Nursing Leadership

problem solving
systematic process that focuses on analyzing a difficult situation and includes a decision-making step; differs from decision making in that it requires problem identification
decision making
complex, cognitive process employed to choose a particular course of action; implies that there was doubt about several courses of action and that a choice was made to eliminate the uncertainty
critical thinking
sometimes referred to as reflective thinking, is related to evaluation and has a broader scope than decision making and problem solving. Dictionary.com (2009) defi nes critical thinking as “the mental process of actively and skillfully conceptualizing, apply-ing, analyzing, synthesizing, and evaluating information to reach an answer or conclusion” (para 1). Critical thinking also involves refl ecting upon the meaning of statements, examining the offered evidence and reasoning, and forming judgments about facts.
Heuristics
use of 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
What’s the limitation of using a heuristics approach in decision making?
These are shortcuts, not fail-safe rules. Relying on this may work most of the time but will not be the best all of the time.
What are strengths of using a heuristics approach in decision making?
This allows quick problem solving by building upon experiences they have gained in their lives.
Characteristics of successful decision makers:
Self-aware
Courageous
Sensitive
Energetic
Creative
Which of the following is a characteristic of a successful thinker?
a. Impulsiveness
b. Courage
c. Decisiveness
d. Whimsy
b. Courage

Rationale: A successful thinker should be willing to take risks.

What is the first step in managerial decision-making model?
a. Identify the problem
b. Evaluate alternatives
c. Gather data
d. Set objectives
Answer: D. Set objectives
Rationale: While the traditional model begins with identifying the problem, in managerial decision-making model one approaches the issue by first deciding on the objectives.
Which of the following is NOT a factor in solving a case successfully?
a. Being self-aware
b. Doing all work independently.
c. Assessing all information given.
d. Watching for faulty logic.
Answer: b. Doing all work independently.
Rationale: It is important to use group process in some way to increase solutions.
Human capital theory
Theory that is an investment in human capital in anticipation of gains in the form of increased productivity and financial returns.
human capital (social capital)
refers to the collective group knowledge or experience. Represents what a group can accomplish together. Accrues within the organization. 21st century idea
Principal agent theory
Theory that suggests that followers may have an informational (expertise or knowledge) advantage over the leader as well as their own preferences, which may deviate from the principal’s. As the principal you must find what motivates the agent so that goals will align.
Servant Leadership
Leadership style that considers follower’s needs first, and then empower them to achieve organizational goals (Howatson-Jones, 2004). Trust, mutual respect, and feedback essential part of the relationship between servant leader and followers. Putting people first.
Emotional intelligence
refers to the ability to use emotions effectively and is required by leader/managers in order to enhance their success.

Emotional intelligence is critical for building a cooperative and effective team.

Ability to get the best results from relationships with others.

Five Components of Emotional Intelligence
Self-awareness
Self-regulation
Motivation
Empathy
Social skills
Which of the Following Is a Component of Emotional Intelligence?

a. Self-reliance

b. Assertiveness

c. Self-regulation

d. Charisma

Answer: c. Self-regulation

Rationale: The five components of emotional intelligence
are self-awareness, self-regulation, motivation, empathy, and social skills. Self-reliance, assertiveness, and charisma are not components of emotional intelligence.

Authentic leadership or congruent leadership
leadership style suggests that in order to lead, leaders must be true to themselves and their values and act accordingly.
What is the definition of transparent integrity?
a. Holding one’s employees accountable
b. Standing by one’s values in the face of pressure
c. Willingly following the rules of one’s organization
d. All of the above
Answer: b. Standing by one’s values in the face of pressure.

Rationale: While the pressure to deliver results can be intense, those possessed of transparent integrity refuse to compromise their principles in the process.

transparent integrity.
This means the willingness to stick with one’s values and principles about work and people, despite pressure to deliver results,
Thought Leadership
“A leader in one’s field” – Innovative. convinces another to consider a new idea, product, or way of looking at things.
Tell whether the following statement is true or false.
Thought leaders attract followers by the promise of representation or empowerment.
True
False
Answer: B. False

Rationale: Thought leaders attract followers by their risk taking and vision in terms of being innovative.

Quantum leadership
Type of leadership that suggests that the environment and context in which people work is complex paradoxical, and dynamic and that this has a direct impact on organizational productivity. All systems respond collectively in the environment. Good leaders use intuition and rationale thinking is just as important as the data that you’ve collected.
What are some struggles faced by foreign nurses?

a. Cultural acclimation

b.Professional dissonance

c. Isolation

d. All of the above

Answer: d. All of the above.

Rationale: Foreign nurses often face numerous difficulties, including cultural, professional, and psychological dissonance. It is especially important that they receive sufficient support during this adjustment period.

Leaders continuously develop, and need to have which of the following characteristics
Transparency
Self-reflection
Consistent
Avoid confrontation
Like people
Team player
Transparency
Self-reflection
Like people
Team player

Rationale: all but consistent and avoid confrontation because these are more related to managers

Management as a process that is used today by nurses in healthcare organizations is best described as:
a Scientific management
b Decision making
c. Commanding and controlling others using hierarchial authority
d. Planning, organizing, staffing, directing, and controlling actions to achieve goals
d. Planning, organizing, staffing, directing, and controlling actions to achieve goals
Tell whether the following statement is true or false:

One way nurses can act as advocates is by directly intervening on behalf of others.

True
False

Answer: A. True

Rationale: Sometimes it is advisable for nurses to advocate for patients by directly intervening on their behalf.

How Nurses Can Act as Advocates
Helping others make informed decisions
Acting as intermediaries in the environment
Directly intervening on behalf of others
A nurse manager overhears a nurse state during interdisciplinary rounds, “After learning he has an inoperable brain tumor, the client wishes to terminate dialysis for his renal failure. Since he has not family, I think we should consider his wishes.” The nurse manager concludes that the nurse is functioning in which role at this time?
A. Clinical practitioner
B. Case manager
C. Client advocate
D. Staff educator
C. Client advocate
Reporting an offense to one’s boss is
an example of:

a. Internal whistle-blowing

b. whistle-blowing

Answer: A. Internal whistle-blowing.

Rationale: Reporting a problem to a higher-up within the organization is called internal
whistle-blowing.

What are some ways nurses can advance the nursing profession? select all that apply
a. Learn about sociopolitical issues.
b. Participate in professional organizations.
c. Participate in bureaucracy.
Answer: a. Learn about sociopolitical issues, and
b. Participate in professional organizations.

Rationale: It is important for nurses to participate in the larger social framework in a professional capacity in order to advance the profession as a whole.

Which of the following should one NOT do when writing a letter to a legislator?

a. Be persistent.

b. Write a personal letter.

c. Address the legislator by his or her title.

d. Make the letter at least two pages long.

Answer: d. Make the letter at least two pages long.

Rationale: The letter should be succinct and to the point (no more than one page in length).

Tell whether the following statement is true or false:

Nurses should avoid media exposure.

True

False

Answer: B. False

Rationale: While many nurses avoid media
exposure out of self-consciousness, in fact
it is advantageous to appear in newspapers and on radio and television when the opportunity arises.

Tell whether the following statement is true or false:

It is usually the rigid culture of organizations that leads to ethical failure.

True
False

Answer: B. False

Rationale: According to Bruhn, it is often
the interaction of the culture of the
organization and the character of the leader
that creates ethical failure.

Tell whether the following statement is true or false:

Moral Conflict occurs when one’s duties or general guiding ethical principles are in doubt.

True
False

Answer: A. True

Rationale: Similar to moral uncertainty, moral conflict is a serious issue that can arise in the nursing profession.

Moral outrage
This occurs when an individual witnesses the immoral act of another but feels powerless to stop it.
moral distress
This is the result of the individual knowing the right thing to do, but organizational constraints make it difficult to take the right course of action.
Ethics Committee
Responds to ethical issues
Comprised of interdisciplinary group. Might include guest(s) from specialty area(s). Family members might be invited
Committee lends guidance and provides resources for ethically sound decisions. Committee does not make a decision.
ANA Code of Ethics
Patient centered
Nurse responsible for safe work environment
Nurse has duty to himself/herself
Ethical Dilemma
no clearly right or clearly wrong decision – no clear-cut answer
Three Characteristics of an Ethical Dilemma
1. The problem cannot be solved using only empirical data.
2. The problem must be so perplexing that it is difficult to decide what facts and data need to be used in making the decision.
3. The results of the problem should have far-reaching effects.
Deontological Ethical Framework
Uses duty-based reasoning and rights-based reasoning. Judges whether the action is right or wrong regardless of the consequences.
Looking at DUTY, not consequences
Teleological (Utilitarianism) Ethical Framework
outcome-focused approach that places emphasis on results and protects the interest of the majority. Greatest good for greatest number of people. The ends can justify the means.

Ex: the insurance company covering yearly check-ups, but not organ. transplant b/c it is the greatest good for the greatest people

Intuitionist Framework
review ethical problem or issue on a case-by-case basis, comparing relative weights of goals, duties, and rights. Weighting determined primarily by intuition.
Ex: Case study about girlfriend vs. family with the pt that is probably not going to make it.
Ethical relativism Framework
make decisions based on what is right or reasonable according to their own value system or culture.
Es: Case study about colon cancer pt who wanted a Shaman present and not Western medicine.
Universalism-
Ethical principles are universal and decisions should not vary based on individual circumstances or cultural differences.

Kind of the opposite of ethical relativism.

Which kind of decision making is primarily focused on outcome?
A. Teleological
b. Deontological
c. Situational
Answer: A. Teleological.

Rationale: The teleological ethic places emphasis on results and on protecting the interest of the majority.

Autonomy
Promotes self-determination/freedom of choice
Beneficence
The actions one takes should be done in an effort to promote good.
Paternalism
One individual assumes the right to make decisions for another.
Justice
Seeks fairness.
Treats “equals” equally.
Treats “unequals” according to their differences.
Veracity
The obligation to tell the truth.
Fidelity
The need to keep promises.
Confidentiality
Keeping privileged information private.
Utility
The good of the many outweighs the wants/needs of the individual.
Which of the following is NOT an element of ethical decision making?
a. Beneficence
B. Paternalism
C. Utility
D. Pragmatism
Answer: d. Pragmatism
Rationale: The principles of ethical decision making include autonomy, beneficence, paternalism, utility, justice, truth telling (veracity), fidelity, and confidentiality.
Tell whether the following statement is true or false:

Trial and error is a necessary element of ethical decision making.
True
False

Answer: B. False

Rationale: The manager should focuses on proven decision-making or problem-solving models rather than trial and error.

The MORAL Decision Making Model
M—Massage the dilemma.
O—Outline options.
R—Review criteria and resolve.
A—Affirm position and act.
L—Look back. Evaluate the decision making.
The new graduate working on a medical unit night shift is concerned that the charge nurse is drinking alcohol on duty. On more than one occasion, the new graduate has smelled alcohol when the charge nurse returns from a break. Which action should the new graduate nurse implement first.
A. Confront the charge nurse with the suspicions.
B. Talk with the night supervisor about the concerns.
C. Ignore the situation unless the nurse cannot do her job.
D. Ask to speak to the nurse educator about the problem.
B. the night supervisor or the unit manager has the authority to require the charge nurse to submit to drug screening. In this case, the supervisor on duty should handle the situation.
The experienced male nurse has recently taken a position on a medical unit in a community hospital, but after 1 week on the job, he finds that the staffing is not what was discussed during his employment interview. Which approach would be most appropriate for the nurse to take when attempting to resolve the issue?
A. Immediately give a 2-week notice and find a different job.
B. Discuss the situation with the manager who interviewed him.
C. Talk with the other employees about the staffing situation.
D. Tell the charge nurse the staffing is not what was explained to him.
B. The nurse should give the manager a chance to discuss the situation before quitting. A temporary problem, such as illness, may be affecting staffing
Reasons Why Ethics Is Becoming a Greater Force in Management Decision Making
-Increasing technology, regulatory pressures, and competitiveness among health care providers
-National nursing shortages
-Reduced fiscal resources
-Spiraling costs of supplies and salaries
-The public’s increasing distrust of the health care delivery system and its institutions
Institutional Review Boards (IRB)
Primarily formed to protect the rights and welfare of research subjects.
A patient is admitted to the emergency department after an auto accident and the driver of the car asks the nurse, “Do you know if my passenger is okay?” The nurse knows the passenger is in critical condition. Using the ethical concept of veracity, how should the nurse answer?
A. “I am not sure of your passenger’s condition.”
B. “I can ask the ED primary care provider for you.”
C. “Your passenger is in critical condition.”
D. “You need to worry about yourself fist, then we will deal with that.”
C. “Your passenger is in critical condition.”
A newly licensed nurse is explaining to a potential applicant to nursing school how nursing practice is regulated. The nurse identifies which of the following as a state statute that constitutes statutory law?
A. Nurse practice act
B. State board of nursing
C. Good Samaritan law
D. Active Labor Act
A. Nurse practice act
Why are nurses at increased liability?
A. Their realm of responsibility has decreased.
B. Fewer nurses have liability insurance.
C. Nurses are making more money.
D. Nurses currently have less independence in decision making.
C. Nurses are making more money.
Rationale: Higher salaries have corresponded to increased liability in the nursing profession.
Five Components Necessary for Professional Negligence to Occur
A standard of care is in place.
There is a failure to meet the standard of care. Breach of duty
Foreseeability of harm must exist. – Events can be expected
There must be a probable correlation between care and harm. Actions or lack of action by the nurse cause harm
Actual patient injury must occur. Additional nonfunctioning time or damages
Tell whether the following statement is true or false:

Following a physician’s order is a valid excuse in a malpractice case.
True
False

Answer: B. False

Rationale: Nurses have a responsibility to safeguard their patients, independent of physician’s orders.

Which of the following are legal terms relevant to the nursing profession?
Res ipsa loquitur
Respondeat superior
Product liability
Stare decisis
All of the above
Answer: e. All of the above

Rationale: All are relevant terms with which nurses should be familiar.

Stare Decisis
Means “to let the decision stand” (to use precedents).
Respondeat Superior
Means “the master is responsible for the acts of his servants.”
Res Ipsa Loquitur
-Means “the thing speaks for itself.”
-Harm is obviously the result of negligence.
Vicarious liability
– the employer responsible too
Product liability
– defective equipment (nurse responsibility)
Which of the following are legal terms relevant to the nursing profession?
Res ipsa loquitur
Respondeat superior
Product liability
Stare decisis
All of the above
Answer: e. All of the above

Rationale: All are relevant terms with which nurses should be familiar.