mistreatment of a patient, the most appropriate level of employee discipline would probably be termination. The organization’s first responsibility is in the protection of patients.
A) It is generally a highly charged emotional event, so the manager should try to soften criticisms to reduce the employee’s defensiveness
B) It should be scheduled in advance at a time agreeable to both the employee and the manager
C) When it is held in front of peers it can be used as a teaching tool
D) It requires the manager to adopt nurturing and counseling roles
All formal disciplinary conferences should be scheduled in advance at a time agreeable to both the employee and the manager. Both will want time to reflect on the situation that has occurred. Allowing time for reflection should reduce the situation’s emotionalism and promote employee self-discipline, because employees often identify their own plan for keeping the behavior from recurring. None of the other options accurately describe this process.
A)The employee will be escorted from the building by security staff
B) The employee will be allowed to work out a 2-week termination period
C) The manager will describe what, if any, references will be supplied to future employers
D) The manager will arrange for a meeting between the employee and senior administration
When a manager terminates an employee for continuous rule breaking, the manager should tell the employee what, if any, references will be supplied to future employers. The remaining options are not generally associated with such a termination.
A) It is less spontaneous and requires more planning than ongoing coaching
B) It is a one-time way of solving problems
C) It requires the manager to assume the role of enforcer rather than supporter or enabler
D) It occurs as a component of an employee’s annual performance appraisal
This form of coaching is less spontaneous and requires more managerial planning than ongoing coaching. In performance deficiency coaching, the manager actively brings areas of unacceptable behavior or performance to the attention of the employee and works with him or her to establish a plan to correct deficiencies.
A) Nonunionized organizations require a demonstration of just cause, whereas unionized organizations do not
B) Discipline in nonunionized organizations tends to entail more procedural, legalistic safeguards than unionized organizations
C) Only unionized organizations have grievance procedures
D) Unionized employees must generally be disciplined according to specific steps and penalties within an established time frame
Unionized employees must generally be disciplined according to specific, pre-established steps and penalties within an established time frame. The remaining options do not accurately describe unionized organizational discipline procedures.
A) It serves as evidence that a manager’s actions have been unfair or arbitrary
B) It means that the conflict will have to be resolved in arbitration
C) It negates the need for the manager to attempt to solve the conflict through communication, negotiation, compromise, or collaboration
D) It requires a great deal of time and energy from both the employee and the manager
Although grievance procedures extract a great deal of time and energy from both employees and managers, they serve several valuable purposes. However, most grievances or conflicts between employees and management can be resolved informally through communication, negotiation, compromise, and collaboration before grievance procedures need to be undertaken. The remaining options are not the result of a grievance filing.
A) Suspend the employee from work for a specified period of time
B) Explain in detail the nature of the inappropriate behavior
C) Complete a formal written reprimand
D) Verbally instruct the employee not to repeat the infraction
The second step in the progressive disciplinary process is for the manager to complete a formal written reprimand signed by the employee and the manager. The second step in the progressive disciplinary process does not involve any of the other options.
A) Provide a verbal warning that includes the rules related to personal telephone calls
B) Determining whether there is a legitimate personal problem that justifies the telephone calls
C) Presenting the nursing aide with a formal written reprimand
D) Suspending the nursing aide for a week
The best choice of action in this case would be to provide an explanation for the rule and proceed to give a verbal admonishment. Since this is a new infraction, the progressive discipline starts with a verbal warning again and none of the other options.
A)It is a necessary means for controlling an unmotivated and self-centered workforce
B) It is a “Big stick” that management can use to eliminate behavior that conflicts with organizational goals
C) It is a means to assist in the development of self-discipline in an employee
D) It is necessary to the organization if established rules are to be enforced
Managers use discipline to enforce established rules, policies, and procedures. The other options are very limited views regarding discipline.
A) To terminate their employment
B) To be a good listener
C) To act as counselor
D) To ensure organizational goals are met
To act as coach and supporter, counselor, or good listener could be enabling to the employee who breaks the rules. The manager should be humanistic, however, and not scold or blame. Not all situations would result in employment termination.
A) Most chemically impaired nurses obtain drugs by stealing them from work
B) Morphine is the most commonly abused drug by nurses
C) Most nurses obtain their drugs on the street and avoid taking drugs from work
D) Most chemically impaired nurses cannot be diverted from drug use
Most chemically impaired nurses abuse drugs they were taking for legitimate health reasons, or they steal drugs from work. The remaining options are not statements supported by research.
A) It is relatively easy to identify employees who are chemically impaired
B)It is easier to recognize if the employee is impaired by alcohol than by drugs
C) Impairment should result in an immediate intervention by the manager
D) Impairment must be supported by data gathering before intervention occurs
For safety reasons and to protect clients, employees should be confronted as soon as possible after chemical impairment is recognized. None of the remaining options are true statements regarding the recognition of a chemically impaired employee.
A) Emphatic denial and defensiveness
B) Reluctant acceptance
C) Gratefulness for finally being discovered
Employee denial and defensiveness are common behaviors in those who are confronted with their impairment. Often, these individuals are in self-denial.
A) It is successful in only a small number of cases despite active treatment programs
B) It is discouraged by the board of registered nursing
C) It should not occur until 3 years after the employee has completed the treatment program
D) It often includes an employer requirement that the employee agree to random urine screening on request by the employer
Most nurses successfully return to work following a treatment program, and this generally takes 1 year. Often, the conditions that the employee has successfully changed his or her lifestyle and will submit to random drug tests must be met before the employee can be allowed to return to work.
A) It is done as an altruistic and benevolent action by the organization
B) It should not be undertaken by management or the personnel department
C) It should include screening that focuses on early detection
D) Is best handled through disciplinary action of the personnel department
The personal and professional cost of chemical impairment demands that nursing leaders and managers recognize the chemically impaired employee as early as possible and provide intervention since such behavior is a serious safety issue associated with patient care. The remaining options are not correct.
A) Marginal performance is generally a result of employee burnout
B) Poor motivation is the most common reason for marginal performance
C) Improving skill should be the focus when assisting the marginal employee
D) Some marginally performing employees will never improve their function levels
It is important for the manager to remember that each person and situation is different and that the most appropriate strategy depends on many variables. Looking at past performance will help to determine if the employee is merely burnt out, needs educational or training opportunities, is unmotivated, or just has very little energy and only marginal skills for the job. If the latter is true, then the employee may never become more than a marginal employee, no matter what management functions and leadership skills are brought into play.
C) Written notice
D) Verbal notice
An employee caught stealing is initially presented with a written warning.
A)All discipline should be administered immediately after rules are broken
B) Each time the rule is broken; there are immediate and consistent consequences
C) All employees must know the rule beforehand and be aware of the punishment
D) Everyone must be treated in the same manner when the rule is broken
All employees must be forewarned that if they break a rule, they will be punished or disciplined. They must know the rule beforehand and be aware of the punishment.
A) Constructive discipline is punitive in its nature
B) The focus of constructive discipline is employee growth
C) Constructive discipline employs the manager as a resource not a helper
D)Behavior modification is the desired outcome of constructive discipline
Constructive discipline uses discipline as a means of helping the employee grow, not as a punitive measure.
A) Forewarns the employee of the consequences of breaking a rule
B) Encourages employees to be self-disciplined in conforming to rules
C) Serves in the role of coach in performance deficiency coaching
D) Recognizes and reinforces the intrinsic self-worth of each employee
Clearly identifies performance expectations for all employees and confronts employees when those expectations are not met. The other options are leadership roles.
A) This behavior disrupts the efficiency of the nursing team
B) The tardiness is costing the facility money
C) This behavior encourages other staff to disregard rules
D) The problem will get worse if it is ignored
Disciplinary problems, if unrecognized or ignored, generally do not go away; they only get worse. The other options are likely outcomes of the staff member’s unacceptable behavior but not the fundamental rational for the disciplinary action.
B) Line and staff authority
C) Span of control
D) Scalar chains
The grapevine lines of communication cannot be placed on an organizational chart because they are constantly in flux. The remaining information is stable and so identified on the chart.
B) Worker satisfaction was integral to productivity
C) Organization charts could depict the hierarchy of authority
D) Impersonality of interpersonal relationships should exist in organizations
Max Weber’s theories did not address worker satisfaction. The other options do represent the Weber organizational theory.
B) It defines how power is used by organizations to direct the work of others
C) It describes the predictable stages of group and organizational development
D) It is a system of symbols, beliefs, values, history, and communication patterns
Organizational culture is the symbols and beliefs, values, history, and communication patterns of the organization. It differs from organizational climate, which is how the employees perceive the organization. The other options are not relevant to the term organizational culture.
A) They are depicted as unbroken lines
B) They are represented by double dotted lines
C) They are shown as a solid, vertical line
D) They are identified with a dotted line.
Dotted or broken lines on the organization chart represent staff positions. Formal relationships, lines of communication, and authority are depicted on a chart by unbroken (solid) lines. Double dotted lines are not generally used on an organizational chart.
A) The number of individuals directly reporting to a manager
B) Having a limited number of top-level managers
C) Each employee having only one boss
D) A flexible structure that encourages participative decision making
6. Which position is characteristic of a middle-level manager?
A) Primary care nurse
B) Team leader
C) Charge nurse
D) Nursing supervisor
Nursing supervisors are middle-level managers. All the others are first-level managers.
7. How does decentralized organizational structure promote decision making?
A) Allows problems to be solved at the level at which they occur
B) Encourages decisions to be made by top-level hierarchy
C) Limits communication to managers at various levels
D) Assigns responsibility at the highest practical level
Decentralized organizational structure allows decision making to be made at the level at which problems occur. None of the other options describes how decentralized organizational structure promotes decision making.
does the term unity of command mean?
8. Which statement about organizational centrality is true?
A) It refers to the decision-making structure in an organization
B) It occurs when there is consonance of subunit cultures in the organization
C) It is a position on the organizational chart where types of communication occur
D) It occurs primarily in line relationships
Centrality is a position on an organizational chart where it is possible to have many different types of communication (upward, downward, lateral, and diagonal). The other statements do not describe organizational centrality accurately.
9. Which is a symptom of poor organizational structure?
A) Communication follows the chain of command
B) The smallest possible number of managers exists to keep units functioning
C) The chain of command is fairly short
D) There is a heavy reliance on committees to solve unit problems
A heavy reliance on committees to solve problems is an indication of a poorly structured organization and often results in delays in critical decision making. The other options describe examples of good organizational structure.
10. Which term is used to identify having official power to act?
Authority means having the official power to act. None of the other terms is used to identify having official power to act.
A) It defines the manager’s decision-making authority
B) It identifies the manager’s abilities and responsibilities
C) It refers to a line-and-staff organizational structure model
D) It is the number of subordinates and manager is responsible for
The number of people directly reporting to any one manager represents that manager’s span of control and determines the number of interactions expected of him or her. None of the remaining options correctly describes this term.
does the term ìoptimum span of controlî mean?
12. Which characteristics are associated with a constructive culture? 1. Affiliative norms
3. Encouragement of humanism
4. Perfectionist norms
A) 1, 2, 3
B) 1, 2, 4
C) 1, 3, 4
D) 2, 3, 4
Affiliation, self-actualization, and encouragement are all characteristics of a constructive culture, whereas perfectionist norms are a characteristic of destructive organizational cultures.
A) New leadership
B) A change agent with management skills
C) Identification with a unit that is not entrenched
D) Administration support
It is extremely difficult to change a unit culture without new leadership. The remaining options are directly involved in the change out of entrenchment.
14. Which would suggest that flattening of the organization is occurring?
A) There is a collective spirit
B) There is reduction in the administration levels
C) There are shared work goals across units
D) There are formal and informal systems are in place to address conflicts
Reducing the numbers of administration levels is called flattening the organization. The remaining options are not related to organizational flattening.
is needed to change a unit culture that has become firmly entrenched?
What occurs during implementation of a shared governance model? A) Lines of authority are altered
B) Joint practice committees are formed
C) Participatory management is initiated D) The roles of first-level managers are stabilized Ans: B Feedback: In shared governance, the organization’s governance is shared among board members, nurses, physicians, and management. Joint practice committees are developed to assume the power and accountability for decision making, and professional communication is egalitarian rather than hierarchical. Shared governance is not associated with the other options.
What is the primary responsibility of the committee chairperson during a committee meeting?
A) Keeping members on task
B) Asking questions
C) Resolving conflicts
D) Providing information on each agenda item
Although all the items may be something the chairperson does, the primary responsibility is to keep members on task so committee work gets completed.
17. What is the leadership role when a unit is attempting to overcome the decentralization of patient care?
A) Determining what changes will be made to the plan of care
B) Facilitating the group’s work
C) Identifying the patient care problems
D) Selecting solutions to problems
In a patient-centered focused activity, the team leader should facilitate the work of the group and should not be the sole decision maker.
What should the leader remember when forming committees?
A) Committees work best when there is an adequate supply of workers, with 10 members being the minimum B) Willingness to work hard is the most important criterion for appointment C) Written agendas provide excessive structure and stifle committee creativity D) There should be sufficient expertise among committee members to accomplish the assigned task Ans: D Feedback: The most important criterion for committee selection is overall adequate expertise to accomplish the agenda. The remaining options are not as relevant as the correct option.
During a strategic planning committee meeting to develop futuristic technology goals, several unit managers spend a considerable amount of time discussing current staffing problems. What is the primary action of the chairperson of this committee?
A) Take the remainder of the meeting time to discuss staffing with all members
B) Adjourn the meeting and reschedule at a time when there are no staffing problems
C) Request that committee members return to discussing items on the agenda
D) Excuse those discussing staffing from the remainder of the meeting
Committee time is wasted when agendas are not adhered to. The remaining options do not address the issue of wasted time effectively.
20. Which characteristics are associated with Magnet hospital status? 1. Centralized environment
2. Open, participatory management 3. Improved patient outcomes
4. Higher staff nurse satisfaction
A) 1, 2, 3
B) 1, 2, 4
C) 1, 3, 4
D) 2, 3, 4
Magnet designation is conferred by the ANCC to health-care organizations exemplifying well-qualified nurse executives in a decentralized environment, with organizational structures that emphasize open, participatory management. Magnet- designated organizations demonstrate improved patient outcomes and higher staff nurse satisfaction than organizations that do not have Magnet status.
21. Which component is considered a part of an organizational structure? Select all that apply.
A) Group formation
B) Lines of communication
C) Decision-making process
D) Channels of legitimate authority
Ans: A, B, C, D
Organizational structure refers to the way in which a group is formed, its lines of communication, and its means for channeling authority and making decisions.
A) Organizational gossip
B) An informal channel of communications
C) An institution’s informal authority chain
D) The connecting format used on an organizational chart
The informal structure also has its own communication channels, often referred to as the grapevine. None of the remaining options accurately describes an organizational grapevine.
23. Research supports that organizational restructure affects nursing in what manner?
A) It decreases nursing autonomy
B) It decreases nursing’s formal authority
C) It increases the effectiveness of patient care
D) It increases patient autonomy
Current research suggests that changing an organization’s structure in a manner that increases autonomy and work empowerment for nurses will lead to effective patient care. The remaining options failed to describe the research supported effect of organizational restructure on nursing.
is an institutional grapevine?
24. When considering the interprofessional approach to healthcare, to whom does the nurse owe accountability?
A) The physician
B) Their patients
C) Their unit manager
D) Their director of nursing
Ans: A, B, C, D
Nurses frequently feel as though they have many individuals to account to because health care often involves an interprofessional approach. Additional individuals the nurse may need to be accountable to may include the immediate supervisor, the patient, the patient’s family, central administration, and the physician. The nurse has no accountability to other nurses in this situation.
25. Which statement is true concerning a bureaucratic organization?
A) It is commonly referred to as a line organization
B) It is typically found in large health-care organizations
C) They resemble Weber’s original design of organization
D) Its authority is represented by its staff organizational chart
Ans: A, B, C, D
Bureaucratic organizational designs are commonly called line structures or line organizations. Those with staff authority may be referred to as staff organizations. Both of these types of organizational structures are found frequently in large health-care facilities and usually resemble Weber’s original design for effective organizations. Because of most people’s familiarity with these structures, there is little stress associated with orienting people to these organizations.
Unity of command means one immediate boss per employee. None of the other options correctly describes the term unity of command.